Trouble Emptying Your Bladder or Bowels? There's Pelvic Floor Therapy for Bladder and Bowel Problems!
Updated: Oct 26
Do you ever sit on the toilet waiting for your pee to start? Feel like you need to push or strain to have a bowel movement? Or finish going to the bathroom only to feel like there's still more left?
These symptoms can be frustrating, uncomfortable, and sometimes embarrassing to talk about. But they're also more common than you might think, and your pelvic floor muscles could be playing a role.
Many people associate pelvic floor physical therapy with leaking urine, pregnancy, or postpartum recovery. But the pelvic floor is just as important for emptying your bladder and bowels as it is for preventing leaks.
At Sage Physical Therapy in Denver, Colorado, our pelvic floor physical therapists help people experiencing urinary hesitancy, incomplete bladder emptying, chronic constipation, difficulty with bowel movements, and other symptoms related to pelvic floor dysfunction.
Let's talk about what's happening, why it happens, and how pelvic floor therapy for bladder and bowel problems may help.
Your Pelvic Floor Does More Than Hold Things In
Your pelvic floor is a group of muscles that sits at the bottom of your pelvis, supporting your bladder, rectum, and other pelvic organs. Think of these muscles as a hammock that can contract, relax, and coordinate with the rest of your body.
When you're holding your urine or stool, your pelvic floor muscles help maintain continence. But when it's time to use the bathroom, those same muscles need to relax and lengthen appropriately so your bladder or bowels can empty.
Here's the important part: A healthy pelvic floor isn't just a strong pelvic floor. It's one that knows when to contract and when to let go.
If your pelvic floor muscles are overly tense, have difficulty relaxing, or aren't coordinating properly, going to the bathroom can become surprisingly difficult. And doing more Kegels isn't necessarily the answer. In fact, strengthening an already overactive pelvic floor without addressing relaxation may make certain symptoms worse.
Why Do I Have Trouble Emptying My Bladder?
Difficulty urinating can show up in several ways. You might notice:
Urinary hesitancy: Sitting on the toilet waiting for your urine stream to start.
Incomplete bladder emptying: Feeling like there's still urine left after you've finished.
Weak or slow urine stream: Your urine comes out slowly or without much force.
Intermittent urine stream: Your urine starts and stops instead of flowing continuously.
Straining to urinate: Feeling like you need to push with your abdominal muscles to empty your bladder.
Double voiding: Needing to urinate again shortly after you've just gone.
There are several possible reasons for these symptoms, including urinary tract infections, certain medications, prostate conditions, urethral narrowing, bladder muscle dysfunction, neurologic conditions, and pelvic floor dysfunction.
How Can Tight Pelvic Floor Muscles Affect Urination?
When you urinate, your bladder muscle contracts while your urinary sphincter and pelvic floor muscles relax. If your pelvic floor doesn't relax appropriately, it can create resistance around the urethra, making it harder for urine to flow freely.
Imagine trying to squeeze water through a hose while someone is partially pinching the end. Even if the water pressure is adequate, the restriction makes flow more difficult. A similar coordination problem can happen between your bladder and pelvic floor.
This is sometimes associated with non-relaxing pelvic floor dysfunction, also called an overactive or hypertonic pelvic floor.
However, these symptoms don't automatically mean your pelvic floor is tight. A medical evaluation may be necessary to rule out other causes and determine whether your bladder is actually retaining urine.
Why Do I Have Trouble Emptying My Bowels?
If you've ever felt like you're pushing and pushing but nothing is happening, your pelvic floor may be part of the problem.
Common symptoms include:
Straining excessively during bowel movements
Feeling like stool is stuck or won't come out
Having bowel movements that feel incomplete
Spending a long time sitting on the toilet
Needing to change positions to pass stool
Feeling pressure or discomfort in your rectum
Using your fingers or hands to assist with bowel movements
Experiencing constipation even when your stool is soft
Constipation can have many causes, including diet, medications, slow movement of stool through the colon, and certain medical conditions.
But sometimes the issue isn't getting stool to the rectum. It's getting stool out.
What Is Pelvic Floor Dyssynergia?
One possible cause of difficulty with bowel movements is pelvic floor dyssynergia, sometimes called dyssynergic defecation. Normally, when you have a bowel movement, your abdominal muscles generate pressure while your pelvic floor muscles and anal sphincter relax to allow stool to pass.
