For nearly two years, Priya Bhuvad, 43, a corporate professional, quietly adjusted her life around a problem she found embarrassing: urine leakage whenever she jumped, exercised, danced or did other high-impact activities.There were other signs, too. She often felt that her bladder was not completely emptying. She noticed her vaginal laxity and reduced sensation during intercourse, but, like many women, did not initially connect these symptoms to a pelvic floor problem. The pelvic floor is a group of muscles and supportive tissues at the bottom of the pelvis that hold the bladder, uterus, vagina and bowel in place and help control urination and bowel movements. Pregnancy, obesity and menopause may weaken them and you need exercises to strengthen them.Fit and busy with work, Bhuvad had not prioritised pelvic floor exercises, core strengthening or rehabilitation after childbirth. She had had two normal vaginal deliveries, the last six years earlier. An examination eventually showed that her urinary bladder was bulging into the vagina, the rectal wall was protruding into the vaginal space and there was first-degree uterine prolapse, a condition in which the uterus slips downward from its normal position into the vagina.She underwent surgery to repair the front and back walls of the vagina and strengthen the tissue between the vagina and anus. Surgery for the uterus was not required because the descent was minimal. Six months later, her urinary incontinence and other pelvic floor symptoms had improved substantially. “Many women believe that urine leakage or a feeling of heaviness after childbirth is a normal part of becoming a mother, so they continue to live with these symptoms for years without seeking medical help or doing muscle-strengthening exercises,” says Dr Surabhi Siddhartha, consultant obstetrician and gynaecologist, Motherhood Hospital, Kharghar, Navi Mumbai.More than a childbirth problemAt her hospital, Dr Siddhartha sees women in their 40s frequently present years after vaginal delivery with pelvic floor problems that may have gone unaddressed since childbirth. “Pregnancy and delivery put considerable stress on the pelvic floor muscles; without rehabilitation, weakness may become more apparent with ageing and the hormonal changes of menopause,” she adds.The scale of urinary incontinence is reflected in Indian studies. A 2023 study of 118 women aged 20 to 70 reported urinary incontinence in 27.1% of participants, with stress urinary incontinence — leakage triggered by activities that increase abdominal pressure — the most common subtype. A separate 2025 study of 500 women aged 40 and above reported urinary incontinence in 37% of participants, with stress incontinence accounting for more than half of the cases.For women, this can mean leakage while coughing, sneezing, laughing, exercising, jumping or dancing.Story continues below this adBut leakage is only one warning sign. Pelvic floor dysfunction can also cause heaviness or pressure, a vaginal bulge, difficulty emptying the bladder or bowel, urinary urgency, painful intercourse and persistent pelvic or lower-back pain.It can affect younger women, tooPregnancy is an important risk factor, but it is not a prerequisite. Dr Anjali Talwalkar, consulting gynaecologist associated with Cama & Albless Hospital, Mumbai, recalls the case of Kiran Kadam, 25, an unmarried woman who developed persistent pelvic pain after treatment for tuberculosis. She had subsequently developed a chronic, irritating cough and an allergic variant of the cough.Investigations eventually pointed to pelvic floor weakness, for which she was advised intensive pelvic floor rehabilitation. Recovery took time: regular exercises, physiotherapy and home practice were needed over several months.Dr Talwalkar attributes the weakness primarily to the repeated increase in intra-abdominal pressure caused by prolonged coughing. Weight loss during her illness had also contributed to physical deconditioning. “Somebody who is having a lot of intra-abdominal pressure symptoms, like chronic cough or chronic constipation, and they are pushing all the time — then the pelvic muscles say, give up,” she explains.Story continues below this adOther contributors can include obesity, repeated heavy lifting, chronic constipation, hormonal changes and physical deconditioning. In other words, pelvic-floor weakness is not synonymous with childbirth.Why women often miss the signsAwareness remains a major problem, particularly among younger women who may not expect pelvic floor symptoms. There is also a gap between knowing about pelvic floor exercises and actually doing them. A Motherhood Hospital report says more than 90% of women are aware of pelvic floor exercises, but only a minority practise them regularly. The postpartum period can be a missed opportunity: routine follow-up often focusses on feeding, contraception and recovery, while pelvic floor assessment receives less attention.Kegels are not a diagnosisPelvic floor exercises, including Kegels, can help, but simply being told to “do Kegels” is not always enough.The first step is determining what is actually causing the symptoms. Pelvic floor assessment may include evaluation of muscle strength and coordination, followed by physiotherapy, biofeedback (sensors measure muscle activity and give the patient visual or audio feedback, so they can see whether they are using the right muscles and improve their technique with practice) or, in selected cases, electrical stimulation.Story continues below this adTechnique matters, too. Some women inadvertently tighten their abdominal muscles instead of the pelvic floor. Others may focus only on strengthening when the problem involves poor coordination or an inability to relax the muscles properly.The postpartum gapFor women whose symptoms begin after childbirth, early rehabilitation can make a difference. Yet many either never start pelvic floor exercises or stop within weeks because they have no obvious symptoms or are unsure whether they are doing them correctly. “Pelvic floor disorders should never be accepted as an unavoidable consequence of ageing or childbirth,” says Dr Siddhartha.Common postpartum exercises include Kegels, pelvic-floor relaxation, deep breathing, gentle core exercises and bridges, ideally introduced with guidance on correct technique.