Pelvic Floor Therapy for the Female Athlete: Why Strong Women Still Need Support
- Marnie Hansen
- May 8
- 9 min read
Blog post written by Dr. Marnie Hansen, DC, for Salt Lake Spine & Pelvis
If you’ve ever leaked a little while running, felt that uncomfortable pressure “down there,” or even wondered why your hips or low back always feel so tight no matter what you do for it… Welcome, my friend. Your body is not broken. You’re probably just an athlete or a highly active woman.
In my humble opinion, female athletes have been wildly under-informed about pelvic floor health for way too long.
For years, we've been told to keep pushing through, train harder, strengthen our core, and keep grinding forward. Meanwhile, many active women were silently dealing with pelvic pain, urinary leakage, low back pain, painful intimacy, constipation, or even that weird, heavy feeling in the pelvis that nobody talks about in the locker room or on the field.
The good news is that we are finally talking about it.
Thank goodness.
And even better news? There’s actually a lot you can do for it, and I'm here to get that conversation started.
As a chiropractor with advanced pelvic health training, and as a former professional snowboard competitor who spent years launching off jumps that were way too big for my britches... crashing even bigger... and basically putting my poor little body through the wringer, pelvic floor dysfunction in female athletes is deeply personal to me. I didn’t get into pelvic health just because it was trendy. I got into it because I needed it myself.
Years of impact from massive tumbles, spinal and pelvic compression, falls (“butt checks” for my snowboarding sisters out there), repetitive force and trauma, and even the physical demands of adjusting patients eventually caught up to my own pelvic floor. The pelvic pain and dysfunction I experienced from years of cumulative overuse and injury totally changed the direction of my career and my mission as a doctor.
Now I help active women reconnect with their bodies, recover from pain, prepare for pregnancy, heal postpartum, transition through perimenopause and menopause, and get back to doing what they love without fear, leakage, or discomfort.
And rest assured... if you are an athlete (or weekend warrior) dealing with pelvic floor symptoms, you are NOT alone.
Wait… Female Athletes Are More Likely to Have Pelvic Floor Issues?
Yep. Research has been pointing to this for years.
A landmark 2016 study found that female athletes experienced significantly higher rates of pelvic floor dysfunction compared to non-athletes, especially in high-impact sports. (https://pubmed.ncbi.nlm.nih.gov/26369504/)
Since then, multiple systematic reviews and sports medicine studies have confirmed the connection between athletics and pelvic floor symptoms. Some research even reports urinary leakage rates as high as 80% in certain high-impact sports such as gymnastics and trampolining (see the reference list at the end of the article).
And before you think, “Well, I’ve never had kids, so that can’t be me…”
Actually, many of these athletes are young, strong, and have never been pregnant. I myself have never had children (yet!) and experienced debilitating symptoms in my early-40s, after years of accumulated athletic activity.
Pelvic floor dysfunction will likely affect most of us, especially considering that 50% of women will experience some form of prolapse by the time they reach 50. (I believe that statistic is much larger, based on what I see in my office). But, I digress...
My overarching point is that pelvic floor dysfunction isn’t just about childbirth. It’s about pressure, force, coordination, muscle balance, and how your body manages load over time.
Think of it like a physics equation:
The type of activity or force to the body (also consider what you do for it), multiplied by how many years you have been doing said activities = the quality and/or quantity of pelvic floor function or dysfunction you will experience.
Still with me?
Great! There's more you should know...
Why Female Athletes Are at Higher Risk
The pelvic floor is a group (I like to call it a 'community') of layered muscles and fascia that serve as a supportive hammock at the base of your pelvis, or pelvic bowl. This complex network of tissues works in sync to support your bladder, bowel, reproductive organs, breathing mechanics, core stability, and sexual function.
For a moment, imagine repeatedly adding:
Jumping
Landing
Sprinting
Heavy lifting
Core bracing
High-impact training
Falls and collisions
Chronic gripping or muscle guarding throughout the hips and abs (eg, how we were taught to "suck it in," or chronic bracing of the pelvic floor with jumping, stress, tension, or in my situation, adjusting too many patients in one day).
Your pelvic floor is your center of gravity and has to absorb and respond to all of that force on a daily basis. Rinse and repeat, for years, and that can add up (cue the physics equation).
Sometimes it adapts brilliantly, and without symptoms.
Sometimes it gets overwhelmed and starts to tell you so.
And here’s the thing. It's one that many women miss: pelvic floor dysfunction does NOT always mean weakness.
In athletic women, I actually see overactive, overperforming pelvic floors repeatedly.
Translation? The muscles are too tight (hypertonic), too guarded, and stuck in “go mode.”
