Pelvic Floor Dysfunction: What It Is and How to Treat It

Leaking a little urine when you laugh, feeling like you’re sitting on a golf ball, or needing an elaborate battle plan just to poop are not “just part of getting older” or “the price of having kids.” Very often, they’re signs of pelvic floor dysfunction a common, highly treatable condition that most people are too embarrassed to talk about.

The good news? Pelvic floor dysfunction is usually manageable with the right combination of pelvic floor therapy, lifestyle tweaks, and, in some cases, medical or surgical treatment. Understanding what’s going on in those hard-working muscles is the first step toward getting your comfort, confidence, and bathroom routine back.

What Is Pelvic Floor Dysfunction?

Your pelvic floor is a group of muscles and connective tissues that stretch like a hammock across the bottom of your pelvis. They support organs such as the bladder, uterus or prostate, and rectum and help control urination, bowel movements, and sexual function. When those muscles don’t coordinate, are too tight, too weak, or both, you can develop pelvic floor dysfunction.

In a healthy pelvic floor, the muscles contract when you need to hold in urine, stool, or gas and relax when it’s time to let things out. With pelvic floor dysfunction, that rhythm gets scrambled. Many people tighten instead of relaxing, or they can’t generate enough strength to keep things in when they cough, sneeze, or jump. Others experience a mix of overactive and underactive muscles.

Clinically, pelvic floor dysfunction is an umbrella term. It can show up as:

• Difficulty emptying the bowels or bladder
• Constipation and straining
• Urinary leakage (incontinence)
• Fecal leakage
• Pelvic pressure or a “falling out” sensation
• Pelvic pain or pain with sex

Pelvic floor dysfunction isn’t limited to women and childbearing years. People of all genders and ages can experience it, including men after prostate surgery, athletes who do heavy lifting, and older adults whose tissues naturally weaken over time.

Common Symptoms of Pelvic Floor Dysfunction

Bowel Symptoms

One of the classic signs is trouble having a bowel movement. You might strain for a long time, pass thin or small stools, feel like you’re never fully empty, or even need to use your fingers to help remove stool. This happens because the muscles that should relax to let stool out are instead contracting or not coordinating with your abdominal muscles.

Bladder Symptoms

On the bladder side, pelvic floor dysfunction can look like:

• Leaking urine when you cough, sneeze, laugh, or exercise
• Urgent, hard-to-control urges to pee
• Going to the bathroom very often (day or night)
• Feeling like you can’t fully empty your bladder

Some of these issues are tied to weak muscles that don’t hold back urine well. Others come from muscles that are too tight and don’t let the bladder empty easily.

Pelvic Pain and Sexual Problems

Overactive or tight pelvic floor muscles can cause chronic pelvic pain, pain during intercourse (dyspareunia), pain with pelvic exams, and even genital or tailbone pain. Men may have trouble getting or maintaining an erection or experience pain with ejaculation.

Pelvic Organ Prolapse

When pelvic floor support structures weaken or stretch, organs such as the bladder, uterus, or rectum can sag downward, known as pelvic organ prolapse. You might feel a bulge at the vaginal opening, heaviness or pressure in the pelvis, lower back discomfort, or trouble inserting tampons.

What Causes Pelvic Floor Dysfunction?

Pelvic floor dysfunction doesn’t usually have a single cause. Instead, it tends to develop from a mix of life events, habits, and health factors. Common contributors include:​

• Pregnancy and childbirth: Stretching, tearing, and nerve changes during pregnancy and delivery can weaken or injure the pelvic floor.
• Aging and menopause: Hormonal shifts and tissue changes can reduce muscle tone and elasticity.
• Chronic straining: Long-term constipation, “power peeing,” or heavy lifting load the pelvic muscles in ways they’re not designed to handle.
• Chronic coughing: Asthma, smoking, or lung disease can lead to repeated spikes in pressure on the pelvic floor.
• Surgery or trauma: Prostate surgery, hysterectomy, pelvic fractures, or falls can affect muscle and nerve function.
• High-impact sports or overtraining: Repetitive impact and poor core mechanics can stress the pelvic floor.
• Obesity: Extra abdominal weight increases pressure on the pelvic structures.

Emotional stress and anxiety can also contribute. Many people unconsciously clench their pelvic floor when they’re anxious like a chronic, invisible fist that never quite relaxes.

How Pelvic Floor Dysfunction Is Diagnosed

Diagnosing pelvic floor dysfunction usually starts with a detailed conversation. Your healthcare professional will ask about bowel and bladder habits, pregnancies, surgeries, pain patterns, sexual function, and lifestyle factors like exercise and diet. Keeping a bladder or bowel diary for a few days can be surprisingly helpful.

Next, many providers perform a gentle pelvic and/or rectal exam to assess muscle tone, strength, coordination, and areas of tenderness. With your consent, they may ask you to squeeze, relax, or bear down while they feel what your muscles are doing.

