Pelvic Floor Dysfunction in Adults: Symptoms, Causes and Treatment

When should you see a doctor before anything else?

What does the pelvic floor do?

The pelvic floor is a layer of muscle slung across the base of the pelvis. It supports the bladder, bowel and pelvic organs, controls the openings, contributes to sexual function, and works with the diaphragm and abdominal muscles to manage pressure inside the abdomen.⁠^30,24

It has to do two opposite things well — hold, and let go. Problems come from a failure of either one, not only from weakness.⁠²⁴

What is pelvic floor dysfunction?

A pelvic floor disorder happens when the muscles or connective tissue of the pelvis weaken or are injured. The most common are urinary incontinence, fecal incontinence and pelvic organ prolapse.⁠¹²

The opposite problem is muscles that cannot relax. Nonrelaxing pelvic floor dysfunction causes pain and problems with urination, bowel movements and sex, all of which need the pelvic floor to relax and coordinate, and it is less widely recognized than weakness.⁠²⁴

Both are common. In a nationally representative sample of 1,961 US women, 23.7% had at least one symptomatic pelvic floor disorder: 15.7% urinary incontinence, 9.0% fecal incontinence and 2.9% prolapse, with the share rising with age.⁠²⁰

They are not only a women's problem: urinary and bowel leakage occur in men as well.⁠¹²

Which pelvic floor symptoms are common but not normal?

Although urinary incontinence is common, it is not a routine part of being a woman or getting older.⁠³

Pain with sex is common too, as are leaking while running and heaviness by the end of the day.⁠^18,3,33

Signs worth raising with a clinician:

• Leaking urine when you cough, sneeze, laugh, lift or exercise⁠⁴
• A sudden, strong urge you cannot hold until you reach a toilet⁠⁴
• Urinating eight or more times a day, or waking at night to go⁠^4,3
• Leaking during sex⁠⁴
• A bulge, or heaviness, fullness or pulling in the vagina that gets worse by the end of the day⁠³³
• Difficulty starting to urinate or emptying the bladder completely⁠³³
• Hard stools, straining, or a feeling that not all stool has passed⁠¹⁰
• Leaking stool, or being unable to hold a bowel movement until you reach a toilet⁠⁷
• Pain in the pelvis, pain with sex, or a feeling that you are sitting on something hard⁠³¹

Many people never mention any of it. Many women are reluctant to tell a clinician because they feel embarrassed, and many think bladder problems are normal and live with them.⁠³³ The sooner you get help, the sooner leaking may improve.⁠³

In women, pelvic floor muscle training can cure or improve urinary incontinence,⁠¹ and its trials mostly enrolled women aged 45 to 65 who had given birth.⁠³²

By life stageWomen's health physical therapy from pregnancy to menopause: postpartum recovery, diastasis recti and the return to exercise

What causes urinary leaking?

Full guideUrinary incontinence — the four types, what treats each, and why Kegels are not always the answer

Bladder — leaking with cough, sneeze, laugh, or exercise; urgency; frequency; difficulty starting or emptying.⁠^4,33

Stress incontinence is leaking when movement, such as coughing, sneezing, laughing or exercise, puts pressure on the bladder. Urgency incontinence is a strong need to go with leaking before you reach a toilet. Having both is mixed incontinence, and overflow incontinence is leaking from a bladder that does not empty all the way.⁠³

Pregnancy, childbirth and menopause make stress incontinence more likely by weakening the pelvic floor, and in men, surgery or radiation for prostate cancer can cause short-term or long-term leaking.⁠⁴

Long-term constipation is often present in women with urinary incontinence, and treating it may help with the urinary symptoms.⁠¹⁶

What is overactive bladder?

Overactive bladder means urgency and frequency, with or without leaking.⁠¹⁶ When it does leak, it is called urgency incontinence: the nerves and bladder muscles do not work together, and urine is released at the wrong time.⁠³

Common triggers include hearing or touching running water and cold places, such as reaching into a freezer.⁠⁴ Caffeinated, carbonated and alcoholic drinks can stimulate the bladder.⁠¹³

First-line treatment is bladder training for at least 6 weeks,⁠²² often with quick, strong pelvic floor squeezes to hold off an urge until you reach the toilet.⁠⁶

What is pelvic organ prolapse, and what does it feel like?

