Month: September 2025

Urinary Incontinence During Exercise: Why It Happens & How to Take Back Control

You’re halfway through a great workout—lifting, running, jumping rope—and suddenly, you feel it: that small (or not-so-small) leak you didn’t sign up for.

If this sounds familiar, you’re not alone. Urinary incontinence during exercise is incredibly common, yet it’s still a topic many people feel embarrassed to talk about. As a pelvic floor physical therapist, I can tell you—this isn’t just “part of getting older” or “the price of having kids.” It’s a sign your body needs some attention, and the good news is, there’s a lot we can do about it.

First Things First: What Counts as Urinary Incontinence?

Urinary incontinence simply means leaking urine when you don’t want to. When it happens during exercise, it’s most often stress urinary incontinence (SUI)—leakage triggered by activities that increase pressure in your abdomen, such as:

Running or sprinting
Jumping jacks, jump rope, or box jumps
Heavy lifting
High-impact sports like tennis or basketball

That increase in pressure pushes down on your bladder, and if your pelvic floor muscles (and surrounding core muscles) can’t coordinate and support properly, some urine escapes.

Why It Happens During Exercise

Think of your pelvic floor muscles as a supportive hammock at the bottom of your pelvis. They have three key jobs:

Support your pelvic organs (bladder, uterus, rectum)
Control bladder and bowel openings
Work with your deep core to stabilize your spine and pelvis

When you jump, lift, or run, your intra-abdominal pressure spikes. Your pelvic floor is supposed to respond instantly, contracting just enough to keep things closed and supported. But if the timing, coordination, or strength of that contraction is off—even by a fraction of a second—leaks can happen.

Several factors can contribute:

Pregnancy and childbirth (vaginal or C-section)
Hormonal changes during menopause that affect tissue elasticity
High-impact training without pelvic floor conditioning
Previous abdominal or pelvic surgery
Chronic coughing or constipation (yes, straining matters here too)

Myth Busting: It’s Not Just About “Do More Kegels”

Kegels—the classic “squeeze your pelvic floor” exercise—are helpful for some people, but not everyone. If your pelvic floor is overactive, tense, or not coordinating well with the rest of your core, simply doing more squeezes can make things worse.

In fact, I see many athletes with pelvic floor muscles that are already too tight, which means they can’t generate the right type of quick, effective contraction when needed. The focus often needs to be on coordination, timing, and pressure management, not just strength.

How a Pelvic Floor PT Can Help

When someone comes into my clinic with exercise-related leaks, here’s how we typically start:

Detailed Assessment

We look at posture, breathing mechanics, pelvic floor muscle activation, and how your core and hips work together. If appropriate, we also do an internal pelvic floor assessment to understand muscle tone, strength, and coordination.

Breath & Pressure Control

The way you breathe during exercise can make or break your pelvic floor’s ability to function. We work on strategies like exhaling during exertion (for example, when lifting the heaviest part of a weight or during a jump) to keep pressure manageable.

Functional Training

We practice pelvic floor activation and relaxation in positions you actually use—standing, squatting, lunging—not just lying on your back.

Gradual Return to High Impact

We break down the movement causing the leak into smaller steps and retrain your body to manage the load. For example, before going back to box jumps, we might progress from squats → squat jumps → low box jumps → full height jumps.

Your At-Home Starting Point

While the most effective plan is tailored to you, here are a few beginner-friendly strategies you can try:

The “Blow Before You Go” Strategy
Before lifting, jumping, or any high-exertion move, exhale gently and activate your pelvic floor + deep core together. This preps your body for the pressure spike.
Coordinate With Your Breath
Avoid holding your breath (Valsalva maneuver) during strength training unless you’ve been specifically coached on safe ways to do so for pelvic health.
Mix in Low-Impact Options
If you’re in the middle of rehab, swap some high-impact moves for low-impact variations to reduce strain while building back capacity.
Address the Whole Core
Your pelvic floor works closely with your transverse abdominis (deep abs), diaphragm, and multifidus (deep spinal muscles). Training all of them together is key.