When needed, additional tests can include:

• Imaging studies such as defecography or dynamic MRI to see how organs and muscles move during bowel movements
• Anorectal manometry to measure pressures and coordination in the rectum and anal sphincter
• Urodynamic testing to evaluate how the bladder fills and empties
• Surface EMG or biofeedback to measure electrical activity in pelvic floor muscles

These tests help distinguish pelvic floor dysfunction from other conditions like inflammatory bowel disease, urinary tract infections, or structural problems that may need different treatments.

How Is Pelvic Floor Dysfunction Treated?

Here’s the encouraging part: pelvic floor dysfunction is rarely something you just have to live with. Evidence strongly supports conservative, non-surgical treatments as the first line of care, especially pelvic floor physical therapy.

Pelvic Floor Physical Therapy and Biofeedback

Pelvic floor physical therapy (PFPT) is not just “doing Kegels.” A pelvic-health–trained physical therapist evaluates how your specific muscles behave which ones are weak, which are tight, and how well they coordinate with your breathing, posture, and abdominal muscles.

Depending on your pattern, therapy may include:

• Manual therapy: Gentle internal and external techniques to release trigger points, reduce muscle tension, and improve mobility.
• Biofeedback: Sensors or small probes that show you, in real time, how your muscles are contracting and relaxing so you can retrain them.
• Strengthening or relaxation exercises: Tailored routines that might involve Kegels, “reverse Kegels,” hip and core exercises, and breath work.
• Posture and movement retraining: Teaching your body to distribute load more evenly so your pelvic floor isn’t doing all the work.
• Home exercise program: Short, consistent routines you can integrate into daily life.

For many people, a series of weeks to a few months of pelvic floor therapy leads to significant improvements in leakage, constipation, pain, and quality of life.

Pelvic Floor Muscle Training and Kegels (Done Right)

Kegel exercises repeated “squeeze and lift” contractions of the pelvic floor can strengthen weak muscles and improve bladder and bowel control. They’re especially helpful for stress incontinence and certain types of fecal incontinence.

The catch? Many people do Kegels incorrectly. Common mistakes include:

• Clenching the glutes or inner thighs instead of the pelvic floor
• Holding the breath (which increases pressure instead of control)
• Overdoing contractions without adequate relaxation, which can worsen pain or urgency

A pelvic floor therapist can help you locate the right muscles and design a plan that balances strengthening with relaxation. In some cases especially when muscles are already too tight relaxation and lengthening exercises take priority over strengthening.

Lifestyle and Habit Changes

Your daily habits can make or break pelvic floor health. Simple changes often pay big dividends:​

• Stop “power peeing” and chronic straining: Pushing hard to pee or poop trains your pelvic floor to do the wrong thing at the wrong time.
• Optimize your toilet posture: Sitting fully, leaning slightly forward, and using a small footstool can help align the rectum for easier bowel movements.
• Boost fiber and hydration: Fiber-rich foods and adequate water soften stool and reduce the need to strain.
• Manage weight and stop smoking: Less abdominal pressure and fewer coughing fits protect the pelvic floor.
• Exercise smart: Swap repetitive high-impact jumps for lower-impact options while you’re healing, and learn to exhale with effort to protect the pelvic floor during lifting.
• Limit bladder irritants if needed: For some people, caffeine, alcohol, and spicy foods worsen urgency and frequency.

Medications, Devices, and Surgery

While pelvic floor therapy and lifestyle changes are the foundation, other treatments may support your care:

• Stool softeners or laxatives to manage constipation under medical guidance.
• Medications for bladder overactivity if urgency and frequency remain severe.
• Vaginal pessaries (support devices) for some types of pelvic organ prolapse or stress incontinence.
• Trigger point injections or nerve blocks for certain pain conditions.
• Surgical repair for significant pelvic organ prolapse or specific incontinence types when conservative treatments haven’t worked.

Treatment is often multidisciplinary, involving gynecologists, urologists, colorectal surgeons, gastroenterologists, pain specialists, and pelvic floor physical therapists working as a team.

What to Expect From Pelvic Floor Therapy

If you’ve never heard of pelvic floor physical therapy, it can sound intimidating. In reality, sessions are typically low-key, private, and very collaborative. Certified pelvic health PTs receive specialized training in internal and external pelvic assessment, and they’re used to talking about topics that most people find awkward.

A typical first visit might include:

• Reviewing your symptoms, history, and goals (for example, “I want to run without leaking” or “I’d like sex to be comfortable again”).
• Assessing posture, breathing patterns, and how your core and hips move.
• With your consent, performing an internal exam (vaginal and/or rectal), using gloved hands, to feel muscle tone, coordination, and tenderness.
• Creating a personalized plan that might include manual therapy, exercises, education, or referrals to other specialists.

Follow-up sessions refine your program, progress exercises, and help you build skills you can maintain long term. Many people start to notice subtle improvements in a few weeks fewer leaks, easier bowel movements, less pressure with ongoing gains over several months.

