It Started With Leaking... But That Wasn’t the Whole Story

Why painful sex, constipation, and bladder leaks are all connected—and what you can do about it.

When most people walk through our doors at Trailhead Physical Therapy & Wellness, they’re usually coming in for one of the more socially acceptable pelvic floor issues—like leaking urine when they sneeze, run, or laugh. It’s frustrating, maybe embarrassing, and definitely not something they want to live with. So they finally book the appointment.

But here’s what we see all the time: After that first visit—or maybe the second or third—someone will pause and say something like:

“Actually, I’ve also had pain with sex for years.” “I didn’t know this could help with constipation too.” “I always thought it was just stress. Or normal after having kids.”

And suddenly the picture starts to come into focus.

Your pelvic floor is involved in so much more than just bladder control.

The pelvic floor isn’t just a group of muscles at the bottom of your pelvis—it’s a central hub that connects to your core, spine, hips, breath, nervous system, and even your emotional regulation. It’s deeply connected to how we move, how we hold tension, how we protect ourselves, and how we feel safe in our own skin.

When something is off—like leaking—it’s often just the tip of the iceberg. Under the surface, we might find:

• Chronic pelvic tension or overactivity

• Scar tissue from childbirth or surgery

• Nervous system dysregulation

• Gut issues like bloating or constipation

• Pain with sex or internal exams

• Fear, shame, or disconnection from the body

None of these things exist in a vacuum. They’re often intertwined—and that’s why we take a whole-person, whole-story approach to care.

The connection between leaking, pain with sex, and constipation

Let’s break it down.

➡️ Leaking (incontinence)Often blamed on “weak” pelvic floor muscles—but for many people, the issue is actually tight or overactive muscles that can’t function properly.

➡️ Painful sex (dyspareunia)If your pelvic floor is holding chronic tension or guarding (often from trauma, stress, or a difficult birth), penetration can feel sharp, burning, or just wrong. It’s not in your head. And it’s not something you need to push through.

➡️ Constipation A tight pelvic floor can make it difficult for your muscles to fully relax to allow for complete bowel movements. Add in gut tension, bracing habits, and fear of pain, and your body stays in a loop of dysfunction.

These aren’t separate problems. They’re different expressions of the same root imbalance in your pelvic health. And treating them means addressing the whole system—not just the symptom you came in for.

So what does treatment actually look like?

At Trailhead, we don’t believe in one-size-fits-all care or rushed appointments that miss the bigger picture.

Instead, we start with a detailed conversation and physical evaluation that looks at:

• How your pelvic floor is functioning (both strength and coordination)

• Posture, breath mechanics, and core control

• Scar mobility and tissue health

• Nervous system tone and stress response

• Your story—birth, medical history, pain experiences, and what you’ve been told about your body

From there, we create a personalized plan that may include:

• Hands-on release work to reduce tension

• Exercises that restore coordination and control

• Gentle strategies for bowel retraining and constipation

• Techniques to reduce pain and build comfort with intimacy

• Mind-body tools to help regulate and reconnect to your body

  
  

This is not just about pelvic floor “exercises.” It’s about healing, connection, and freedom.

So if you’ve been dealing with leaks, or painful sex, or constipation—or maybe all three—it’s not a coincidence. And it’s not something you have to silently live with.

You deserve care that honors your story, respects your boundaries, and helps you feel at home in your body again.

Let’s figure out what’s really going on and create a plan that fits your life—not just a checklist of symptoms. Let’s take the first step together.