When to Seek Professional Help

If leaking happens every workout, or you notice it’s getting worse, it’s time to see a pelvic floor PT. Also seek help if you have:

Pelvic pain or heaviness
Urgency/frequency changes
Bowel symptoms (constipation, difficulty holding gas or stool)
Lower back or hip pain that worsens with exercise

These symptoms often go hand-in-hand and point to underlying coordination issues we can address.

The Bottom Line

Leaking during exercise is common, but not normal—and definitely not something you have to live with. With the right assessment, targeted exercises, and smart training modifications, you can get back to running, jumping, lifting, and living without worrying about leaks.

Your workouts should make you feel strong and empowered—not anxious about what might happen mid-rep. Pelvic floor therapy offers the tools to get you there.

If you’re ready to take the next step, reach out to schedule a pelvic floor assessment. Whether you’re an athlete, a weekend warrior, or just getting into exercise, we can create a plan that keeps you moving confidently—leak-free.

The Hormonal Landscape After Birth

During pregnancy, your body is flooded with estrogen and progesterone to support the growing baby and maintain the uterine lining. But after birth, especially if you’re breastfeeding, estrogen levels plummet. This hormonal shift is a normal, expected part of postpartum physiology, but it can create real and uncomfortable changes—particularly in the pelvic region.

Low estrogen can result in:

Vaginal dryness
Decreased tissue elasticity
Pelvic floor thinning or fragility
Increased sensitivity or irritation
Delayed tissue healing

Estrogen levels remain lower throughout the breastfeeding journey, often mimicking a temporary menopausal state. That means even months after giving birth, many people experience ongoing pelvic discomfort, especially during activities like intercourse, exercise, or simply sitting for long periods.

Common Postpartum Complaints Linked to Hormones

Let’s break down a few of the most frequent issues we see in the clinic:

Pain with Intercourse (Dyspareunia)

After birth, especially while breastfeeding, low estrogen can contribute to vaginal dryness, thinning of the vaginal tissues, and reduced natural lubrication. Combine that with the physical stress of labor or a perineal tear, and the result is often pain or discomfort with penetration. Many new parents are surprised—and sometimes distressed—by this, especially if no one warned them it could happen.

Pelvic Floor Tension or Pain

While we often talk about pelvic floor weakness postpartum, it’s equally important to consider overactivity or tension. Stress, sleep deprivation, and hormonal shifts can all lead to a hypertonic (tight) pelvic floor. This can feel like deep aching, pressure, or stabbing pain in the pelvis, and may worsen with intercourse, bowel movements, or prolonged sitting.

Scar Sensitivity: Perineal or C-Section

Whether you delivered vaginally or via Cesarean, you may be left with scar tissue. Estrogen supports skin and tissue regeneration, so in its absence, scars may feel stiffer, more sensitive, or less mobile. C-section scars can pull uncomfortably on surrounding tissue, while perineal scars may cause sharp or burning sensations, especially with activity.

How Pelvic Floor Physical Therapy Can Help

The good news? Pelvic floor therapy is a powerful tool in addressing these hormone-related changes and restoring function, comfort, and confidence.

Here’s how we help:

Manual Therapy and Scar Mobilization

Pelvic floor therapists use gentle, hands-on techniques to release tension in pelvic tissues and improve blood flow. We can also mobilize scar tissue—whether from a C-section or perineal tear—so it becomes more pliable and less painful.

Education and Empowerment

Understanding how your body has changed is often the first step to healing. We explain the impact of hormones, provide practical strategies, and help you feel connected to your pelvic floor again. You’ll learn how to use your breath, posture, and movement to support healing.

