As a pelvic health physiotherapist, I often meet strong, capable women who can deadlift impressive weights, run half marathons, and train consistently each week, yet quietly wonder:
“Is it normal that I leak a little?” “Why do I feel heaviness after long runs?” “Why does my hip or back pain keep returning?”
Let me say this clearly. Pelvic floor symptoms are common in active women, but they are not something you have to accept as part of training.
What is the pelvic floor, really?
The pelvic floor is a group of muscles that sit at the base of your pelvis. They support your bladder, bowel, and uterus, help control continence, contribute to sexual function, and play a critical role in core stability.
They do not work alone.
Think of your core as a coordinated pressure system:
- The diaphragm manages breathing and pressure from above.
- The abdominal muscles provide front support.
- The glutes and back muscles generate power and stability.
- The pelvic floor responds and supports from below.
When this system works well, you feel stable and strong. When coordination or strength is reduced, symptoms can develop.
Common pelvic floor issues in active women
Research shows a high prevalence of pelvic floor dysfunction in physically active women, particularly in high impact and strength sports.
You may experience:
- Stress urinary incontinence: leakage with coughing, jumping, running, or lifting.
- Urge incontinence: sudden strong urges to urinate.
- Prolapse symptoms: heaviness, dragging, or a bulge sensation in the vagina.
- Persistent hip, groin, pelvic, or lower back pain.
More than 30 percent of women who lift heavy weights report leakage during intense sets. Endurance runners often report symptoms that worsen with fatigue or longer distances. Impact forces challenge the pelvic floor’s ability to absorb load, especially when technique or breath control is not optimal.
Life stages matter
Pelvic health changes across the lifespan.
Pregnancy and birth increase load and stretch on the pelvic floor. Postpartum, the system needs rehabilitation just like any other muscle group after strain. Menopause brings hormonal changes that can affect tissue quality and muscle function.
However, pelvic floor dysfunction is not limited to postpartum or menopausal women. It can occur in adolescents, young athletes, and nulliparous women as well.
What contributes to symptoms?
Several factors increase risk:
- High impact exercise without adequate recovery
- Poor lifting mechanics
- Breath holding during heavy lifts, increasing intra abdominal pressure
- Chronic constipation
- Low energy availability in athletes
- Hormonal shifts
- Stress and high muscle tension
Holding your breath during squats or deadlifts significantly increases pressure within the abdomen. A controlled brace with coordinated exhalation often reduces strain and leakage risk.
It is not just about Kegels
Pelvic floor training is not simply stopping your urine midstream or doing endless Kegels. Effective rehabilitation includes:
- Individualised assessment
- Strengthening or relaxing the pelvic floor as required
- Breathing retraining
- Load management and impact modification
- Glute and deep hip rotator strengthening
- Education on toileting posture, hydration, and bowel health
- Recovery planning, including sleep and deload weeks
Just like any muscle group, the pelvic floor can be overtrained. It also needs recovery.
When to seek help
You should seek assessment if you experience:
- Leakage during exercise
- Vaginal heaviness or bulging
- Pain with intercourse
- Persistent pelvic, hip, or back pain
- Symptoms that limit your training
Pelvic health physiotherapy is proactive. It is not a “wait and see” approach. With structured guidance, women can move through a clear rehabilitation pathway: addressing symptoms, rebuilding strength and coordination, and returning to high level activity with confidence.
Pelvic floor symptoms are not a sign that you need to stop exercising. They are a sign that your system needs support and smarter training.
Strong women deserve strong support, at every level of the body.
