Do I Need Pelvic Floor Physical Therapy?

Many people assume pelvic floor physical therapy is only for women who leak urine after having a baby. In reality, pelvic floor dysfunction can affect people of all ages and can show up as pain, pressure, difficulty emptying the bladder, constipation, painful intercourse, or trouble pushing a baby out during labor.

A healthy pelvic floor is both strong and flexible. Think of it like a trampoline: it needs enough tone to support your organs, but enough elasticity to stretch, relax, and coordinate when needed.

Unfortunately, many women have no idea their pelvic floor may be contributing to symptoms they experience every day. Others assume leaking, pelvic pain, or pressure are simply normal parts of pregnancy, birth, or aging. The good news is that pelvic floor physical therapy can often help.

Signs Your Pelvic Floor May Be
Too Tight

An overly tight pelvic floor can cause muscles to remain contracted when they should relax.

Common signs include:

• Pain with intercourse

• Pain inserting tampons or menstrual cups

• Pelvic pain or aching

• Tailbone pain

• Hip pain that doesn't improve with other treatment

• Low back pain

• Difficulty starting urination

• Feeling unable to completely empty the bladder

• Urinary urgency or frequency

• Constipation

• Straining during bowel movements

• Painful bowel movements

• Pain during pregnancy

• Difficulty relaxing during labor

• Prolonged pushing stage during birth

• Painful scar tissue after birth

Red Flags You Might Have a Tight Pelvic Floor

Certain activities and life experiences can increase the likelihood of developing an overly tight pelvic floor. While these activities are not harmful and do not automatically cause pelvic floor dysfunction, they can be clues worth considering if you are also experiencing symptoms.

You may be at higher risk for a tight pelvic floor if you:

• Participate in CrossFit or high-intensity strength training

• Practice Pilates extensively

• Have a background in dance or ballet

• Participated in gymnastics

• Ride horses regularly or have a long history of horseback riding

• Frequently "hold in" your stomach or brace your core throughout the day

• Perform heavy lifting as part of work or exercise

• Have a history of chronic stress or anxiety

• Tend to clench your jaw or grind your teeth

• Often feel like you are "holding tension" in your body

• Have a history of pelvic pain, painful periods, or painful intercourse

• Have chronic constipation or regularly strain during bowel movements

• Spend long periods sitting

• Have a history of hip, sacroiliac (SI), or tailbone pain

Many athletes and performers develop excellent strength, body awareness, and endurance. However, they may also become very skilled at keeping their core and pelvic floor muscles engaged all the time. Over time, muscles that are constantly "on" can lose the ability to fully relax.

Signs Your Pelvic Floor May Have
Low Tone

A low-tone pelvic floor lacks adequate strength and support.

Common signs include:

• Urine leakage with coughing, sneezing, laughing, running, or jumping

• Feeling pressure or heaviness in the vagina

• Sensation that something is "falling out"

• Pelvic organ prolapse

• Difficulty controlling gas

• Fecal leakage

• Reduced sensation during intercourse

• Core weakness

• Ongoing low back instability

• Difficulty maintaining good posture

• Feeling unsupported during exercise

• Persistent abdominal separation (diastasis recti) after birth

Why Pelvic Floor Health
Matters for Birth

During pregnancy and birth, the pelvic floor has an important job. It must support the growing uterus and baby throughout pregnancy while also being able to relax and stretch during labor.

Many people assume that a stronger pelvic floor automatically leads to an easier birth. In reality, a pelvic floor that is strong but unable to relax can make labor more difficult. Likewise, a pelvic floor with poor tone may contribute to feelings of heaviness, instability, or postpartum recovery challenges.

The goal is not simply strength. The goal is strength, flexibility, coordination, and awareness.

A well-functioning pelvic floor can:

• Support the bladder, uterus, and bowel during pregnancy

• Improve comfort and stability during daily activities

• Enhance fetal descent and rotation during labor

• Improve pushing efficiency during birth

• Reduce the risk of birth-related muscle injury

• Improve postpartum healing and recovery

• Reduce urinary leakage and pelvic pressure symptoms

• Improve sexual function and comfort

One of the most surprising things we see is that many women who need pelvic floor therapy are not weak. They are highly fit. Runners, dancers, gymnasts, CrossFit athletes, Pilates enthusiasts, equestrians, and women who regularly perform intense core workouts often develop pelvic floors that are very strong but have difficulty relaxing and lengthening.

For birth, relaxation is just as important as strength. The pelvic floor needs to soften, lengthen, and stretch to allow the baby to descend through the pelvis. A pelvic floor that is strong but unable to release may contribute to discomfort, difficulty with fetal descent, prolonged pushing, or increased risk of muscle injury.

The goal is not a weaker pelvic floor—it's a pelvic floor that can both contract and relax effectively when needed.

When Should You Seek an Evaluation?

If you recognize several of the symptoms listed above, a pelvic floor assessment may help identify the root cause and provide targeted treatment.

Pelvic floor physical therapists are specially trained to evaluate muscle tone, strength, coordination, posture, breathing patterns, and movement habits that may be contributing to symptoms.

At Frisco Midwifery, we frequently refer clients to Cara Hartoon, PhD, PT, with Pure Pelvic. Cara specializes in pelvic floor health, pregnancy, birth preparation, postpartum recovery, and helping clients optimize pelvic floor function before and after birth.

Whether you're experiencing pain, leakage, pressure, constipation, difficulty pushing, painful intercourse, or simply want to prepare your body for pregnancy and birth, a pelvic floor evaluation can be an important step toward feeling stronger, more comfortable, and more confident.

Not Sure If Your Pelvic Floor Is Too Tight or Too Weak?

Many women are surprised to learn that pelvic floor dysfunction can involve a combination of tightness and weakness at the same time. Muscles that stay chronically contracted often become fatigued and ineffective, leading to symptoms that overlap both categories.

A pelvic floor evaluation can help determine exactly what is happening and provide a personalized plan to improve strength, flexibility, coordination, and comfort.