Pelvic floor dysfunction: the muscles behind leaks, pressure and low-back pain.
Leaks, pressure, and stubborn low-back pain often trace to the pelvic floor — and it can be too tight as often as too weak. Here's the musculoskeletal side, and when to see a pelvic floor PT.
Leaking a little when you cough, laugh, or jump; a heavy, dragging feeling of pressure "down there"; or nagging low-back, hip, or tailbone pain that adjustments never quite settle — these often trace back to the same place. The surprising part is that the muscles involved can be too tight just as often as they are too weak, which is exactly why Kegels are not always the answer. The clinical name for the whole picture is pelvic floor dysfunction.
What is your pelvic floor actually doing?
Picture a canister at the base of your torso. The diaphragm forms the lid on top, the deep abdominal muscles wrap around the sides, and the pelvic floor — a hammock of muscle slung between your pubic bone and tailbone — forms the bottom. Together they are your deep core, and they are built to work as one unit.
Every time you breathe, that canister changes pressure. On the inhale the diaphragm drops and the pelvic floor gently lengthens; on the exhale both recoil back up. When you cough, lift, or laugh, the whole system is supposed to brace and manage that spike in pressure together — and when one wall stops coordinating with the others, the pressure has to go somewhere, often straight down through a floor that cannot respond in time.
Why aren't Kegels always the answer?
The instinctive fix for leaking is to squeeze — more Kegels, harder and more often. That works when the floor is genuinely weak, but a large share of pelvic floor problems come from muscles that are already too tight and never fully let go. Cleveland Clinic describes this over-clenched pattern as a hypertonic pelvic floor, and piling more squeezing onto an already-shortened muscle usually makes symptoms worse, not better.
A tight floor cannot produce a strong, well-timed contraction any more than a weak one can — a muscle held short all day has nothing left to give when you actually need it. That is why the honest first question is never "how do I strengthen this?" but "is this floor too weak, too tight, or just poorly coordinated?" Pregnancy and childbirth are among the most common triggers of both patterns, which we cover separately in the pelvic floor after childbirth.
A pelvic floor that never relaxes is not a strong pelvic floor — it is an exhausted one. Coordination beats brute squeezing almost every time.
How do your hips, SI joint and breathing feed the problem?
The pelvic floor does not hang in isolation. It anchors to the same bony ring as your sacroiliac joints and hips, so when the pelvis is not moving or sitting well, the floor is working on an unstable foundation. Irritation in the sacroiliac joint or tight, underpowered hips changes how the floor loads with every step.
Sleepy glutes are a common culprit — when the gluteus medius is not doing its job of stabilizing the pelvis, the floor often over-grips to compensate. Shallow chest breathing plays a role too: if the diaphragm barely moves, the lid of the canister never drives the pressure rhythm the floor depends on, so the floor tends to hold tension all day. These are all musculoskeletal patterns, and they are squarely in a chiropractor's lane.
What does The Spine Studio actually do?
At The Spine Studio, Dr. Andersen starts by looking at the whole canister, not just the symptom. Precision Spinal Adjustments to the pelvis and sacroiliac joints restore the movement the floor anchors to, so it is not bracing against a stuck or twisted foundation.
For the surrounding hips, glutes and low back, Pin & Stretch and Cupping & Scraping release the tight tissue that keeps the floor over-recruited. Then Corrective Exercise Programming retrains the piece most programs skip — breathing that actually moves the diaphragm, and deep-core coordination that lets the floor relax and contract on time. You can see the full list on our services page.
Where does a pelvic floor physical therapist come in?
Here is the honest boundary. Everything above is external, musculoskeletal work — the bones, the surrounding muscles, and the breathing pattern that drive how the floor behaves. The floor muscles themselves are best assessed internally, and that is the specialty of a pelvic floor physical therapist. You can read the full range of symptoms on Cleveland Clinic's overview of pelvic floor dysfunction.
Internal assessment and treatment of the pelvic floor is the domain of a pelvic floor physical therapist, and we refer to one directly. If you have persistent leaking or incontinence, symptoms of prolapse (that heaviness or a bulge), or pain with intercourse, a pelvic floor PT should be on your team. We handle the musculoskeletal and coordination piece and work alongside them — the two approaches together get people further than either one alone.
What should you expect?
Most people are surprised how much of their pelvic floor story is written in their hips, their pelvis, and how they breathe. Sorting out which of those is driving your symptoms is the first visit's job, and it tells us quickly whether this is something we lead on, co-manage with a pelvic floor PT, or refer out entirely.
If leaking, pressure, or that stubborn tailbone and low-back pain has been shrugged off as "just something that happens," it is worth a proper look. The floor is a muscle system like any other — it responds when the whole canister around it is working.
Get the hip, pelvis and breathing piece sorted out — book an assessment with Dr. Andersen today.
Frequently asked questions
- Why do I leak when I cough or sneeze?
- A cough or sneeze sends a sudden spike of pressure down through your abdomen, and your pelvic floor is supposed to brace against it in the same instant. When that floor is weak, too tight, or just poorly timed with your breathing, it cannot manage the spike and a little urine escapes. It is common, but it is not something you simply have to accept. The right fix depends on whether the floor is under-powered or over-clenched, which is why an assessment matters more than defaulting to Kegels.
- Can a chiropractor help pelvic floor dysfunction?
- A chiropractor can address the musculoskeletal side — the pelvis and sacroiliac joints, tight hips and glutes, and the breathing pattern that all influence how your pelvic floor behaves. At The Spine Studio in Cottleville, Dr. Andersen uses Precision Spinal Adjustments, Pin & Stretch, Cupping & Scraping, and Corrective Exercise Programming to retrain that whole deep-core system. What a chiropractor does not do is internal pelvic floor work — that is the domain of a pelvic floor physical therapist, and we refer to one directly for persistent incontinence, prolapse symptoms, or pain with intercourse. The two approaches work best together, not in place of each other.
- Are Kegels bad for a tight pelvic floor?
- Kegels strengthen the pelvic floor by squeezing it, which helps when the floor is genuinely weak. But a large share of pelvic floor problems come from muscles that are already too tight and never fully relax, and adding more squeezing to an over-clenched muscle can make symptoms worse. That is why blindly doing Kegels is not always the answer — the first step is figuring out whether your floor needs strengthening, releasing, or better coordination.
- When should I see a pelvic floor physical therapist instead of a chiropractor?
- A pelvic floor physical therapist assesses and treats the floor muscles internally, which is the right level of care for persistent leaking or incontinence, symptoms of prolapse such as heaviness or a bulge, and pain with intercourse. A chiropractor handles the external, musculoskeletal contributors — the pelvis, hips, and breathing mechanics. In practice these are not either-or: we often co-manage, handling the joint and coordination piece while the pelvic floor PT does the internal work.