Pelvic Floor Downtraining and Desensitization

If you’re dealing with pain during intercourse, we guide you through graded techniques to improve tolerance and comfort. This may include use of vaginal moisturizers or lubricants, dilator training, and gentle pelvic floor relaxation exercises. Many of our patients are relieved to find that intimacy can feel good again—with the right support.

Muscle Balancing and Coordination

Whether your pelvic floor is too tight, too weak, or just uncoordinated after birth (which is common!), we assess your muscle function and create a personalized plan. This may include core strengthening, breathing exercises, and pelvic floor retraining to restore full function.

You’re Not Alone—and You Don’t Have to Wait

Too often, postpartum people are told to “just give it time,” or assume that pain is a normal part of new parenthood. But while hormone fluctuations are part of the process, suffering doesn’t have to be.

Pelvic floor physical therapy bridges the gap between postpartum recovery and long-term wellness. It’s never too soon—or too late—to seek care. Whether you’re weeks, months, or even years postpartum, your body deserves attention, support, and healing.

A Final Word

Postpartum hormones—especially low estrogen while breastfeeding—can significantly impact pelvic floor health. If you’re feeling confused about the changes in your body, or struggling with pain or tension, you’re not imagining it. Your body is doing the best it can in a low-estrogen environment, and with the right tools and support, it can heal.

Pelvic floor therapy is here to help you reconnect with your body, relieve pain, and restore comfort—so you can focus on what really matters: caring for your family and yourself.

The Hidden Link: How Constipation Affects Focus & Mood in Children

When a child is struggling with focus in the classroom or seems irritable at home, we often think of sleep schedules, screen time, or academic challenges. But as a pediatric pelvic floor physical therapist, I see another powerful—and often overlooked—factor: constipation.

Constipation doesn’t just affect the body. It can impact how a child feels, behaves, and learns. In school-aged kids, chronic constipation can quietly drain energy, cloud concentration, and lead to emotional outbursts that seem unrelated to digestion.

How Common Is Constipation in Kids?

Research shows that up to 30% of children experience constipation at some point, and many cases go unreported because kids are embarrassed or parents assume it’s “just a phase.” Some children are constipated for months—or even years—without realizing that infrequent, difficult, or incomplete bowel movements aren’t normal.

Why Constipation Affects the Brain & Emotions

The gut and the brain are in constant communication through what’s called the gut–brain axis. When a child is constipated:

The colon stretches, sending signals of discomfort or pain to the brain.
Nerve messages become altered, increasing body tension—including in the pelvic floor muscles.
Hormones and neurotransmitters that affect mood, like serotonin, are produced differently. (Fun fact: about 90% of serotonin is made in the gut.)

When a child’s gut isn’t working well, the brain receives a steady stream of “distress” signals, which can show up as:

Shorter attention span
Difficulty sitting still
Irritability or tearfulness
Avoidance of activities they normally enjoy

In the Classroom: The Constipation–Focus Connection

Imagine trying to listen to your teacher while you’re distracted by a stomachache, pelvic pressure, or the fear that you might have to rush to the bathroom. Many children describe feeling “full” or “tight” when constipated, which makes it hard to think about anything else.

Some kids with chronic constipation also develop toilet avoidance—especially if previous bowel movements were painful—which adds anxiety to the school day. The mental energy spent worrying about using the bathroom is energy they can’t spend on learning.

At Home: Mood & Behavior Changes

Parents often notice their child becoming more irritable or prone to emotional meltdowns during bouts of constipation. This isn’t “bad behavior”—it’s the body’s stress response.

Pain, bloating, and pelvic muscle tension can make even fun activities less enjoyable. Over time, constipation can affect sleep quality, which further impacts mood and focus.

How Pediatric Pelvic Floor Therapy Can Help

Pelvic floor physical therapy for kids isn’t just about teaching them how to sit on the toilet—it’s about restoring healthy bowel habits and reducing the physical and emotional stress constipation causes.

Here’s how we address the constipation–focus–mood connection in my clinic:

Education for Kids & Parents

We explain in kid-friendly terms how the bowel works and why going regularly matters—not just for the stomach, but for the brain and mood.

