Q&A: Pelvic Floor Drops, Weak and Tight Muscles, Tilted Pelvis and More

In Stress Urinary Incontinence by Stephanie Prendergast and Elizabeth Rummer93 Comments

Since launching the blog, we have received many questions from readers. In this post, we’re going to tackle a handful of them. If you have a question of your own, please take the opportunity to post it in the “comments” section of this blog.

Stop UTIs from Impeding PT Progress

Dear Stephanie and Liz,

I have PFD and am currently in physical therapy. Unfortunately I’m also a person who is prone to getting one or two UTIs a year. It’s frustrating because every time I think I have this PFD licked, a UTI comes along causes my muscles to spasm and tighten and ruins my progress. My question is: Can the pelvic floor be rehabbed enough to at some point withstand the destructive power of a UTI?


UTI Prone

Dear UTI Prone,

The short answer to your question is yes, the pelvic floor can be rehabilitated to a point where events like a UTI will not exacerbate the pain cycle. However, your question brings up an important point about what you can do to ensure that a UTI does not wreak havoc on your already impaired pelvic floor.

However, before we get into any of that, we first want to note that it’s important for you to make sure that your UTIs are culture-proven infections. The symptoms of a UTI mimic those of pelvic floor pain, and it’s never a good idea to take an unnecessary round of antibiotics, which can upset the balance of your vaginal flora making you vulnerable to a yeast infection.

Now, assuming that the UTIs are culture-proven, when you have pelvic floor problems, typically you’re going to respond more intensely to a UTI than someone who does not. Everyone with symptomatic UTIs will have some level of urinary frequency and urgency, and most likely will also have pain. What’s causing the pain is twofold: the infection itself and the tightening of the muscles when you guard against your increased level of pain.

It’s this guarding reflex that causes the exacerbated pain cycle and the interruption in your progress with PT. (But, you should know that once you’ve gotten to a specific place in your healing, your body maintains the ability to get back to that place despite setbacks.) That guarding reflex occurs both because of the increased level of pain and because of the urgency brought on by the infection and the ramped up pelvic floor muscles.

The good news is that even though the guarding is reflexive, you can control it, and reverse it by doing pelvic floor drops like the ones described in the upcoming question. So in your case, if you do get a UTI, instead of playing into it by guarding, override the reflex, and drop, drop, and drop some more.

Even if the dropping causes a spike in your pain level in the moment, at the end of the day, it’s the best way for you to avoid further tightening of your pelvic floor muscles and an exacerbation of your pelvic floor problems. It’s perhaps during the first few days of the infection that you should be the most vigilant about doing your drops. In addition, treating the pain of an infection with analgesic medication and also drinking lots of water to make your urine less acidic will also help to keep the UTI from exacerbating your current pelvic floor issues.

All the best,

Stephanie and Liz


The Tight/Weak Pelvic Floor Diagnosis Explained

Dear Liz and Stephanie,

 After my daughter was born 2 ½ years ago, I began to experience urinary frequency, retention, and occasional vaginal irritation that led to full pelvic pain down the road. Upon starting PT several months back I was told I had some muscle spasms and knots but also a very weak pelvic floor. My question is: now that my pain is subsiding, when do I begin to strengthen my pelvic floor to prevent problems from a cystocele/rectocele, and what exercises/how often is the recommendation?



Weak Diagnosis

Dear Weak Diagnosis,

The answer to your question is totally patient specific. We would not give you advice on specific exercises to do for a potentially weak pelvic unless we were to examine your pelvic floor ourselves to verify that it was indeed weak. The issue is that tight muscles physiologically cannot contract to generate strength, thereby the muscle will appear weak when PTs test for weakness or measure for weakness using a biofeedback machine.

That’s not to say that a tight pelvic floor can’t also be weak. A PT just can’t  accurately measure the strength of the pelvic floor until it’s no longer tight. If you still have a tight pelvic floor, at this point in your therapy, your PT can’t know if there is also weakness there because the tight muscles cannot contract properly to get an accurate assessment. She has to wait until your muscles are no longer hypertonic to accurately make that call.

Also, some PTs who are more experienced treating incontinence will be thrown off by the bulk of a tight pelvic floor and might wrongly misconstrue what they are feeling for some sort of prolapse. Oftentimes, once a pelvic floor has been returned to a normal tone, it won’t read as weak when a PT is strength testing it.

Another consideration is that treatment to strengthen the pelvic floor is the opposite of treatment to lengthen the pelvic floor, and it can reverse the progress of lengthening the pelvic floor causing your symptoms to re-occur. So you definitely never want to do strengthening exercises while your pelvic floor is still tight.


Stephanie and Liz


How To: Pelvic Floor Drops

Dear Stephanie and Liz,

What is the “drop position” for pelvic pain?  I have been to several pelvic pain PT and do not know what that is?


Ready to Drop

 Dear Ready to Drop,

The purpose of doing a pelvic floor drop is that it puts your body into the most relaxed state that your pelvic floor can get into. It’s also a position that facilitates the lengthening of the pelvic floor. A good way to understand how this happens is to think about what happens when you flex your biceps—your triceps have to relax, otherwise you wouldn’t be able to carry out that movement. So with a pelvic floor drop what’s happening is you’re using a contraction of antagonistic muscles (in this case your hip flexors, abductors, and external rotators, among others) to make the pelvic floor turn off.

