Common, But Not Normal | Let’s Talk Pelvic Health

Have you ever reached out wide for a backhand or jumped to crush an overhead down the line, and thought oops… I just tinkled a little? While this is very common, it is not normal. This may embarrass some, but really the pelvic floor is just a group of muscles that get tight or weak and begin to lose normal function just like any other muscle group in the body. So what can we do to fix it?

If you have clicked on the link you may be looking for answers or maybe you are just curious. Pelvic Health is an emerging field dedicated to helping women (and men) with  urinary leakage, pelvic pain, low back pain, and hip pain associated with pelvic floor dysfunction. In this article we will just be talking about those leaky pipes!

Setting the stage

We all know how important the core is. Everyone talks about the abdominals as part of “the core” and some know specifically of the transverse abdominis and mulitifidi. But rarely does anyone mention the diaphragm or the pelvic floor. These four structures help control changes in intra-abdominal pressure giving you a strong core when working correctly. It doesn’t require great core strength as much as good firing coordination.


Pelvic floor dysfunction is the inability to correctly contract and/or relax the pelvic floor muscles. Incontinence can caused by a variety of pelvic floor dysfunctions, however most commonly we see that the pelvic floor muscles are either too weak or the muscles or too tight and have limited ability to contract properly. Childbirth is most certainly a cause and affects 70% of women. Recently there was a study on female endurance runners under 30 yo that had never been pregnant. Shockingly, 30% reported leaking – likely from core breakdown during long distance running. Menopause and peri-menopause seem to increase incidence so there is likely a hormonal influence. As we get older, we tend to get more symptoms of pelvic dysfunction – our muscles should still work fine well into our old age but the more time we are alive, the more time we have to develop a problem. However, this should not be expected or accepted.

There are different types of incontinence but what is experienced on the tennis court is called stress incontinence. Stress incontinence also happens with other activities like jumping, agility courses, or running. Simply laughing or sneezing can be enough to trigger leaking. Again this is common but not normal. Leaking can cause a great deal of stress and embarrassment in some cases which makes you hold the muscles even tighter increasing the dysfunction. Let’s get rid of the barriers and solve this! You do not have to live this way.

What’s up with Kegels?

If you have had a baby, you know about Kegels and they are great exercise to help tone the pelvic floor. If you have not tried to use them to solve a leaking problem then you should give it a go. However, because tightness is a common reason for the dysfunction, sometimes trying to squeeze (Kegels) is like trying to take a breath when the lungs are already full. If Kegel’s are not successful (which is not uncommon) then find a physical therapist who can help. This is not traditional PT so make sure the PT has specialty training. Treatment can bring very fast results in many cases. Don’t let embarrassment or the thought that this is normal keep you from solving this problem. There will be some other side benefits too that have  to do with the pelvic floor that will improve you quality of life … but that’s another topic for another day. Ladies! Come on, we do not have to live this way!


Dr. Mary Brian Yoffe PT is a pelvic health specialist at Back in Action Physical Therapy in Apex. Contact her if you have questions or want any additional information. yoffe.biapt@gmail.com.

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