Prolapse happens when the muscles and tissue of the pelvis can no longer support one or more pelvic organs, so they drop or press into the vagina.⁠¹²

Prolapse shows up as heaviness, dragging, or a bulge, and many women have no symptoms at all; a clinician may find it during a routine exam.⁠^15,33

The main cause is pregnancy and vaginal childbirth. Menopause, aging, repeated heavy lifting, constipation with straining and chronic coughing add to it, and most women who develop symptoms do so after menopause.⁠¹⁵

Pelvic floor muscle training can improve symptoms but cannot correct the prolapse itself.⁠¹³ In a trial of 447 women, one-to-one training reduced prolapse symptoms at 12 months more than a lifestyle advice leaflet,⁠²¹ and NICE suggests at least 16 weeks of supervised training for stage 1 or 2 prolapse.⁠²² A pessary, a device worn in the vagina, supports the organs and gives many women immediate relief, and surgery is an option when other treatment has not helped.⁠¹⁵

What causes pelvic pain and painful sex?

Pain — pelvic pain, pain with sex, pain with tampon use, coccyx pain, and pain after surgery.⁠^31,26

Chronic pelvic pain is pain in the pelvic area that lasts 6 months or longer. It can come from the reproductive organs, the bladder, the bowel, or the muscles and joints, sometimes from more than one at once.⁠¹⁷

Persistent pelvic pain frequently involves the same processes as persistent pain elsewhere: the nervous system becomes more sensitive, and pain continues without ongoing tissue damage. That does not mean it is imagined.⁠¹⁷

RelatedPersistent painPacing and activity management

It also frequently involves overactive rather than weak muscles, which is why the Kegel point matters most here: an expert consensus puts high-tone pelvic floor dysfunction at 80% of women with chronic pelvic pain.⁠²³

Pain with sex is treatable, and it is a legitimate reason to seek care. Nearly 3 out of 4 women have pain during intercourse at some time.⁠¹⁸ In a trial of 212 women with provoked vestibulodynia, the most common kind of chronic vulvar pain, physical therapy reduced pain during intercourse more than lidocaine ointment.⁠²⁶

Can the pelvic floor cause constipation or bowel leakage?

Bowel — leaking; urgency; constipation and difficulty emptying.⁠^7,10

Fecal incontinence, or accidental bowel leakage, affects about 1 in 3 people who see a primary care provider. With the urge type, you feel the need but cannot hold it until you reach a toilet, and the pelvic floor muscles may be too weak from muscle injury or nerve damage.⁠⁷

Constipation can come from the pelvic floor too: delayed emptying from pelvic floor disorders is one cause, especially in women.⁠¹⁰ When the muscles that control bowel movements are the problem, a doctor may recommend biofeedback therapy to retrain them.⁠¹¹

Simple treatments, including diet changes, medicines, bowel training and pelvic floor exercises, improve fecal incontinence symptoms by about 60 percent and stop it in about 1 in 5 people.⁠⁸

Do men get pelvic floor problems?

Men have pelvic floors and pelvic floor problems, and the field is heavily framed around women.

Common in men: urinary symptoms after prostate surgery, pelvic pain, and bowel symptoms.⁠^4,28,12 As many as 1 in 3 men over 65 may lose urine by accident,⁠³ and men may underreport it.⁠³⁰

Pelvic floor muscle training helps leaking after radical prostatectomy. An umbrella review of 18 reviews covering 29,925 men found a good effect, with biofeedback adding benefit, though every review it included was of critically low methodological quality.⁠²⁷

Prostatitis is the most common urinary tract problem in men younger than 50. Its most common form, chronic prostatitis or chronic pelvic pain syndrome, can be treated with physical therapy, including pelvic floor exercises, myofascial release, relaxation exercises and biofeedback.⁠²⁸

And it applies across the lifespan, not only after childbirth.⁠²⁰

RelatedFalls and balance

How are pelvic floor problems diagnosed?