Below are photos of a flat back drop:

Below is a photo of a squat drop:


Squat Drop versus Flat on Back Drop

The Squat Drop is actually preferable because its gravity assisted. However, not all patients can do the squat because of limitations, such as hip or sacroiliac joint problems or pudendal nerve irritation. For these patients, the flat on back drop is a great alternative. (To do the flat on back drop, simply lie on your back and pull your legs up and drop to each side with feet together.)

The other useful component of the pelvic floor drop is that for PTs it can be a first step toward treating your patients how to relax their pelvic floors. Ultimately, we want patients to be able to drop their pelvic floors without having to use the assistance of other muscles.

Below is one of our videos on Youtube about on pelvic floor drops on YouTube:


Be Well,

Stephanie and Liz


What is a Tilted Pelvis?

Dear Liz and Stephanie,

At my last PT apt., my PT said that my pelvis was tilted. What is a tilted pelvis? Can it contribute to pelvic pain? Can the pelvis be “untilted?”




Dear Tilted,

When your PT says your pelvis is “tilted” she is referring to the alignment of the joints within your pelvic girdle.

When your pelvis is tilted, or out of alignment, it means that either one of your sacroiliac joints or your pubic symphysis is out of alignment, meaning the joints are not properly connecting. “SI joint dysfunction,” with “SI” standing for “sacroiliac” is another commonly used phrase for this problem.

pelvis with ligaments

Pelvis with Ligaments

There are various ways these joints can get out of alignment. For instance, a person’s ligaments can become loose and fall out of alignment due to pregnancy or injury. For others, too tight muscles can pull the joints out of place. And others simply have naturally loose ligaments that fall out of alignment.

There are various manual techniques physical therapists use to realign these joints. PTs will also give the patient exercises to do at home to maintain the joint alignment achieved during treatment.

To answer the last part of your question, yes, a misaligned pelvis can contribute to pelvic pain. When joints are out of alignment, the surrounding muscles must compensate to maintain function, like walking and bending forward. The pelvic floor muscles can be among the muscles that overcompensate. When muscles over compensate, they usually develop impairments or dysfunction, such as becoming too tight or developing myofascial trigger points. When muscles become too tight or develop trigger points they can become painful, refer pain to other parts of the pelvis, or cause dysfunction, like urinary, bowel, and/or sexual dysfunction.


Liz and Stephanie


Trigger Point Injections Explained

 What are trigger point injections, and are they useful in conjunction with PT?


Trigger Injection Curious


Dear Trigger Injection Curious,

Trigger point injections (TPIs) are a method of treatment used to eliminate myofascial trigger points, or taut painful bands within muscles. TPIs are administered by a physician or a nurse to inject or penetrate the trigger point within the muscle. Typically an anesthetic, such as lidocaine, is used to inject into the trigger point.

However, it’s actually the introduction of the needle into the trigger point that helps to deactivate, and ultimately eliminate, the trigger point, not the medication itself. That’s why a “dry needle” or an acupuncture needle can be used just as effectively to treat trigger points.

Trigger point injections or dry needling can both help to expedite treatment when performed in conjunction with physical therapy. We would use either on a daily basis if they were more accessible.

Best to you,

Liz and Stephanie


  1. I have been diagnosed with IC for many years now and have tried almost every thing. In conjunction with IC I have vulvodynia pain and have Pudendal Neuralgia. I am presently seeing a Professor in a Pain clinic and he is suggesting a Spinal Cord Stimulation appliance of which I have researched and am doubtful of the risks and success rate. Would you please give me your opinion regarding this procedure?
    thanking you

    1. Dear Margaret,

      Thank you for your question. Before I answer your question, I want to clarify that I am not the best person to ask about a spinal cord stimulator. A pain MD will be able to give you much more information. I have very little experience with them, but I can tell you what I know and the research available. Spinal cord stimulators can be very effective for some people with chronic back pain. There is also research showing the effectiveness of stimulators with urinary dysfunction. However, there is very little research looking at the effectiveness of stimulators with chronic pelvic pain. The research that is available shows some promising results, but much more research needs to be done. Personally, I have not had a patient that had success with a stimulator, but if it were effective the person would not be seeking my help. Therefore, my perception is skewed. In general, I think stimulators should be considered only when all other conservative treatment options have been exhausted. I have never referred a patient to have a stimulator implanted, but I do think that it’s a valid treatment option for some patients. I don’t think there’s many additional risks in the procedure different from the risks associated with the surgery itself. Worst case scenario is it doesn’t reduce your pain. I would highly doubt it if it increased your symptoms. I hope this helps.

      All my best,

  2. I have had two spinal cord stimulators. I had them implanted for chronic intractable spinal pain and peripheral neuropathy. However, the appliance also helped my pelvic pain and relaxed the muscles because the pain signals were interrupted. I had a slight buzzing affect instead.

    You can have a test of the SCS. The wires are outside of your body with the paddles just under the skin. The operating device is also outside and you can adjust the strength of the signal.

    1. Thank you so much for sharing your story Ann. That is so wonderful that you have had such success with spinal cord stimulators!

