Leaking, pelvic pain, painful sex, prolapse, urgency, tailbone pain, chronic constipation. These all sit on top of muscles that aren't doing their job. Physical therapy is the first-line treatment for most of them.
Your pelvic floor is a group of muscles slung like a hammock across the bottom of your pelvis. They support your bladder, bowel, and reproductive organs, help control continence, contribute to sexual function, and are part of your core. They also coordinate with your breathing, your hips, and your spine, which is why a problem here rarely stays here.
"Pelvic floor dysfunction" just means these muscles aren't working right. They can be too tight. Too weak. Uncoordinated, firing when they shouldn't, or not firing when they should. The symptoms depend on which of those is going on, and the treatment changes accordingly.
The medical literature is clear: physical therapy is the first-line treatment for most pelvic floor conditions. It's effective, it's low-risk, and for many patients it resolves the problem entirely. We don't promise individual outcomes, but we do know that getting to a clinician who actually evaluates what's happening is the single most important step most people can take.
Recognize yourself in two or three of these? That's enough reason to call. You don't need to be sure your case is “bad enough.”
This is the part most people don't hear. “Just do Kegels” is the wrong advice for at least half the patients who walk in.
The pelvic floor is stuck in a partially contracted state. Common symptoms: pelvic pain, painful sex, urgency that doesn't match how full your bladder is, constipation, tailbone pain. Kegels make this worse, because Kegels are a contraction, and these muscles need to learn to let go.
Treatment focus: down-training, manual release, breath coordination, stretching of related hip muscles.
The pelvic floor isn't generating enough force or endurance. Common symptoms: stress incontinence (leaking with cough, sneeze, lift, run), prolapse symptoms, postpartum core weakness. Strengthening (which sometimes includes Kegels, often done wrong) is part of treatment, but always coordinated with breathing, core, and load.
Treatment focus: graded strengthening, coordination training, return-to-load progression.
A lot of patients arrive with a mix: tight in some areas, weak in others. That's why blanket prescriptions (“do a hundred Kegels a day”) so often don't help. The right approach starts with finding out what's actually going on.
Assessment. The work starts with figuring out what's tight, what's weak, what's uncoordinated, and how it's interacting with your hips, low back, and breathing. Internal exam is included only when clinically appropriate and with your explicit consent.
Manual therapy. Hands-on work to address muscle tension, scar tissue, and movement restrictions. Internal or external, depending on the case.
Targeted exercises. The exercises that match your presentation. Sometimes that's strengthening. Often it's down-training, breath work, mobility, and coordination drills. Not Kegels by default.
Education. Bladder and bowel habits, posture, breathing patterns, what to do (and what to avoid) between visits. A lot of pelvic floor work happens outside the clinic, and understanding what you're doing and why is part of the treatment.
Progressive return to activity. Whatever you want to be doing, whether that's running, lifting, intimacy, or your job, the plan builds toward you doing it without symptoms.
Pelvic floor dysfunction rarely sits in a silo. We treat it alongside the related orthopedic and running work in the same plan, with the same clinician, in the same full-hour visits.
That matters because most patients carrying a pelvic floor diagnosis are also carrying a hip that flares, a back that gives out, a return-to-running goal that's stalled. The pelvic floor doesn't operate independently of those things. Treating it in a vacuum often misses where the actual fix lives.
Related conditions we also treat:
For most presentations, yes. Physical therapy is the first-line treatment recommended in clinical guidelines for incontinence, pelvic pain, sexual dysfunction, and most prolapse. Many patients improve substantially or fully resolve without surgery.
Some cases benefit from a combined approach with a physician or surgeon. We work alongside referring providers when that's the right path.
Four things, repeatedly: assess, treat with hands and movement, teach, and progress you back to what you want to be doing. Internal exam is one tool in the toolkit, not the whole job. The bigger work is figuring out what's going on, why it's going on, and what's going to fix it.
No. The conversation around pelvic floor health has historically centered on women's health, but pelvic floor dysfunction affects people of all genders. Men experience pelvic pain, post-prostatectomy incontinence, chronic prostatitis-type symptoms, and other pelvic floor conditions. Centered treats all patients.
Two possibilities. One: you have a hypertonic pelvic floor, and Kegels are making things worse. Two: your pelvic floor is weak in the way Kegels can help, but you're doing them in a way that isn't translating to function (timing, breathing, posture, force production). An assessment sorts out which one is happening for you.
Centered Physical Therapy & Wellness