Pelvic floor therapy isn’t for everyone. But if you pee when you sneeze or awkwardly run to the bathroom after a laughing fit, this is a telltale sign that your pelvic floor needs a little lovin’. Recurring urinary tract infections or battling with interstitial cystitis can also point to your pelvic floor.
A basket that holds your fruit
The pelvic floor is a diaphragm of sorts – a flat floor of muscles that extends from the base of your tailbone to your pubic bone. Like other muscles in the body, it can contract and relax. Also like other muscles in the body – chronically tight, overly-contracted muscles or weak and slack muscles will invariably lead to problems.
If it helps, think of your pelvic floor as a basket holding all your abdominal organs. Nearest and dearest to the pelvic floor are things like your uterus, bladder, and colon.
You want your basket to stay taut and supple as you move through your day. But with all the sitting, lounging, and heel-wearing we do – it’s tough to keep the pelvic floor happy. Here are 5 warning signs to watch out for if you think you might need pelvic floor therapy.
#1 – You pee when you sneeze. Or cough. Or laugh. Or run.
Pee should stay in the bladder until it’s intentionally released. Any accidental “leakage” – whether a dribble or a flood – is a sign that your pelvic floor isn’t as taut and supple as you’d like it to be.
Before you add a 100 Kegels a day to your pelvic floor therapy, bear in mind that tightening the pelvic floor pulls the base of the tailbone to the pubic bone. This is exactly the same position you see when pelvic floor muscles are lax. Kegels won’t stop the pee and they can make incontinence worse.
For more insight on pelvic floor therapy and urinary incontinence, pick up a copy of The Bathroom Key.
#2 – It hurts to pee or you’ve been diagnosed with IC
Sit much? Yeah, me too. Sitting in your car, at the dinner table, at your desk, on the couch – it’s what people do. People also wear heels and carry a lot of mental stress.
The result is tight muscles. And chronically tight muscles means lumpy, wadded-up connective tissue (the stuff that connects muscles and organs).
The problem with lumpy, wadded-up connective tissue is that it ends up pulling on the structures around it. This can mean pain in the bladder or the diagnosis of interstitial cystitis (IC).
Take sitting, for example. When you sit – your hamstrings, the muscles that run from your butt to your knees – are slack like a loose rubber band. Sitting often, as we do, shortens and tightens your hamstrings. These muscles pull on your pelvis and the pelvic floor, causing it to “tuck.” Tuck your birthin’ hips for too long – like, all the time – and you’re going to need pelvic floor therapy as the muscles of the pelvic floor shorten and become tight.
Other areas that may feel weak, tight, and lumpy – ultimately affecting your pelvic floor and its ability to hold up your bladder:
- The side of the legs
- The butt
- The lower back
- The groin
You can release this lumpy, tight tissue with a little DIY pelvic floor therapy: try rolling on Yoga Tune Up balls and some calf stretches.
#3 – It hurts to have sex
A tight pelvic floor, lumpy connective tissue, or scar tissue can make sex painful.
During pelvic floor therapy, internal work – assessing tightness of the pelvic floor and learning how to relax it – can help. Sort of like a pap smear, an internal exam involves a therapist going into the vaginal cavity. Unlike a pap smear, there’s no speculum – only the pressure of one finger along with some coaching to feel and relax the pelvic floor.
Gentle pressure on the muscle will tell it to let go. Along with breathing exercises, you begin to feel where you’re holding tension and how to release it.
#4 – Urinary tract infections are your norm
There’s a clear link between recurring infections down there and problems with your pelvic floor. These problems are obvious things, like incontinence or falling organs.
While an imbalance of good and not-so-good bacteria is an issue, recurring infection also has to do with pressure placed on the valve between the bladder and the ureter – the tube connecting your kidneys to your bladder.
It’s like reflux…of the ureter. This is when bacteria from the bladder can move up into the more sterile ureter and kidneys. So, while remedies for UTI are important – it’s just as important to address falling organs while taking the pressure off of the valve connecting your bladder to your ureter. This is where pelvic floor therapy shines.
#5 – You’re pregnant and you hurt
Sore feet, sore knees, sore hips, a sore back. All of this can point to your pelvic floor. Remember that tight, underused muscles affect your alignment and your pelvic floor.
During pregnancy, it’s normal to feel more pain than usual – but it’s not ideal. With a taut and supple pelvic floor in mind, you want to do all you can to create space and support the extra load you’re carrying in front. Pelvic floor therapy can help you make healthy adjustments as your belly grows and your gait changes – like keeping your weight in your heels or pulling in your lower ribs while untucking your pelvis.
Get on the hunt for pelvic floor therapy
Weirdly, conventional medicine doesn't readily offer pelvic floor therapy. You might have to do a funny dance to be heard and then fight for a referral.
