Pelvic Floor Retraining


Our Pelvic Floor Retraining program (or PFR for short) is one of the cornerstones of successful conservative (non-surgical) treatment of pelvic floor conditions. Constipation, difficult bowel evacuation or poor bowel control can all be improved by pelvic floor retraining. Mild to moderate symptoms can respond very well and might enable you to postpone surgery or may even make surgery unnecessary.

People with severe symptoms can still benefit from the programme. By optimising your pelvic floor function in preparation for surgery and ensuring that bowel habits are as healthy as possible, you will experience a faster recovery and longer lasting results from your surgery.

Pelvic Floor Retraining consists of educational sessions provided by our specialist nurse practitioners. In these sessions you will receive expert advice completely centred around you, tailored to match your history, symptoms and conditions.

The appointments are kept informal. We encourage you to engage and ask questions about what you would like to know regarding your condition and focus on symptoms you need help with.


In the beginning, a short education session is held to explain the normal function and anatomy of the large bowel and rectum. This is followed by a brief explanation of pelvic floor disorders.

You will discuss several issues:

Diet: If you have a stool consistency that is too hard or too soft the nurses will assess your diet. They will work with you to try to improve your bowel function through making changes to what you eat on a daily basis. If more extensive guidance is necessary they might ask your consultant to refer you to our dietitian.

Pelvic floor exercises: To regain control over your pelvic floor muscles, exercises are essential. Your nurse will give you advice and guidance on how to perform your pelvic floor exercises properly.

Medication: Another step in the treatment of your bowel condition could be to start medication to improve your bowel function. Click here to see our ‘Medication’ page.

Optimising bowel habits: An important factor in our program is to identify and improve possible ‘unhealthy bowel habits’, which might include how often and when you go to the toilet, or your position on the toilet. Your bowel habits develop in childhood, and it may take time for you to alter your behaviour. Together you will identify possible problem areas and try to find solutions.

Help you cope with your problem: Our specialist nurses can give you extensive information on aids that can help with dealing with your bowel condition. You can ask them for information on RADAR keys, incontinence materials, anal plugs and tampons and rectal irrigation.

Together with your specialist nurse you will come up with a sustainable treatment plan consisting of two or three goals. After three months you will return for a second appointment where your goals and progress will be evaluated. Along with the nurses you will explore the option of adding new goals or discuss the barriers you have encountered.

It is important to note that there are patients who do not show any appreciable benefit from undergoing PFR. In these cases your consultant surgeon will propose further clinical solutions, which could include neuromodulation or surgery.

General Advice:

  • Have regular meals and take time to eat.
  • Avoid missing meals or leaving long gaps between eating.
  • Drink at least eight cups of fluid per day, especially water or other non-caffeinated drinks, for example herbal teas.
  • Reduce intake of alcohol, coffee and fizzy drinks.
  • Reduce intake of 'resistant starch' (starch that resists digestion in the small intestine and reaches the colon intact), which is often found in processed or re-cooked foods.
  • Limit fresh fruit to three portions per day (a portion should be approximately 80g).
  • People with diarrhoea should avoid sorbitol, an artificial sweetener found in sugar-free sweets (including chewing gum) and drinks, and in some diabetic and slimming products. People with wind and bloating may find it helpful to eat oats (such as oat-based breakfast cereal or porridge) and linseeds (up to one tablespoon per day)