“I just thought leaking when I sneezed was the price of having three kids,” Sarah admitted during her annual well-woman exam. She was 38, active, and otherwise healthy. But for the past four years, she had stopped running, avoided jumping jacks at the gym, and carried a spare pair of underwear in her purse. “My mom did it. My friends joke about it. I figured it was just normal.”
It is incredibly common. But it is not normal.
The normalization of pelvic floor dysfunction—whether it is urinary incontinence, pain during intercourse, or a constant feeling of heaviness—prevents millions of women from seeking treatment for highly correctable conditions. Your pelvic floor is a complex, vital muscle group. When it stops functioning correctly, it impacts your daily life, your confidence, and your physical activity.
Here is what you need to know about your pelvic floor, how to recognize when it is struggling, and why you do not have to simply live with the symptoms.
What Is the Pelvic Floor?
Your pelvic floor is a hammock-like group of muscles, ligaments, and connective tissues that stretch across the base of your pelvis. [1] These muscles serve several critical functions. They support your pelvic organs, including your bladder, uterus, and bowel, keeping them in their proper positions. They control the release of urine and feces by wrapping around the urethra and rectum. They also play a significant role in sexual function and core stability.
Like any other muscle group in your body, your pelvic floor muscles can become too weak (hypotonic) or too tight (hypertonic). Both extremes cause dysfunction, but they present with very different symptoms.
Recognizing Pelvic Floor Dysfunction
Pelvic floor dysfunction occurs when you are unable to correctly coordinate the contraction and relaxation of these muscles. [2] The symptoms are often dismissed as inevitable consequences of aging, childbirth, or menopause.
If your pelvic floor muscles are too weak, they cannot adequately support your pelvic organs or control your sphincters. Symptoms of a weakened pelvic floor include:
- Stress urinary incontinence (leaking urine when you cough, sneeze, laugh, or lift something heavy)
- Fecal incontinence or difficulty controlling gas
- A feeling of heaviness, pressure, or a bulge in your vagina, which may indicate pelvic organ prolapse [3]
Conversely, if your pelvic floor muscles are too tight or in a state of chronic spasm, they cannot relax enough to allow for normal function. Symptoms of a hypertonic pelvic floor include:
- Pelvic pain or lower back pain that has no other obvious cause
- Pain or discomfort during sexual intercourse (dyspareunia)
- Difficulty emptying your bladder completely, or a frequent, urgent need to urinate
- Chronic constipation or straining during bowel movements [2]
It is entirely possible to experience a combination of these symptoms. For example, a woman with a hypertonic pelvic floor may experience urinary urgency because the tight muscles are constantly irritating her bladder.
Why Does Dysfunction Happen?
The pelvic floor is subjected to significant stress throughout a woman’s life. Pregnancy and vaginal childbirth are the most common catalysts for pelvic floor dysfunction, as the muscles and connective tissues are stretched and sometimes torn. [4] However, you do not have to have been pregnant to experience these issues.
Other common causes include:
- Chronic straining due to constipation
- High-impact sports or heavy lifting without proper core engagement
- Chronic coughing (often associated with smoking or asthma)
- Menopause, as the decrease in estrogen thins and weakens the pelvic tissues
- Endometriosis or interstitial cystitis, which can cause the pelvic floor muscles to tighten protectively in response to chronic pain [5]
The Role of Pelvic Floor Physical Therapy
If you are experiencing symptoms of pelvic floor dysfunction, the first step is a comprehensive evaluation by your gynecologist to rule out infections or other medical conditions. Once a diagnosis is confirmed, the most effective, evidence-based, first-line treatment is often pelvic floor physical therapy (PFPT). [6]
Pelvic floor physical therapy is not just about doing Kegels. In fact, if your pelvic floor is already too tight, doing Kegels can actually worsen your symptoms. [7]
A specialized pelvic floor physical therapist will assess your muscle tone, strength, and coordination. If your muscles are weak, they will teach you how to properly isolate and strengthen them, often using biofeedback to ensure you are engaging the correct muscles. If your muscles are too tight, the therapist will use internal and external manual release techniques, trigger point therapy, and relaxation exercises to lengthen the muscles and relieve pain. [8]
PFPT has robust evidence supporting its effectiveness. Studies show that targeted pelvic floor muscle training can significantly improve or resolve urinary incontinence in up to 59 percent of women. [9] It is a conservative, non-surgical approach that addresses the root cause of the dysfunction rather than just managing the symptoms.
You Do Not Have to Live With It
Leaking when you laugh is not a punchline. Pain during intimacy is not something you should endure. A constant feeling of pelvic pressure is not a normal part of aging.
If you are modifying your life, your wardrobe, or your activities because of your pelvic floor, it is time to seek help. Schedule a consultation with Women’s Integrated Healthcare to discuss your symptoms. We can provide a thorough evaluation, discuss your treatment options, and connect you with the specialized care you need to regain control and comfort.
References
[1] Cleveland Clinic. (2025). Pelvic Floor Muscles: Anatomy, Function & Conditions. https://my.clevelandclinic.org/health/body/22729-pelvic-floor-muscles [2] Cleveland Clinic. (2024). Pelvic Floor Dysfunction: What It Is, Symptoms & Treatment. https://my.clevelandclinic.org/health/diseases/14459-pelvic-floor-dysfunction [3] American College of Obstetricians and Gynecologists. (2024). Pelvic Support Problems. https://www.acog.org/womens-health/faqs/pelvic-support-problems [4] National Institute of Child Health and Human Development. (2025). What are the symptoms of pelvic floor disorders (PFDs)? https://www.nichd.nih.gov/health/topics/pelvicfloor/conditioninfo/symptoms [5] American Academy of Family Physicians. (2021). Chronic Pelvic Pain in Women: ACOG Updates. https://www.aafp.org/pubs/afp/issues/2021/0201/p186.html [6] PubMed. (2019). Pelvic floor physical therapy in the treatment of pelvic floor disorders. https://pubmed.ncbi.nlm.nih.gov/31609735/ [7] Johns Hopkins Medicine. (2024). Pelvic Floor Therapy. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/pelvic-floor-therapy [8] APTA Pelvic Health. (2024). Benefits of Pelvic Health Physical Therapy. https://www.aptapelvichealth.org/info/the-benefits-of-pelvic-health-physical-therapy [9] National Center for Biotechnology Information. (2023). Effectiveness of Pelvic Floor Muscle Training on Quality of Life. https://pmc.ncbi.nlm.nih.gov/articles/PMC10301414/
