Up to five million women in the UK leak urine. This impacts their physical, mental and social wellbeing. It results in significant costs to women, health services, society and the environment.
It is more common in women who have been pregnant or are overweight and becomes more likely with increasing age. Crucially, in most instances, this is not just treatable, but entirely preventable.
Doing this is relatively simple: it involves exercises to strengthen muscles close to the bladder. These exercises can prevent problems in pregnancy and can help treat problems at any age. Knowing how to do them could help tens of thousands of women, but you need to be taught to do them correctly, and most NHS staff do not know how.
We worked with midwives to design training on these exercises that worked for them, their patients and services. We tested it and found it worked: women trained by the midwives were less likely to experience problems leaking.
The NHS Long Term Plan says all areas should have a service to deal with “perinatal pelvic health”. Our training programme is recommended as part of this. The programme uses a “train the trainer” approach and has been delivered in 9 trusts with 9 more planning delivery. To date, more than 200 midwife service leads have been trained, who have then trained 100s more to provide the service.
The training for midwives included videos and we realised members of the public could also learn from them, further increasing the preventive aspect of this work. We made the videos publicly available and they have been watched over 10,000 times.
A partnership with Health Innovation South West and parenting charities is promoting further spread. Working with women from underserved populations in rural and coastal communities, the team have produced materials which allow pregnant women from these communities to directly access the programme.
We are adapting the training so that it can be used in primary care settings, and aiming for national rollout, to further ensure our approach helps as many people as possible.
Learn more about the Antenatal Preventative Pelvic Floor Exercises and Localisation (APPEAL) Project.
Updated: August 2025