Here’s the good news—and there’s plenty of it. The vast majority of pelvic floor dysfunction cases can be caught early if we are educated and if we ask the right questions. After all, this is how we approach other symptoms of dysfunction in sport performance. But if you are experiencing symptoms of pelvic floor dysfunction like leaking, tightness, pressure, etc., pelvic floor PT can help you rehab for better pelvic health.
In my PT practice and in Floor It, you may notice that prevention is one of my favorite strategies—let’s consider prevention in the context of a more “relatable” body part, like the knee. You walk in to see a trainer with a slight limp after doing sprints yesterday. The trainer asks what you are feeling and when you first noticed it, then rules out any major issues.
Depending on their field, the trainer may do some hands-on work to desensitize the painful spots, mobilize tissues, and get you back on your feet. The trainer might also take you into the gym and ask you to perform specific movements both to offload the knee and to prevent this particular pain from happening again while also working with you and your coach to modify upcoming runs as needed. Catching your injury in the acute phase likely prevented a stress reaction from becoming a stress fracture—this is a win! Instead of being sidelined for two months, you need only a few weeks of cross-training and targeted rehab to return to your sport at full capacity.
Now let’s translate this experience to the pelvic floor.
An athlete walks in and mentions that they’re tired from poor sleep the previous night. When I ask for more details, they mention that they woke up three times to use the restroom, which isn’t their normal routine (nor should it be anyone’s normal routine). They dismiss it, saying they had a lot of water yesterday, and mention that their back feels a little stiff, but they’re ready for their program. Instead of getting started, I ask more questions as part of a pelvic floor assessment: “What has your training load looked like this week? Have you had any hip, groin, or hamstring issues lately? Did you do a lot of core work yesterday?” Usually, I rule out any major issues such as dermatomal or myotomal concerns, sudden weakness, saddle anesthesia, and more (of course this is the responsibility of the clinician/provider/trainer, not the athlete).
Assuming we’re in the clear, I can now use my time to teach the athlete about urinary frequency and the reverse Kegel and maybe do a quick external pelvic floor exam to see if they’re able to mobilize the muscles. I realize that after their sprint workout yesterday, their pelvic floor is having a hard time relaxing. I take time to educate them on how this can contribute to frequent night wakings and low back compensation.
We continue with our program, but I’m mindful to adjust and observe for changes in form. (In a case like this, changes might include difficulty with hinging, limited hip internal rotation in the squat, or minimizing range of motion in frontal plane tasks to avoid symptoms, just to name a few.)
Meanwhile, I encourage the athlete to constantly communicate what they’re experiencing. I may place increased focus on activities that mobilize the pelvic floor and have the athlete focus heavily on breathwork between sets to ensure that the pelvic floor isn’t maximally engaged throughout the entire workout.
Pelvic Floor Dysfunction Symptoms Are Warnings
Assuming we have the awareness and education, we have more opportunity to stop pelvic floor dysfunction before it becomes a bigger problem. While we can’t directly correlate it with injury prevention, from a clinical perspective, this intervention may limit the likelihood of more time-loss injuries that require sitting out of sport, such as disc herniations, hamstring tears, or groin strains.
For providers, coaches, and athletes, recognizing the early warning sign of “I woke up three times to use the restroom last night” as readily as the early warning sign of a slight limp is a game changer.
As we’ve discussed, there are several reasons why pelvic floor dysfunction is missed in the training room: lack of awareness, embarrassment about symptoms, lack of recognition of the prevalence of similar symptoms, and lack of training or not understanding how to adequately address the symptoms. The athlete’s awareness or lack thereof can also hinder the full resolution of pelvic symptoms more noticeably than the resolution of other pain and strain. Generally, athletes will not hesitate to say they’re unable to complete a task due to shoulder pain, but if the symptom is pelvic pain, they are more likely to dismiss it. The demands of high performance, pressure to return to sport, and pervasive misunderstanding regarding the care of the pelvic floor can hinder the ability of the athlete or provider to truly treat the area as we do the surrounding musculature. (See “Meet Your Pelvic Floor“.)
Let’s floor it! See more from Dr. Rachel Selman and her groundbreaking book on pelvic health and sports.
About Floor It
Floor It is the groundbreaking guide to your pelvic floor, the unsung hero of core strength and your hidden powerhouse for sports.
Dr. Rachel Selman, DPT, the NSCA’s 2026 Personal Trainer of the year, offers a fascinating resource to understand pelvic floor dysfunction and pelvic muscle training for endurance sports, team sports, power sports, and sports that involve twisting like tennis and golf.