Warning Signs Your Pelvic Floor May Not Be Working Properly
When most people think about pelvic floor problems, they picture one thing: leaking urine when you cough or sneeze. While stress incontinence is certainly a common symptom of pelvic floor dysfunction (PFD), emerging clinical evidence reveals a much wider range of warning signs that many people—and even some healthcare providers—don't immediately connect to the pelvic floor.
At Burlington Pelvic Physiotherapy, our team regularly works with patients who've been experiencing concerning symptoms for months or even years before realizing their pelvic floor might be the source of their problems. Understanding these lesser-known warning signs can help you recognize when it's time to seek specialized care.
What Is Pelvic Floor Dysfunction?
Pelvic floor dysfunction refers to a broad constellation of symptoms related to abnormal function of the pelvic floor musculature. This dysfunction corresponds to either increased muscle activity (hypertonicity), diminished activity (hypotonicity), or inappropriate coordination of the pelvic floor muscles.
While the three most commonly recognized symptoms are urinary incontinence, fecal incontinence, and pelvic organ prolapse, clinical research reveals a much wider symptom profile that often goes unrecognized. Many people experience multiple symptoms across different categories—bladder issues, bowel problems, sexual dysfunction, and chronic pain—without realizing they all share a common underlying cause.
Beyond Leaking: Recognizing the Full Spectrum of Symptoms
That Uncomfortable "Heaviness" or Pressure
One of the most commonly reported but least understood symptoms is a persistent feeling of heaviness, fullness, or pressure in the pelvis. Evidence suggests this sensation typically worsens as the day progresses, particularly after prolonged standing, exercise, or lifting.
People with pelvic organ prolapse typically describe this as fullness or pressure in the vagina, as if something were falling out. You may experience a feeling of heaviness or a dragging sensation in the pelvis that may get worse throughout the day. Some patients describe feeling or seeing a bulge or lump inside (or coming out of) the vagina, though early symptoms may simply include a constant aching or fullness in the pelvis.
This heaviness isn't limited to prolapse. Many people with high-tone pelvic floor dysfunction—where muscles remain chronically tense and fail to relax properly—also report sensations of pressure and discomfort in the lower abdomen and pelvis.
If you're experiencing symptoms that sound like prolapse, our post on understanding pelvic organ prolapse provides more detailed information about this specific condition.
Urgency That Won't Quit
Sudden, intense urges to urinate—even when your bladder isn't full—may signal pelvic floor dysfunction rather than a bladder problem. Research indicates that urgency may be due to increased tension of pelvic floor muscles and restrictions in connective tissue of the pelvis, abdomen, inner thighs, and buttocks.
Myofascial urinary frequency syndrome, characterized by bothersome urinary frequency resulting from bladder discomfort or pelvic pressure conveying a sensation of bladder fullness, is increasingly recognized as having a musculoskeletal component. The referred sensation of obturator internus or levator ani myofascial trigger points—or spasm of pelvic floor muscles—may cause a sensation of urgency even when the bladder contains minimal urine.
Evidence from studies of pelvic floor physical therapy shows that 62.5% of women with urgency and frequency symptoms reported being "much better" or "very much better" after treatment, suggesting a significant musculoskeletal component to what's often assumed to be purely a bladder issue.
Our team frequently sees patients who've been told they have an "overactive bladder" when the real issue is overactive pelvic floor muscles. If this sounds familiar, you may find our post about retraining an overactive bladder helpful.
Pain That Travels: Understanding Myofascial Patterns
One of the most confusing aspects of pelvic floor dysfunction is that the pain often shows up far from its source. Myofascial pelvic pain is a major component of chronic pelvic pain, and the hallmark diagnostic indicator is myofascial trigger points in the pelvic floor musculature that refer pain to adjacent sites.
Clinical evidence shows that women may complain of pain in the abdomen, back, thorax, hip/buttocks, and lower leg, with the perineum, vagina, urethra, and rectum being common referral sites. This referred pain pattern means you might experience discomfort in your lower back, inner thighs, or even your tailbone when the actual problem lies within your pelvic floor muscles.
High-tone pelvic floor dysfunction—characterized by non-relaxing pelvic floor muscles—affects approximately 80% of women with chronic pelvic pain and results in lower urinary tract and defecatory symptoms, sexual dysfunction, and widespread pelvic pain.
The severity of myofascial pain at pelvic floor sites has been independently correlated with lower urinary tract symptoms including pain in the lower abdomen and difficulty emptying the bladder, as well as defecatory dysfunction including sensation of incomplete rectal emptying.
We explore this topic further in our posts about male pelvic pain and painful intercourse, as myofascial pain patterns affect people of all genders.
That Feeling of Never Being "Empty"
Sensations of incomplete bladder or bowel evacuation are surprisingly common indicators of pelvic floor dysfunction. If there is shortening in the puborectalis muscle—a key component of the pelvic floor—patients may complain of constipation, pain before, during, or after defecation, and sensations of incomplete bowel or bladder evacuation.
Research shows that patients describe constipation symptoms including a feeling of incomplete evacuation, prolonged time needed to evacuate, as well as a need to strain or apply manual pressure. This occurs because the pelvic floor muscles, instead of relaxing to allow elimination, may remain tense or even paradoxically contract—a condition called anismus or dyssynergic defecation.
In anismus, muscles that usually hold in stool fail to relax during bowel movements and may even tighten instead. Some people are unable to coordinate their muscles to generate enough force to push effectively, leading to chronic constipation despite adequate fiber intake and hydration.
