Bladder and Bowel Control: How Pelvic Floor Physical Therapy Can Help

Incontinence affects people at every stage of life, yet many assume nothing can be done about it. That is certainly not the case. In fact, there are proven strategies that can help.

Here, Dr. Trish Strazar, doctor of Physical Therapy at Southwest General Health Center, explains how the core and pelvic floor work together to control bladder and bowel function, and how physical therapy can meaningfully improve these issues.

What Continence Really Means

Continence is simply the ability to control bowel and bladder function. When that control breaks down, whether through accidental leakage of urine, stool or gas, it's considered incontinence. “If you find yourself accidentally leaking urine or passing gas in situations that you should not be doing so, we would consider that incontinence,” explains Dr. Strazar.

The Core and Pelvic Floor: A Team Effort

The core consists of the abdominal muscles that hold the body's organs in proper “The core is the center of your universe. If you don't have good core control, nothing else that moves off the core will be working as effectively and as efficiently as it can,” cautions Dr. Strazar.

The pelvic floor sits beneath the core, forming a supportive sling around the vagina, urethra and rectum. Dr. Strazar compares it to a paper grocery bag: weak abdominal muscles let contents spill from the sides, while a weak pelvic floor lets everything fall through the bottom. Together, two muscle groups tighten automatically during activities like coughing or lifting, preventing involuntary leakage and relax to allow normal bathroom function.

What Weakens These Muscles

Pregnancy and childbirth are the most common causes of pelvic floor dysfunction in women. A growing baby puts sustained pressure on the bladder and bowels, and vaginal delivery can traumatize the pelvic floor muscles directly. Even cesarean delivery, which involves cutting through the abdominal wall, can disrupt the core's supportive function.

In men, prostate issues, particularly prostatectomy, often lead to sudden incontinence, since men rarely need to consciously engage these muscles beforehand. Menopause also plays a role, as hormonal changes reduce muscle firmness over time.

Neuromuscular conditions like multiple sclerosis and ALS can disrupt the nerve signals needed for muscle control. And surprisingly, athletes—including runners and young weightlifters—frequently experience incontinence when core and pelvic floor strength don't keep pace with physical demands.

What to Expect From Pelvic Floor Physical Therapy

Physical therapists today complete doctoral-level training, equipping them to diagnose and treat the specific nerves, muscles and joints involved in incontinence. A first visit typically begins with a detailed conversation about symptoms and history, along with an assessment of the spine and hips, since many issues originate outside the pelvic floor itself. Internal evaluation, when needed, usually happens on a later visit. “It's a muscle just like any other joint of the body,” Dr. Strazar notes. “It just happens to be in an area that for many people is a private area.”

Biofeedback is one particularly effective tool, using electrodes to show patients in real time how their pelvic floor muscles are functioning. Treatment is always individualized. Sometimes the issue is weakness; other times, surprisingly, the muscles are too tight to contract further, and relaxation techniques become the focus.

Incontinence Is Not Just a Normal Part of Aging

Dr. Strazar wants people to understand one thing above all. “Incontinence really isn't a normal part of aging. It is very treatable,” she assures. She also notes that incontinence is a leading reason older adults end up in institutional care, making pelvic floor health a meaningful investment at every life stage.

To request an appointment or learn more, visit swgeneral.com.