Diagnosis starts with your history and a physical exam. For leaking, you may be asked to cough with a full bladder to see whether urine leaks, and to keep a bladder diary for 2 to 3 days: what you drink, when you urinate, and when and how you leak.⁠⁵

For prolapse, the exam includes vaginal and rectal exams, sometimes standing as well as lying down, while you strain or cough.⁠¹⁵

Tests depend on the symptoms: urinalysis for infection, urodynamic testing of how the bladder stores and releases urine, and cystoscopy to look inside the bladder.⁠⁵ For bowel problems, anorectal manometry and electromyography check the muscles and nerves of the anus, pelvic floor and rectum, and dynamic defecography watches the pelvic floor during a bowel movement.⁠^9,14

The pelvic floor muscles themselves are assessed by touch, which shows whether they contract, relax and are tender.⁠²⁴ What that exam involves, and your right to decline it, is in what happens at the first pelvic floor therapy visit.

What treats pelvic floor problems?

Treatment depends on the problem and how much it bothers you, and some prolapse needs no treatment at all.⁠¹⁵

• Lifestyle changes: limiting drinks that stimulate the bladder, eating enough fiber to avoid straining, and losing weight if you have overweight or obesity.⁠¹³
• Pelvic floor muscle training: first-line treatment for stress and mixed urinary incontinence, given as at least 3 months of supervised training.⁠²²
• Relaxation training for muscles that cannot let go: pelvic floor physical therapy is first-line treatment for high-tone pelvic floor dysfunction.⁠²³
• Bladder training for urgency: at least 6 weeks, as first-line treatment.⁠²²
• A pessary for prolapse or stress incontinence.⁠^15,6
• Medicines for urgency incontinence, and botulinum toxin injected into the bladder when other treatment has not worked.⁠⁶
• Nerve stimulation for urgency incontinence when medicines and lifestyle changes have not helped.⁠⁶
• Surgery, such as a sling for stress incontinence or a prolapse repair, usually after other treatment.⁠^6,15

Pelvic floor therapy is one of these treatments, not all of them. What it involves, from the first visit to the techniques, the number of sessions and the cost, is in the pelvic floor therapy guide.

Why are Kegels not always the answer?

Pelvic floor symptoms can come from muscles that are too weak, muscles that are too tight, or poor coordination between them.⁠²⁴

If the muscles are already overactive, adding more squeezing typically makes symptoms worse. That is common in pelvic pain, pain with sex, and some urgency and difficulty emptying.⁠^23,24

And a pelvic floor contraction is harder to perform correctly than it sounds. Bearing down instead of lifting is a common error, and instructions alone are not enough to get it right. After brief verbal instruction, 49% of women in one study produced an ideal contraction, and 25% used a technique that could promote incontinence.⁠²⁵

Who treats pelvic floor problems?

Gynecologists, urologists and geriatricians often talk with people about bladder control problems.⁠³ Chronic pelvic pain can involve a gastroenterologist, a urogynecologist, a pelvic floor physical therapist, a pain specialist or a mental health professional, sometimes several of them.⁠¹⁷

Pelvic floor physical therapy is a specialty area within physical therapy,⁠³⁰ and access to it is still limited.⁠²

How to find one, what credentials to look for and whether you need a referral: how to find a pelvic floor therapist · Direct access · Find a physical therapist

Frequently Asked Questions

Sources

1. Dumoulin, C., Cacciari, L. P., & Hay-Smith, E. J. C. (2018). Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews, 10, CD005654. PMID 30288727.
   Show the passageHide the passage

   31 trials, 1,817 women from 14 countries, generally followed up for less than 12 months. “Based on the data available, we can be confident that PFMT can cure or improve symptoms of SUI and all other types of UI.”
2. American Physical Therapy Association, Academy of Pelvic Health Physical Therapy — practice resources on pelvic health physical therapy. aptapelvichealth.org. Checked October 29, 2026. In an appeal tied to H.R.
   Show the passageHide the passage

   4074, the Optimizing Postpartum Outcomes Act, the Academy's home page says: “Pelvic health conditions affect millions, yet access to care remains limited.” “Support federal legislation that helps expand access to pelvic health physical therapy across the United States.”
3. National Institute of Diabetes and Digestive and Kidney Diseases (2021). Definition & facts for bladder control problems (urinary incontinence). niddk.nih.gov. Checked October 29, 2026.
   Show the passageHide the passage

   “Although UI is common, it is not a routine part of being a woman or getting older.” “As many as 1 in 3 men over the age of 65 may lose urine by accident.” “Health care professionals—especially gynecologists, urologists, and geriatricians—often talk with people about bladder control problems.” “The sooner you get help, the sooner UI may improve.”
4. National Institute of Diabetes and Digestive and Kidney Diseases (2021). Symptoms & causes of bladder control problems (urinary incontinence). niddk.nih.gov. Checked October 29, 2026.
   Show the passageHide the passage

