Your pelvic floor health can significantly impact your quality of life, affecting your bladder, bowel and sexual function. Amr Sherif El Haraki, MD, a urogynecologist at Atrium Health Wake Forest Baptist Urology - Lexington, explains the symptoms you shouldn’t ignore.
“I often see how deeply pelvic floor issues can affect a woman’s quality of life. These muscles play a vital role in your bladder, bowel, and sexual health—so when they’re not functioning well, it can have a ripple effect on your everyday comfort, confidence, and well-being,” says El Haraki.
What Is Pelvic Floor Dysfunction?
El Haraki explains the pelvic floor is a group of muscles at the base of your pelvis. They support your bladder, uterus, and rectum, and they need to work in two keyways. “The pelvic floor contracts when you need to hold in urine or stool or support your body during activities like lifting or sneezing. It needs to relax and lengthen so you can empty your bladder or bowels, and have comfortable, pain-free sex.”
“When these muscles are too tight, too weak, or not working in harmony, we call that pelvic floor dysfunction,” says El Haraki.
Symptoms You Shouldn’t Ignore
Pelvic floor dysfunction shows up in different ways, explains El Haraki. “It’s not just something that comes with age or just happens after having kids.” Some common symptoms include:
- Leaking urine when you cough, laugh, sneeze, or exercise
- Constipation or feeling like you can’t fully empty your bowels
- Trouble starting or stopping your urine stream
- Frequent urges to go to the bathroom
- Pain during sex or pelvic exams
- Vaginal or rectal pressure or pain
- Painful urination without infection
- Leaking stool
What Causes Pelvic Floor Dysfunction?
Pelvic floor dysfunction can be caused by:
- Pregnancy and childbirth
- Pelvic surgeries like hysterectomy
- Trauma or injury
- Hormonal shifts (especially during perimenopause and menopause)
- Chronic stress or anxiety
- Poor posture or shallow breathing
- Overuse or straining during bowel movements
- Connective tissue conditions
“There are many possible causes, and often, it’s a combination of things,” says El Haraki. “Sometimes the issue is purely physical, but emotional stress and lack of sleep can also play a role. Your pelvic floor responds to your nervous system. It’s all connected.”
Why Kegels Aren’t Always the Answer
While Kegel exercises (tightening and relaxing your pelvic muscles) are often touted as the gold standard for improving pelvic floor health and strength, they aren’t right for everyone. And, depending on the cause of your pelvic floor symptoms, they could make matters worse.
“We need a balance: muscles that are strong and flexible. Relaxation is just as important as strength. That’s why I often refer patients to a pelvic floor physical therapist so they can assess exactly what your body needs,” says El Haraki.
What to Expect at a Pelvic Floor Physical Therapy Appointment
Your first visit will feel more like a conversation than a workout. The therapist will ask about:
- Your symptoms
- Health and surgical history
- Bowel and bladder habits
- Sexual health
- Breathing, posture, and movement patterns
At your first appointment, your pelvic floor physical therapist will talk with you about your stress levels, breathing patterns, posture and potential back and hip issues. They’ll also ask about your health history and current symptoms. They can do an internal exam (similar to a pelvic exam at the gynecologist) to assess your pelvic floor function. If you prefer not to have an internal exam, your therapist can assess your pelvic floor muscles externally.
After the assessment, your physical therapist will develop your individualized treatment plan, usually a combination of in-office physical therapy sessions and exercises you can do at home.
Depending on your insurance plan, you may be able to make an appointment directly with a physical therapist. If you need a referral, ask your gynecologist.
When to Reach Out for Help
“You don’t have to live with leaks, pain, or discomfort,” says El Haraki.
El Haraki encourages people to trust their instincts and see their gynecologist or a pelvic floor physical therapist if something doesn’t seem right.
“Whether you’re dealing with minor leaks or significant discomfort, you are not alone—and effective, compassionate care is available,” says El Haraki.
To learn more about our Women’s Health services, visit Atrium Health Wake Forest Baptist Women’s Health.