The Gut–Pelvic Floor Connection No One Explains

If you've been told that your pelvic pain, bladder symptoms or pelvic floor problems are because your core isn't strong enough, you might have been given a familiar prescription: “Just do more core.” Planks. Crunches. Leg raises. More bracing. But for some people, this advice can actually make symptoms worse. Especially if your pelvic floor is already overactive or struggling to relax. Your pelvic floor is part of your core Your pelvic floor works together with your diaphragm, abdominal muscles and back muscles to help support your body and manage pressure. So yes, core strength matters. But more tension doesn't always equal more support. Your pelvic floor needs to be able to contract when necessary and relax when it's supposed to. When can more core work be a problem? If you're already holding a lot of tension through your abdomen and pelvic floor, constantly bracing your core may increase pressure and muscle activity. This can be particularly relevant if you experience: Pelvic pain Pain during sex Difficulty relaxing your pelvic floor Constipation or difficulty emptying your bowel Urinary urgency or frequency Pain that increases with exercise A feeling of constant pelvic tension In these situations, the goal may not be to make everything stronger. It may be to improve coordination and relaxation. But aren't core exercises good for you? Absolutely. Core exercises can be an important part of rehabilitation and general fitness. The problem is assuming that everyone needs more of them. Someone with poor abdominal strength may benefit from strengthening. Someone who is constantly bracing may need to learn how to let go. And many people need a combination of both. What should you do instead? Rather than asking: “How can I strengthen my core?” The better question is: “How is my core and pelvic floor functioning?” A pelvic health physiotherapist can assess how your breathing, abdominal muscles and pelvic floor work together during movement. Your program might involve strengthening—but it might also include: Breathing exercises Pelvic floor relaxation Movement retraining Mobility work Gradual strengthening Pressure management Exercise modification The right exercise depends on why you're having symptoms. When should you get assessed? If you've been exercising your core regularly but your symptoms aren't improving—or are getting worse—it's worth getting an individual assessment. Particularly if you're experiencing pelvic pain, painful sex, constipation, urinary urgency or persistent pelvic tension. The Bottom Line Your pelvic floor doesn't always need more strength. Sometimes it needs better coordination and the ability to relax. Core training isn't bad. But “just do more core” isn't a complete treatment plan for pelvic floor dysfunction. If your symptoms aren't improving, stop guessing and find out what your muscles actually need. A pelvic health physiotherapist can assess your pelvic floor, breathing and core function and help you exercise in a way that supports your symptoms—not aggravates them.

Yes. Some children deliberately limit fluids to avoid using the toilet, and it is more common than many parents realise. This "drink to wee" avoidance can set up a cycle of concentrated urine, bladder irritation, toileting anxiety and even accidents or pain. Why children restrict fluids Children may cut back on drinks for several understandable reasons: Toilet anxiety or embarrassment : school toilets, noise, lack of privacy, or fear of accidents can make a child reluctant to go, so they drink less to "stay safe". Previous pain or urgency : if weeing has stung (often from concentrated urine or a mild UTI), a child may try to avoid the sensation by drinking less. Control or routine issues: some children dislike interrupting play, screen time or classroom activities to use the bathroom. Sensory or neurodivergent factors : bathroom sounds, smells, seat texture or transitions can be overwhelming for some kids. The unintended consequence is that low fluid intake makes urine more concentrated, which can sting, increase urgency, and ironically make accidents and bladder symptoms more likely. Signs your child may be avoiding drinks to avoid weeing Watch for patterns such as: Very low fluid intake – rarely asking for drinks, refusing water bottles, or only taking tiny sips. Infrequent toileting – going fewer than 4–5 times in the day, or holding for long stretches at school or during activities. Urgency, accidents or "dancing" behaviours – crossing legs, squatting, fidgeting, or rushing to the toilet at the last minute. Concentrated, dark or strong-smelling urine – a sign they are under-hydrated. Complaints of tummy or bladder discomfort , or pain when weeing. Avoiding certain places or situations – refusing outings, school trips or activities where toilet access is uncertain. How a pelvic health physiotherapist