With pelvic floor dyssynergia, those muscles don't coordinate appropriately. Instead of relaxing, the pelvic floor or anal sphincter may contract, fail to relax enough, or work against the pressure you're generating. The result? You're pushing, but the muscles responsible for allowing stool to pass aren't cooperating. This can contribute to chronic constipation, excessive straining, and the sensation of incomplete bowel emptying.
Importantly, dyssynergic defecation is a specific condition that may require testing, such as anorectal manometry and balloon expulsion testing, to diagnose.
The good news is that pelvic floor retraining is an evidence-supported treatment for dyssynergic defecation.
Can You Have a Tight Pelvic Floor Without Pelvic Pain?
Absolutely.
One of the biggest misconceptions about pelvic floor dysfunction is that it always causes pain.
While some people experience pelvic pain, painful intercourse, tailbone pain, or discomfort with sitting, others have primarily bladder or bowel symptoms.
You might have no pain whatsoever but still struggle to start urinating or pass a bowel movement.
That's because pelvic floor dysfunction isn't always about pain or muscle weakness. Sometimes it's about coordination, relaxation, and learning how to use your muscles effectively. This is why a thorough pelvic floor assessment can be helpful, even if you've never experienced pelvic pain.
How Does Pelvic Floor Physical Therapy Help With Bladder and Bowel Emptying?
Pelvic floor physical therapy addresses the muscular and movement-related factors that may be contributing to difficulty emptying your bladder or bowels.
At Sage Physical Therapy in Denver, we take an individualized approach to understanding why you're experiencing these symptoms.
Here's what treatment may involve.
1. Learning How to Relax Your Pelvic Floor
If your pelvic floor muscles are overly active or have difficulty letting go, your physical therapist may teach you techniques to improve relaxation. This might include diaphragmatic breathing, pelvic floor lengthening exercises, gentle mobility work, or relaxation strategies.
The goal isn't simply to stretch your muscles. It's to improve your awareness and control so you can appropriately relax your pelvic floor when using the bathroom.
2. Improving Pelvic Floor Coordination
Sometimes your muscles have adequate strength and flexibility but aren't working together at the right time. Your pelvic floor PT can help you practice coordinating your breathing, abdominal pressure, and pelvic floor relaxation. For bowel movements, this may involve learning how to generate appropriate abdominal pressure without simultaneously tightening your anal sphincter. For urination, treatment may focus on reducing unnecessary pelvic floor tension and allowing the bladder to empty without straining.
3. Addressing Muscle Tension and Mobility
Your pelvic floor doesn't work in isolation. The muscles of your hips, abdomen, diaphragm, and pelvis all contribute to movement, breathing, and pressure management. Depending on your assessment, your physical therapist may use manual therapy, mobility exercises, or other techniques to address restrictions that could be contributing to your symptoms. Internal pelvic floor assessment or treatment may be offered when appropriate, but it's always based on your symptoms, clinical needs, and informed consent.
4. Teaching Better Bathroom Habits
Believe it or not, how you sit on the toilet can make a difference.
Your PT may recommend:
Using a footstool to elevate your knees during bowel movements
Leaning slightly forward and relaxing your abdomen
Practicing breathing techniques rather than holding your breath and straining
Avoiding prolonged toilet sitting
Developing consistent bowel habits
Adjusting bathroom routines to reduce unnecessary pushing
Small changes in positioning and coordination can make bowel movements easier for some people.
5. Biofeedback and Muscle Retraining
Biofeedback is another treatment approach that can help people better understand and coordinate their pelvic floor muscles. Depending on the equipment and clinical situation, biofeedback may use sensors to provide information about muscle activity or pressure during simulated bowel movements. For patients with confirmed dyssynergic defecation, specialized biofeedback training has particularly strong evidence.
Your physical therapist can help determine whether biofeedback or additional evaluation by a gastroenterologist or other specialist would be appropriate.
Should I Do Kegels If I Have Trouble Emptying My Bladder or Bowels?
Not necessarily!
Kegels are pelvic floor contractions designed to improve muscle strength and control. They're useful for certain conditions, but they're not the universal solution to pelvic floor problems.