   “Seek care right away” for being unable to pass urine, eight or more bathroom visits a day, blood in the urine, or painful urination. Triggers for a sudden urge “can include drinking or touching water, hearing running water, or being in a cold environment, such as reaching into the freezer at the grocery store.” Pregnancy, childbirth and menopause are among the life events that “can lead to stress incontinence in women by weakening the pelvic floor muscles,” and “men who have a history of radiation or surgery for prostate cancer may have short-term or long-term UI.”
5. National Institute of Diabetes and Digestive and Kidney Diseases (2021). Diagnosis of bladder control problems (urinary incontinence). niddk.nih.gov. Checked October 29, 2026.
   Show the passageHide the passage

   “You may be asked to cough while your bladder is full to see if you leak urine. This is called a stress test.” “You may want to keep a bladder diary for 2 to 3 days before seeing your health care professional.” “Urodynamic testing, including electromyography, looks at how well parts of the urinary tract—the bladder, urethra, and sphincters—are storing and releasing urine.” “Cystoscopy is a procedure that uses a cystoscope—a long, thin instrument—to look inside the urethra and bladder.”
6. National Institute of Diabetes and Digestive and Kidney Diseases (2021). Treatment for bladder control problems (urinary incontinence). niddk.nih.gov. Checked October 29, 2026.
   Show the passageHide the passage

   “Gradually lengthening the time between trips to the bathroom can help stretch your bladder.” “Quick, strong squeezes of the pelvic floor muscles can help suppress urgency when it occurs.” “Health care professionals may use botulinum toxin A, also known as Botox, to treat UI when other medicines or self-care treatments don't work.” A pessary is “inserted into the vagina for stress incontinence.” “If medicines and lifestyle changes don't help your UI, your health care professional may suggest electrical nerve stimulation for urgency incontinence and other symptoms.” “The most common surgery to treat stress incontinence in women is sling surgery.”
7. National Institute of Diabetes and Digestive and Kidney Diseases (2017). Definition & facts for bowel control problems (fecal incontinence). niddk.nih.gov. Checked October 29, 2026.
   Show the passageHide the passage

   “Medical experts consider fecal incontinence a common problem, affecting about 1 in 3 people who see a primary health care provider.” With urge incontinence, “your pelvic floor muscles may be too weak to hold back a bowel movement due to muscle injury or nerve damage.”
8. National Institute of Diabetes and Digestive and Kidney Diseases (2017). Treatment for bowel control problems (fecal incontinence). niddk.nih.gov. Checked October 29, 2026.
   Show the passageHide the passage

   “The first step in treating your fecal incontinence is to see a doctor.” “Simple treatments—such as diet changes, medicines, bowel training, and exercises to strengthen your pelvic floor muscles—can improve symptoms by about 60 percent.” “These treatments can stop fecal incontinence in 1 out of 5 people.”
9. National Institute of Diabetes and Digestive and Kidney Diseases (2017). Diagnosis of bowel control problems (fecal incontinence). niddk.nih.gov. Checked October 29, 2026.
   Show the passageHide the passage

   Tests include “anorectal manometry—a test that checks how sensitive your rectum is, how well it works, and how well the anal sphincters work,” “defecography—an x-ray of the area around the anus and rectum to see how well you can hold and release stool,” and “electromyography—a test that checks how well the muscles and nerves of your anus and pelvic floor are working.”
10. National Institute of Diabetes and Digestive and Kidney Diseases (2018). Symptoms & causes of constipation. niddk.nih.gov. Checked October 29, 2026.
    Show the passageHide the passage

    Listed symptoms include “a feeling that not all stool has passed.” See a doctor right away for constipation with “blood in your stool,” “fever,” or “losing weight without trying.” Causes include “delayed emptying of the colon from pelvic floor disorders, especially in women.”
11. National Institute of Diabetes and Digestive and Kidney Diseases (2018). Treatment for constipation. niddk.nih.gov. Checked October 29, 2026.
    Show the passageHide the passage