That can create:
Pelvic pain
Tailbone pain
Pain with sitting
Hip tightness
Painful intimacy
Constipation
Urinary urgency
Leaking
Low back tension
Feeling like you can’t fully relax
Sound familiar?
The “Strong Core” Myth
This one deserves its own section (I could likely write an entire book on this. Maybe I am...).
Fitness and hustle culture have convinced women that the answer to everything is:
More core work
More squeezing
More Kegels
More tightening
More, more, more!
But if your pelvic floor is already overworking, adding MORE tension and strength can actually do you a disservice and make symptoms worse.
That’s why pelvic floor therapy is not considered to be a one-size-fits-all situation.
Some women need strengthening. Others need deeper relaxation methods, coordination, breath work, mobility, and nervous system regulation.
For the female athlete, more often than not, we need to work on relaxation and lengthening of the pelvic floor first to properly strengthen it. And it can be a process. With athletes, we often need to teach the pelvic floor to relax and let go, in order to facilitate a full, healthy contraction (let alone proper mobility, but more on this later).
The definition of a healthy pelvic floor isn't just strength and support, but it's also responsiveness.
Symptoms Female Athletes Commonly Ignore
Athletes are incredibly adept at pushing through or normalizing discomfort.
I know because I did it too. Below are some common signs your pelvic floor may need a little extra support:
Leaking Urine During Exercise
Especially during:
Running
Jumping
CrossFit
Skiing or snowboarding
Trampoline work
Heavy lifting
And no, leaking is not “just a part of being active.” It may be common, but it is not normal.
Pelvic Pressure or Heaviness
Some women describe this sensation as:
A tampon falling out
Heaviness after workouts
Pressure in the pelvis
Dragging sensations
Pain with Sitting
This was a huge one for me personally. At one point, I couldn't sit for more than 20 minutes without a deep burning and achy sensation in my pelvic floor and tailbone.
Deep pelvic aches, or tailbone pain, as I had after prolonged sitting, are shockingly common and can absolutely be connected to pelvic floor dysfunction.
Hip and Low Back Tightness
The pelvic floor is connected to, and works closely with:
The diaphragm
Deep core muscles and abs
Glutes
Hips
Muscles and fascia of the lower back
SI joints
When one area compensates, the whole system gets cranky.
Painful Intercourse
A very common symptom that many women feel uncomfortable discussing. I will be dedicating an entire blog post to this in the near future. Stay posted! In the meantime, know you are not alone on this one, and there is a lot you can do.
Constipation or Difficulty Emptying
Pelvic floor tone, function, and coordination matter for bowel function, too.
So… What Does Pelvic Floor Therapy Actually Do?
Sometimes the pelvic floor just needs a little extra help. And this is where the pain and dysfunction can often turn around...
Pelvic floor therapy is about restoring balance, coordination, mobility, strength, and nervous system regulation throughout the entire core and pelvis.
At my office, treatment may include:
Chiropractic care
Pelvic floor muscle assessment
Breathing mechanics
Core retraining
Hip mobility work
Nervous system regulation
Manual therapy
Myofascial release
Postural correction
Movement retraining
Exercise modifications
Education around pressure management
And no, pelvic floor therapy is NOT just doing endless Kegels in a dark room.
Thank goodness.
Athletes Need a Different Approach
One thing I’m deeply passionate about is helping female athletes feel understood.
Athletes don’t want generic rehab advice and want to get to the bottom of the issue quickly and efficiently.
They want:
To train hard again
To lift again
To snowboard again
To run without leaking
To jump confidently
To stay active during pregnancy
To recover fully postpartum
To transition through hormonal changes without losing connection to their body
My "lengthen it to strengthen it" motto: Athletes are accustomed to performance. But pelvic health also asks us to prioritize recovery, coordination, lengthening, relaxation, and sustainability to get back in the game. There is a season for everything, and recognizing the need to shift into another gear for a short while can be powerful for the course of recovery.
And you don't have to stay stuck in one gear forever!
Pregnancy, Postpartum, and Menopause Matter Too
Hormones are all the buzz lately. And for good reason. This is also not a 'one size fits all' topic in women's health. The conversation (and the research) is very nuanced, and, to be honest, still in its infancy as far as we know.
Athletic women often assume they’ll “bounce back” quickly because they’re fit.
But fitness does not automatically protect the pelvic floor, or guarantee smooth recovery or resilience.
Hormonal shifts during:
Pregnancy
Postpartum recovery
Perimenopause
Menopause
…can all influence tissue health, muscle coordination, recovery capacity, and affect symptoms.
The good news? Pelvic floor therapy can be incredibly effective during every phase of life.
And honestly, women deserve an informative roadmap and support BEFORE things get severe. Not just after.
