Originally published July 2018. Reviewed and expanded August 2026.
Pelvic floor dysfunction could be affecting you, ladies — and gentlemen.
Chronic urinary tract infections? Bowel trouble? Pelvic pain? Painful sex? Urinary incontinence?
I know what you’re thinking — my pelvic floor muscles control all of that? Absolutely. And their dysfunction often goes undiagnosed for years, which means people get treated for the wrong thing, repeatedly, while the actual cause goes unaddressed.
What is the pelvic floor?
It’s a group of muscles lining the floor of the pelvis, running to the tailbone — just like it sounds. They work as a sling, and they’re involved in bladder and bowel control, sexual function, and core stability and posture. When they don’t work properly, all of those things can go wrong.
What it gets mistaken for
Because the pelvic floor is involved in so much, its problems get filed under other diagnoses. Pelvic floor dysfunction can cause, worsen, or be confused with:
- urinary urgency, frequency and incontinence
- bladder pain and interstitial cystitis
- constipation, straining, bloating, and a sense of not emptying completely
- irritable bowel syndrome
- chronic prostatitis and chronic pelvic pain syndrome in men — the non-bacterial kind, which is by far the most common form and the usual way men encounter this diagnosis
- painful intercourse, and pain that arrives during or in the day after sex
- sexual difficulties in both men and women, including problems with orgasm
Causes include pregnancy and childbirth, surgery, injury, chronic constipation and straining, heavy lifting or high-impact activity, habitual clenching or breath-holding, endometriosis, and chronic stress. A history of sexual trauma is also a recognised contributor.
Why Kegels sometimes make it worse
This is the part most people get wrong on their own, and it is the single most useful thing on this page.
Kegels — squeezing the pelvic floor — are the exercise everyone has heard of, and for some patients they are exactly right. Women with stress incontinence who do proper pelvic floor muscle training are far more likely to improve than women who do nothing.
But a large share of pelvic floor problems aren’t weakness at all. They’re the opposite: muscles that are already overworking and can’t let go. That’s called a non-relaxing, or high-tone, pelvic floor, and it’s the usual driver of pelvic pain and pain with intercourse. At one chronic pelvic pain clinic, roughly two out of three patients had it.
If your pelvic floor is stuck clenched, Kegels ask an already-exhausted muscle to squeeze harder. Symptoms often get worse. Treatment for these patients runs the other direction — learning to lengthen and release, sometimes called reverse Kegels, along with breathing and coordination work.
Same symptom, opposite exercise. That is exactly why this is worth being examined for rather than guessing — and why so many people conclude “Kegels didn’t work for me” when they were never the right exercise to begin with.
How it’s diagnosed
Mostly by a careful history and a hands-on exam. We’ll ask about bladder habits, bowel habits, sexual function, and where the pain sits and travels. The exam checks something people are rarely checked for: not just whether these muscles can contract, but whether they can relax afterward, and whether specific muscles are tender to gentle pressure.
Further testing — ultrasound, bladder function studies, or for men a urine culture and sometimes a look inside the bladder to rule out other causes — is added only if the picture calls for it. The practical point: this is a diagnosis made largely by an exam, so it gets missed by anyone who doesn’t do that exam.
What actually helps
Pelvic floor physical therapy is the first-line treatment and the foundation of everything else. A pelvic health physical therapist is not a personal trainer for your pelvis — a first visit typically includes assessment of the pelvic girdle and soft tissue and, with your consent, an internal muscle assessment.
Treatment can include hands-on work for tight or tender muscles, biofeedback so you can actually see what your muscles are doing, breathing and core coordination, posture and body mechanics, and a home programme built for your problem rather than a generic one.
And it works. In randomised trials, patients receiving targeted pelvic floor physical therapy improved roughly twice as often as those receiving general massage. Medications and, rarely, injections are options if therapy alone isn’t enough — but they come after, not instead.
When to be seen promptly rather than referred to therapy
Most pelvic floor problems are frustrating rather than dangerous. A few things aren’t. Call us or come in promptly for: fever with pelvic pain; inability to urinate; sudden severe one-sided pelvic pain; blood in the urine; bleeding after intercourse or any bleeding after menopause; new pelvic pain starting after menopause; unexplained weight loss; or new loss of bladder or bowel control with numbness between the legs or leg weakness. Those need evaluation first.
Don’t suffer any longer
Talk to your primary care provider and find out whether this is the culprit. Plenty of people are living with this, and your provider will not be offended or embarrassed to discuss it — we have this conversation regularly.
If you need a provider, call our office at (417) 332-3639. We’d be happy to help, and we can refer you to a pelvic health physical therapist.
Carolyn Clark, NP-C