  3. Hello I have been having severe pelvic pain for 2 years now. I have had experienced vaginal dryness all my life. I am 46 years old I have one child age 11. I had a c- section due too her being breech, I have also been incontinent to the point that I wear attends. I have had accidents of voiding in my sleep, adult relations are extremely painful. I’ve been to my GYN and also my Urologist and expressed my concerns. My sex life is awful I don’t enjoy it anymore due to the pain in my pelvic area. I’m constantly nauseated, my back and hips hurt like I’ve been hit by a semi. I’m awakened by the pain in my hips where I cry and need assistance to get out of bed. I also suffer from Neurofibromatious also known as NF 1 I was diagnosed in 05. My husband and I have tried everything to try to help me relax. This is ruining my life I want my adult life back it is no fun when you are in pain. The pain starts with penetration on a scale from 1- 10 it is a 30 on the rictor scale. What can I do if anything can be done at all?????? Have tried all please help

    1. Hi Cindy,

      I’m so sorry to hear about all that you are going through. I recommend that you see a good pelvic floor PT. Where are you located? Perhaps we can refer one to you in your area.

      All my best,

  4. Hi!

    I have suffered several bouts of UTI before I was told by the Uro specialist that I have developed a condition called pelvic tension myalgia.
    It seems that I am constantly squeezing and releasing my vagina opening without knowing. At this stage I am at a loss as to how that area should feel? Whenever I feel the urge to urinate I will contract my pelvic muscle until I can get to the loo. Is this normal?
    Thank You

    1. Dear Valerie,

      With an initial urinary urge you should not have to actively contract your pelvic floor muscles to prevent urine leakage. When you feel the initial urge to urinate try to relax the muscles in your vagina and around your anus. Do not contract your buttock or abdominal muscles as contracting those muscles will cause the pelvic floor muscles to contract as well. You should also practice relaxing your pelvic floor muscles at other times during the day, when you don’t have the urge to urinate. Consistently practicing relaxing your pelvic floor muscles, combined with pelvic floor physical therapy, should successfully treat pelvic tension myalgia, thereby eliminating your symptoms.

      All my best,

  5. My pelvic floor muscles are so hypertonic that I have
    increased pain and urgency when I do pelvic floor drops.
    Should I keep on practicing them? Will things get better
    in time?

    1. Dear Lisa,

      I’m sorry, but without evaluating you, I can’t recommend home exercises or give you feedback on your prognosis. My advice to you is to see a pelvic floor PT as soon as possible for an evaluation and for treatment.

      All my best,

  6. Dear Stephanie

    One of my worries is has vaginal skin been burned by metramona ovules used topically for thrush. Would this be something you could possibly evaluate with Pt. Many thanks.


    1. Dear Janet,

      I’m sorry, but I don’t understand your question. Could you provide more detail?

      Many thanks,

  7. My pelvis is tipped forward, and also tips down to the left side. An improvement in either, if not each, of these distortions would be mightily appreciated. Walking is severely restricted and painful. Any suggestions for me to try?
    Thank you,

    1. Dear Jay,

      You need to see a qualified PT, start with a pelvic floor PT, and he/she may also refer you to an orthopedic PT. Best, Liz

  8. Hi Liz,

    Thanks for answering my question. I have been treated for pelvic tension myalgia by my urologist who has some experience in treating patients with this condition. However I noticed that my vaginal/urethral still go into spasm even after treatment. She uses a Tens/probe to send electrical pulse, not sure if this is the same as E-stim.
    I also can feel this muscle lump above my public bone. I am considering of traveling to USA for treatment . I am from Singapore by the way.
    Can you provide me with more information on the treatment, cost etc?

    1. I’m from Singapore too. Did your manage to find a local PT who does internal pelvic floor work? I found one, but she has limited experience with males. Could pass you the contact if you haven’t already found one.

      I have decided to fly to seek treatment as well.

  9. I am looking for practitioners in the UK who have experience of treating
    Women with tight pelvic floor muscles.

  10. I started dating a man in his 50s while I am in my very early 30s. For the next 7 months, we lived together and had sex every day multiple times in a day. The period he was away on a trip, he called me and told me to do KEGEL exercise before he gets back and I said ok. I know he uses Viagra drugs before we always have sex, I felt bad when he kept reminding me about the kegel and even go on to ask me to insert a finger inside my vagina to feel if it grips my vagina. I felt so bad because i felt it was an insult to me. I reminded him of how he doesn’t have an erection sometimes and he said it was because he was bothered about some issues. What do you honestly think?

    1. Dear Enell,

      I’m sorry, but we cannot answer your question. I recommend that you see a sex therapist in your area.


  11. Liz,
    Hope you can help me. I suffered from a severe uti and yeast infection a year ago. Ever since I have been experiencing pain on the left side of my vulva back to the 5 o’clock area inside my vagina. It feels as though a nerve is being stretched. I am currently pregnant and had a tummy tuck two years ago. I did see a pt for pelvic pain and she said I was tight through my abs and inside I had to stop treatment due to being pregnant but my pt said that pregnancy could help. It seems a though it has worsened. Please help what should I do!? Thanks so much.

    1. Dear Sharon,

      I’m sorry to hear that your pain has worsened. If a patient has a hypertonic pelvic floor prior to pregnancy, becoming pregnant may place additional stress on the pelvic muscles, and exacerbate symptoms. This is why continuing pelvic floor therapy during pregnancy should be considered. As long as you are cleared by your OB to receive internal treatment, pelvic floor therapists can help to minimize the “stretching” feeling that you are experiencing. Additionally, a therapist can help moms to be to prepare for delivery, by addressing any other musculoskeletal issues that arise during pregnancy.