The Biggest Thing I Want Female Athletes to Know
Your symptoms are common; I see them in my office every day. But know that they are NOT something you just have to live with.
Urinary leaking is common. Pelvic pain is common. Hip tension is common. But that does not mean they’re normal.
Your body isn’t failing you. It's intelligently communicating with you and hopes you will listen. And what it’s likely asking for is better support, recovery, coordination, and balance. Not harder training or punishment.
It's asking for a communicative and compassionate relationship with you... and to be heard.
Final Thoughts: Strong Women Deserve Pelvic Support Too
Female athletes are powerful humans. But power without mindful recovery eventually catches up to us. It doesn't mean you have to undergo a full overhaul of your routine or activities. Sometimes it just means making small tweaks, gaining knowledge, or adjusting your exercise patterns.
Whether you’re:
A runner
A snowboarder
A CrossFitter
A dancer
A skier
A lifter
A busy mom chasing kids
Or just an active woman who wants to feel good in her body again…
The health of your pelvic floor matters. And taking care of it isn’t a weakness. It's quite empowering to learn to train smarter, not harder, as cliché as that may sound.
At Salt Lake Spine & Pelvis, my goal is to help women move better, feel stronger, heal smarter, and stay active for the long haul... without shame, fear, or the idea that pelvic pain is “just part of being a woman.”
You deserve better than that.
FAQs About Pelvic Floor Therapy for Female Athletes
Can athletes have pelvic floor dysfunction even if they’ve never had kids?
Yes, absolutely. High-impact sports, repetitive force, heavy lifting, and chronic muscle tension can all contribute to pelvic floor dysfunction.
Is leaking during workouts normal?
Common? Yes. Normal? No. Leakage is usually a sign that the pelvic floor and pressure system need better coordination.
Do Kegels fix pelvic floor problems?
Not always. Some women actually need relaxation and retraining instead of more tightening. (e.g., lengthen to strengthen!)
Can pelvic floor dysfunction cause hip and back pain?
Yes. The pelvic floor is deeply connected to the hips, core, SI joints, and low back.
What sports have the highest risk for pelvic floor issues?
High-impact sports like gymnastics, running, CrossFit, volleyball, trampoline, and weightlifting tend to show higher rates of symptoms. Does it mean you shouldn't do them? No. More on this in a later blog, as there is a lot to unpack.
Can pelvic floor therapy help during menopause?
Definitely. Hormonal changes can affect pelvic tissues and muscle function, and therapy can help improve support, mobility, and symptom management.
Research continues to support the connection between athletics and pelvic floor dysfunction in women, especially in high-impact sports.
Pelvic floor therapy for the female athlete can be a huge win for the world at large, not just on the playing field. The more we know about women's health and the pelvic floor, the more we know what to do!
Research and References:
Almeida MB, Barra AA, Saltiel F, Silva-Filho AL, Fonseca AM, Figueiredo EM. Urinary incontinence and other pelvic floor dysfunctions in female athletes in Brazil: A cross-sectional study. Scand J Med Sci Sports. 2016 Sep;26(9):1109-16. doi: 10.1111/sms.12546. Epub 2015 Sep 15. PMID: 26369504.
Schwamberger T, da Roza TH, Arbieto ERM, Ferreira IC, Schuler LBT, Duarte LHC, da Luz SCT. Triathletes and Urinary Incontinence: An Investigation of Prevalence and Associated Factors. Neurourol Urodyn. 2025 Nov;44(8):1607-1613. doi: 10.1002/nau.70145. Epub 2025 Sep 8. PMID: 40922593; PMCID: PMC12550347.
Dakic JG, Hay-Smith J, Lin KY, Cook J, Frawley HC. Experience of Playing Sport or Exercising for Women with Pelvic Floor Symptoms: A Qualitative Study. Sports Med Open. 2023 Apr 25;9(1):25. doi: 10.1186/s40798-023-00565-9. PMID: 37097457; PMCID: PMC10127961.
Culleton-Quinn E, Bø K, Fleming N, Cusack C, Daly D. Prevalence and Experience of Urinary Incontinence Among Elite Female Gaelic Sports Athletes. Int Urogynecol J. 2024 Dec;35(12):2357-2365. doi: 10.1007/s00192-024-05893-2. Epub 2024 Aug 16. PMID: 39150568; PMCID: PMC11732913.
Pires T, Pires P, Moreira H, Viana R. Prevalence of Urinary Incontinence in High-Impact Sport Athletes: A Systematic Review and Meta-Analysis. J Hum Kinet. 2020 Jul 21;73:279-288. doi: 10.2478/hukin-2020-0008. PMID: 32774559; PMCID: PMC7386138.
https://journals.sagepub.com/doi/10.1177/1089313X231176629?utm_source=chatgpt.com
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