Pelvic Floor Physical Therapy for Bladder Dysfunction in San Francisco, CA

The urinary function would be impossible without the pelvic floor muscles. Muscles within the pelvic floor typically assist in supporting the bladder, maintaining continence, give control over the release of urine, and for the most part, let us give little thought to the function. When a dysfunction appears within the pelvic floor muscles, it may turn your bladder into an issue. Bladder dysfunction symptoms add a nuisance to our lives, removing control over urination. Bladder symptoms may be normal, but you are not without a solution. Pelvic floor physical therapy can help.


Normal Bladder Function

  • Normal urination frequency is six to eight times in 24 hours
  • Leaking urine is never normal
  • Bladder urge should not feel like a five-alarm fire
  • Normal voiding time is roughly 20 seconds
  • Starting the urinary stream should be easy and quick
  • Bladder urgency should go away after voiding
  • Increasing our fluid intake should increase the amount we urinate, not the frequency
  • Normal bladder capacity is 300 – 600ml
  • People under 60 years old may wake once per night to urinate, over 60 years old twice per night
  • Pain before, during, or after urinating is never normal


  • Stress incontinence (leaking urine when coughing, laughing, sneezing, and/or during exercise)
  • Urge incontinence ( leaking on the way or before you get to the bathroom)
  • Mixed Incontinence (both stress and urge incontinence)
  • Pain or burning in the bladder and/or urethra before, during or after urinating
  • Urinary urgency without a full bladder
  • Urinary frequency without a full bladder
  • Urinary hesitancy, slow or deviated urine stream
  • Urinary urgency during sexual activity
  • Urinary urgency/frequency after sexual activity or exercise
  • Urethra or bladder pain
  • Climacturia (leaking urine with orgasm)
urinary symtoms of pelvic floor dsfunction

Associated Diagnoses

Bladder symptoms are commonly associated with pelvic floor dysfunction and other diagnoses. Syndromes such as Endometriosis, Vulvodynia, Interstitial Cystitis/Painful Bladder Syndrome, Pudendal Neuralgia, Chronic Pelvic Pain Syndrome/Male Pelvic Pain, post-prostatectomy complications, the Genitourinary Syndrome of Menopause, and postpartum women often have bladder issues.

pelvic floor pain
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Cause of bladder dysfunction

  • Repetitive urinary tract and yeast infections
  • Hormonal suppressive medications such as oral contraceptives, GnRH agonists (i.e. Lupron), acne medications
  • Childbirth, breastfeeding, and menopause
  • Surgical trauma
  • Orthopedic injuries or traumas
  • Biomechanical or structural dysfunction (hip dysfunction, sacro-iliac joint dysfunction, piriformis syndrome, scoliosis, leg length discrepancy)
  • Pelvic floor dysfunction
  • Pelvic organ prolapse
  • Constipation and gastrointestinal distress/bloating

Diagnostic Challenges

Pelvic floor dysfunction can mimic the feelings of sexually transmitted infections and prostate and/or urinary tract and bladder infections which can lead to diagnostic confusion. It is common for people to feel certain they have an infection and then feel perplexed when the tests return normal. Because bladder dysfunction has been normalized for women to such an extent, they usually do not seek help. Often, women hear that these problems are due to giving birth recently or that it’s normal as they get older. Many men undergoing prostatectomy are not warned that up to 80% of men have post-surgical urinary incontinence. Regardless of your situation and underlying causes, an evaluation with a pelvic floor physical therapist is beneficial.

How We Can Help You

If you are experiencing bladder dysfunction you will benefit from an evaluation with a pelvic floor physical therapist to determine the role pelvic floor dysfunction may be playing in your symptoms. Bladder dysfunction can be associated with pelvic floor muscles that are too tight, and/or too weak, or they may be uncoordinated and do not function properly. It is important to understand that historically people were told to ‘do your kegels’ for bladder health. If your pelvic floor muscles are too tight, kegel exercises may actually make your symptoms worse, which is why we advise working with a pelvic floor physical therapist to ensure proper rehabilitation. The pelvic floor muscles may need to be lengthened before they are strengthened. During the evaluation, the physical therapist reviews your history and symptoms with you, what you have been diagnosed with in the past, the treatments you have undergone, and how effective or not effective these treatments have been. Importantly, we understand what you have been going through and that most people are frustrated by the time they get to see us.

During the physical examination, the physical therapist examines muscles, tissues, joints, nerves, and movement patterns. Once the examination is complete your therapist reviews your findings with you. The physical therapist creates an assessment that explains how you developed your symptoms and creates short and long-term goals for your treatment plan. Typically, the frequency of physical therapy treatment is one to two times per week for roughly 12 weeks. You are given a home exercise program to complement your in-person sessions, and your physical therapist will help to coordinate your recovery with the other members of your treatment team. We are here to help you recover and live your best life!

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