Pelvic floor dysfunction can cause much more than bladder leakage. Urinary urgency, frequent bathroom trips, constipation, pelvic pressure, painful intercourse, difficulty with insertion, low back or tailbone pain, and pelvic organ prolapse can all be associated with problems involving the pelvic floor.
The tricky part is that many of these symptoms are commonly dismissed as a normal part of aging, pregnancy, childbirth, or simply “something you have to live with.”
They’re common—but that doesn’t necessarily mean they’re normal or that nothing can be done about them.
What Is the Pelvic Floor?
The pelvic floor is a group of muscles and connective tissues that supports the pelvic organs, including the bladder, bowel, rectum, uterus, and vagina. These muscles also play an important role in bladder and bowel control, sexual function, movement, and managing pressure through the abdomen and pelvis.
When the pelvic floor muscles are weak, overly tight, painful, poorly coordinated, or aren’t working appropriately with the rest of the body, symptoms can develop.
Signs You May Have Pelvic Floor Dysfunction
Pelvic floor dysfunction doesn’t look the same for everyone. Some symptoms are obvious, while others may not immediately seem related to the pelvic floor.
Signs that may warrant a pelvic floor evaluation include:
- Urinary leakage when coughing, sneezing, laughing, running, or exercising
- Sudden or frequent urges to urinate
- Going to the bathroom more frequently than expected
- Difficulty emptying your bladder completely
- Constipation or straining during bowel movements
- Difficulty controlling gas or stool
- Pelvic or vaginal pressure or heaviness
- Feeling or seeing a vaginal bulge
- Pain during intercourse
- Pain or difficulty with tampon insertion
- Pelvic pain
- Tailbone pain
- Low back or hip pain associated with pelvic symptoms
- Burning or pain with urination when infection or other medical causes have been ruled out
You don’t need to have every symptom—or urinary leakage at all—to benefit from an evaluation.
Pelvic Floor Dysfunction Is More Than Bladder Leakage
One of the biggest misconceptions about pelvic floor physical therapy is that it is primarily for people who leak urine.
Urinary incontinence is certainly one reason someone may see a pelvic floor physical therapist, but pelvic rehabilitation addresses much more.
Pelvic floor dysfunction may contribute to bladder and bowel symptoms, pelvic organ prolapse, pelvic pain, painful intercourse, difficulty with insertion, and other problems affecting daily activities.
This is also why simply being told to “do Kegels” isn’t always the right answer.
Are Kegels Always the Answer?
No. Pelvic floor dysfunction does not always mean the pelvic floor muscles are weak.
Some people have muscles that are overly tight or have difficulty relaxing. Others have weakness, poor coordination, difficulty managing abdominal pressure, or a combination of these problems.
Strengthening an already overactive or poorly coordinated pelvic floor without first understanding what the muscles are doing may not address the underlying problem and, in some cases, may aggravate symptoms.
The appropriate exercises depend on what is actually happening with your pelvic floor.
How Can You Tell What’s Actually Going On?
A pelvic floor physical therapy evaluation looks beyond a single symptom.
Your assessment may include:
- A detailed medical and symptom history
- An orthopedic and musculoskeletal assessment
- Evaluation of posture and movement
- Assessment of breathing and pressure management
- Evaluation of movements or activities that reproduce your symptoms
- Assessment of pelvic floor muscle strength, coordination, tension, and ability to relax
- An internal pelvic floor muscle examination when appropriate and with your consent
For someone experiencing pelvic pressure, for example, we may assess what happens while you are standing, lifting, exercising, or performing the movement that causes your symptoms.
For someone experiencing pelvic pain, an assessment may look at muscle tension, tenderness, movement, coordination, and other potential contributors to that pain.
Being able to reproduce—and sometimes reduce—a symptom during the evaluation can give us valuable information about what may be contributing to the problem and how to build an individualized treatment plan.
Can an MRI, Ultrasound, or Other Medical Test Diagnose Pelvic Floor Muscle Dysfunction?
Medical testing can be extremely important for ruling out disease, infection, structural problems, and other causes of pelvic symptoms. However, these tests do not necessarily tell us how your pelvic floor muscles are functioning during movement and everyday activities.
Depending on your symptoms, your medical team may recommend tests such as:
- MRI
- Bladder ultrasound
- Cystoscopy
- Pap testing
- Urodynamic testing
- Colonoscopy
These tests answer different medical questions and may be an important part of your care. A pelvic floor physical therapy evaluation answers a different question:
How are your pelvic floor muscles, joints, movement patterns, and pressure-management strategies functioning—and could they be contributing to your symptoms?
The two approaches can complement one another.
When Should I Consider Seeing a Pelvic Floor Physical Therapist?
Consider a pelvic floor evaluation when bladder, bowel, pelvic pain, sexual, or pressure-related symptoms are interfering with your daily life—especially when you’ve been told testing is normal but your symptoms continue.
You don’t need to wait until symptoms become severe.
You also don’t necessarily need to know exactly what’s wrong before scheduling an evaluation. Determining whether the pelvic floor is contributing to your symptoms is part of the assessment.
Frequently Asked Questions
Can I have pelvic floor dysfunction without leaking urine?
Yes. Urinary leakage is only one possible symptom. Pelvic floor dysfunction can also be associated with urinary urgency and frequency, constipation, pelvic pressure, painful intercourse, pelvic pain, difficulty with insertion, and other bladder or bowel symptoms.
Can a tight pelvic floor cause problems?
Yes. Pelvic floor muscles need to both contract and relax appropriately. Muscles that remain overly tense can contribute to pain, difficulty with insertion, bowel or bladder symptoms, and problems coordinating normal pelvic floor function.
Should I just start doing Kegels?
Not necessarily. Kegels are pelvic floor strengthening exercises, but strengthening isn’t appropriate for every pelvic floor problem. An evaluation can determine whether your muscles need strengthening, relaxation, improved coordination, or another treatment approach.
What happens during a pelvic floor physical therapy evaluation?
Your physical therapist will discuss your symptoms and medical history and assess factors such as movement, strength, mobility, breathing, and coordination. Depending on your symptoms and comfort level, an internal pelvic floor muscle examination may also be recommended.
Do I need a pelvic floor evaluation if my other tests are normal?
Potentially. Medical tests and pelvic floor physical therapy evaluations assess different things. Normal medical testing does not necessarily tell you how the pelvic floor muscles are functioning during movement, bowel and bladder activity, exercise, or other everyday tasks.
The Bottom Line
Pelvic floor dysfunction isn’t limited to bladder leakage, and you don’t need to wait until your symptoms become severe to ask for help.
If you’re experiencing urinary urgency or leakage, constipation, pelvic pressure, painful intercourse, pelvic pain, difficulty with insertion, or other persistent pelvic symptoms, a specialized pelvic floor evaluation can help determine whether the pelvic floor is contributing.
Understanding why you’re having symptoms is the first step toward choosing treatment that actually addresses the problem.