      All my best,


  12. Hello! Just researching and came across your website. I went to a urologist who claims I have a overactive pelvic floor which is causing my one symptom of a constant sensation to urinate…and when I say constant I mean constant:) I am just confused as to how something like this could really cause this sensation. I have no burning and no pain during intercourse. Please give me any information you have to support the diagnoses that my urologist made.
    I have noticed since I have had this sensation for 4 months now, I am doing a constant clenching of my pelvic floor to hold the sensation of having to pee. This is causing pains in my abdomen, ribs, and lower pelvis area. Does this sound accurate too?

    Thank you!!!!

    1. Hello Amanda,

      Physicians often use terms such as “overactive” to describe the hypertonicity, or tightness of pelvic muscles. To answer your question I will need to give you a brief anatomy lesson. The pelvic muscles are a group muscles that attach to our sacrum and pelvis; thus creating a sling which supports organs such as the bladder, uterus, and rectum. When these muscles are hypertonic, or too tight, they will produce symptoms such as pelvic pain, urinary urgency, and increased urinary frequency. A pelvic floor physical therapist addresses your pelvic muscles internally in order to release any tension, or possbile “trigger points” in your pelvic floor. Although patients may not feel any pain, certain patient behavior can contribute to further dysfunction. Straining when urinating, or clenching the pelvic floor in order to hold in urine are habits that we dont encourage! So in addition to the manual work, a pelvic floor therapist can work with you to not only address the pelvic floor muscles, but also to help eliminate any unhealthy behaviors that you may not even be aware of. I hope this explanation helps you!

      All my best,


    2. Amanda, can you update me on your progress. I am currently in the same spot you were in. I feel like I have to constantly pee, even after I just went. I’m 54 and had two foot surgeries prior to this problem, so thinking is that might have contributed to this. Tons of urological tests and now Dr sending me to PT. thanks

  13. Could you please recommend a pelvic floor therapist in my area of South Jersey. Thanks!!!

  14. Hi I’m at my wits end and really don’t know what to do or how to help myself. Since my second baby I cannot go for a poo without taking laxatives , I have a small diagsatis in my tummy and have been doing core strength ting exercises for 4 months mutu program. I have been working on my alignment also. I am not coming to the conclusion that I actually have a tight pelvic floor . I requently go for a wee cannot poo, I have pain in my right side of my hip but it doesn’t stop me doing anything. I have had no problem with doing mutu but strengthening my pelvic floor seems to have made my bowel constipation even worst. I have a really good diet I’m sure people say they do but seriously I do I have plenty of fibre and drink loads. I have roughly 4 uti this year then due to antibiotics I then get thrush. I have never had an orgasm and although I can live with that I think it is all related to a tight pelvic floor. Every time I go doctors about it they don’t listen and prescribe laxative for my bowel movements or tell me to wait until my next urine infection. Everywhere I look tells me I need to see a women health pt, but I cannot find any in the uk. Please can u help me or direct me to the right place everyday I become more stressed about it and I’m not good at relaxing anyway. I’ve tried the video on u tube and I can’t even do that. Please help

  15. Hi,

    Can you recommend a pelvic physical therapist in Chicago and Australia to treat pelvic tension myalgia?


  16. Hi,
    i have been having severe pain in my neck and shoulder for two and a half year.the pain has been so bad that i could not work or continue my studies. i took alot of different treatments from psychosomatic medicine to physiotheraphy but nothing worked…pain would reduce but very slowly and only uptp a point . now a doctor has actually identified a tilted pelvis as the cause of my neck and back pain. i saw the x ray…even i can see that it is definately titled. but i dont hav much problem of pain in my pelvis.
    so my question is can you please explain how a tilted pelvis can cause neck pain and tightening of neck muscles and if it can be cured completely. also because my sensitivity to pain is very high my doctor says he is going to use an approach that doesnt require much physical force which uses posture correction treatment and pulsed signal therapy.do you know anything about this treatment.
    thanking you

    1. Hello Esha,

      When your pelvis is out of alignment, your daily body mechanics can also be affected. Your gait may change as you walk, sitting, which muscles are working, and which not be activating can all be affect, and can causea neck and back pain as a result. We recommend that you see an orthopedic physical therapist for a second opinion.



  17. Hello, I have a query that might be TMI but I will ask here anyway, in case someone else could also benefit from the information. I had an anal intercourse in July’14 which resulted in pain in the sphincters at night and then a couple of mild bowel incontinence episodes during the day. I was back to normal by the evening. It all sorted itself out and I never had this kind of intercourse since for obvious reasons. However the incontinence happened again (very, very slight) after using transdermal Magnesium oil in November. I stopped the oil and all stopped since but I have become quite paranoid and worried. Does that mean that the sphincters are now damaged and quite lax? Will it get worse with time? Is there any chance to regain the strength and tighten them back? I can’t really do Kegel exercises because I have hypertonic muscles in the pelvis (from frequent UTI’s) and when I try Kegels the pain increases. I’ve only just managed to get to a good place with them through relaxation and pelvic muscle drop. Obviously I have both hypertonic and hypotonic muscles in my pelvis. Any advice would be great.

    1. Hello Anna,

      Thank you for sharing your situation. Alot of patients don’t realize that pelvic floor physical therapists can also help with fecal/bowel/constipation symptoms as well. Given the description of your symptoms, it seems that you do in fact present with a combination of both weak and tight muscles, but without an evaluation it is impossible to tell which muscles are not being activated, and which are overly active. I would recommend that you continue treatment with your physical therapist, or that you obtain a second opinion. Along with treatment, your pelvic floor therapist will be able to suggest diet modifications to help bulk up your stool, positioning techniques for improved bowel elimination, and other important information.