If you're having difficulty emptying because your pelvic floor muscles aren't relaxing, repeatedly contracting those muscles may not address the underlying issue.
Sometimes your pelvic floor needs to learn how to relax before strengthening exercises are appropriate.
That's why we don't believe in giving everyone the same pelvic floor exercise program.
At Sage Physical Therapy, we assess your specific muscle function, symptoms, and goals before determining which exercises make sense for you.
When Should You See a Pelvic Floor Physical Therapist?
Consider seeking an evaluation if you regularly experience difficulty starting urination, straining to have bowel movements, a sensation of incomplete emptying, or constipation that hasn't improved with typical strategies.
You don't need to wait until your symptoms become severe or significantly interfere with your daily life.
However, pelvic floor PT isn't a replacement for medical evaluation. New or persistent urinary symptoms should be assessed for causes such as infection, obstruction, or urinary retention. Chronic constipation may also warrant medical or gastrointestinal evaluation.
Seek urgent medical attention if you're suddenly unable to urinate, particularly with a painful or swollen lower abdomen. New bowel or bladder dysfunction accompanied by saddle numbness, new leg weakness, or severe back pain also requires emergency assessment.
Blood in your urine or stool, unexplained weight loss, or other concerning changes should be discussed promptly with a medical professional.
What to Expect at Your First Pelvic Floor PT Appointment at Sage
We know that discussing bathroom habits can feel personal. But for our pelvic floor physical therapists, these conversations are an everyday part of what we do.
At your initial evaluation, we'll talk through your symptoms, medical history, bathroom routines, and goals. We'll assess relevant factors such as breathing mechanics, abdominal coordination, mobility, and pelvic floor muscle function. An internal pelvic floor examination may be discussed when clinically appropriate, but it's never required without your consent. From there, we'll develop an individualized treatment plan and coordinate with your medical providers when needed.
Our appointments are 55 minutes of one-on-one care with a Doctor of Physical Therapy, giving us time to understand your symptoms, answer questions, and work toward meaningful improvement.
Frequently Asked Questions About Pelvic Floor Therapy for Bladder and Bowel Problems
Can pelvic floor therapy help me pee more easily?
Yes, when difficulty urinating is related to pelvic floor muscle tension or poor coordination, physical therapy may help improve relaxation and urinary function. However, it's important to rule out other causes of urinary hesitancy or retention.
Can pelvic floor physical therapy help chronic constipation?
Yes, particularly when constipation involves difficulty coordinating the muscles responsible for bowel movements. Pelvic floor retraining and specialized biofeedback are established treatment approaches for dyssynergic defecation. Other types of constipation may require different treatments.
Why do I feel like I still have to poop after a bowel movement?
This sensation can occur with incomplete evacuation, pelvic floor dyssynergia, constipation, rectal conditions, or other gastrointestinal issues. A pelvic floor assessment and, when appropriate, medical testing can help identify contributing factors.
Can men benefit from pelvic floor therapy for urinary or bowel problems?
Absolutely. Pelvic floor dysfunction affects people of all genders. Men can experience urinary hesitancy, incomplete emptying, constipation, and pelvic floor muscle tension, and may benefit from pelvic floor physical therapy.
Do I need a pelvic floor examination to start treatment?
Not necessarily. An internal examination can provide useful information, but treatment can also begin with education, breathing techniques, movement assessment, and external muscle coordination exercises. Your comfort and consent always guide the process.
Pelvic Floor Physical Therapy for Bladder and Bowel Emptying in Denver, Colorado
Struggling to empty your bladder or bowels isn't something you have to simply accept as normal.
Whether you're dealing with urinary hesitancy, incomplete bladder emptying, chronic constipation, or difficulty coordinating your pelvic floor muscles, understanding the underlying cause is the first step toward finding relief.
At Sage Physical Therapy in Denver's Platt Park neighborhood, our team specializes in pelvic floor physical therapy for adults of all genders. We help patients from Wash Park, South Denver, and surrounding communities address pelvic floor dysfunction with individualized, evidence-informed care.
Ready to get to the bottom of your bladder or bowel symptoms?
Contact Sage Physical Therapy to schedule a pelvic floor evaluation and find out whether pelvic floor PT could be the missing piece in your care.