Improving Bowel Mechanics

We teach:

Proper toilet posture (feet supported, knees above hips)
Breathing techniques to help the pelvic floor relax during a bowel movement
Avoiding straining, which can worsen pelvic floor tightness

Lifestyle & Diet Guidance

We work with families to increase fiber, hydration, and movement—three key pillars for bowel health. Sometimes, small changes (like adding a morning glass of water or a fiber-rich snack) make a big difference.

Pelvic Floor Relaxation Training

If constipation has led to pelvic floor muscle overactivity, we guide kids through gentle exercises and breathing patterns to help those muscles “let go” at the right time.

Coordination with Other Professionals

For complex cases, we collaborate with pediatricians, dietitians, or mental health providers to create a full-circle plan.

Helping Your Child at Home

While professional evaluation is the gold standard for persistent constipation, here are steps parents can try:

Create a bathroom routine: Have your child sit on the toilet for 5–10 minutes after meals, when the body’s natural “gastrocolic reflex” is strongest.
Make hydration fun: Use special cups or straws, or add fruit slices to water.
Keep a gentle tone: Avoid pressure or punishment for bathroom habits—constipation is not a child’s fault.
Encourage movement: Outdoor play, bike riding, or family walks can all help stimulate digestion.

When to Seek Help

See a pediatric pelvic floor physical therapist or your child’s doctor if:

Bowel movements happen less than three times per week
Your child regularly strains, has pain, or passes very large stools
They withhold stool or avoid the bathroom due to fear or discomfort
You notice recurring mood changes or concentration issues tied to bowel habits

The Takeaway

Constipation in children is more than a digestive issue—it’s a whole-body, whole-child concern. The discomfort and pelvic tension it creates can quietly chip away at focus, mood, and daily confidence.

The good news? With the right approach, constipation is highly treatable, and improving bowel health often leads to better attention, calmer moods, and happier kids—both in the classroom and at home.

As pediatric pelvic floor therapists, our role is to help children feel comfortable in their bodies again—so they can focus less on their stomach and more on simply being kids.

Pelvic Floor Health & Mental Well-Being: The Mind–Body Connection You Shouldn’t Ignore

When we think about pelvic floor issues—like leakage, pain, or difficulty relaxing—we often picture physical causes: childbirth, surgery, posture, muscle weakness. But as a pelvic floor physical therapist, I can tell you there’s another powerful piece of the puzzle that often gets overlooked: your mental and emotional well-being.

Stress, anxiety, and past trauma don’t just live in your mind. They leave an imprint on your body, and your pelvic floor is one of the places that can hold that tension.

Your Pelvic Floor: More Than Just Muscles

Your pelvic floor is a group of muscles, fascia, and connective tissues at the base of your pelvis. Physically, they support your bladder, bowel, and reproductive organs, and they control when you start and stop using them.

But here’s the thing: your pelvic floor is directly connected to your nervous system. It responds to emotional states just as much as it responds to physical movement.

How Stress & Anxiety Affect Pelvic Floor Muscles

When you feel stressed or anxious, your body shifts into “fight, flight, or freeze” mode. This is your sympathetic nervous system gearing up to protect you.

In that state:

Your breathing becomes shallow
Your shoulders and jaw may tense
And—without you even realizing it—your pelvic floor muscles tighten

For short bursts, that’s fine. But when stress becomes chronic, your pelvic floor may stay in a heightened state of tension. Over time, this can lead to:

Pelvic pain
Urinary urgency or leakage
Difficulty with bowel movements
Pain with intimacy
Trouble fully relaxing the pelvic floor

The Role of Trauma

For people who have experienced trauma—whether medical, physical, or emotional—the pelvic floor can hold protective tension as a form of subconscious guarding. This is especially true for those with a history of pelvic or sexual trauma, but it can also happen after non-related events like a car accident, long-term illness, or emotionally distressing periods of life.

