Pelvic Health

Pelvis: Foundation of support for the body

Pelvic Floor: A group of muscles, ligaments and tissues that support the organs of the pelvis which include the bladder, urethra, and rectum as well as the uterus and vagina for women and prostate for men

Functions of the Pelvic Floor Muscles

What Causes Pelvic Floor Disorders?

Pelvic floor disorders can develop for many different reasons and are often influenced by a combination of physical, hormonal, neurological, and emotional factors. The pelvic floor muscles may become either too weak (hypotonic) or too tight (hypertonic), both of which can contribute to pain, bladder symptoms, bowel dysfunction, and sexual health issues.

Weak Pelvic Floor Muscles (Hypotonic Pelvic Floor)

A weak pelvic floor may contribute to:

• Stress urinary incontinence
• Pelvic organ prolapse
• Reduced pelvic stability and support

Tight or Overactive Pelvic Floor Muscles (Hypertonic Pelvic Floor) 

An overactive pelvic floor may contribute to:

• Urinary urgency and frequency
• Urge/stress incontinence
• Difficulty emptying the bladder or bowels
• Painful intercourse (dyspareunia)
• Pudendal neuralgia
• Chronic pelvic pain
• Bladder pain syndrome
• Pelvic organ prolapse

Common Risk Factors for Pelvic Floor Dysfunction

Pelvic floor disorders may be associated with:

• Chronic stress, anxiety, trauma, fear, or shame
• Pregnancy and childbirth
• Hormonal changes and menopause
• Prior pelvic surgery or pelvic radiation
• Heavy lifting or chronic straining
• Obesity
• Aging
• Genetic or connective tissue factors
• Persistent coughing or constipation

Stress can play a major role in pelvic floor dysfunction. The pelvic floor muscles are often one of the first muscle groups in the body to respond to physical and emotional stress, leading to increased tension and nervous system sensitivity over time.

Understanding Pelvic Pain

Pelvic pain refers to pain felt in the lower abdomen or pelvic region, between the belly button and groin. It can affect people of all genders and may be acute or chronic.

Pelvic pain is often complex and multifactorial, meaning symptoms can arise from several overlapping systems, including:

• Muscles and connective tissues
• The bladder or bowel
• Hormonal influences
• The nervous system
• Gastrointestinal or visceral structures

Common Characteristics of Pelvic Pain

Pelvic pain may:

• Feel dull, sharp, aching, burning, throbbing, or heavy
• Be constant or intermittent
• Radiate into the lower back, buttocks, or thighs
• Worsen with sitting, exercise, urination, bowel movements, or intercourse
• Feel like pressure and mimic the symptoms of a prolapse
• Be associated with a sensitive or overactive nervous system 

In some cases, pelvic pain may also involve irritation or sensitization of nerves within the pelvis.

Symptoms of Pelvic Floor Dysfunction

Pelvic floor dysfunction symptoms can vary widely depending on the muscles, organs, and nerves involved.

Bladder Symptoms

• Leakage of urine with coughing, sneezing, laughing, or exercise
• Urinary urgency or frequency
• Difficulty fully emptying the bladder
• Difficulty starting urination
• Strong urges that lead to leakage

Bowel Symptoms

• Difficulty passing stool
• Fecal urgency or incontinence
• Straining during bowel movements

Pain Symptoms

• Pelvic pain or pressure
• Burning or stinging sensations in the pelvis
• Pain in the vagina, rectum, clitoris, penis, or perineum
• Pain in the tailbone, buttock or pelvic girdle
• Pain in the vagina/pelvis during or after intercourse
• Pain and heavy cramping with menstruation
• Postpartum pelvic, pubic bone, or low back pain

• Feelings of not emptying the bladder fully after urinating
• Heaviness/pressure within the pelvic region
• Protrusion of tissues inside/outside of the vaginal/anal entrance (prolapse)

Prolapse Symptoms

• Heaviness or pressure in the pelvis
• A bulging or protrusion at the vaginal or anal opening
• Sensation of “falling out” or pelvic fullness

Pelvic Floor Dysfunction Treatment Options

Treatment for pelvic floor dysfunction is most effective when it takes a multidisciplinary and biopsychosocial approach, addressing the muscles, nervous system, lifestyle factors, and emotional wellbeing together.

Counselling and Behavioural Support

Counselling can help address the emotional, behavioural, and lifestyle factors that may contribute to pelvic floor symptoms and chronic pain. This may include support for:

• Stress and anxiety management
• Trauma-informed care
• Fear avoidance behaviours
• Pain coping strategies
• Lifestyle and dietary modifications
• Bladder and bowel habit retraining
• Improving sleep, movement, and overall nervous system regulation

For many individuals, combining physical treatment with psychological and behavioural support can improve long-term outcomes and quality of life.

Pelvic Floor Physiotherapy

Pelvic floor physiotherapy uses a range of evidence-based techniques to improve muscle function, coordination, and symptom control. Depending on your presentation, this may include relaxation strategies, strengthening, or a combination of both.

Common components include:

• Breathing and coordination training
• Myofascial release and connective tissue mobilization
• Stretching and joint mobilization
• Bladder and bowel retraining

Education and Nervous System Support

Education is a key part of treatment and helps individuals better understand:

• Pelvic floor anatomy and function
• Pain science and nervous system sensitization
• The relationship between stress and pelvic symptoms
• Lifestyle and behavioural strategies that support recovery

Relaxation and Mind-Body Techniques

Mind-body approaches may help reduce pelvic floor tension and nervous system overactivity, including:

• Yoga
• Meditation
• Tai chi
• Qigong
• Breathwork and mindfulness practices

Biofeedback Therapy

Biofeedback uses sensors or a small vaginal/rectal probe to help improve awareness and coordination of the pelvic floor muscles through visual feedback.

Electrical Stimulation

Electrical stimulation may be used to:

• Improve muscle activation
• Reduce pain
• Enhance pelvic floor awareness and coordination

Balloon Training

Balloon training may help improve anorectal coordination and bowel control in cases of chronic constipation or fecal incontinence.

Joint and Mobility Treatment

Treatment may also address surrounding structures such as the:

• Lumbar spine
• Hips
• Coccyx (tailbone)
• Sacroiliac joints

Improving mobility and reducing tension in these areas can help support pelvic floor function and reduce pain.

• Counselling: To modify lifestyle, diet and toileting habits to optimize bladder/bowel and pain control
• Pelvic Floor Muscle Relaxation and/or Strengthening Exercises: Can include massage, myofascial release, connective tissue manipulation, stretching and joint mobilization to promote relaxation and mobilization/activation of tissues

Debunking Pelvic Floor Myths 

MYTH #1

“Pelvic floor dysfunction only affects women.”

❌ False.
Men have pelvic floor muscles too — and they can experience pelvic pain, urinary symptoms, constipation, and sexual dysfunction just like women.

MYTH #2

“Painful intercourse is normal.”

❌ False.
Pain during intercourse is common, but it is NEVER considered normal — at any age or life stage.

MYTH #3

“Urinary incontinence is to be expected.”

❌ False.
Incontinence can happen from childbirth and aging, but improvement is seen in 80% of those who do pelvic floor exercises.

MYTH #4

“You should pee ‘just in case.’”

❌ False.
Frequently emptying your bladder before it’s full can train your bladder to signal urgency too early — which may worsen frequency and urgency over time.

MYTH #5

“Kegels are beneficial for everyone.”

❌ False.
Not all pelvic floors are weak. Some pelvic floor muscles are actually too tense or overactive — and Kegels can make symptoms worse in those cases.