  18. Hi I am a male and hv been suffering pelvic pain for two yrs plus. Initially thought is prostatitis but all urologists say i dont hv that. Recently the pain got worse when i carry heavy weights at the gym. I feel like my butt inside is tense and painful all the time. Standing and wearing tight pants make it worse and my right foot below has a feeling of a ‘lump’ although there isnt any. Could this pain be a result of some injury to my pelvic floor muscles? Thanks!

      1. Hi Liz thanks for sharing! I m residing in Singapore and I wonder if you know of any PT that can help to address my problems? Thanks again!

        1. Hello Ken,

          We do not have therapist recommendations in your area. Are you able to travel?



          1. Hi Liz cost will be an issue for me as I believe you are in the States. May i know which area are u at anyway? Are there any clinics in NY area? I’d try to see if i know anyone staying there, thanks again!

          2. Hello Ken,

            Here are therapist recommendations for New York.

            Diana Kafka, DPT
            Beyond Basics Physical Therapy
            New York, NY

            Stacey Futterman, PT
            Five Points Physical Therapy
            New York, NY



  19. I am a 30 year old male I have had pelvic pain due to tight muscles for years it has only gotten so bad at one point I saw a urologist and went through PT however I know muscles have still been tight even after I had gotten over that. PT helped a lot but I get bad again especially under stress. I had a question on this condition can it cause the pelvis to rotate? I now have a lot of problems with one hip being a lot higher and is causing a lot of problems further down with my knees. I have looked for an answer to this but it seems I cant find it. Please Help!

    1. Hello Colin,

      I would encourage you to seek a second opinion from a different pelvic floor physical therapist. Although pelvic pain does not cause a pelvis to rotate, it can cause limitations in movement, which can then affect an individuals gait when walking, body mechanics, and posture when sitting, etc. Although these changes appear to be structural in nature, they can actuallly be treated effectively with pelvic PT. I am happy to offer you a therapist recommendation.



  20. I had a UTI 1/28/15 and prescribed cipro for 7 days by PCP. The uti didn’t clear so about 6 days later I was given Levaquin for 3 days by urgent care dr. I then had more frequency,racing thoughts, insomnia, anxiety and depression. The frequency was sometimes voiding every hr or 3 times an hour and my urine looks like water when I haven’t had anything to drink. I didn’t know what was wrong with me. Early March I saw a Urologist who gave me macrodantin to prevent another UTI. At this point I was scared to take another antibiotic and am currently on Lexapro and seeing a therapist.
    I feel that I’m constant kageling and wondering if this is where I carry my stress. Along with the tightness in pelvic region, my hip and left leg have some discomfort.
    I also had a transoptarator tap or sling surgery about 8 years ago. No problems until given Levaquin.
    Not sure if coincidental.
    I need help.
    This is weird too, sometime in February, I woke up in the middle of the night having an orgasim and pelvic floor felt tight afterwards. Recently while sitting on my hubby, fully clothed, I had an orgasam and had pelvic foot tightness afterwards. I’m afraid to have intercourse.
    The urologist says nothing is anatomically wrong with me after by scan and a culture and wants to give me over active bladder medication.
    Please help.

    1. Hello Diane,

      It’s difficult to say without first evaluating you, but it sounds like you can greatly benefit from pelvic physical therapy, if you have not already started treatment. Where are you located? I may be able to recommend a local therapist.



  21. Thanks Liz
    What are common symptoms of a tight pelvic floor?
    I see a urogynecologist mid July, what are some good questions to ask?
    I’m also hoping to see a physiotherapist or physical ASAP but not sure who to ask to refer me?
    What is the difference in therapist?
    Fresno, CA.

    1. Hello Diane,

      Unfortunately there are no local therapists for Fresno that I can recommend, but Risa MacDonald is located about 2 1/2 hours away from you. Here is her information. Also, these blogs talk more about pelvic pain, and also what a good physical therapy session is like. I wish you the best in your recovery.



      Risa MacDonald,PT
      East Sacramento Physical Therapy
      Sacramento CA
      (916) 457-8802



  22. Hello,
    Three weeks ago I had surgery for prolapse and it included a midurethral sling for SUI. Since then I have had trouble urinating and have had to use a catheter. Last week I had the sling adjusted and I am still having trouble retaining urine. The doctor says my sling was adjusted correctly and that my problem is a tight pelvic floor. I was sent home with self catheter supplies. I have no idea how to fix this problem and am devastated that something that was suppose to solve my problems created another one. I did not have this problem before the surgey.
    Do you have any thoughts on what could help? Thank you

    1. Hello Lacey,

      I would recommend that you consult a local pelvic floor therapist who can evaluate you. Where are you located? I may be able to offer a recommendation.



  23. Hi there,
    Although its slightly odd that I’m probably the only teenager commenting on this post I was wondering why I experience certain hip/pelvic “clicks” often e.g when i walk up the stairs/ get out of bed and they are mostly painless but sometimes unconfortable I don’t know how to stop them from happening. Does it sound like snapping syndrome or some kind of pelvic/ligament disorder- is it worth seeing the gp??