Living With Pelvic Floor Dysfunction: Practical Tips

While treatment is underway, a few day-to-day strategies can make life easier:

• Plan ahead for triggers: If you know certain situations (like a long car ride) flare your symptoms, talk with your provider about specific strategies to use beforehand.
• Use “the knack”: A quick pelvic floor squeeze right before a cough or sneeze can reduce leaks while you’re still building strength.
• Train your bladder: With guidance, gradually lengthen the time between bathroom trips to reduce urgency without over-holding.
• Incorporate movement breaks: Prolonged sitting can increase pelvic pressure. Short standing or stretching breaks help.
• Support your mental health: Chronic pelvic symptoms can be isolating and frustrating. Counseling, support groups, or online communities can offer validation and coping tools.

Most importantly, remember that needing help with pelvic floor issues is not a personal failure. These are biomechanical, neurological, and tissue-based conditions not moral ones and they respond to evidence-based care.

As always, this article is for general information only and is not a substitute for personalized medical advice. If you suspect pelvic floor dysfunction, it’s worth discussing your specific symptoms with a qualified healthcare professional or a certified pelvic floor therapist.

Real-Life Experiences and Lessons Learned

To make all this information less abstract, it helps to look at what pelvic floor dysfunction can feel like in everyday life. The following examples are composites based on common patient stories shared by pelvic health professionals; they’re not any one real person, but they capture patterns many people recognize.

Take “Sarah,” for instance, a 36-year-old office worker and mom of two. After her second vaginal delivery, she noticed that every time she sneezed, she leaked urine. At first, she shrugged it off as a joke about “mom bladder” and started carrying spare leggings in her bag. Over time, she stopped joining friends for high-intensity workout classes and avoided long walks where bathrooms weren’t nearby. The leaks were mild, but the anxiety was not.

When a friend casually mentioned pelvic floor therapy, Sarah decided to ask her OB-GYN for a referral. In therapy, she discovered that her pelvic floor muscles were actually weaker than she thought, and her strategy of clenching constantly to “hold everything in” was backfiring. Her therapist taught her how to locate the correct muscles, breathe through her core, and coordinate pelvic floor contractions with everyday movements like lifting her toddler. After several months of consistent work 10–15 minutes of exercises most days she found she could laugh, jog, and attend workout classes with far fewer leaks. What changed her life the most wasn’t just the physical improvement, but the realization that she wasn’t stuck with the problem forever.

Then there’s “James,” a 62-year-old who underwent prostate surgery for cancer. Post-surgery, he struggled with both urinary leakage and an overwhelming need to know where every bathroom was, everywhere he went. He felt embarrassed and old before his time. A urologist reassured him that this was common and referred him to pelvic floor physical therapy. There, James learned that his pelvic floor muscles had been weakened by the surgery and that his bladder had become overly protective, sending “urgent” signals at the slightest filling. Through a combination of biofeedback, tailored strengthening, and a guided bladder-training program, his leaks steadily decreased. Just as important, he gained a sense of control and confidence, feeling that there was something he could actively do rather than simply waiting and hoping things would get better.

Another common story looks more like “Mia,” a 29-year-old with chronic constipation and pelvic pain. For years she bounced between different providers for bloating, abdominal discomfort, and pain with intercourse. She tried changing her diet, taking laxatives, and “relaxing more,” but nothing seemed to stick. Eventually, a gastroenterologist suggested she might have pelvic floor dyssynergia essentially a coordination problem and sent her to a pelvic health PT. Mia’s therapist discovered tight, overactive pelvic floor muscles that didn’t relax well during bowel movements. The treatment plan focused much less on Kegels and much more on reverse Kegels, diaphragmatic breathing, manual release work, and improving stool consistency with nutrition and fluid strategies. Over time, bowel movements became easier, her pain decreased, and sex became less painful and more enjoyable.

Across these stories, a few themes keep appearing:

• Shame is common and unhelpful: Many people wait years because they’re embarrassed to talk about leaks, constipation, or sexual pain. Once they finally do, they often wish they’d spoken up sooner.
• Pelvic floor issues rarely have a quick fix: Most people need weeks to months of steady, realistic work. Progress may be gradual, but even small wins one less nighttime trip to the bathroom, a walk without fear of leaks add up.
• The right team matters: Working with providers who take symptoms seriously, explain things clearly, and involve you in decisions can transform the experience from frustrating to empowering.
• Small daily habits are powerful: The way you breathe, sit, lift, and use the toilet multiple times a day often has as much impact as the 10 minutes of formal exercises you do.

If you see yourself in any of these experiences, you’re not alone, and you’re not “broken.” Pelvic floor dysfunction is extremely common and thoroughly studied, and there are many paths to feeling better. The first step is simply acknowledging that your symptoms matter and that help is available then reaching out to a trusted healthcare professional or pelvic floor physical therapist to start a plan that fits your body and your life.