THE FOUNDATION YOU CANNOT SEE
When we talk about core strength, most of us picture the visible muscles, the abs, obliques, the six-pack. But the true foundation of the core is a group of muscles you cannot see and probably rarely think about: the pelvic floor.
The pelvic floor is a hammock of muscles and connective tissue spanning the base of the pelvis. These muscles support your bladder, bowel, and uterus, maintain continence, enable sexual function, and form an integral part of the stability system that every single movement depends on, from a heavy deadlift to a 10k run to carrying your child.
For active women in Dubai, runners, CrossFitters, tennis players, swimmers, cyclists, gym regulars, the pelvic floor is under enormous demand. High-impact activities, heavy lifting, and intense abdominal training all create intraabdominal pressure that the pelvic floor must manage, repeatedly, sometimes for hours. When it cannot manage that demand, symptoms appear. And despite being experienced by a significant proportion of active women, pelvic floor dysfunction remains vastly underreported, undertreated, and strangely taboo in sports culture.
WHAT IS PELVIC FLOOR DYSFUNCTION?
Stress Urinary Incontinence — Leaking During Sport
This is the most recognised symptom, urinary leakage when activity increases abdominal pressure: coughing, sneezing, jumping, running, lifting heavy. Studies suggest between 25 and 50 percent of female athletes experience stress urinary incontinence during sport. The vast majority manage around it: wearing pads, avoiding certain exercises, never mentioning it to their coach or doctor. That is not a solution. And it is absolutely not inevitable.
Urge Incontinence and Urgency
A sudden, intense urge to urinate that is difficult to defer, sometimes resulting in leakage before reaching the bathroom. This can occur in women with a hypertonic pelvic floor, not just weakness, and needs a completely different treatment approach. This is exactly why proper assessment matters before starting any treatment.
Pelvic Pain During or After Exercise
Pain in the pelvis, lower abdomen, groin, or perineum during or after training. For cyclists, saddle pressure is a common cause. For runners, pelvic pain may be mistaken for hip flexor issues. For weightlifters, pain may present during heavy squats or deadlifts. All of these presentations are assessable and treatable.
Core Weakness that Does not Respond to Training
Many active women have done extensive core work, hours of planks, Pilates, heavy
compound lifts and still feel fundamentally unstable through the trunk or have persistent lower back pain. When the pelvic floor is the weakest link in the core chain, adding load above it without addressing the base achieves limited results. You cannot build a strong core on an unstable foundation.
Diastasis Recti — Abdominal Separation
During pregnancy, the two halves of the rectus abdominis can separate along the midline connective tissue. This affects around 60 percent of pregnant women. The issue for active women is returning to high intensity training postpartum before this has been properly assessed and rehabilitated. A physiotherapy assessment identifies whether diastasis is present, its degree, and what training is genuinely safe to resume and when.
Pelvic Organ Prolapse
Prolapse occurs when pelvic organs descend from their normal position, often creating sensations of heaviness, pressure, or something falling out, particularly noticeable after exercise or prolonged standing. Crucially, prolapse does not mean the end of exercise. With appropriate physiotherapy, load management, and technique adjustments, most women with prolapse can continue active training.
Pain During Intercourse
Pain during or after sexual intercourse can be caused by pelvic floor hypertonicity, vaginismus, scar tissue from delivery or surgery, or vulvodynia. This is profoundly underreported because of shame and embarrassment. It is a genuine medical condition — and physiotherapy can address it effectively.
The Postnatal Athlete
The pressure on women to bounce back after pregnancy is real, socially pervasive, and physiologically problematic. The pelvic floor, abdominal muscles, and connective tissue need time to recover from pregnancy and birth — whether vaginal or by caesarean section. The current evidence-based guidance for return to sport is:
- Walking is fine from the early postnatal period
- Pelvic floor physiotherapy assessment at 6 weeks — before or alongside your standard GP check
- Low-impact exercise for at least the first 12 weeks
- Return to running: no earlier than 12 weeks, and only after physiotherapy clearance
- Return to heavy lifting and high-impact training: 16 weeks or beyond, guided by
assessment
These timelines apply even for women who had uncomplicated births and feel absolutely
fine. The absence of symptoms is not the same as readiness for load.