    1. Hello Rebecca,

      It is difficult to be sure without a full assessment, but if there is any discomfort involved it is best to consult with a local therapist for further insight/resolution.

      All my best,


  24. Hello, I have pain during intercourse. It feels like my uterus or something is hanging in my vagina and when he hits it a sharp pain shoots. It’s sore to the touch and everything but when I have paps they never mention or seem to think anything is abnormal. I never noticed this until I had my daughter a little over 2 years ago. Just wondering if you had an idea of what this could be or who I need to see to treat it?
    Thank you so much!
    – Josie

    1. Hello Josie,

      You could have a musculoskeletal impairment or a prolapse. In order to be sure you will need to consult with a local pelvic floor therapist who can evaluate you.



  25. I’m currently with my second pelvic floor therapist and my question has to do with my hips and the stretches both have me. The first one I went to gave me some stretches that worked and I almost got back to normal but I went to Disney and did 5 days worth of walking. my muscles have tightened up to the beginning again. It literally feels like my muscles have been sucked back up into my body. My current therapist is says my hips are out of ailment which I agree with her but my question is the stretches she gave me. I know my old stretches worked on helping out my pelvic floor but the made my hips worse. The stretches now help my hip but doesn’t seem to be helping my floor any. Which set of stretches would you recommend? The ones I know work but makes my hips worse or the ones who help my hips but I’m not sure it’ll help my pelvic floor muscles.

    1. Hello Ashely,

      As we are not sure what your findings are, nor what your current treatment plan entails, we highly encourage you to communicate with your therapist to troubleshoot this situation. We are also happy to recommend a therapist for a second opinion if necessary.



  26. Hi, I have had cpps for quite a long time. Through trearment allot of my syptoms have disappeared and become less intense. The worst part at the moment is my legs burn when I wear certain clothes, especially jeans. I also notice my pelvic floor tighten when this pain onsets, I am quite concerned that I might have some sort of nerve damage or somthing worse,is a burning sensation when wearing certain clothes apart of pelvic pain ? I haven’t seen many people mention it on cpps forums. From what I can tell my muscles are tight near the cocyxs, do you know what area of the pelvic floor could cause leg irritation?

    Much Thanks


    1. Hello Chris,

      Actually, discomfort while wearing clothing, certain types of clothing and material, is a common experience among many of our patients. I would highly encourage you to consult with a local pelvic floor therapist if you have not already done so.



  27. Hi. I am post menopausal and over past 2 years sex has become painful. Tried vagifem local hrt but this didn’t help. For past 18 months each episode of sex brings on UTI. Urine showed infection when tested but doctor has no solution except antibiotics. Think I have tight pelvic floor. Sounds like pelvic floor therapy might help painful sex issue but could it also help prevent UTIs? When there is infection is pelvic floor often implicated? Thanks so much. Evie.

  28. I’m a GYN RN, so I’m probably overthinking.

    In 2013 I had a sacrospinous colpopexy and hysterectomy which has ruined my quality of life since.

    I’ve had several positive diagnostic pudendal blocks, and I have a great pelvic floor PT who says she thinks my vagina is suspended from the sacrospinous ligament too tightly causing PN and pelvic floor tension.

    The surgeon is offering exploration and attempt of removal of the ribbon of mesh around the nerve, but doesn’t offer too much hope with release of scar tissue.

    I’m afraid to not try, but also afraid he will make the spasms and tension worse.

    Do you have any thoughts?

    1. Author Stephanie Prendergast says:

      I am sorry to hear of your trouble and this is always a tough decision to make. I suggest consulting with 2 – 3 professionals that can help you make your decision. Mark Conway in NH and Michael Hibner in Phoenix both specialize in this type of situation. If there is a surgically-induced entrapment it may need to be surgically revised.

  29. Just had a bad kidney infection last month. Super sick. Still having problem urinating,esp at night. Just won’t come out. Been doing kegels daily for years. Have appt w a therapist in 2 weeks. Urine starting to get smelly again and scared to get another infection. Should I wait it out ? Please advise.
    PS so thankful for site.

  30. Hi I have endometriosis. Nearly 2 years ago I had a lap where a left chocolate cyst was removed and adhelious all on left side. Have had chronic pelvic pain since which has gradually got worse and haven’t been able to work since last April. Its very dibilitating it started as extremily painful periods all pain in left groin hip thigh(which still does) and now can flare any time im too active which is not much activity! Walking and standing very limited. Can’t walk at all when at its worst. Severe pain during and after sex and any exam. Its taken over my life. After seeing several consultants they are now saying they think it’s musculoskeletal am waiting for pelvic physio to start in may. Am thinking it’s tight pelvic floor with all my symptoms including defecating / constipation problems and urinary issues. My question is can you develop tight pelvic floor after pelvic surgery? Also the last couple times I’ve had alcohol ( was only one glass of wine ) I experienced urine retention and pain after could this be related to pelvic floor ?