    “Your health care professional may recommend using a laxative for a short time.” “If you have problems with the muscles that control bowel movements, your doctor may recommend biofeedback therapy to retrain your muscles.” “By using biofeedback therapy, you can change how you make your muscles work.”
12. Eunice Kennedy Shriver National Institute of Child Health and Human Development (2020). About pelvic floor disorders (PFDs). nichd.nih.gov. Checked October 29, 2026.
    Show the passageHide the passage

    “A PFD occurs when the pelvic muscles and connective tissue weaken or are injured.” “Prolapse” happens in women “when the pelvic muscles and tissue can no longer support one or more pelvic organs, causing them to drop or press into the vagina.” “The leaking of urine, a problem called urinary incontinence, can occur in women or men.”
13. Eunice Kennedy Shriver National Institute of Child Health and Human Development (2025). How are pelvic floor disorders (PFDs) treated? nichd.nih.gov. Checked October 29, 2026.
    Show the passageHide the passage

    “Often referred to as Kegel exercises, PFMT involves squeezing and relaxing the pelvic floor muscles.” Performed correctly and routinely, it “may improve the symptoms of urinary incontinence and prolapse,” but “PFMT cannot correct prolapse.” “Women can do the exercises on their own or with the help of a pelvic floor physical therapist.”
14. Eunice Kennedy Shriver National Institute of Child Health and Human Development (2020). How are pelvic floor disorders (PFDs) diagnosed? nichd.nih.gov. Checked October 29, 2026.
    Show the passageHide the passage

    A healthcare provider may “see or feel a bulge during a routine pelvic exam that suggests a prolapse.” Dynamic defecography “is used to evaluate the pelvic floor and rectum while the patient is having a bowel movement.”
15. American College of Obstetricians and Gynecologists (2025). Pelvic support problems (FAQ012). acog.org. Checked October 29, 2026.
    Show the passageHide the passage

    “The main cause of POP is pregnancy and vaginal childbirth, which can weaken muscles of the pelvic floor.” “POP can occur at any age, but most women who develop symptoms do so after menopause.” “Many women do not need treatment.” You may be examined “while lying down or while standing,” and “asked to strain or cough during the exam to see if you leak urine.” “Many women find immediate relief from their symptoms with pessary use.”
16. American College of Obstetricians and Gynecologists (2022). Urinary incontinence (FAQ081). acog.org. Checked October 29, 2026.
    Show the passageHide the passage

    “Most cases of urinary incontinence can be cured or greatly improved with treatment.” If you have an “overactive bladder,” “it means that you have symptoms of urgency and frequency that may or may not include incontinence.” “Long-term constipation is often present in women with urinary incontinence, especially in older women.”
17. American College of Obstetricians and Gynecologists (2025). Chronic pelvic pain (FAQ099). acog.org. Checked October 29, 2026.
    Show the passageHide the passage

    “Chronic pelvic pain is pain in the pelvic area that lasts for 6 months or longer.” “Your pain is real even if an injury or disease cannot be found.” “It may be necessary to see other specialists to help treat your pain, such as a gastroenterologist (a doctor who focuses on digestive problems), urogynecologist (a gynecologist specializing in urinary and related problems), pelvic floor physical therapist, pain specialist, or mental health professional.”
18. American College of Obstetricians and Gynecologists (2020). When sex is painful (FAQ020). acog.org. Checked October 29, 2026.
    Show the passageHide the passage

    “Pain during intercourse is very common—nearly 3 out of 4 women have pain during intercourse at some time during their lives.” “Women who have had an episiotomy or tears in the perineum during childbirth may have pain during sex that may last for several months. Treatments include physical therapy.” In menopause, “decreasing levels of the female hormone estrogen may cause vaginal dryness.”
19. American College of Obstetricians and Gynecologists (2025). Back pain during pregnancy (FAQ115). acog.org. Checked October 29, 2026.
    Show the passageHide the passage

    “Your expanding uterus shifts your center of gravity and stretches out and weakens your abdominal muscles”; a hormone “relaxes the ligaments in the joints of your pelvis”; “If you have severe back pain, or if the pain goes on for more than two weeks, call your obstetrician–gynecologist”; back pain “can be a symptom of preterm labor” or a urinary tract infection; and your ob-gyn “may recommend that you see a rehabilitation specialist or a physical therapist.”
20. Nygaard, I., Barber, M. D., Burgio, K. L., Kenton, K., Meikle, S., Schaffer, J., et al. (2008). Prevalence of symptomatic pelvic floor disorders in US women. JAMA, 300(11), 1311–1316. doi:10.1001/jama.300.11.1311 (PMID 18799443).
    Show the passageHide the passage