WHY ACTIVE WOMEN ARE A HIGHER-RISK GROUP
Counterintuitively, highly active women are in some ways more at risk of pelvic floor
dysfunction than sedentary women. Not because exercise causes damage, but because of
several compounding factors:
- High training volumes create cumulative loading over years
- Heavy lifting with poor breathing mechanics creates repeated extreme intraabdominal pressure
- High-impact sport generates repeated impact loading at 1.5 to 3 times body weight through the pelvis
- Athletes often have a high pain threshold and normalise symptoms that should not be normalised
- Sports culture discourages discussing anything that might seem like weakness
- Relative energy deficiency in sport impairs connective tissue quality including pelvic
floor fascia
WHAT PELVIC HEALTH PHYSIOTHERAPY ACTUALLY INVOLVES
Many women are uncertain, and sometimes apprehensive, about what pelvic floor physiotherapy actually involves. Here is an honest account of what to expect at UPANDRUNNING.
The Initial Assessment
A thorough pelvic health assessment starts with a detailed conversation about your symptoms, your sport and training history, any pregnancies and births, and your goals. A good physiotherapist creates a safe and respectful space for this. Nothing should feel rushed or uncomfortable.
Physical Examination
Assessment typically includes external assessment of posture, breathing mechanics, and movement quality; observation of how you manage intraabdominal pressure with everyday movements; and an internal pelvic floor assessment — with your full informed consent — to assess muscle strength, coordination, tone, and any areas of tenderness or restriction. The internal assessment is the gold standard for understanding what is actually happening, and the information it provides is genuinely transformative for treatment planning. Treatment
Treatment is highly individualised and built around what the assessment reveals. It may include:
- Targeted pelvic floor muscle training — specific exercises for your pattern of dysfunction, not just generic Kegel repetitions
- Downtraining techniques — because if your pelvic floor is hypertonic, strengthening alone is not the right approach
- Breathing and pressure management — retraining how you brace during lifting, sprinting, and high-impact movement
- Core rehabilitation integrating pelvic floor function into your actual training movements
- Return-to-sport programming with a structured, progressive reintroduction of high- impact activities
- Manual therapy where tightness, scar tissue, or restricted connective tissue requires hands-on treatment
Not Sure Where to Start?
Book an appointment with our doctors. We will create a personalized treatment plan for you.
Frequently Asked Questions
What is pelvic floor physiotherapy and what does it treat?
Pelvic floor physiotherapy is a specialist form of physiotherapy focused on the muscles,
ligaments, and connective tissue of the pelvic floor. It treats conditions including stress urinary incontinence, urge incontinence, pelvic pain, diastasis recti, pelvic organ prolapse, and pain during intercourse. It is suitable for women of all ages, including those who have
never been pregnant.
Is it normal to leak when running or exercising?
Leaking during exercise is common but it is not normal. It is a symptom of pelvic floor dysfunction and is highly treatable with physiotherapy. Studies suggest up to 50 percent of female athletes’ experience stress urinary incontinence during sport, most of whom never
seek treatment. UPANDRUNNING’s women’s health physiotherapists in Dubai offer specialist assessment and treatment for this condition.
When can I return to exercise after having a baby?
Current evidence-based guidance recommends walking from the early postnatal period, low- impact exercise for the first 12 weeks, return to running no earlier than 12 weeks after
physiotherapy clearance, and return to heavy lifting from 16 weeks, guided by assessment.
A pelvic floor physiotherapy assessment at 6 weeks postpartum is strongly recommended
before returning to any structured exercise programme.
Do I need to have had children to see a pelvic floor physiotherapist?
No. While pregnancy and childbirth are significant risk factors, many active women who have never been pregnant experience symptoms due to high training loads, heavy lifting, high- impact sport, and hormonal changes. A pelvic floor assessment is valuable for any woman experiencing symptoms, regardless of obstetric history.
Where can I find a women’s health physiotherapist in Dubai?
UPANDRUNNING offers specialist women’s health and pelvic floor physiotherapy at our
various clinics across Dubai — call 04 518 5400 or WhatsApp 04 343 9391 to book.
How many sessions of pelvic floor physiotherapy will I need?
For many women with straightforward presentations such as stress incontinence during running, significant improvement is seen within 4 to 5 sessions combined with a consistent home exercise programme. More complex presentations take longer. Your physiotherapist will give you an honest expectation of the timeline from the first appointment.