If you're struggling with persistent constipation despite dietary changes, our post on chronic constipation explores why more fiber isn't always the answer.
The Posture Connection You Didn't Know About
Here's a warning sign most people never connect to their pelvic floor: chronic postural changes or discomfort maintaining certain positions. Research reveals a clear connection between postural alignment and pelvic floor muscle activity, with significant implications for maintaining continence, providing support for pelvic organs, and overall core stability.
When sitting in a slumped posture, pelvic floor muscle activity is significantly less than when sitting tall. Studies have found that asymptomatic women had increased curves in their lower back compared to those suffering with stress urinary incontinence. This connection works both ways: poor posture can contribute to pelvic floor dysfunction, and existing pelvic floor problems can affect your ability to maintain good posture.
Increased lumbar lordosis (swayback) can increase intra-abdominal pressure, which places more strain on the pelvic floor, while a flattened lumbar curve may reduce the pelvic floor's ability to contract effectively. Research demonstrates that posture correction therapy improved pelvic floor muscle activity parameters during contraction, noting the impact of body posture on muscles and stressing the necessity of posture correction in therapy.
If you experience chronic back pain alongside other pelvic symptoms, our post exploring why your chronic back pain might actually be a pelvic floor issue may provide valuable insights.
The Multiple Symptom Pattern
Research from the Pelvic Floor Disorders Consortium—composed of colorectal surgeons, urogynecologists, urologists, gynecologists, gastroenterologists, and physiotherapists—indicates that if you have three or more symptoms including pelvic pain, urinary symptoms, bowel symptoms, or sexual dysfunction, pelvic floor dysfunction is likely and warrants professional assessment.
This multi-symptom pattern is crucial to recognize. Many patients at Burlington Pelvic Physiotherapy arrive having seen multiple specialists for what seemed like separate problems: their urologist for bladder urgency, their gastroenterologist for constipation, their gynecologist for painful intercourse, and their physiotherapist for chronic back pain. Only when these symptoms are viewed together does the pelvic floor connection become clear.
When Tight Isn't Right: Understanding High-Tone Dysfunction
A critical misconception about pelvic floor problems is that weakness is always the issue. Evidence shows that high-tone pelvic floor dysfunction—where muscles remain chronically tense and fail to relax—is a distinct and common problem, particularly among those with chronic pelvic pain.
These non-relaxing pelvic floor muscles can cause the same symptoms as weak muscles: incontinence, urgency, prolapse symptoms, and pain. The difference lies in the treatment approach. While weak pelvic floor muscles may benefit from strengthening exercises, tight muscles need relaxation techniques, manual therapy, and coordination training.
This is why the common advice to "just do Kegels" can sometimes make symptoms worse rather than better, as we discuss in our post about why "just do Kegels" might be the worst advice you've heard.
Pelvic Floor Dysfunction Across Life Stages
Warning signs can emerge during different life phases:
During pregnancy and postpartum: Pregnancy places significant demands on the pelvic floor, and symptoms may develop during or after pregnancy. Evidence suggests that pelvic physiotherapy can help prepare for birth and address postpartum concerns. Our posts on preparing for birth and returning to running after baby offer guidance for these specific stages.
Perimenopause and menopause: Hormonal changes can affect pelvic floor tissue and function. Our post on managing menopause explores this connection.
After surgery: Procedures like prostate surgery or hysterectomy can impact pelvic floor function. Learn more in our post about life after prostate surgery.
Athletic populations: High-impact activities can stress the pelvic floor. We address this in our post about why strong athletes still experience pelvic floor issues.
What to Do If You Recognize These Warning Signs
If you're experiencing several of these symptoms, the evidence strongly supports pelvic floor physical therapy as first-line treatment. There is universal agreement among clinical guidelines for pelvic floor physical therapy as first-line treatment for high-tone pelvic floor dysfunction, and substantial evidence supports its effectiveness for various forms of PFD.
Pelvic floor disorders caused by relaxed muscles are often readily identified; however, symptoms of non-relaxing pelvic floor muscles vary and often are not attributed to the pelvic floor, making these disorders less widely recognized. This is precisely why working with a specialized pelvic physiotherapist is valuable—they can identify patterns that others might miss.
At Burlington Pelvic Physiotherapy, our assessment includes a comprehensive review of bladder, bowel, sexual function, pain patterns, and postural habits to identify the full scope of dysfunction and develop an individualized treatment plan. Treatment may include internal and external manual therapy, specific exercises (which may or may not include traditional Kegels), postural retraining, breathing techniques, and education about lifestyle modifications.
This content is for educational purposes and does not replace professional medical advice. If you're experiencing pelvic floor symptoms, consult with a qualified healthcare provider for proper assessment and treatment planning.
Ready to Address Your Symptoms?
You don't need to wait until symptoms become severe or significantly impact your quality of life. Early intervention with pelvic physiotherapy can help prevent progression and restore normal function more quickly.
To learn more about how we can help with your specific concerns, explore our pelvic pain and discomfort services or review our frequently asked questions. We also offer virtual physiotherapy appointments for those who prefer remote care or have scheduling constraints.
If you're ready to take the next step toward understanding and resolving your pelvic floor symptoms, book an appointment with our team in Burlington. We're here to help you feel like yourself again.
Reviewed by: Juhi Israni, Pelvic Health Physiotherapist
Burlington Pelvic Physiotherapy is located at 960 Cumberland Ave, Burlington, ON L7N 3J6. For appointments, call 905-635-5711 or book online.