  31. I have had chronic yeast inf since it have had my kids. They are 16 months apart and my oldest is almost 2 and a half. My doctor had mentioned that I needed to go right to the gym so my pelvic floor didn’t drop. I was just having 2 babies so I didn’t listen. Is it possible that my pelvic floor has dropped and I now get chronic yeast inf due to not proper “drainage”

    1. Author Stephanie Prendergast says:

      This is not likely. It is possible that you have musculoskeletal impairments that are mimicking a yeast infection or if there is an actual and ongoing infection you may have systemic candida and both the vaginal and systemic problems should be treated. Please see another blog we’ve written, “Where’s the Yeast? When Pelvic Floor Dysfunction Mimics Yeast Infections”

  32. Hi, I am 54 and had bunion surgery on both feet 9/15 and 12/2015, with boot and knee scooter used. In mid Feb 2016 out of nowhere I has the sense to urinate and it never went away. I don’t have pain just this constant feeling of needing to go, sometimes mild, sometimes extremely uncomfortable. I have had exam by urogynocologist at the Cleveland Clinic, cat scan, cystoscope and all urinalysis, all were fine. He sent me to Pelvic floor therapy where my PT ( been only 2x) says she can feel my compressor urethral muscle on one side but not the other. She says she should not be able to feel it and it is tight. Working on loosing muscles by stretches, relaxation and I’m to start my own perineal stretching and trigger point release. When she does internal work, I don’t feel much pain or tenderness at all, maybe a bit tender at 3 and 9 o’clock. Does this sound like I’m on the right track, or should I be having pelvic pain and pain on internal work if it’s caused by the PF muscles? Just find it hard to believe this little muscle could cause this feeling and come from no where. I am healthy and one UTI in my lifetime 25 years ago, 2 c-sections. Wondering if being laid up and in aircast and on scooter with my foot surgeries could have triggered this. I was up and about in sneakers for about two week before this started, and I distinctly remember the feeling came on suddenly when I was walking up the stairs. Felt like a twinge on the side of my urethra and the feeling of having to go has been there most of the time for months. Every once in awhile I will catch a few hours where I feel normal then it comes back. Sorry this is so long, but it’s so frustrating . Thank you so much for your time.

    1. Author Stephanie Prendergast says:

      “It is possible that the asymmetry in your pelvis from using the the boot/scooter led into pelvic girdle muscle and pelvic floor muscle issues, or sacroiliac joint issues, that are creating a sense of constant urge. Your physical therapist should do an internal and an external examination and be able to explain to you which structures are likely causing the sensation and create a treatment plan to treat the issues.”

  33. I have a stiff lower abdominal and lower back pain when walking or lifting 30 pounds. Feel like my hips are pulled downwards like a duck.I ran almost every day without resting for one day until one day i stopped running and felt a burning sensation in the groin area. I just want to know if the pc muscles or any other muscles are tight or injured?

    What can i do to go back running and lifting heavy?

  34. I’ve had urinary urgency and frequency for a year. I’ve seen urologists and had the following procedures/tests: ultrasound scan, cystoscopy, urethral dilatation and urodynamics. I’ve been prescribed medication for overactive bladder which has had no positive impact. I was fed up and saw a urogynaecologist privately 2 days ago and on examination he commented on my tight pelvic floor muscles. He is referring me (on the NHS) for physiotherapy. I’ve now been doing lots of research and I’m convinced my hypertonic pelvic floor muscles are causing my bladder symptoms. My question is, due to long NHS waiting times I am considering seeking private therapy, can you recommend anywhere in London or the South of England? My life has been on hold for a whole year now and I am eager to start treatment!

    Thank you in advance


    1. There are also a few books with some great stretching excercises that have helped me a lot. Heal Pelvic Pain by Amy Stein and Ending Female Pain by Isa Herrera. That was my only symptom too, urinary urgency and frequency. These stretches along with doing yoga helped me a lot. I’m still doing some PT but am about 80% back to normal, thank goodness! Good luck at PT, they are amazing!

      1. Thanks for the recommendations, I feel very positive about PT. I also need to tackle my stress and anxiety because I know that doesn’t help my symptoms. I’m glad to hear you are feeling almost back to normal!

        1. I had two foot surgeries that threw of my gait, using knee
          scooters, aircast etc, but I also think stress had a lot to do with it too. Had tons of tests too, all good. Tried meds, no help because the problem wasn’t my bladder but the PFM. My husband lost his job over a year ago and still looking. I didn’t realize how much I was clenching down there and pressing my knees together when I sat and drove the car. I listen to meditation recordings on my iPad when I go to sleep. Also deep breathing while trying to release those muscles. It’s all in the books! Good luck and keep us posted how your doing. Can’t believe you have been dealing with it for a year. I was about 2 months and was going crazy before I started with some relief! You’ll be feeling better soon!! Thanks to this website to allow us to support eachother and learn!

          1. I have been more conscious of my pelvic floor since being told they are hypertonic and noticed I sit clenched up a lot, so there’s a whole lot of tension in that area. The meds haven’t worked for me either, leading me to believe that the root of my problem is muscular rather than my bladder not functioning properly. I’ve ordered the Amy Stein book you recommended, so I look forward to it arriving. I’m also going to start meditation classes, even if my symptoms don’t improve, it will surely help my overall health and wellbeing – I’m such an uptight person! Yes it’s been a very testing year – I’ve just turned 26 and in the last year I’ve been going through a rough time with these symptoms and my 8 year relationship has broken down – what doesn’t kill you makes you stronger right?! I’m sorry you had to put up with it for 2 months, that’s far too long in my opinion! I will keep you posted, hopefully I will be able to report back with success, time will tell. x

  35. I’m so glad you ordered the book. It will really help and it feels good to stretch! Sorry to hear you’re having a hard time now, you’re still very young and have lots to explore and experience. I’m a ripe old 54, but I have daughters 24 and 28. It’s not always easy out there, but there are always people that have it worse. I was very anxious most of my life and have tried to really stop being so. So you are smart to try and get ahold of it now and get it under control. Worrying never changes anything and just makes you an anxious mess. I think back on the wasted time worrying about stuff! Ugh! And usually it winds up being fine. Only so much we have control over and have to believe there is a reason why for everything! Please let me know how you get along, and hope things improve quickly! Best wishes!