    1,961 nonpregnant US women in a nationally representative survey; 23.7% had at least one pelvic floor disorder (15.7% urinary incontinence, 9.0% fecal incontinence, 2.9% prolapse), with the proportion “ranging from 9.7% (95% CI, 7.8%-11.7%) in women between ages 20 and 39 years to 49.7% (95% CI, 40.3%-59.1%) in those aged 80 years or older.”
21. Hagen, S., Stark, D., Glazener, C., Dickson, S., Barry, S., Elders, A., et al. (2014). Individualised pelvic floor muscle training in women with pelvic organ prolapse (POPPY): a multicentre randomised controlled trial. The Lancet, 383(9919), 796–806. doi:10.1016/S0140-6736(13)61977-7 (PMID 24290404).
    Show the passageHide the passage

    447 women with newly diagnosed, symptomatic stage I, II or III prolapse, randomized to one-to-one pelvic floor muscle training or a lifestyle advice leaflet. “Women in the intervention group reported fewer prolapse symptoms (ie, a significantly greater reduction in the pelvic organ prolapse symptom score [POP-SS]) at 12 months than those in the control group.” “One-to-one pelvic floor muscle training for prolapse is effective for improvement of prolapse symptoms.”
22. National Institute for Health and Care Excellence (2019). Urinary incontinence and pelvic organ prolapse in women: management (NG123), recommendations. nice.org.uk. Checked October 29, 2026.
    Show the passageHide the passage

    “Offer a trial of supervised pelvic floor muscle training of at least 3 months' duration as first-line treatment to women with stress or mixed urinary incontinence”; programs of “at least 8 contractions performed 3 times per day”; “bladder training lasting for a minimum of 6 weeks” for urgency or mixed incontinence; “at least 16 weeks” of supervised training for stage 1 or 2 prolapse. On devices: “Do not use perineometry or pelvic floor electromyography as biofeedback as a routine part of pelvic floor muscle training,” “Do not routinely use electrical stimulation in combination with pelvic floor muscle training,” and both “should be considered for women who cannot actively contract pelvic floor muscles.”
23. Torosis, M., Carey, E., Christensen, K., Kaufman, M. R., Kenton, K., Kotarinos, R., et al. (2024). A treatment algorithm for high-tone pelvic floor dysfunction. Obstetrics & Gynecology, 143(4), 595–602. doi:10.1097/AOG.0000000000005536 (PMID 38387036).
    Show the passageHide the passage

    An 11-expert Delphi consensus guideline: high-tone pelvic floor dysfunction, “affecting 80% of women with chronic pelvic pain,” found “universal agreement for PFPT as first-line treatment for HTPFD.” If it helps, “the patient can be discharged with a home exercise program.”
24. Faubion, S. S., Shuster, L. T., & Bharucha, A. E. (2012). Recognition and management of nonrelaxing pelvic floor dysfunction. Mayo Clinic Proceedings, 87(2), 187–193. doi:10.1016/j.mayocp.2011.09.004 (PMID 22305030).
    Show the passageHide the passage

    “Nonrelaxing pelvic floor dysfunction is not widely recognized.” It can cause “pain and problems with defecation, urination, and sexual function, which require relaxation and coordination of pelvic floor muscles and urinary and anal sphincters.” The primary care provider can help by “providing early referral for physical therapy.”
25. Bump, R. C., Hurt, W. G., Fantl, J. A., & Wyman, J. F. (1991). Assessment of Kegel pelvic muscle exercise performance after brief verbal instruction. American Journal of Obstetrics and Gynecology, 165(2), 322–329. doi:10.1016/0002-9378(91)90085-6 (PMID 1872333).
    Show the passageHide the passage

    47 women given brief standardized verbal instruction in a Kegel contraction. “Twenty-three (49%) had an ideal Kegel effort”—a significant increase in the force of urethral closure—and “twelve subjects (25%) displayed a Kegel technique that could potentially promote incontinence.”
26. Morin, M., Dumoulin, C., Bergeron, S., Mayrand, M. H., Khalifé, S., Waddell, G., et al. (2021). Multimodal physical therapy versus topical lidocaine for provoked vestibulodynia: a multicenter, randomized trial. American Journal of Obstetrics and Gynecology, 224(2), 189.e1–189.e12. doi:10.1016/j.ajog.2020.08.038 (PMID 32818475).
    Show the passageHide the passage