can help Pelvic health physiotherapists assess and treat bladder habits, toileting behaviours and the muscle patterns that support healthy emptying. Your child's assessment may include: Bladder and bowel habits : frequency, urgency, accidents, fluid intake, stool patterns. Toileting posture and routine: how they sit, foot support, relaxation and timing. Pelvic floor muscle function : whether muscles are overactive, tight or poorly coordinated. Breathing and relaxation strategies : to reduce guarding and improve emptying. Lifestyle and school factors : access to toilets, sensory issues, anxiety, and daily routines. T reatment may involve: Education for you and your child about healthy bladder habits and why regular drinking matters. Fluid planning – structured drink targets across the day, with school-friendly strategies. Timed toileting – scheduled sits every 2–3 hours to retrain bladder habits and reduce urgency. Relaxation and breathing techniques – to make weeing easier and less stressful. Pelvic floor down-training – gentle exercises to reduce overactivity and improve coordination. Collaboration with your GP, paediatrician or school – to address pain, UTIs, constipation, anxiety or toileting accommodations. When to seek help It is worth seeing a healthcare professional if your child: Regularly restricts fluids to avoid using the toilet. Wees fewer than 4–5 times per day or holds for very long periods. Has frequent urgency, accidents or "holding" behaviours . Complains of pain, burning or discomfort when weeing. Has dark, strong-smelling urine most days. Shows signs of anxiety about toilets at school, in public or away from home. Has recurrent UTIs, constipation or bedwetting alongside daytime symptoms. Early assessment can prevent a cycle of pain, anxiety and bladder dysfunction from becoming entrenched. Frequently Asked Questions Is it normal for a child to avoid drinking to avoid weeing? It is not "normal" in the sense of being healthy, but it is a recognised pattern, especially in children with toilet anxiety, previous pain, or sensory sensitivities. It is important to address because it can lead to concentrated urine, bladder irritation and more accidents. How much should my child be drinking? As per the guidelines from Healthdirect and the Royal Children’s Hospital (RCH) Melbourne (total fluids from all drinks and foods): 1 to 3 years : about 4 cups (≈1 L) per day 4 to 8 years : about 5 cups (≈1.2 L) per day 9 to 13 years : about 5–6 cups (≈1.4–1.6 L) per day 14 to 18 years : about 6–8 cups (≈1.6–1.9 L) per day Water should be the main drink. Limit caffeine, fizzy drinks and very sugary juices, which can irritate the bladder. When to increase fluids Children need extra drinks when: Playing sports or being very active The weather is hot or humid They have a fever, vomiting, or diarrhoea In these situations, encourage small, frequent sips before, during and after activity or illness, and use oral rehydration solutions if they are unwell. Won't more drinking mean more accidents? Initially, yes. Your child may wee more often. But regular, adequate fluids produce lighter, less irritating urine and help the bladder learn a normal capacity and rhythm. Over time, this usually reduces urgency and accidents. What if my child refuses to drink at school? Work with the teacher to: Allow a visible water bottle on the desk Use a marked water bottle with time-based targets (for example, "finish to this line by recess") so your child has a clear, visual goal. Use a reward system for sips and toilet sits Agree on a consistent routine (for example, drink and toilet at morning snack, lunch and afternoon snack) so it becomes a normal part of the day. Small, frequent sips are often easier than big drinks. Can pelvic floor physiotherapy help if my child is scared of the toilet? Yes. Pelvic health physios use child-friendly strategies to reduce fear, improve relaxation on the toilet, and retrain bladder habits. They often work alongside psychologists, GPs and schools when anxiety or sensory issues are significant. The Bottom Line Avoiding drinks to avoid weeing is a common but fixable pattern. It often stems from toilet anxiety, previous pain, or routine pressures, and it can make bladder symptoms worse by concentrating urine and increasing urgency. If your child is restricting fluids, having frequent accidents, or showing signs of bladder discomfort, a pelvic health assessment can help. Together, you can build a simple, school-friendly plan for drinking, timed toileting and relaxation so your child feels more comfortable, confident and in control of their bladder. You do not have to manage this alone. Our pelvic health physiotherapists can assess your child's bladder habits, address any muscle tension or coordination issues, and work with you and your school to create a practical plan that makes drinking and weeing feel safe and manageable again.

