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I didn’t think twice about my pelvic floor until after I had my twins. Honestly, before that, I wasn’t even totally sure what the pelvic floor was. But I’ll never forget being at a wedding a few months postpartum, dancing barefoot in the middle of the reception hall, and suddenly realizing I couldn’t jump. Or more accurately, I shouldn’t jump. Because if I did, I might pee a little.
Flash forward to life after baby number three, and I’m dealing with a completely different issue: now it’s harder for me to pee. Like, I want to go, but my body feels like it’s holding on.
That’s when I realized something I wish more people talked about: pelvic floor dysfunction isn’t always about leaking. Sometimes, it’s about the opposite. And sometimes, it’s about a whole range of symptoms that don’t seem obviously connected but actually are.
It turns out, pelvic floor health is a lot more nuanced — and a lot more essential — than I ever realized. And if you're dealing with symptoms that don’t quite add up, you’re not imagining things, and you’re definitely not alone. In fact, I’m not alone. In a recent survey of our Rescripted community, 30.2% said they’ve never done pelvic floor exercises, and nearly a quarter (23.8%) weren’t even sure what pelvic floor exercises were. Even more eye-opening? Among 35–44 year-olds — the very group most likely to be postpartum — a whopping 71.4% said they had never done pelvic floor exercises. Only 2.4% of respondents said they started pelvic floor work because a healthcare provider recommended it, pointing to just how much more education and support is still needed.
What is the pelvic floor, and why is it important?
Your pelvic floor is a group of muscles, ligaments, and fascia at the base of your pelvis. Think of it like a supportive sling that holds up your bladder, urethra, vagina, uterus, and rectum. These muscles are mostly voluntary skeletal muscles that help control urination and bowel movements, play a role in sexual function, assist in the movement of blood and lymph through the trunk and pelvis, and provide stability to your core.
"The pelvic floor works with your respiratory diaphragm, deepest layer of abdominal muscles (transversus abdominis), and deepest layer of back muscles (multifidi) to create your innermost core stabilization system", explains Lauren Dickerman, DPT, an experienced women's health physical therapist.
They’re constantly working in the background — when you walk, sit, lift, go to the bathroom, and even when you breathe. And because they’re internal, it’s easy to go years without giving them much thought… until they stop functioning the way they’re supposed to.
Pelvic floor dysfunction: Signs of a weak or tight pelvic floor
Here’s the confusing part: a weak pelvic floor and a tight (or overactive) pelvic floor can produce a lot of similar symptoms. And sometimes, they even coexist. That’s why understanding the root cause and getting the right kind of support is so important.
Common symptoms of a weak pelvic floor
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- Leaking urine when you cough, sneeze, laugh, or jump
- A feeling of heaviness or pressure in the pelvic area
- Pelvic organ prolapse (a sensation like something is falling or bulging)
- Frequent urination or urgency
- Trouble holding in gas or stool
- Lower back pain or lack of core stability
- Reduced sensation during sex or difficulty achieving orgasm
Common symptoms of a tight (overactive) pelvic floor
- Trouble starting your urine stream or feeling like your bladder never fully empties
- Loss of control of your urine, gas, or stool
- Constipation or pain with bowel movements
- Painful sex, especially with penetration
- General pelvic pain or vaginal discomfort
- Hip or tailbone pain
- Low back, hip, or tailbone pain
- A constant sense of tension in your lower body
- Decreased core stability
A tight pelvic floor isn’t necessarily “strong.” In fact, chronically clenched muscles can become weak over time. That’s why exercises like Kegels aren’t always the answer and can even make things worse if your pelvic floor is already overactive.
Why pelvic floor health matters for women
When your pelvic floor isn’t working well, it can affect everything from your bathroom habits to your sex life to your overall sense of well-being. It’s not just a postpartum issue, and it’s not something you have to put up with “because you had kids” or “because you’re getting older.”
Pelvic floor dysfunction can impact your day-to-day life in ways that are both subtle and significant. You might stop running, avoid long car rides, feel nervous about intimacy, or just not feel right in your body — and not know why.
Getting curious about what’s going on, instead of brushing it off, is a powerful first step.
How to treat a weak or tight pelvic floor
If any of the symptoms above sound familiar, it’s worth seeing a pelvic floor physical therapist. Yes, they exist. And yes, they’re incredible.
A pelvic floor PT will assess your muscles (internally and externally, with your consent), help figure out whether your pelvic floor is weak, tight, or both, and work with you on a plan to restore healthy function.
That plan might include:
- Learning how to properly engage, or relax, your pelvic floor muscles
- Breathwork and posture adjustments
- Manual therapy to release tension
- Mobility and strength exercises tailored to your body
- Education around habits that may be contributing to the issue (like straining to pee, clenching, or sitting too long)
The point is: there’s help. And you don’t have to figure it out on your own. “Pelvic floor PTs have many techniques to treat pelvic floor dysfunction, so if thinking about internal work seems too stressful, rest assured, there are ways to successfully treat you without you needing to undress,” says Lauren.
The bottom line on pelvic floor dysfunction
We talk a lot about self-care, but tuning into your pelvic floor is next-level self-awareness. This isn’t about bouncing back or being “tight” or “toned.” It’s about feeling connected to your body, comfortable in your daily life, and confident that your basic functions (like peeing, pooping, and having sex) aren’t things you just have to deal with.
“It’s terrific that conversations about the pelvic floor are happening. Women should be equipped with this education to have improved body and health literacy so they can better understand what’s happening in their bodies, advocate for care, and seek preventative strategies to optimize their muscle performance to decrease risk of injury and dysfunction,” shares Lauren.
Pelvic floor health matters. It affects every woman, at every stage of life, and it deserves more attention, more conversation, and way less stigma.
So if you’ve been putting off that weird pelvic ache or wondering if your bladder habits are normal, consider this your nudge. You’re not alone. You’re not broken. And help is out there. Per Lauren, “It’s never too late to seek out care from a pelvic floor physical therapist.”
Kristyn Hodgdon is a passionate women's health advocate and the Co-Founder and Chief Creative Officer of Rescripted, where she helps break down complicated medical info into content that's easy to understand — and actually helpful. As an IVF mom who’s experienced pregnancy loss and lives with PCOS, Kristyn blends her professional know-how with real-life experience to support others navigating similar journeys. Her work has been featured on Good Morning America, ScaryMommy, and more, and she’s the host of the podcast From First Period To Last Period. A Fordham University grad, Kristyn also volunteers with the Fly Again Foundation, which supports breast cancer patients. You can find her on Instagram or connect with her on Linkedin.