Let’s Talk Pelvic Floor: Why Leaking, Prolapse & Pain Are Common… But Not Normal

If you’ve ever crossed your legs before a sneeze, laughed a little too hard and felt a leak, or quietly wondered, “Is this just what happens after 40?” — you are so not alone.

On our No Expiration Date Podcast, we sat down with pelvic floor physical therapist Amanda to unpack what’s really going on “down there” and why so many of us are living with symptoms we think are normal… but absolutely don’t have to be.

This blog is your gentle, no-shame guide to pelvic floor health, especially for women in midlife.

First Things First: What Is the Pelvic Floor?

Most of us didn’t grow up talking about the pelvic floor at the dinner table. So if you’ve thought, “What even is that?”—same.

Amanda explains the pelvic floor as:

• A group of muscles that run from your pubic bone to your tailbone

• Shaped kind of like a hammock

• Responsible for supporting your:

  • Bladder

  • Uterus and pelvic organs

  • Bowel function

  • Sexual function

  • Stability of your pelvis

  • Childbirth and continence (aka not peeing or pooping your pants)

It’s the foundation of your core, not just this random mystery area.

The Pelvic Floor Is Part of a Team

One of the biggest takeaways from our conversation:

Your pelvic floor does not work alone.

It’s part of a “pressurized canister” with:

• Your core muscles

• Your diaphragm (how you breathe)

• Your back muscles

Think of it like a soda can. When pressure builds inside, it has to escape somewhere.

• For some people, pressure escapes as urinary leakage

• For others, it may show up as hernias, diastasis recti (ab separation), or core weakness

Everything is connected, which is why just doing a few random Kegels usually isn’t the answer.

Diastasis, Leaking & Other Early Signs We Brush Off

We tend to laugh off pelvic floor issues, especially with other women:

“Oh, I pee when I sneeze, too!”
“Jumping jacks? Absolutely not.”

But those “jokes” are often red flags that your pelvic floor needs help.

Some early signs of pelvic floor dysfunction include:

• Urinary leakage (sneezing, coughing, laughing, jumping, running)

• Feeling like you can’t fully empty your bladder

• Constipation or chronic straining

• Hemorrhoids

• Feeling pressure or heaviness in your pelvic area (like something is “falling out”)

• Pain with intercourse or during speculum exams

• Needing to pee again very soon after you just went

These things might be common, but they are not normal. And they’re absolutely treatable.

Are You Actually Emptying Your Bladder?

If you feel like you always “kind of” have to pee, or you pee and still feel full, your pelvic floor might not be relaxing fully.

To fully empty your bladder, your pelvic floor muscles have to relax, not just stay clenched in survival mode.

Signs you may not be fully emptying your bladder:

• You pee, but only a little comes out

• You still feel like you have to go right after

• You’re back in the bathroom again shortly afterward

Pelvic floor therapy can help retrain your body to coordinate relaxing and contracting so you actually get a full release.

Pelvic Floor Dysfunction: It’s Not Just a “Mom Problem”

When we think “pelvic floor issues,” we think:

“You had a baby, so now you pee your pants. That’s just how it is.”

But Amanda shared that 40–50% of her patients are either not moms or are men.

Common contributors to pelvic floor dysfunction include:

• Pregnancy and postpartum

• Perimenopause and menopause

• Low estrogen (including while breastfeeding)

• Abdominal or pelvic surgeries

• Chronic constipation or straining

• High-impact sports or heavy lifting (without proper support and technique)

• Aging and hormonal shifts

And yes—men have pelvic floors too, and they can also struggle with leakage, pain, and pelvic dysfunction.

Hormones, Menopause & Your Pelvic Floor

Here’s a biggie for midlife women:

Your pelvic floor loves estrogen.

When estrogen drops—during perimenopause, menopause, or breastfeeding—those tissues become:

• Thinner

• More fragile

• Drier

• More prone to tiny tears, UTIs, and pain

This can lead to:

• New or worsening prolapse

• Painful intercourse

• Increased dryness

• More UTIs

The good news? Hormone therapy (like topical estrogen, when appropriate) can be a game-changer for symptoms like these. It’s a conversation worth having with a knowledgeable doctor.

Prolapse: The “Hernia” No One Talks About

Prolapse sounds terrifying, and honestly, it can feel that way.

Prolapse is when the supporting walls around your bladder, uterus, or rectum start to descend or bulge into the vaginal canal.

You may notice:

• A feeling of heaviness or “something falling out”

• A visible bulge at the vaginal opening when you bear down or cough

It can be incredibly emotionally triggering—especially if you’ve been told “No lifting. No running. No more.”

But Amanda made it clear:

• Many people with prolapse can still lift, run, exercise, and have babies

• It’s not an automatic sentence to C-sections or giving up movement

• Pelvic floor PT can help you learn to manage pressure and strengthen support

For very severe prolapse, surgery may be necessary—but even then, pelvic floor therapy before and after surgery makes a huge difference in recovery and function.

Let’s Talk About Sex (and Orgasms)

Yup, we went there too.

An orgasm is literally your pelvic floor muscles contracting rhythmically.