Putting in a tampon should not feel like you're fighting your own body. Yet for many people, tampon insertion can cause: Pain or burning A feeling of tightness Resistance or a “wall” Difficulty inserting it at all Pain when removing it Discomfort that lingers afterwards And often, the response is, “Just relax.” But if you've tried to relax and it still hurts, there's probably more to the story. Why can tampons hurt? There are many possible reasons. Painful tampon use can be associated with: Pelvic floor muscle tension Vaginal dryness Irritation or infection Skin or vulval conditions Hormonal changes Previous painful experiences Conditions affecting the vulva or vagina Sometimes more than one factor is involved. Could your pelvic floor be too tight? It could be. Your pelvic floor muscles surround the vaginal opening and need to relax to allow comfortable insertion. If these muscles are overactive or you're unconsciously tightening them, inserting a tampon can feel painful, difficult or even impossible. This can happen even if you are otherwise healthy. And importantly, a tight pelvic floor isn't necessarily something you can simply “relax” on command. Pain can create a cycle Imagine inserting a tampon hurts. The next time you try, you naturally expect it to hurt. Your body may respond by tightening the pelvic floor muscles before you've even realised it. Then insertion hurts again. Over time, this can create a cycle: Pain → fear or anticipation → muscle tightening → more pain. Breaking this cycle often requires more than simply trying harder to relax. Does painful tampon use mean something is wrong? Not necessarily, but persistent pain deserves attention. If tampon use has always been painful, has suddenly become painful, or is becoming increasingly difficult, it's worth finding out why. A GP, gynaecologist or pelvic health physiotherapist can help identify potential contributors. How can pelvic floor physiotherapy help? A pelvic floor physiotherapist can assess whether your pelvic floor muscles are contributing to the pain. Depending on your symptoms and comfort level, treatment may include: Education about pelvic floor function Breathing and relaxation strategies Pelvic floor down-training Gentle manual therapy where appropriate Gradual desensitisation Advice around comfortable tampon insertion Strategies to reduce muscle guarding An internal examination is not automatically required. Your physiotherapist should explain your options and work within your comfort and consent. Don't force it If inserting a tampon is painful, don't keep pushing through significant pain. Pain is useful information. And if you're experiencing significant pain, burning, unusual discharge, bleeding or other new symptoms, speak with your GP or gynaecologist to rule out medical causes. Frequently Asked Questions Why does inserting a tampon hurt? Tampon insertion can hurt for many reasons, including pelvic floor muscle tension, vaginal dryness, irritation, infection, hormonal changes or vulval conditions. A healthcare professional can help identify the cause. Can a tight pelvic floor make tampons difficult to insert? Yes. If the pelvic floor muscles around the vaginal opening are overactive or unable to relax, insertion may feel painful, tight or blocked. Can pelvic floor physiotherapy help with painful tampon insertion? Yes. When pelvic floor muscle tension or poor relaxation is contributing to symptoms, pelvic health physiotherapy can help with relaxation, coordination and gradually reducing sensitivity and muscle guarding. The Bottom Line Tampon use shouldn't be something you have to grit your teeth through. If inserting a tampon is consistently painful, difficult or impossible, there may be a reason—and it's worth investigating. You don't need to simply “get used to it,” and you certainly don't need to push through pain. If painful tampon use is affecting your periods, exercise, swimming or everyday life, a pelvic health physiotherapist can help you understand whether your pelvic floor is contributing and work with you towards more comfortable, confident movement.