By Dr. Marissa Anderson, PT, DPT
Pelvic floor symptoms are incredibly common, but many people feel uncomfortable talking about them. If you leak urine when you cough or jump, rush to the bathroom when you get home, or feel pressure or weakness through your core, you are not alone. The good news is that the pelvic floor can often be improved with education, breathing, coordination, and gradual strengthening.
This guide will help explain what the pelvic floor is, why leakage happens, and how physical therapy exercises can help you regain control and confidence.
What Is the Pelvic Floor?
The pelvic floor is a group of muscles located at the bottom of your pelvis. Think of it like a supportive hammock that holds up your bladder, bowel, and reproductive organs. These muscles work together with your core, breathing muscles, and hips to provide support, stability, and control.
When these muscles work together properly, the body can manage pressure during daily activities like lifting, coughing, exercising, and walking.
Breathing, Posture, and the Pelvic Floor Connection
One important concept in pelvic floor therapy is maintaining a “neutral pelvis.” This means your pelvis is in a balanced position rather than excessively tucked under or arched forward.
Your breathing also directly affects the pelvic floor.
When you inhale:
- The diaphragm moves downward
- The pelvic floor gently relaxes and lengthens
When you exhale:
- The diaphragm rises
- The pelvic floor naturally contracts and lifts
Many people unknowingly hold tension in their pelvic floor or breathe shallowly through the chest. Learning proper diaphragmatic breathing is often the first step in improving pelvic floor control.
Understanding Stress vs. Urge Incontinence
There are two very common types of urinary leakage: stress incontinence and urge incontinence.
Stress Incontinence
Stress incontinence happens when pressure is placed on the bladder and pelvic floor. This may occur during:
- Coughing
- Sneezing
- Jumping
- Lifting
- Running
- Laughing
You may notice leaking “dribbles” during these activities.
Many people assume stress incontinence only happens because the pelvic floor is weak. In reality, the muscles may also be too tight, poorly coordinated, or not reacting at the right time.
Urge Incontinence
Urge incontinence is the strong sudden urge to urinate that can feel difficult to control.
Common examples include:
- Feeling the urge when putting your key in the front door
- Hearing running water
- Standing up after sitting
- Suddenly needing the bathroom “right now”
This often happens because the bladder becomes overly sensitive and starts signaling urgency before it is actually full.
How to Manage Urges
One of the most important things to know is: do not immediately rush to the bathroom every time you feel an urge. Quickly giving in to every urge can train the bladder to become more sensitive over time.
Instead, try strategies that may help calm the bladder and reduce urinary urgency. These include:
- Sitting down
- Taking slow deep breaths
- Relaxing your body
- Performing gentle pelvic floor quick contractions, often called “quick flicks”
- Using an adductor squeeze (light squeeze of a pillow or towel between the knees)
Healthy Bathroom Habits
Avoid “Just-in-Case” Peeing
Many people urinate before leaving the house or before activities “just in case.” While understandable, this can train the bladder to empty too frequently. Try to urinate based on true bladder need rather than habit.
Limit Bladder Irritants
Caffeine and alcohol can irritate the bladder and increase urgency or leakage in some people. You do not necessarily need to eliminate them completely, but reducing intake may help symptoms.
Timing Your Urination
A healthy bladder emptying should generally take about 12–20 seconds, with 8 seconds being the minimum for many people. Very short bathroom trips may indicate incomplete relaxation or frequent unnecessary emptying.
Testing Pelvic Floor Control
Occasionally, you can test pelvic floor control by briefly stopping the flow of urine midstream. This should only be done occasionally as a test, not as a regular exercise. Doing it too often can disrupt normal bladder function.
Building Pelvic Floor Control Step by Step
Pelvic floor rehabilitation is a progression. Before jumping, running, or lifting heavy weights, the body first needs good control during basic daily activities.
Early Therapy Exercises
1. Awareness and Palpation
The first step is learning where these muscles are and how they work.
This may include:
- Feeling the front of the pelvis
- Identifying the sitting bones (ischial tuberosities)
- Learning abdominal activation
- Practicing belly breathing with hands on the abdomen
2. Breathing with Pelvic Floor Coordination
A common starting exercise is coordinating the breath with pelvic floor movement:
- Relax the pelvic floor during inhale
- Gently contract during exhale
- Add a small pelvic tilt if needed
This teaches the muscles to work naturally with pressure changes in the body.
3. Pelvic Floor Holds
Once the muscles can be identified, the next step is building endurance. This includes both short contractions, long holds, and progressing towards contraction during movement.
Exercise Progression
Pelvic floor strengthening progresses from simple positions to more challenging movements.
Supine (Lying on Your Back)
Exercises may include:
- Knee fallouts
- Heel slides
- Marches
- Arm movements
- Dead bugs
Bridges
Bridges help connect the pelvic floor and glutes together. The focus is learning how the glutes and pelvic floor cooperate rather than overpowering each other.
Side Lying
Progressions may include:
- Clamshells
- Side planks
These strengthen the hips and improve pelvic stability.
Prone and Quadruped Positions
Exercises may include:
- Arm lifts
- Leg lifts
- Bird dogs
- Tabletop pelvic tilts
- 8-point planks
These movements challenge coordination and core stability.
Returning to Squats, Lifting, and Jumping
Once daily activities improve without leaking, therapy can progress into more functional movement.
Squat Progressions
Squats may begin:
- Narrow stance
- Small motion
- Slow speed
Then gradually progress to:
- Wider stances
- Sumo squats
- Faster movement
- Larger ranges of motion
Jumping Progressions
Jumping is introduced gradually to help the pelvic floor handle impact.
Progression may include:
- Heel raises
- Gentle bouncing
- Small jumps
- Higher-impact jumping
The goal is building confidence and control without leaking.
Final Thoughts
Pelvic floor symptoms are common, treatable, and nothing to be embarrassed about. Leakage and urgency are not simply something you “just have to live with.”
Improving pelvic floor function is about more than strengthening. It involves:
- Breathing
- Coordination
- Relaxation
- Timing
- Core control
- Gradual progression
With consistency and proper guidance, many people return to lifting, exercising, running, and daily activities with much better control and confidence.
If you are experiencing pelvic floor symptoms, give us a call or text at 920-648-2400. We can help you identify the cause and create a plan specific to your body and goals.
