Pelvic Floor Dysfunction

Pelvic floor dysfunction is common in runners, yet it’s often dismissed as a normal side effect of high-impact training. Symptoms like leaking during runs, pelvic or tailbone pain, painful sex, heaviness, or bowel and bladder changes are signs that the system supporting your body isn’t adapting well to load.

The pelvic floor is a group of muscles and connective tissue that supports the pelvic organs and works closely with breathing, core stability, and hip function. Dysfunction doesn’t just mean weakness. Many runners have pelvic floors that are overactive and constantly gripping, not allowing the system to lengthen, contract and relax efficiently, leading to pelvic symptoms.

Running places repeated impact forces through the body with every stride. These forces must be managed by the pelvic floor along with the diaphragm, abdominals and hips. Increases in training parameters, combined with breath holding, excessive core tension, fatigue, hormonal changes, or postpartum recovery, can overwhelm this system—even in strong, experienced runners.

Pelvic health physical therapists should address pelvic floor dysfunction through a whole-body approach. Treatment may include breathing and pressure management, reducing excess muscle tension, improving coordination, targeted strengthening, manual therapy, and return-to-run guidance. It’s often not about doing more kegels; it’s about restoring balance and efficiency.

Runners should consider pelvic floor physical therapy if they experience:

• Urinary leakage with running or impact

• Pelvic, tailbone, hip, or low back pain

• Pain with intercourse or tampon use

• Pelvic heaviness or pressure

• Symptoms that worsen with training

Pelvic floor dysfunction may be common, but it’s not something runners have to accept. With the right support, physical therapy can help runners train comfortably, confidently, and without fear of symptoms.