What Is the Pelvic Floor?
Think of your pelvic floor like a trampoline at the bottom of your pelvis.
It’s a group of muscles that can descend, ascend, contract, and relax depending on what your body is doing.
Rather than working by itself, your pelvic floor works together with your diaphragm, abdominal muscles, rib cage, spine, hips, and other muscles around the pelvis to help your body manage pressure and movement.
Your pelvic floor helps:
- Maintain and manage intra-abdominal pressure
- Support your pelvic and abdominal organs
- Control urination and bowel movements
- Assist with sexual function
- Respond to changes in pressure when you breathe, cough, sneeze, lift, or carry
- Coordinate with the rest of your body during movements like squatting, lunging, throwing, walking, running, and jumping
So your pelvic floor isn’t just something you use when you need to go to the bathroom.
It’s part of your movement system.
Every time you take a breath, pick something up, go for a run, or squat down to the floor, your pelvic floor has to respond to what the rest of your body is doing.
And like a trampoline, it needs to move in both directions.
It needs to contract and ascend when necessary, but it also needs to relax and descend. A pelvic floor that is constantly tight isn’t necessarily functioning any better than one that can’t generate enough tension.
What Happens When the Pelvic Floor Isn’t Working Properly?
Pelvic floor dysfunction doesn’t always mean the muscles are weak.
They may have difficulty generating enough force. They may be overly tense and have trouble relaxing. They may have enough strength but poor timing or coordination. Or they may not respond appropriately when the pressure or physical demand placed on your body increases.
That’s when symptoms can start to appear.
You may leak urine when you cough, sneeze, run, jump, or lift.
You might feel pressure or heaviness in your pelvis when exercising.
You may have constipation, difficulty emptying your bladder or bowels, pelvic pain, or pain during sex.
For some people, everything feels relatively normal until they ask their body to do something more demanding, like lifting a heavier weight, running farther, jumping, or returning to exercise after pregnancy.
That’s an important distinction.
Sometimes the problem isn’t whether your pelvic floor is strong. It’s whether it can do the right thing at the right time.
Think about something as simple as a squat.
As you breathe, brace, lower into the squat, and stand back up, pressure inside your abdomen changes. Your diaphragm, abdominal wall, pelvic floor, rib cage, spine, pelvis, and surrounding muscles all have to work together to manage that pressure while creating movement.
Now add weight.
Or more repetitions.
Or speed.
Or fatigue.
The demand on that system increases.
If your pelvic floor isn’t doing its job effectively, your body doesn’t simply stop moving.
It still has to breathe. It still has to brace. It still has to walk, squat, lift, run, and create movement. And it still has to find a way to create and manage intra-abdominal pressure.
So the rest of the system has to adapt.
That may change how your rib cage moves, how your spine and pelvis are positioned and controlled, how your abdominal wall manages pressure, or how other muscles contribute during movement.
This is why pelvic floor dysfunction becomes a whole-body problem.
There are situations involving direct trauma, surgery, childbirth, or other local factors where the problem may begin at the pelvic floor. But even then, the rest of your body still has to respond to that change and figure out how to manage pressure and movement.
That’s why simply asking whether the pelvic floor is “weak” or “tight” doesn’t give us enough information.
We need to understand how the entire system is working together.
How Do You Know If You Might Need Pelvic Floor Physical Therapy?
Pelvic floor physical therapy may be appropriate if you’re experiencing:
- Urine leakage with coughing, sneezing, laughing, running, jumping, or lifting
- Frequent or sudden urges to urinate
- Difficulty fully emptying your bladder
- Pelvic pressure or heaviness
- Symptoms associated with pelvic organ prolapse
- Constipation or difficulty with bowel movements
- Pelvic pain
- Pain during or after sex
- Symptoms during pregnancy or after childbirth
- Difficulty returning to exercise postpartum
- Pelvic floor symptoms when lifting, running, jumping, or exercising
- Changes following abdominal or pelvic surgery
You don’t have to wait until symptoms become severe.
If you’re changing how you exercise, avoiding certain activities, constantly thinking about where the nearest bathroom is, or giving up things you enjoy because you’re worried about symptoms, it’s worth figuring out what’s going on.
You don’t have to figure this out alone. A free discovery call is a conversation, not a commitment. We’ll listen and point you toward the right next step.
Book a Free Discovery Call →What Does Pelvic Floor Physical Therapy Typically Look Like?
Pelvic floor physical therapy should begin with an evaluation to understand your symptoms, history, goals, and what your body is currently able to do.
Depending on your symptoms, your therapist may assess your breathing, abdominal and core function, hip strength and mobility, lower back and pelvic mobility, movement, strength, and your ability to coordinate the pelvic floor.
An internal pelvic floor examination may also be discussed when appropriate. This can provide information about pelvic floor muscle strength, tension, relaxation, tenderness, and coordination.
An internal examination should only be performed with your consent and isn’t required if you’re not comfortable with it.
Treatment depends on what the evaluation finds.
It may include:
- Pelvic floor strengthening
- Pelvic floor relaxation
- Breathing and pressure-management exercises
- Core and hip strengthening
- Mobility exercises
- Manual therapy
- Movement retraining
- Education
- An individualized home exercise program
And yes, sometimes Kegels may be appropriate.
But they’re one tool, not the entire solution.