So if your pelvic floor is:

• Too weak → it may be harder to reach orgasm or feel intensity

• Too tight → you may have pain with penetration or orgasm

Either way, pelvic floor dysfunction can absolutely impact sexual enjoyment and intimacy.

And beyond the physical:

• Many women pull away from intimacy because of pain, dryness, leakage, or shame

• Some even avoid cuddling and affection because they’re afraid it will lead to sex they’re not comfortable having

Pelvic floor therapy isn’t just about muscles; it’s about helping you feel safe, connected, and at home in your body again.

But Wait… Aren’t Kegels the Answer?

Short answer: sometimes.

Long answer: not for everyone, and not forever.

If your pelvic floor is already tight and overactive, doing more Kegels is like clenching your jaw harder when it already hurts.

For some women, Kegels help. For others, they make things worse. That’s why getting an individualized assessment is crucial.

And even if you do need Kegels, they’re just the starting point.

You don’t live your life lying on your back doing tiny squeezes. You live it:

• Standing

• Walking

• Lifting

• Laughing

• Chasing kids or grandkids

• Playing sports

• Dancing in your kitchen

So pelvic floor rehab eventually has to move into functional strength training—things like squats, deadlifts, glute bridges, and core work, done with proper coordination and breathing.

What Actually Happens at a Pelvic Floor PT Appointment?

If the idea of an exam makes you cringe, you’re not alone. But it’s very different from a typical OB/GYN visit.

Here’s what Amanda shared:

• No stirrups

• No harsh overhead lights

• You’re mostly covered

• Tons of consent and communication

A typical session might include:

1. Internal assessment (if you’re comfortable) using a single gloved, lubricated finger vaginally to:

   • Check muscle strength

   • Identify tight spots or trigger points

   • See how your muscles respond when you cough, sneeze, or contract

2. Coordinated exercises like:

   • Kegels with glute bridges

   • Ball squeezes

   • Breathing and core activation

3. Gym-based strength work once you’ve got the basics down:

   • Kettlebell deadlifts

   • Squats

   • Planks

   • Hip hinge patterns

And if you’re not comfortable with internal work for any reason—trauma history, anxiety, or just “not ready”—there are lots of external tools and strategies they can use instead. You’re allowed to say, “No internal exam right now.”

How Long Does It Take to See Results?

Here’s the hopeful part:

Many women start seeing significant improvement in about six weeks of focused pelvic floor therapy.

Meanwhile, research shows women often wait six years before telling a doctor about leakage or pelvic floor symptoms.

Six years of suffering… for something that may start improving in six weeks.

Let that sink in.

Everyday Lifestyle Shifts That Help Your Pelvic Floor

You don’t have to overhaul your entire life to start supporting your pelvic floor. Simple changes go a long way:

• Drink more water – Dehydration can irritate your bladder and worsen constipation.

• Increase fiber – Helps keep your bowels moving and reduces straining.

• Move your body daily – Walking, gentle mobility, and regular movement all support bowel motility and circulation.

• Don’t “just in case pee” all day – Constant pre-emptive peeing can train your bladder to feel full sooner.

• Breathe – Good diaphragmatic breathing helps your pelvic floor relax and coordinate with your core.

The Emotional Side: Identity, Shame & Isolation

Pelvic floor issues aren’t just physical; they’re deeply emotional.

Women shared things like:

• Avoiding exercise classes or sports they love

• Skipping wine nights and social events for fear of leaking

• Pulling away from intimacy or touch

• Feeling embarrassed or “broken”

When you’ve always seen yourself as active, strong, or social, pelvic floor issues can create a painful mismatch between who you were and what your body is letting you do now.

You are not broken. You just need support.

How to Talk to Your Doctor (and Advocate for Yourself)

If you need a referral to pelvic floor PT, go in prepared:

• Write your symptoms on a sticky note or card:

  • What you’re experiencing

  • How often

  • How it impacts your life (emotionally, socially, physically)

• Be honest: don’t minimize it with “It’s not that bad” if it is that bad

• Clearly ask:

  “Can you refer me to a pelvic floor physical therapist?”

Remember: a good provider should not gatekeep pelvic floor therapy. And in many places (like Texas), you can often go directly to a pelvic floor PT without a referral, depending on insurance.

You Don’t Have to Just “Live With It”

Here’s the heart of Amanda’s message—and ours:

• Leakage is treatable.

• Prolapse is manageable.

• Pain with sex is not something you have to accept.

• Pelvic floor dysfunction is common, but it is not normal.

If your body is sending you signals—leaks, pain, pressure, constipation, fear of sneezing in public—please know:

✨ You are not alone.
✨ You are not “too old” to fix it.
✨ And you are absolutely worth getting help.

Your life doesn’t come with an expiration date, and neither does your right to feel comfortable, confident, and at home in your own body.

Connect with Amanda Frank, PT, PhD at UpLift Physical Therapy or call (210) 468-7398

Want more conversations like this?

Listen to the full pelvic floor episode on the No Expiration Date Podcast and share it with a friend who needs to hear that she does not have to cross her legs and suffer in silence anymore. 💙

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