Quick answer: Common signs you may need pelvic floor physical therapy include leaking urine during exercise or laughter, needing to pee frequently or urgently, straining during bowel movements, pelvic pain or pressure, and pain during sex. These symptoms are not “normal” and are treatable with targeted pelvic floor physical therapy from a trained specialist.

If you’ve ever laughed too hard and leaked a little urine, or found yourself wincing during intimacy, you might have brushed it off as just another quirk of being a woman, or getting older, or having kids. I’m here to tell you something important: you don’t have to accept these symptoms as your new normal.

I’m Sherryl DeVries, MSPT, and I’ve spent years as a trauma-informed pelvic floor physical therapist helping people in Seattle reclaim their bodies and their confidence. I’ve heard countless stories from patients who lived with pelvic floor dysfunction for years before finally seeking help, often because no one told them there was another option. My hope with this article is to change that for you.

Pelvic floor dysfunction affects millions of people, yet it remains significantly underdiagnosed and undertreated. According to a 2022 study published in Scientific Reports, 32% of the more than 25,000 women studied had at least one pelvic floor disorder. Other research suggests the number climbs even higher, with some studies citing that up to 47% of women experience a pelvic floor disorder, including chronic pelvic pain. These aren’t rare, isolated issues. They’re common experiences that deserve real attention and real treatment.

Let’s walk through the five signs that most often bring people through my door, why they happen, and what you can do about them.

What Is the Pelvic Floor and Why Does It Matter?

Your pelvic floor is a group of muscles, ligaments, and connective tissue that stretches like a hammock from your pubic bone to your tailbone. These muscles support your bladder, uterus, and rectum, and they play a critical role in bladder control, bowel function, and sexual health.

Think of your pelvic floor as part of your body’s core, working alongside your abdominal muscles, diaphragm, and deep back muscles to stabilize your spine and pelvis. Like any other skeletal muscle in your body, your pelvic floor can become weak, tight, or uncoordinated. And just like a strained shoulder or a tight hamstring, dysfunction here can cause a ripple effect of symptoms throughout your body.

Here’s what I want you to understand: symptoms like leaking, pain, or pressure are not just an unavoidable part of being a woman, giving birth, or aging. They’re signals from your body that something needs attention. The sooner you listen, the sooner you can start feeling better.

Sign #1: Urinary Leakage During Activity

Do you leak a little urine when you cough, sneeze, laugh, run, or lift something heavy? This is called stress incontinence, and it’s one of the most common signs of pelvic floor dysfunction I see in my practice.

This happens because your pelvic floor muscles aren’t providing adequate support to your bladder and urethra. When there’s sudden pressure on your abdomen, like from a sneeze or a jump during a workout, weakened muscles simply can’t hold everything in place.

I know it can feel embarrassing, even isolating. But please know this: stress incontinence is incredibly common, and it’s also highly treatable. It’s not something you need to just manage with panty liners for the rest of your life. A thorough professional assessment can identify exactly what’s happening with your muscles and create a plan to help you regain control.

Sign #2: Frequent or Urgent Urination

If you’re running to the bathroom more than once every two to three hours, or you experience sudden, intense urges that make it hard to hold on, this could indicate an overactive bladder or broader pelvic floor dysfunction.

This symptom affects far more than your bladder. It disrupts your sleep, forces you to map out bathroom locations before you leave the house, and can create real social anxiety. I’ve worked with patients who stopped attending long meetings or road trips because they were so worried about finding a restroom in time. That’s a lot of mental energy spent managing a symptom that doesn’t have to control your life.

Frequent urgency often stems from miscommunication between your bladder and pelvic floor muscles. The good news? Targeted pelvic floor physical therapy can help retrain this communication, giving you back both your bladder control and your peace of mind.

Sign #3: Difficulty With Bowel Movements

Chronic constipation, straining, a feeling of incomplete emptying, or even accidental bowel leakage are all signs your pelvic floor might need support. These symptoms are often overlooked or considered too embarrassing to discuss, even with a doctor, but they can have a significant impact on your quality of life and overall health.

Why does this happen? Your pelvic floor muscles need to coordinate properly to allow for smooth, complete bowel movements. When these muscles are too tight, too weak, or not working together correctly, that coordination breaks down. According to Johns Hopkins Medicine, pelvic floor therapy can help manage constipation, hemorrhoids, and anal fissures caused by straining.

You deserve to feel comfortable in your own body, including during something as basic as a bowel movement. If this is a daily struggle for you, please know that help is available, and it starts with understanding what your pelvic floor muscles are doing.

Sign #4: Pelvic Pain or Pressure

Pain during intercourse, a feeling of heaviness or pressure in your pelvis, a bulging sensation, or chronic pain in your lower back, genitals, or rectum can all point to pelvic floor dysfunction.

This sign is a little more complex because it can stem from two very different sources. Some people have muscles that are too tight, called high-tone dysfunction, which creates pain and restriction. Others have muscles that are too weak, or low-tone dysfunction, which can lead to a lack of support for pelvic organs. According to Johns Hopkins Medicine, high-tone dysfunction may show up as vaginismus or myofascial pelvic pain, while low-tone dysfunction is often linked to pelvic organ prolapse.