The goal of physical therapy at EVO is to understand what’s driving your symptoms, address the areas that aren’t working well, and progressively prepare your body for what you want to get back to doing.
How Pelvic Floor Therapy at EVO Is Different
At EVO, we don’t treat pelvic floor dysfunction as an isolated pelvic floor problem.
We look at how your entire body is working together to manage pressure and create movement.
The pelvic floor works with the rib cage, spine, pelvis, diaphragm, abdominal wall, hips, and the muscles that connect these areas.
Every time you breathe, walk, squat, run, lift, or throw, these different parts of your body have to coordinate.
That’s why our assessment looks beyond whether your pelvic floor is simply “weak” or “tight.”
We want to understand how your rib cage, spine, and pelvis work together.
How are you breathing and managing pressure?
Can you control different positions?
Can the pelvic floor ascend and descend appropriately?
What happens when we introduce movement?
And what changes when we add complexity, repetitions, resistance, speed, or fatigue?
We’re not just looking for the symptom.
We’re trying to understand why your body is having difficulty managing the demand being placed on it.
We Start With Control, Then Build Capacity
Treatment begins by helping you develop better control of your body and pelvic floor in positions where you can be successful.
One way we do this is by using principles from the developmental sequence.
Think about how humans originally learn to move.
We develop control in more supported positions before progressing toward increasingly challenging positions and movements against gravity.
We can use those same principles in rehabilitation to gradually increase the demands placed on your pelvic floor and the rest of your pressure-management system.
Instead of immediately jumping into complex exercises, we can first create an environment where you can successfully coordinate your breathing, rib cage, spine, pelvis, abdominal wall, and pelvic floor.
Then we make it harder.
Because being able to control your pelvic floor in one position is only useful if we can eventually transfer that ability to real movement.
Then We Apply Strength Training Principles
Once you have better control, we apply the same principles of strength training that we use throughout our 10-Step Recovery Process.
Getting out of pain or reducing symptoms is only one part of recovery.
Your body also needs to rebuild the strength and capacity required for the things you actually want to do.
With pelvic floor rehabilitation, that means progressively manipulating three important variables:
Movement complexity. Volume. Intensity.
Maybe you can control pressure during a basic squat.
Great.
What happens when we add weight?
Can you maintain that control for more repetitions?
What happens when you move faster?
What happens when you become fatigued?
Can you lunge?
Carry?
Jump?
Run?
Lift something heavy?
This is where pelvic floor rehabilitation starts to look less like isolated pelvic floor exercises and more like what we believe good physical therapy should look like: progressively preparing your body for the demands of your life.
As your capacity improves, your rehabilitation should progress with it.
And the progression should be specific to you.
Someone who wants to comfortably walk, garden, and play with their kids may need something very different than someone who wants to return to distance running, CrossFit, or heavy squats and deadlifts.
Your goals determine where the process ultimately needs to go.
The Goal Isn’t Just a Stronger Pelvic Floor
Ultimately, we’re not trying to build a pelvic floor that only works when you’re lying on a treatment table thinking about your pelvic floor.
We want it to work automatically as part of your body.
Your pelvic floor shouldn’t require your conscious attention every time you pick something up.
It should respond as part of the system when you breathe, brace, lift, run, jump, change direction, pick up your child, or go about your day.
That’s why we don’t isolate pelvic floor rehabilitation from the rest of the body.
We figure out where the system isn’t working well.
We rebuild control.
We progressively strengthen it.
Then we expose your body to increasingly challenging versions of the movements and activities that matter to you.
Because a pelvic floor problem doesn’t stay isolated to the pelvic floor.
When the pelvic floor can’t effectively do its job, the rest of the body has to figure out another way to manage pressure and movement.
Our job is to help the entire system work together again.
Ready to Figure Out What’s Going On?
If you’re experiencing leaking, pelvic pressure, pain, difficulty returning to exercise, or other pelvic floor symptoms, you don’t have to simply avoid the activities that bring them on.
And you don’t have to guess which exercises you should be doing.
At EVO Health + Performance, our physical therapy approach starts by understanding what’s actually happening throughout your body and then building a plan around what you want to get back to doing.
Schedule a free Discovery Call to talk with our team about what you’re dealing with, what you want to get back to, and how we may be able to help.
Research & References
Pelvic floor rehabilitation continues to evolve as we better understand the relationship between the pelvic floor, breathing, pressure management, movement, and exercise. The following research provides additional background on several of the principles discussed in this article:
- 1.Bø K, Frawley HC, Haylen BT, et al. An International Urogynecological Association/International Continence Society joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction. International Urogynecology Journal. 2017;28:191–213.
- 2.van Reijn-Baggen DA, Han-Geurts IJM, Voorham-van der Zalm PJ, et al. Pelvic floor physical therapy for pelvic floor hypertonicity: a systematic review of treatment efficacy. Sexual Medicine Reviews. 2022;10(2):209–230.
- 3.Davenport MH, Nagpal TS, Mottola MF, et al. Clinical and exercise professional opinion of return-to-running readiness after childbirth: an international Delphi study and consensus statement. British Journal of Sports Medicine. 2024;58:183–195.
- 4.Hodges PW, Sapsford R, Pengel LHM. Postural and respiratory functions of the pelvic floor muscles. Neurourology and Urodynamics. 2007;26(3):362–371.
