When people hear the words “pelvic floor,” they often immediately think of pregnancy, postpartum recovery, Kegels, or ‘women’s health’.
But Everyone has a pelvic floor!
And while there are obvious anatomical differences between male and female bodies, the pelvic floor system itself is far more similar than most people realize. The pelvic floor muscles in every body, support the pelvic organs, control bladder and bowel function, and play a role in sexual function, core stability, pressure management, and pain.
So, What Is the Pelvic Floor?
The pelvic floor is a group of muscles that sits at the base of the pelvis. These muscles act like a supportive sling or hammock for the organs above them.
In all bodies, the pelvic floor helps with:
- Urinary control
- Bowel control
- Sexual function
- Pelvic and core stability
- Pressure management
- Support during lifting, coughing, sneezing, exercise, and daily movement
One of the biggest anatomical differences is that in the female anatomy, there is an additional opening through the pelvic floor: the vaginal canal. Because of that, there are two additional pelvic floor muscles (drop that fact at your next trivia night) along with connective tissue considerations related to that extra opening.
But even with those anatomical differences, the overall function of the pelvic floor remains the same. The muscles still need to know how to contract, relax, lengthen, coordinate, and respond to pressure. When the pelvic floor muscles are too tight, too weak, uncoordinated, painful, or overworked, symptoms can show up. And those symptoms are often very similar across bodies.
.Different Anatomy, Same Problem
Pelvic floor dysfunction can happen across all genders and anatomies. The story behind the symptoms may look different, but the symptoms themselves often overlap. For example, someone may experience urinary leaking after pregnancy or childbirth, while another person may experience leaking after prostate surgery. The cause may be different, but the system being affected is very similar: bladder control, pelvic floor coordination, strength, endurance, and pressure management.
Anyone can experience:
Bladder symptoms
- Urinary leaking
- Urgency
- Frequency
- Difficulty fully emptying
- Dribbling after urination
- Getting up at night to pee
Bowel symptoms
- Constipation
- Straining
- Incomplete emptying
- Rectal pressure
- Fecal leakage
Pain symptoms
- Pelvic pain
- Tailbone pain
- Hip or low back pain
- Pain with sitting
- Rectal pain or pressure
- Genital pain
Sexual symptoms
- Pain with intimacy
- Pain with erection or ejaculation
- Pain with penetration
- Difficulty with orgasm
- Changes in sexual function or confidence
These symptoms may be common, but they are not normal just because they happen often. And they are not something someone should have to quietly live with.
Pelvic Floor Therapy Looks More Similar Than You Think
Many people assume pelvic floor therapy must look completely different depending on someone’s anatomy or gender, but in reality, the exam and treatment process are often more similar than people expect. A pelvic floor therapist is still looking at the same major categories of muscle function and asking how the pelvic floor is contributing to someone’s symptoms, comfort, and daily life.
During an evaluation, we may assess things like:
- Tone: Are the muscles relaxed, overactive, guarded, tender, or restricted?
- Strength: Can the muscles contract effectively?
- Endurance: Can the muscles sustain a contraction when needed?
- Coordination: Can the muscles contract, relax, and lengthen at the right time?
- Pressure management: Can the pelvic floor work with the breath, core, and diaphragm during movement, lifting, coughing, sneezing, and exercise?
- Functional impact: How are symptoms affecting urination, bowel movements, intimacy, sitting, exercise, sleep, work, and daily life?
Whether someone is recovering after childbirth, healing after prostate surgery, dealing with pelvic pain, struggling with urgency and frequency, or avoiding intimacy because of pain, the bigger clinical questions are often the same: What is the pelvic floor doing? What does it need to do better? And what else in the body may be contributing?
It’s Not Just About Kegels
One of the biggest misconceptions about pelvic floor therapy is that everyone simply needs to strengthen their pelvic floor, but not every pelvic floor needs more ‘squeezing. Some pelvic floors are weak and need strengthening, while others are tight and need relaxation. Some are strong but poorly coordinated, others have decent strength but poor endurance, and some can contract but have a hard time fully letting go.
This is why treatment must be based on what the pelvic floor is actually doing, not just the symptoms someone is experiencing. A person leaking after childbirth may need strength, coordination, breathing mechanics, and pressure management. Someone recovering after prostate surgery may need very similar training to improve urinary control and confidence. A person with pain during intimacy may have pelvic floor muscles that are overactive, guarded, or painful, and someone experiencing pain with sitting, orgasm, difficulty reaching orgasm, or intimacy may be dealing with that same type of overactivity or guarding.
Different anatomy can still come with very similar muscle behavior and treatment principles. That is why pelvic floor therapy is so much more than “just do Kegels.”
Why This Matters
When pelvic floor therapy is framed as only “women’s health,” many people are left out of conversations and care that could truly help them. And when we look at pelvic health through anatomy alone, we miss the bigger picture: the pelvic floor is part of a whole-body system that functions in many of the same ways across all humans. The more we normalize these conversations for everyone, the sooner people can get the support they need. Someone experiencing urinary leaking after prostate surgery deserves the same quality of rehab as someone leaking after birth. Anyone with pain during intimacy, pelvic pain, urgency, frequency, or pain with sitting deserves answers too. No one should be told to simply live with symptoms that pelvic floor therapy may be able to improve.
What Treatment May Include
Treatment depends on what the exam shows and what symptoms the person is experiencing. But because the pelvic floor system functions similarly across bodies, treatment may include many of the same strategies for both men and women:
- Pelvic floor muscle training
- Pelvic floor relaxation and down training
- Breathing mechanics
- Core and hip strengthening
- Bladder retraining
- Bowel habit education
- Urge suppression strategies
- Internal manual therapy
- Scar tissue or post-surgical care
- Mobility work
- Nervous system regulation
- Education around intimacy, pain, and return to activity
- Functional strengthening and pressure management
The goal of pelvic floor therapy is not simply to make every pelvic floor “stronger.” It is to help the pelvic floor function better. While different bodies have different anatomy, including additional openings through the pelvic floor and other anatomical considerations, the overall role of these muscles is remarkably similar across bodies. The way we assess the pelvic floor, the treatment principles we use, and the symptoms people experience often overlap more than most people realize. What should never differ is the need for compassionate, skilled pelvic health care.
Whether someone is experiencing leaking after childbirth, leaking after prostate surgery, urgency, frequency, constipation, pelvic pain, pain with intimacy, difficulty with orgasm, or pain with sitting, pelvic floor therapy can help identify what the muscles are doing and what they need in order to work better. Pelvic health is not just “women’s health.” Pelvic health is human health.
In healing and hope,
Dr. Tara