Written by: Nikki Maciejewski, PTA
As a Physical Therapist Assistant, one of the most common things I hear from patients is: “I didn’t even know I had pelvic floor muscles.” And honestly, that’s normal. These muscles are not something we’re typically taught about, but they play a huge role in your everyday function.
After completing advanced training through the Herman & Wallace Pelvic Rehabilitation Institute, I’ve been able to better understand the many ways pelvic floor dysfunction can impact people and more importantly, how we can treat it.
Yes, that’s right—there is hope. You don’t have to keep dealing with what’s going on “down there” all on your own. I promise, you’re not the only one, and you’re definitely not stuck like this forever.
This guide is here to help you understand what’s going on in your body in a way that actually makes sense.
What Are the Pelvic Floor Muscles?
Your pelvic floor muscles (PFM) sit at the bottom of your pelvis like a supportive hammock. Pelvic floor function is a necessary balance between mobility and stability among pelvic structures. Organs must expand and contract, and tissues need to support structures without being too rigid. They help with:
- Bladder and bowel control
- Supporting pelvic organs (bladder, uterus, rectum)
- Sexual function
- Core stability and breathing
Think of them as your body’s “support team”—quietly doing a lot of work behind the scenes… until they decide not to…
Common Pelvic Floor Issues…
1. Urinary Leakage (Incontinence)
This is one of the most common concerns I see in clinic and it is treatable, not just “part of aging.”
Types include:
- Stress incontinence: leakage with coughing, sneezing, laughing, or exercise
- Urge incontinence: strong, sudden urge to go
- Overflow: difficulty emptying completely
- Neurogenic: related to nerve dysfunction
Risk factors include:
- Chronic coughing (very common in women)
- Pregnancy and childbirth (especially first-time moms)
- BMI over 24
- Vaginal delivery
- Diabetes
2. Urinary Retention
This is when the bladder doesn’t empty fully.
Common causes:
- Postpartum changes (episiotomy, epidural, long labor)
- Post-surgical effects (anesthesia, medications)
- In women: muscle dysfunction or obstruction
- In men: prostate enlargement
If ignored, this can lead to infections or other complications, it’s something we take seriously.
3. Urgency & Frequency
Going “too often” or always scouting out the nearest bathroom? You’re not alone.
This can be linked to:
- Smoking history
- Obesity, hypertension, diabetes
- Anxiety or depression
- Constipation
- Neurological conditions
And yes your habits matter too. “Just in case” peeing might seem harmless, but it can actually train your bladder to think it needs to go more often. (Your bladder gets a little too comfortable being the boss.)
4. Pelvic Organ Prolapse (POP)
This occurs when pelvic organs shift due to decreased support. Proplapse may be associated with connective tissue laxity and weakness as well as loss of nerve, muscle, ligament of fasical integrity.
Up to 50% of women will develop pelvic organ prolapse (POP) over their lifetime (Carroll et al., 2022)
Most common types of POP:
- Cystocele- Cysto= bladder + Cele= hernia or swelling
- Common Symptoms- Poor or prolonged urinary stream, feeling incomplete emptying, stress urinary incontinence, post dribble
- Rectocele- Recto=Rectum + Cele= hernia or swelling
- Common Symptoms-Vaginal pressure/discomfort, protrusion from posterior vaginal wall, needing to reposition during bowel movement.
- Uterine- refers to Uterus
- Common Symptoms- Blood-stained purulent discharge, low back pain or discomfort as day progresses, difficulty in bowel or bladder emptying, increase discomfort w/prolonged standing feels better in supine (laying on back)
- Enterocele- Entero= intestine + Cele= hernia or swelling
- Common Symptoms- Pelvic or vaginal pressure, difficulty evacuating rectum and bladder, low back discomfort worsens as day progresses, and increased discomfort prolong standing, relieved by lying down.
Risk factors of POP:
- Congenital- bladder exstrophy, collagen defects & connective tissue disorder, anatomy
- Childbirth- Vaginal delivery forceps assisted, first delivery, trauma, perineal lacerations, denervation
- Raised intra-abdominal pressure- Chronic obstructive airway disease, chronic cough, straining, constipation, heavy lifting
- Increase age– Estrogen deficiency, inconclusive contributions from menopause
- Iatrogenic– Pelvic surgery (example: hysterectomy)
- Body Size– BMI >30, waist circumference >88 cm, hypertension
POP Research:
- Prolapse, Postpartum & Vaginal Delivery- “Women with POP sxs were significantly more likely to experience incontinence, hard stools before and after pregnancy, and straining habits during defecation before pregnancy than those without…” (Murayama et al., 2023)
- Hypermobility & Prolapse- “Clinical joint hypermobility was found in 35% patients…Women with joint hypermobility have more recurrent genital prolapse as compared to women with normal joint mobility. Plain hypermobility was associated with higher concentration for types I procollagen. Patients with recurrent prolapse and joint hypermobility have significant high concentration for types III procollagen” (Knuuti et al., 2011)
- Expiratory Breath & Prolapse- “Weak abdominal muscles in women with low MEP (maximum expiratory pressure) may overload pelvic floor muscles due to abdominal-pelvic synergy, leading long-term weakening. Pelvic floor muscle training may contribute to increasing expiratory muscle strength, in addition to reducing the occurrence and symptoms of POP” (Azevedo et al., 2021)
Pelvic floor therapy can help improve symptoms and support.
5. Pelvic Pain
Chronic pelvic pain affects about 1 in 4 women worldwide and can impact daily life, relationships, and emotional well-being.
Treatment is not just about muscles—it’s about a whole-body and whole-person approach, including movement, education, and nervous system support.
Other Information- The Connection Between Hypermobility & Pelvic Floor:
If you’re someone who is naturally flexible or “double-jointed,” your connective tissue may be more lax. This can increase your risk for:
- Stress incontinence (up to 60%)
- Urgency symptoms (54%)
- Prolapse (21%)
If you also experience joint pain, fatigue, or skin changes, it may be worth discussing further screening with your provider. Navigating these symptoms can feel overwhelming, but recognizing that your pelvic floor needs a little extra support is the first step toward reclaiming control. Remember: while these issues are incredibly common, they are not something you just have to live with. Whether you are dealing with minor leaks, pelvic pressure, or chronic pain, your body is capable of healing, and specialized pelvic floor physical therapy can guide you there. You do not have to figure this out alone.
What’s Coming Next…
Now that you know what the pelvic floor is and the common signs of dysfunction, you might be wondering what actually happens next. How do we figure out exactly what your unique support team needs? In Parts 2 & 3 of this series, we are going into the books and the clinic to look at:
Bladder Mechanics & The Nervous System: How your bladder fills, empties, and how to finally stop letting it be the boss of your daily schedule. Why stress and your brain play a massive role in how your pelvis feels.
The Assessment: What to actually expect during a pelvic muscle evaluation (spoiler: it’s not as scary as you think!).