  36. Dear Stephanie and Liz
    I’ve been having some problems for a while now. It used to be normal for me to wake up once a night to use the bathroom due to having to drink a glass of water for taking meds right before bed. Over the last year for some unknown reason once a night went from once an hour between 9-midnight, then to every 2 hours, and now nearly hourly. And many times, when I wake up feeling like I need to pee, nothing happens. I try to just sit and let my body relax but that doesnt change anything. I cant imagine that half a glass of water would cause all of this.

    I talked to my GP a few months back, but I’m finishing up school right now so I’m not home to work with her regularly. My school is in an isolated area and I dont have a car so I can’t really get help when I am at school. Do you have any thoughts what might be going on and what I can do on my own time to handle it?

    1. Hi Carina,

      It sounds like you may have a pelvic floor disorder. Unfortunately we cannot make specific recommendations without evaluating you. We would be happy to evaluate you in one of our locations or you can use our website to find a pelvic floor physical therapist in your area that can help.


  37. I don’t understand the problem I have. I had duplex kidney on my left side. Upper part was not functioning so I got that operated 4 years ago as I was getting pain and red colour urine and bowel problems. I was unable to hold poop for longer time and problem to pass urine . It used to take 20 seconds to make urine come out. I have visited many doctors and still I didn’t get solution to the problem. As the days passed I got epidydimitis which frequents urine. So sometimes I have to rush for urine and sometimes it doesn’t bother. Recently I got haemorrhoid type of bulge at the tip of butt hole. The bulge us increasing day by day. Now passing urine is more hard for me. I have to wait for more than a minute to make it come out. I cant hold poop at all. Please someone help me how can I get rid of these problems

    1. Hi Pavan,

      It sounds like you may have a pelvic floor disorder. Unfortunately we cannot make specific recommendations without evaluating you. We would be happy to evaluate you in one of our locations or you can use our website to find a pelvic floor physical therapist in your area that can help.


  38. Hello. I am 32, female, healthy, and have had no pregnancies. A few months ago I developed the urge to urinate way more frequently than usual, especially at night. The sensation feels intense in my urethra and more mild pressure in the bladder. It definitely feels different than a UTI and is not painful. I did get a UTI about a month ago, was treated with antibiotics and symptoms went away except this urge to constantly urinate is now worse than before. I’ve also noticed that when this feeling occurs, I am unknowingly pushing my pelvic muscles “out”. The opposite of kegels basically. My question is, could this possibly be causing or related to my symptoms? And would you recommend I start with seeing a GP, urologist, or urogynecologist? Thanks you!!

    1. Stephanie Prendergast, MPT says:

      It sounds like you may be unintentionally using you pelvic floor in a way that could be associated with your symptoms. We recommend seeing a pelvic floor physical therapist and a urologist who does urodynamic testing.

  39. I had a baby which was my third child two yrs ago. Afterwards I did wear a girdle rather tight. I’m not sure if this is the cause but I also have scoliosis. I have what feels like a knot between my left hip ,like right above it. The knot is on my nerve because I have numbness and tingling which goes from my hip down my groin. When I mess with the knot my outer thigh will feel itchy. It feels superficial but It can cause dull ache pain that can be on occasion to constant, and it can hurt more if I gain a few lbs. I had a CT done and nothing showed, a Dr. Examined me and because it’s superficial he isn’t concerned. But I’m concerned because of the dull ache pain.It feels more sore after work outs.Could it be a muscle knot from my scoliosis or a tight girdle? Is there anyone else out there that has something similar?

    1. Hello,

      It sounds like you may have a pelvic floor disorder. Unfortunately we cannot make specific recommendations without evaluating you. We would be happy to evaluate you in one of our locations or you can use our website to find a pelvic floor physical therapist in your area that can help.


  40. Hello,

    I am a 29 year old woman, living with what I have always thought to be chronic UTIs (always systematically get cystitis after intercourse). However antibiotics don’t always work to cure the flare ups. I just came across this site when googling my symptoms, which include having extreme pain in the vagina, and an impression that my flesh is “ripped” on the inside. I’ve noticed I seem to get more flare ups when stressed also (not necessarily involving intercourse), and have always suspected a psychological trigger to my problems. I live in Belgium and have never heard any of the doctors/hyena talk about pelvic pain as a potential cause to my problems. Are there any PTs in Belgium ?
    Regards and thanks
    For your help.

  41. Hi, I am have pelvic floor disfunction, My pelvic floor is too tight. My left side was affected. after orgasm or leg exercises i get spasm in pelvic and i experience urinary frequency, not fully emptying bladder, slow and thin stream and when my therapist checked my muscles it was found that my piriformis muscles are too tight and pelvic is anteriorly tilted . Can psoture and piriformis cause urinary problems along with tight pelvic?

    1. Absolutely. Hypertonic adductors, hip external rotators, abdominal muscles, and pelvic floor muscles can all contribute to the symptoms you listed, collectively and on individually on their own.

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