The nervous system remembers, and the pelvic floor often reflects that memory through altered muscle tone, pain, or changes in function.

It’s Not Just “In Your Head”

The symptoms you feel are real and physical, even if stress or trauma is the root cause. Imagine clenching your hand into a fist for hours—eventually, your hand would ache, feel weak, and lose flexibility. Your pelvic floor works the same way: chronic tightening leads to dysfunction.

Signs Your Pelvic Floor Symptoms May Be Stress-Related

While each person’s situation is unique, here are some patterns I often see in my clinic:

Symptoms worsen during stressful weeks and improve when you’re more relaxed
Pelvic pain that seems “random” or doesn’t match a clear injury
Difficulty starting urination or feeling like you can’t empty fully
Constipation without obvious dietary cause
Pain with intercourse that increases during life stressors

How Pelvic Floor PT Addresses the Mind–Body Link

When we work on pelvic floor health in the context of mental well-being, our approach is more than just exercises. We focus on nervous system regulation, body awareness, and movement retraining.

Here’s what that might look like:

Breathwork

Your diaphragm and pelvic floor work together with every breath. Deep, slow belly breathing helps shift you into a calmer “rest and digest” state while encouraging the pelvic floor to release tension.

Gentle Manual Therapy

If appropriate and with your consent, internal or external pelvic floor techniques can help restore normal tone and mobility. The key is to approach this in a trauma-informed, patient-led way.

Awareness Training

Many people aren’t aware when they’re holding their pelvic floor tight. We practice “body scans” and mindful check-ins throughout the day so you can recognize tension before it builds.

Movement & Stretching

Gentle yoga poses, hip openers, and positions that relax the pelvic floor—like child’s pose or supported deep squats—can help retrain your muscles to let go.

Stress Management Tools

We integrate relaxation strategies you can use outside the clinic:

Guided meditation or mindfulness
Journaling
Gentle walks or nature time
Progressive muscle relaxation

Your Nervous System Is Part of the Treatment Plan

One of the most important things I share with patients is that pelvic floor recovery isn’t just about strengthening or stretching. It’s about creating a safe, supported environment—both physically and emotionally—so your nervous system allows the muscles to function normally again.

That might mean:

Slowing down your return to high-impact exercise until your body feels ready
Working with a mental health professional alongside pelvic floor therapy
Addressing sleep, nutrition, and other whole-body wellness factors

When to Reach Out for Help

If your pelvic floor symptoms seem connected to stress, anxiety, or trauma—or if they’ve been persistent despite your best self-care—it’s time to see a pelvic floor physical therapist. We can help you:

Identify whether muscle overactivity or underactivity is at play
Teach you strategies to release tension and improve muscle coordination
Support you in regaining trust in your body

The Takeaway

Your pelvic floor doesn’t exist in isolation—it’s influenced by every system in your body, including your mind. Stress, anxiety, and trauma can cause real, physical changes in muscle tone and function. The good news? With the right combination of pelvic floor therapy, nervous system regulation, and emotional support, you can restore balance and function.

Pelvic floor health is about more than just muscles—it’s about feeling safe, supported, and in control of your body again. And that’s a journey worth taking.

Pelvic Floor & Constipation in Adults: Beyond Just Toilet Posture

Constipation isn’t just uncomfortable—it can impact your pelvic floor health in ways many people don’t realize.

As a pelvic floor physical therapist, I often meet adults who have been struggling with constipation for years, trying every “quick fix” they find online. While proper toilet posture (like using a footstool to elevate your knees) can absolutely help, there’s much more to the story.

If you’re finding yourself straining, going less than three times a week, or feeling like you’re never fully empty, it’s time to look beyond just your bathroom setup.

