What everyone should know about building strength and supporting pelvic health

Urinary leakage when you cough or sneeze may be common. So are chronic constipation, pelvic pain, painful intercourse and changes in bladder or bowel control as we get older. Because these issues affect so many people, it can be easy to assume they are simply part of childbirth, menopause or aging and that there is not much to be done about them.

Pelvic health specialist Laura Bunso, PT, MTC, wants to challenge that assumption. As she explained to Dr. Stephan Esser on NHA Today, “just because it’s common doesn’t mean it’s normal.”

Laura has specialized in pelvic health, women’s and men’s health and spine care since 1999. Through her work at Smart Body Physical Therapy, she regularly sees patients whose lives have gradually become smaller because of symptoms they were uncomfortable discussing or did not realize could be treated. Understanding the pelvic floor, she believes, can help remove some of that uncertainty and give people practical ways to improve their function.

Your Pelvic Floor Is Muscle, Too

The pelvic floor can seem mysterious largely because we cannot see it. Laura describes it as a group of muscles stretching from the pubic bone in the front to the tailbone in the back and from one side of the pelvis to the other. These muscles sit beneath the pelvic organs and play important roles in bladder and bowel control, sexual function, movement and support.

Although these muscles are hidden, they are still part of the musculoskeletal system. They can become stronger or weaker, experience injury and lose coordination just as other muscles can. Laura compares the pelvic floor to a supportive structure at the bottom of the pelvis that must be able to both contract and relax appropriately depending on what the body is doing.

That distinction matters because pelvic floor dysfunction is not always a problem of weakness. Some people have muscles that are too tense or have difficulty relaxing them. Others may have adequate strength under normal circumstances but not enough strength or endurance for the demands they place on their bodies. This is why pelvic health can be an issue for someone who is sedentary as well as someone who is an experienced runner or weightlifter.

Why Kegels Aren’t Always the Answer

Kegel exercises have become nearly synonymous with pelvic floor health, but Laura cautions against assuming that everyone with pelvic symptoms simply needs to do more of them.

She regularly sees patients who have spent years attempting Kegels only to discover during an evaluation that they are not correctly activating their pelvic floor. Other patients may already be holding too much tension in these muscles. Asking them to repeatedly contract an already tense pelvic floor may not address what is causing their symptoms.

Healthy pelvic floor function requires the muscles to move through a fuller range of motion. They need to contract and lift when appropriate, but they also need to lower and relax. That relaxation is particularly important for functions such as having a bowel movement. A pelvic floor physical therapist can evaluate strength, relaxation, coordination and endurance to determine what an individual actually needs rather than relying on a one-size-fits-all exercise prescription.

Pelvic Health Changes Throughout Life

Pelvic floor problems are often associated with pregnancy and childbirth, and for good reason. Pregnancy places additional demands on the pelvic floor, while delivery can involve stretching, tearing or other tissue changes. Laura recommends that postpartum women pay attention to persistent symptoms and seek a pelvic floor evaluation rather than assuming pain or dysfunction will eventually disappear on its own.

However, childbirth is only one reason someone might benefit from pelvic floor physical therapy. Menopause, surgery, cancer treatment, injuries, chronic constipation, athletic training and aging can all affect how these muscles function. Men can experience pelvic floor dysfunction as well, including symptoms following prostate procedures or injuries that may initially be mistaken for other conditions.

Aging is particularly important because the pelvic floor does not exist separately from the rest of the body’s musculature. As maintaining muscle mass and strength becomes increasingly important with age, pelvic floor strength and coordination deserve attention too. Changes in bladder or bowel control may become more common over time, but that does not automatically make them an inevitable consequence of getting older.

The Overlooked Connection to Constipation

One of the less obvious topics Laura and Dr. Esser discuss is the relationship between chronic constipation and pelvic floor function.

Dietary fiber, hydration and regular physical activity are important for healthy bowel function, but they are not the entire picture. The pelvic floor also needs to relax and coordinate correctly to allow stool to pass. When those muscles do not relax appropriately, repeatedly straining can make the process even more difficult.

Laura sees patients who have undergone extensive testing or relied on medications for constipation before anyone evaluated whether their pelvic floor was contributing to the problem. She would like pelvic floor assessment to become a more routine consideration for people with persistent constipation, particularly when other serious causes have been ruled out.

This does not diminish the importance of appropriate medical evaluation for chronic bowel changes. Instead, it adds another potential piece to the puzzle. Understanding whether the pelvic floor is functioning correctly may help determine what kind of treatment is most appropriate.

Strength Matters, but So Does Coordination

One of the most encouraging parts of understanding the pelvic floor as muscle is recognizing that function can often be worked on.

Laura explains that rehabilitation begins by determining whether someone can correctly identify, contract and relax these muscles. Once that foundation is established, strengthening and conditioning can be progressed according to the person’s needs. Someone returning to everyday activities will place different demands on the pelvic floor than a competitive runner or someone lifting heavy weights, so rehabilitation should reflect the activities a person wants to perform.

Endurance matters as well. The pelvic floor must often provide low-level support over extended periods rather than producing one brief, powerful contraction. Laura uses biofeedback in her practice to help evaluate how well patients can activate, maintain and relax their pelvic floor muscles. This can help patients learn what correct movement feels like and eventually practice more effectively on their own.

Everyday Habits Can Support Pelvic Health

Pelvic health does not exist in isolation from overall health. Laura encourages regular movement, adequate hydration and habits that support healthy bowel function. She also points out that certain beverages and ingredients, including caffeine, alcohol and artificial sweeteners, may irritate the bladder for some people. Becoming aware of those connections can help people recognize patterns in their own symptoms without assuming they need to eliminate everything they enjoy.

The first step may be even simpler: learning where the pelvic floor is and becoming aware of whether you can contract and relax it. If you cannot identify those muscles, cannot comfortably move through that range of motion or are experiencing ongoing symptoms, Laura recommends working with a qualified pelvic floor physical therapist rather than trying to solve the problem with exercises found online.

It’s Okay to Talk About Pelvic Health

Perhaps one of the greatest barriers to better pelvic health has nothing to do with muscle strength. Bladder leakage, bowel problems, painful sex and pelvic pain are deeply personal, and embarrassment can keep people from mentioning them even to a healthcare provider.

Over time, people may quietly adapt their lives around their symptoms. Someone worried about bladder or bowel control may avoid certain activities, plan every outing around access to a restroom or simply stay home more often. When this happens gradually, it can be difficult to recognize just how much a health problem has begun to influence everyday life.

Talking about these symptoms is not something to be embarrassed about. Pelvic health is part of whole-body health, and understanding how these muscles work can make an unfamiliar problem feel much more manageable.

Whether changes have appeared after childbirth, surgery, menopause, years of athletic activity or simply with age, the goal is not to assume that every symptom can be solved with a few exercises. It is to recognize when something has changed, understand that there may be options for improving it and seek the right evaluation when needed.

As Laura’s conversation with Dr. Esser makes clear, common does not have to mean inevitable. Supporting pelvic health can be another part of maintaining strength, function and quality of life throughout every stage of life.

Learn More

Smart Body Physical Therapy:
https://www.smartbodypt.com/

Listen to Laura’s podcast, Pelvic Like It Is:
https://podcasts.apple.com/ie/podcast/pelvic-like-it-is/id1871478598

Follow Dr. Stephan Esser on Instagram:
https://www.instagram.com/esserhealth/

Watch NHA Today on YouTube:
https://www.youtube.com/@nationalhealthassociation

Learn more about the National Health Association:
https://www.healthscience.org/