A PHYSIOTHERAPIST’S GUIDE TO TRAINING WITH CONFIDENCE

Many active women assume pelvic floor issues only happen after childbirth or later in life. But in clinical practice, we see runners, lifters, athletes and highly active women experiencing pelvic symptoms across all life stages. If you have ever noticed leakage during training, heaviness after workouts, or persistent hip or back pain, your pelvic floor may be asking for support. Pelvic health is not about stopping exercise. It is about training with better strategy, awareness and long-term resilience.

WHAT ARE THE PELVIC FLOOR MUSCLES?

The pelvic floor muscles form a supportive sling at the base of the pelvis. They help with:

• Bladder and bowel control
• Pelvic organ support
• Core stability
• Breathing pressure regulation
• Sexual function
• Movement efficiency in sport

They work closely with the diaphragm, deep abdominal muscles, hips and spine. When this system is coordinated, movement feels strong and controlled. When it is not, symptoms can develop.

WHY PELVIC FLOOR ISSUES OCCUR IN ACTIVE WOMEN

Pelvic floor dysfunction is influenced by multiple factors, not just pregnancy and childbirth. Common contributors include:

• High-impact exercise such as running
• Heavy lifting with poor pressure management
• Breath holding during effort
• Hormonal changes (postpartum or menopause)
• Chronic constipation
• Low energy availability in athletes
• Stress and poor recovery
• Previous injuries
• Genetics

Understanding these factors allows women to continue training while reducing risk.

SIGNS OF PELVIC FLOOR DYSFUNCTION DURING EXERCISE

Active women often normalise symptoms, especially if they appear only during training. However, early signs should not be ignored.

RUNNING-RELATED SYMPTOMS:

• Urinary leakage
• Urgency during runs
• Pelvic heaviness or dragging sensation
• Symptoms worsening with fatigue or distance

LIFTING-RELATED SYMPTOMS:

• Vaginal pressure or bulging sensation
• Leakage during heavy lifts
• Pelvic or tailbone pain

GENERAL PELVIC HEALTH SYMPTOMS:

• Pain with intercourse
• Persistent hip or lower back pain
• Feeling of incomplete bladder or bowel emptying
• Increased symptoms postpartum or during menopause

These symptoms are treatable and often improve with targeted rehabilitation.

HOW BREATH MECHANICS AFFECT PELVIC FLOOR HEALTH

Breath holding during exercise increases intra-abdominal pressure. In movements such as squats, deadlifts and high-intensity training, poor pressure control may contribute to:

• Leakage
• Prolapse symptoms
• Pelvic pain
• Reduced performance efficiency

Learning coordinated breathing and bracing strategies can significantly improve both symptoms and strength outcomes.

RUNNING AND PELVIC FLOOR HEALTH

Running itself does not damage the pelvic floor. However, high-impact loading requires:

• Adequate hip and core strength
• Shock absorption capacity
• Proper load progression
• Sufficient recovery and nutrition

Symptoms often appear when training loads increase too quickly or when fatigue accumulates. With appropriate management, most women can continue running safely.

STRENGTH TRAINING, LIFTING AND PROLAPSE

Many women are advised to stop lifting when pelvic symptoms arise. In reality, strength training can support pelvic health when:

• Technique is optimised
• Breath strategies are retrained
• Hip strength is improved
• Load progression is gradual
• Whole-body coordination is addressed

The pelvic floor is designed to handle load. Rehabilitation focuses on restoring its capacity.

THE ROLE OF RECOVERY IN PELVIC FLOOR FUNCTION

Active women frequently prioritise training intensity over recovery. However, pelvic floor function is influenced by:

• Sleep quality
• Stress levels
• Hormonal balance
• Nutritional intake
• Hydration
• Periodisation of training

Overtraining may contribute to increased pelvic symptoms.

WHAT ACTIVE WOMEN CAN START DOING TODAY

Simple changes can improve pelvic health:

• Exhale during effort
• Strengthen hips and glutes alongside core training
• Avoid frequent “just in case” toileting
• Optimise bowel habits and hydration
• Ensure adequate energy intake for training
• Include rest days and de-load periods
• Address persistent symptoms early

WHEN TO SEE A PELVIC HEALTH PHYSIOTHERAPIST

Seek professional assessment if you experience:

• Leakage during exercise
• Vaginal heaviness or bulging
• Persistent pelvic, hip or tailbone pain
• Difficulty returning to sport postpartum
• Symptoms worsening with training
• Ongoing sexual pain

Early management improves long-term outcomes and supports continued participation in sport.

PELVIC HEALTH PHYSIOTHERAPY AT ACTIVE PELVIC HEALTH, MELBOURNE

At Active Pelvic Health in Spotswood, we follow a structured rehabilitation framework:

SURVIVE

Reduce symptoms and improve daily comfort

PERFORM

Restore strength, coordination and exercise confidence

THRIVE

Support long-term performance and active lifestyle goals

Pelvic health care should empower women to remain active, not limit their potential.

FINAL TAKEAWAY

Pelvic floor symptoms are common in active women, but they are not normal. With the right guidance, most women can continue running, lifting and training with confidence. Awareness leads to action. Action leads to strength. Strength supports longevity in movement.