Why Your Pelvic Floor Cares About Your Bowel Habits

Your pelvic floor muscles play a big role in healthy bowel movements. They need to relax fully so stool can pass without resistance. Chronic constipation can lead to:

Tight or overactive pelvic floor muscles from repeated straining
Hemorrhoids or anal fissures
Pelvic organ prolapse risk
Worsening bladder symptoms (yes, constipation affects your bladder too!)

By improving bowel function, you not only feel better—you protect your pelvic floor from unnecessary stress.

Step 1: Hydration That Actually Works

One of the simplest but most overlooked constipation remedies is enough water—consistently. Many adults think they drink “a lot,” but when we track it, they’re often falling short.

A good starting goal is half your body weight in ounces per day, adjusting for activity level and climate. For example, a 150-pound adult might aim for about 75 ounces daily.

Pro tip: Warm fluids in the morning, like herbal tea or warm lemon water, can stimulate bowel activity.
Watch the caffeine: Coffee can help some people go, but too much caffeine can be dehydrating, so balance it with water.

Step 2: Diet That Supports Soft, Easy-to-Pass Stools

Fiber is your friend—most of us just aren’t getting enough. The goal for adults is generally 25–35 grams per day.

Soluble fiber (found in oats, apples, beans) helps form soft, gel-like stools.
Insoluble fiber (found in whole grains, vegetables) adds bulk to help move things along.

But here’s the catch: if you suddenly increase fiber without enough water, constipation can get worse. Always pair added fiber with adequate hydration.

Other helpful diet tips:

Include healthy fats (avocado, olive oil, nuts) to lubricate the stool.
Limit highly processed foods which can slow digestion.
Watch dairy intake—for some people, it can be constipating.

Step 3: Breathing & Pressure Management

This is where pelvic floor therapy really shines. The way you breathe directly impacts how well your pelvic floor can relax during a bowel movement.

When you strain, you might bear down with your breath held (Valsalva maneuver), creating excessive downward pressure. Over time, this can weaken pelvic support structures.

Instead, try the “exhale and drop” technique:

Sit in your optimal position (knees higher than hips, feet supported).
Take a slow inhale into your belly, feeling your pelvic floor gently lengthen.
As you exhale, keep your jaw and shoulders relaxed, and imagine your pelvic floor melting downward.
If you feel the urge to push, do so gently, timed with your exhale—not by breath-holding.

This breathing strategy protects your pelvic floor and helps coordinate muscle relaxation.

Step 4: Movement as Medicine

Your colon thrives on movement. Long sedentary periods slow everything down.

Gentle walking after meals can stimulate digestion.
Yoga poses like supine twists, cat–cow, and child’s pose encourage natural bowel motility.
Core exercises that involve rotation and gentle abdominal massage movements can also help (without excessive straining).

Step 5: Train Your Gut with a Routine

Your body loves predictability. Aim to use the bathroom around the same time each day—often 20–30 minutes after breakfast is ideal, when your digestive reflexes are most active.

Don’t ignore the urge to go; consistently delaying can make constipation worse.

When It’s More Than Lifestyle

Sometimes constipation has underlying causes that require extra attention:

Pelvic floor dyssynergia (when muscles don’t coordinate properly to allow stool to pass)
Irritable Bowel Syndrome (IBS)
Side effects from medications
Neurological conditions

If you’ve tried hydration, fiber, breathing, and routine changes without improvement—or if constipation alternates with diarrhea, is accompanied by pain, or there’s blood in your stool—consult your doctor and consider a pelvic floor PT evaluation.

The Bottom Line

Constipation isn’t just a nuisance; it’s a pelvic floor health issue. By addressing hydration, diet, breathing mechanics, movement, and routine, you can improve bowel function and protect your pelvic floor from unnecessary strain.

As a pelvic floor physical therapist, I’ve seen patients make huge progress once they start looking beyond just toilet posture. Your pelvic floor and your digestive system work together—support one, and you support the other.

If you’re ready to break the cycle of constipation and strain, we can create a personalized plan to get your bowels (and your pelvic floor) functioning optimally again.