Bladder and bowel leakage are common, especially after pregnancy, childbirth, prostate surgery, and as we get older. However, these problems are not something you simply have to live with. Pelvic floor physical therapy is an evidence-based treatment for urinary incontinence, fecal incontinence, urinary urgency, and pelvic floor dysfunction. A pelvic floor physical therapist can identify the cause of your symptoms and create a personalized treatment plan to improve bladder and bowel control without surgery whenever possible.
What is urinary incontinence?
Urinary incontinence is the involuntary leakage of urine, also known as bladder leakage. It can range from leaking a few drops when you cough or laugh to experiencing a sudden, overwhelming urge to urinate that is difficult to control.
Millions of women and men experience urinary incontinence, but many never seek treatment because they assume it is something they simply have to live with. In many cases, conservative treatment through pelvic floor physical therapy can significantly improve or even eliminate symptoms. Pelvic floor physical therapy is recommended as a first-line treatment for many types of urinary incontinence.
What is fecal incontinence?
Fecal incontinence, sometimes called bowel leakage, is the accidental loss of stool or gas. Symptoms may occur occasionally or become more frequent over time, affecting daily activities, social interactions, and overall quality of life.
Like urinary incontinence, bowel leakage is often treatable with specialized pelvic floor rehabilitation.
What causes bladder or bowel leakage?
There are many reasons someone may experience urinary or fecal incontinence. Common causes include:
- Pregnancy and childbirth
- Pelvic floor muscle weakness
- Pelvic floor muscle overactivity or loss of coordination
- Aging
- Menopause
- Prostate surgery
- Chronic straining with bowel movements/Constipation
- Nerve injuries
- Pelvic organ prolapse
- Chronic coughing
- Obesity
- Previous pelvic or abdominal surgery
- Diabetes
Because every patient is different, identifying the underlying cause is essential to creating an effective treatment plan.
What are the different types of urinary incontinence?
There are several types of urinary incontinence, including:
Stress Incontinence
Leakage occurs during activities that increase pressure inside the abdomen, such as coughing, sneezing, laughing, exercising, lifting, or jumping.
Urge Incontinence
A sudden, intense urge to urinate followed by leakage before reaching the bathroom. This is often associated with an overactive bladder.
Mixed Incontinence
A combination of both stress and urge incontinence.
Overflow Incontinence
Overflow incontinence occurs when the bladder doesn’t empty completely. This can cause frequent dribbling or small leaks because the bladder becomes too full. This type of leakage should be evaluated by a healthcare provider to determine the cause. Depending on the cause, pelvic floor physical therapy may help improve bladder function and reduce symptoms.
A pelvic floor physical therapist can determine which type of incontinence you are experiencing and recommend the most appropriate treatment.
How can pelvic floor physical therapy help treat incontinence?
Pelvic floor physical therapy addresses many of the modifiable factors that contribute to bladder and bowel leakage, helping improve muscle function, coordination, bladder and bowel habits, and overall movement.
During your evaluation, your physical therapist will assess:
- Pelvic floor muscle function
- Bladder and bowel habits
- Core stability
- Breathing patterns
- Posture
- Hip and spine mobility
- Strength
- Functional movement patterns
- Lifestyle factors contributing to your symptoms
The goal is to improve muscle function, reduce leakage, and help you regain confidence in everyday activities.
Can pelvic floor physical therapy help after pregnancy and childbirth?
Yes. Pregnancy and childbirth place tremendous stress on the pelvic floor muscles and supporting tissues.
Many women experience urinary leakage after delivery, particularly when coughing, laughing, exercising, or lifting their baby. Others may notice bowel control changes or feelings of pelvic heaviness.
Pelvic floor physical therapy helps restore muscle strength, improve coordination, restore tissue mobility while supporting safe return to activity and exercise.
Can pelvic floor physical therapy help men?
Absolutely. Men commonly experience urinary leakage following prostate surgery, and may develop symptoms related to pelvic floor dysfunction or certain cancer treatments. Pelvic floor rehabilitation can improve muscle strength and coordination while helping men regain bladder control and return to normal activities with greater confidence.
What treatments may be included in pelvic floor physical therapy?
Every treatment plan is customized to the individual patient. Depending on your needs, treatment may include:
- Pelvic floor muscle rehabilitation
- Manual therapy
- Muscle re-education
- Bladder retraining
- Bowel retraining
- Core strengthening
- Functional movement training
- Breathing coordination
- Lifestyle and dietary education
- Home exercise programs
- Dry needling (for select muscle impairments if appropriate)
- Focused shockwave therapy (for select muscle dysfunction if appropriate)
Treatment focuses on improving how the entire body functions—not just the pelvic floor.
When should you see a pelvic floor physical therapist?
You should consider scheduling an evaluation if you experience:
- Leaking urine when coughing, sneezing, or exercising
- Frequent urges to urinate
- Difficulty reaching the bathroom in time
- Waking frequently to urinate (if bothersome)
- Accidental bowel leakage
- Difficulty controlling gas
- Leakage that interferes with work, exercise, travel, or social activities
Many people delay seeking treatment, although conservative treatment can often improve symptoms and quality of life regardless of how long symptoms have been present.
Why choose Dr. Kristina Koch for pelvic floor physical therapy?
Dr. Kristina Koch, PT, DPT, specializes in the treatment of pelvic floor dysfunction and brings nearly three decades of clinical experience to every patient she treats. In addition to her advanced pelvic health training, she has extensive orthopedic experience, allowing her to evaluate how the spine, hips, pelvis, core muscles, and pelvic floor work together.
As a faculty member and curriculum developer for the Herman & Wallace Pelvic Rehabilitation Institute, Dr. Koch remains at the forefront of evidence-based pelvic health care. Her personalized treatment approach combines manual therapy, pelvic floor rehabilitation, movement retraining, strengthening, dry needling, focused shockwave therapy, and patient education to help patients regain bladder and bowel control while improving overall function and quality of life.
Is pelvic floor physical therapy right for you?
If bladder leakage, bowel leakage, pelvic floor weakness, or urinary urgency is affecting your quality of life, pelvic floor physical therapy may help. These symptoms are common, but they are not something you have to accept as a normal part of life.
A comprehensive evaluation can identify the underlying cause of your symptoms and create a personalized treatment plan to help you reduce leakage, restore confidence, and return to the activities you enjoy.