When you do get a referral – or if you find an online program that you love – keep an eye out for the recommendation to do Kegel exercises, which involve contracting and releasing muscles within the pelvic floor. This is a red flag. If you hear this recommendation during pelvic floor therapy, run the other way.
Kegel exercises tighten the pelvic floor and pull the base of the tailbone towards the pubic bone – similar to what happens when you sit down and your pelvis is tucked under you.
During a good pelvic floor therapy session, you will learn how to tone and lengthen the space between the base of the tailbone and the pubic bone.
Ideally, you take away tips that you can practice all the time. Literally every moment you walk, stand, or sit. Pelvic floor therapy is about changing a lifetime of habits. Because the pieces of the body are all connected, you'll often see benefits in other areas that feel stiff or hurt.
Do you think you need pelvic floor therapy? I would love to hear about your experience below!
I need pelvic floor therapy. I am a 47 year old woman who recently attained black belt status in Mixed Marital Arts. Every time I spar, I pee a little (I’m assuming from the jarring motions of getting & giving punches & kicks). It’s embarassing while out on the floor in front of the class – of mostly younger folks. What can I do?
Emily Bartlett says
Congratulations on the black belt! If you only want to focus on your pelvic floor, I recommend reading the work Katy Bowman and even picking up her mini-classes here: Nutritious Movement for a Healthy Pelvis Download and Alignment Snacks: All fo’ the pelvic flo’
If you’re interested in a full program, my favorite is the MuTu System.
You’ll notice a pretty big difference after a short time of integrating these exercises into your practice.
All the best!
In the article there was mention of online programs. Can you recommend one or be very specific what to look for?
Emily Bartlett says
If you’re looking for a full online program, I highly recommend the MuTu System because it focuses on both your core alignment and your pelvic floor. It gives you a complete understanding of how to care for your pelvic floor.
Katy Bowman is also an excellent resource for home exercises. She offers two mini-classes that you can download — they focus exclusively on the pelvic floor and are not a comprehensive system:
Hope this helps and good luck!
I think it is important to speak with your doctor if you are having problems, as they can help as well – with exercise/therapy recommendations. Great information, thanks for sharing!
I know I have a weak pelvic floor. My coxiis has been in severe pain for about two years now.
Ashley Chapman says
Hi! I feel like I need a pelvic-floor message. Even five years after having my daughter, sex is extremely painful, it’s even painful to insert a tampon. It feels almost too tight. After sex, just inside my opening is incredibly raw and very sore and sometimes it bleeds. It honestly scares me a little bit and I’m not really sure what to do. I dab on 4% Lidocaine but has little effect. HELP ME PLEASE!
Sound like you have a tight pelvic floor.
You should learn how to relax those muscles.
You probably need a pelvic floor practitioner to show you how.
I think I may have a pelvic muscle spasm/problem. Had a baby 7 months ago. Sex is extremely painful, like there is a point in the middle of penetration that is brutal. Not sure if therapy or massage is necessary.
I’m 64. Have a lot of trouble pooping. Living on miralax. Tight pelvic floor. Now going to a pelvic therapist. Some days are better than others. Will I ever be normal again?
After my first child, I had burning bladder & was diagnosed with IC in 2003. It took 3 years of many doctor visits & medications with no relief. I was in so much pain with a baby to raise. I started practicing yoga and in time it completely healed my pelvic floor. I had my second child in 2019 and now i have to start all over again but know there’s a rainbow at the end of thid path. I must say, it’s very painful to have a tight pelvic floor.
Alice Carroll says
It’s interesting to know that needing pelvic floor physical therapy can be directly connected to urinary tract infection. Ever since I was a sophomore in college, you could say that it has been my norm. Thanks for the tip to avoid Kegels during the therapy as well.
I recently had a full hysterectomy with pelvic organ prolapse repair. I am now cleared for sex and my husband can barely enter me it’s so tight. I also hurt and burn upon entry which was never the way before. I start pelvic floor therapy this week, can’t wait really. I also can barely sit, my lower tailbone area is so tender, I had to buy a cockrosacrial (spelling?) pillow.
I have oa in my left hip which makes all the muscles on my left side extremely tight. Due to this it makes me pee a lot. It seems as the bladder fills the muscles react. Once I pee I’m ok. But trying to stay hydrated can be a problem. I am supposed to get my hip replaced but not sure when due to the pandemic. Any suggestions?
I am suffering with really bad periods pain every month. It affects me to the stage where I can’t move from bed for 2 or 3 days. I’ve been offered medical solutions such as pills, NSAID, and kegels exercise, I know non of it is right, side effects from drugs and kegels tighten even more my pelvic floor which is too tight already. I am also experiencing painful sex. Can you please tell me if the MUTU program is for me in this case? If not can you recommend something else?
Hi my name is Juliet and I assume that there is something wrong with my pelvic floor. For me sex is very painful n there’s no enjoyment with it aslo I urniate a lot like 10 times a day.