Here’s my advice: if you’re experiencing any of these symptoms, don’t try to self-diagnose based on internet searches alone. A pelvic floor specialist can perform a thorough assessment to determine exactly what’s happening with your specific muscles, and create a treatment plan tailored to you.

Sign #5: Pain or Dysfunction During Sexual Activity

Painful intercourse, known as dyspareunia, erectile dysfunction, or difficulty reaching orgasm are all signs that your pelvic floor may need attention. These symptoms often carry an emotional weight that goes far beyond the physical. They can strain relationships, diminish self-confidence, and leave people feeling disconnected from their own bodies.

Muscle tension, weakness, or even nerve involvement can all contribute to sexual dysfunction. And while these conversations can feel vulnerable, I want you to know that as a trauma-informed provider, creating a safe, judgment-free space for these discussions is central to how I practice.

You deserve a fulfilling, pain-free intimate life. If sexual activity has become something you dread rather than enjoy, that’s a sign worth addressing, not ignoring.

Why These Signs Matter and When to Seek Help

Every single one of the symptoms above is a signal, not a life sentence. And yet, so many people wait years before seeking help, often because they’ve been told these experiences are simply “normal” for their age, their gender, or their life stage (like pregnancy or menopause).

I want to be direct with you: they’re not normal, and you don’t have to live with them.

Pelvic floor physical therapy can benefit women of all ages, pregnant and postpartum women, men experiencing erectile dysfunction or pelvic pain, and trans and GNC folk who are experiencing pelvic pain and dysfunction. Really anyone noticing the symptoms described above should seek care. Early intervention matters because these issues rarely resolve on their own. Left untreated, they tend to worsen over time, whereas early treatment can prevent progression, improve your outcomes, and help you feel like yourself again.

What to Expect During Pelvic Floor Physical Therapy

If you’re considering pelvic floor physical therapy for the first time, know that a good provider will meet you exactly where you are, both physically and emotionally.

Your first visit typically includes a comprehensive evaluation, which may involve an internal and external examination. I know this can feel intimidating, especially if you’ve experienced trauma or discomfort with medical exams in the past. That’s exactly why a trauma-informed approach matters so much. You should always feel in control of your own care, with the ability to ask questions, take breaks, or modify any part of the exam at any time.

From there, treatment often includes a combination of the following:

• Pelvic floor exercises: This goes well beyond basic Kegels. Depending on your specific dysfunction, you may need strengthening, relaxation techniques, or a combination of both.
• Manual therapy and myofascial release: Hands-on techniques help release tension and improve mobility in tight or restricted tissue.
• Biofeedback: This technology helps you visualize how your pelvic floor muscles are functioning in real time, which can make it much easier to learn proper technique.
• Postural training and breathing techniques: Since your pelvic floor works in coordination with your entire core, addressing posture and breathing patterns is often essential to lasting results.

Sessions typically last anywhere from 30 minutes to two hours, depending on the complexity of your condition. Many of my patients start noticing meaningful improvement within 6 to 12 sessions, especially when they stay consistent with their home exercises between visits.

You Don’t Have to Live With These Symptoms

If you recognized yourself in any of the signs above, I want you to know something clearly: pelvic floor dysfunction is treatable, and you are not alone in this experience. Whether you’re dealing with leakage, pain, pressure, or sexual dysfunction, there is a path forward, and it doesn’t have to involve suffering in silence.

My commitment as a trauma-informed pelvic floor specialist is to provide personalized, compassionate care that respects your comfort, your history, and your goals. You deserve to feel confident and comfortable in your own body again.

If you’re ready to take that first step, I’d love to help. Schedule a consultation today, and let’s start working toward a life with less pain and more confidence.

Frequently Asked Questions

How do I know if my symptoms are serious enough to see a pelvic floor physical therapist?
If you’re experiencing any leaking, urgency, pain, pressure, or sexual dysfunction that affects your daily life, it’s worth scheduling an evaluation. You don’t need to wait until symptoms become severe. Early intervention often leads to faster, more complete improvement.

Is pelvic floor physical therapy only for women who have given birth?
No. While pregnancy and childbirth are common triggers for pelvic floor dysfunction, this type of therapy benefits women of all ages and life stages, as well as men experiencing pelvic pain or erectile dysfunction.

Will my first appointment include an internal exam?
An internal exam is often part of a thorough evaluation, but it’s never required. A trauma-informed provider will explain the process, answer your questions, and let you decide what you’re comfortable with at every step.

How long does it take to see results from pelvic floor physical therapy?
Many patients notice meaningful improvement within 6 to 12 sessions, though this varies depending on the complexity of your symptoms and your consistency with home exercises.

What if I’m too embarrassed to talk about my symptoms?
That feeling is completely understandable, and you are far from alone in it. Part of my role as a trauma-informed pelvic floor specialist is to create a safe, nonjudgmental space where you can talk openly about your body and your concerns.