    212 women with provoked vestibulodynia, “the most common subtype of chronic vulvar pain,” randomized to physical therapy or topical lidocaine. “Multimodal physical therapy was more effective than lidocaine for reducing pain intensity during intercourse,” and the difference was maintained at 6-month follow-up.
27. Yang, J. M., Ye, H., Long, Y., Zhu, Q., Huang, H., Xie, H. Y., et al. (2023). Effect of pelvic floor muscle training on urinary incontinence after radical prostatectomy: an umbrella review of meta-analysis and systematic review. Clinical Rehabilitation, 37(4), 494–515. doi:10.1177/02692155221136046 (PMID 36305082).
    Show the passageHide the passage

    18 reviews, 29,925 patients, all “of critically low methodological quality.” “PFMT has a good effect on improving post-radical prostatectomy incontinence in men, and biofeedback can have an additional beneficial effect.”
28. National Institute of Diabetes and Digestive and Kidney Diseases (2014). Prostatitis: inflammation of the prostate. niddk.nih.gov. Checked October 29, 2026.
    Show the passageHide the passage

    “Prostatitis is the most common urinary tract problem for men younger than age 50.” Chronic prostatitis/chronic pelvic pain syndrome is “the most common and least understood form of prostatitis.” Treatment can include physical therapy, such as “Kegel exercises,” “myofascial release,” and “relaxation exercises.”
29. American Association of Neurological Surgeons. Cauda equina syndrome. aans.org. Checked October 29, 2026.
    Show the passageHide the passage

    Among the “red flag” symptoms of cauda equina syndrome: urinary retention, urinary or fecal incontinence, and a sensory disturbance in the saddle region. “If a patient is experiencing any of the ‘red flag’ symptoms above, immediate medical attention is required to evaluate whether these symptoms represent CES.”
30. American Physical Therapy Association. Physical therapy guide to urinary incontinence. ChoosePT. choosept.com. Checked October 29, 2026.
    Show the passageHide the passage

    The pelvic floor muscles “form a hammock structure that lifts and supports the internal organs” and create “the base of your core.” “Women may be more likely than men to have urinary incontinence. However, men may underreport the condition.” “Women's health or pelvic floor physical therapy is a specialty area.”
31. American Physical Therapy Association. Physical therapy guide to pelvic pain. ChoosePT. choosept.com. Checked October 29, 2026.
    Show the passageHide the passage

    Pain that can feel like “sitting on something hard, like a golf ball.” The exam looks “for any joint issues, muscle tightness or weakness, or nerve involvement,” and includes being shown “how to identify the appropriate muscles, such as the pelvic floor, deep abdominals, and diaphragm.”
32. Hay-Smith, E. J. C., Starzec-Proserpio, M., Moller, B., Aldabe, D., Cacciari, L., Pitangui, A. C. R., et al. (2024). Comparisons of approaches to pelvic floor muscle training for urinary incontinence in women. Cochrane Database of Systematic Reviews, 12, CD009508. doi:10.1002/14651858.CD009508.pub2 (PMID 39704322).
    Show the passageHide the passage

    A Cochrane update of 63 trials and 4,920 women comparing the exercise type, dose and delivery of PFMT, mostly “mid-age (45 to 65 years) parous women with stress or stress-predominant mixed urinary incontinence.” “Many comparisons had low- or very low-certainty evidence, often because there was only one trial or several small trials with methodological limitations.”
33. Eunice Kennedy Shriver National Institute of Child Health and Human Development (2025). What are the symptoms of pelvic floor disorders (PFDs)? nichd.nih.gov. Checked October 29, 2026.
    Show the passageHide the passage

    “Heaviness, fullness, pulling, or aching in the vagina that gets worse by the end of the day” and “difficulty starting to urinate or emptying the bladder completely” are both listed as symptoms. “Many women are reluctant to tell their healthcare provider about symptoms because they may feel embarrassed,” and “many women think that problems with bladder control are normal and live with their symptoms.”

Medical disclaimer. This page is for general educational purposes and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider about your individual situation. See a doctor for new, severe, or worsening pelvic pain, bleeding, or any loss of bladder or bowel control.