What If Your Pelvic Floor Isn’t Weak — It’s Just Never Learned to Relax?

A Q&A with a friend of mine and Pelvic Floor expert Dr. Allison Oswald, PT, DPT, WCS, on the most commonly missed diagnosis in women’s health.

If you’ve noticed a little leaking when you sneeze, run, or laugh too hard — or a new sense of pressure or urgency you can’t quite explain — you’ve probably been told it’s just part of getting older, or part of having had kids, or part of menopause. You’ve probably also been told to do more Kegels.

I sat down with a friend Dr. Allison Oswald, PT, DPT, WCS — a doctor of physical therapy and board-certified Pelvic Floor Specialist — to get the real story. Her answers line up with everything I teach (and more) inside the 5 Foundations and: your hormones, your nervous system, and your body’s structure are not separate stories. They’re one story, and the pelvic floor is one of the clearest places that shows up in midlife.

Q: What are the most common questions you get from clients about the pelvic floor?

The questions I hear most often are, “Is it normal to leak when I exercise?” and “Am I doing Kegels correctly?” Many women are surprised to learn that symptoms like leaking, urgency, pain, or pelvic pressure aren’t just things they have to put up with. A lot of my work involves helping women understand what’s happening in their bodies and reassuring them that there are often effective treatment options available.

Q: What are the biggest misconceptions women bring to you about pelvic floor health?

One of the biggest misconceptions is that pelvic floor issues are just a normal part of being a woman, especially after having children or during menopause. While these symptoms are common, they’re not something you simply have to accept. Another misconception is that a weak pelvic floor is always the problem. In reality, the pelvic floor can also be overly tense, uncoordinated, or not working well with the rest of the body.

Q: Are there conditions that consistently go undiagnosed for too long?

One condition that often goes undiagnosed for too long is pelvic floor tension or overactivity. Many women assume their symptoms are caused by weakness and spend months or even years doing strengthening exercises when what they actually need is relaxation, coordination, and improved movement patterns.

Q: High-impact training — running, jumping, heavy lifting — gets a lot of bad press for pelvic floors. What’s your take?

I don’t think high-impact exercise is the enemy. Our bodies are incredibly adaptable, and many women can run, lift heavy weights, and jump without pelvic floor problems. The key is making sure the pelvic floor has the strength, coordination, and support it needs to handle those demands. Symptoms like leaking or heaviness during exercise are valuable information, not a sign that you need to stop but perhaps make some adjustments. Often, they simply mean we need to shift some training, build capacity, or address underlying issues.

“I always emphasize the importance of listening to your body — it’s always communicating with you.”

Q: There’s a common belief that Kegel exercises fix everything — what’s the reality from a clinical perspective?

Kegels might be helpful for some women, but they’re not a universal solution. Pelvic floor health is about much more than squeezing muscles. Just like any other muscle group, the pelvic floor needs strength, relaxation, coordination, endurance, and the ability to respond to different demands. For some women, Kegels can be part of the solution. For others, they may actually make symptoms worse if tension is already part of the problem.

Q: What is your experience working with women going through perimenopause, and how does it affect the pelvic floor?

Perimenopause is a significant transition, and I work with many women navigating changes during this stage of life. Hormonal shifts can affect tissue quality, muscle function, bladder symptoms, and pelvic floor support. Some women notice increased urgency, leaking, vaginal dryness, or a feeling of heaviness that wasn’t there before. Understanding these changes can be incredibly empowering because it helps women realize they’re not imagining things and that support is available so they don’t have to simply accept these symptoms as part of aging.

Q: Does pelvic floor work become a bigger priority as women move through perimenopause?

During perimenopause, maintaining strength, muscle mass, bone health, and overall fitness is incredibly important. I focus on helping women continue doing the activities they enjoy while supporting recovery, managing symptoms, and ensuring the pelvic floor is working well within the whole system. It’s less about doing endless pelvic floor exercises and more about building a resilient body that can adapt to the changes happening during this stage of life.

Q: Is it ever too late to start pelvic floor physiotherapy — can women in their 60s or 70s still see real results?

Absolutely not. I’ve worked with women in their 60s, 70s, and beyond who have made meaningful improvements in bladder control, pelvic pain, confidence, and quality of life. Like any area of the body, the pelvic floor can respond to training and rehabilitation at any age. It’s never too late to learn more about your body and make positive changes.

Q: If you could put one message about pelvic floor health on a billboard, what would it say?

“Common doesn’t mean normal and you don’t have to live with it.”

So many women assume their symptoms are just part of life, when in reality there are often solutions available.

Q: What do you wish more women knew about their pelvic floor — that nobody is talking about?

I wish more women knew that the pelvic floor doesn’t work in isolation. It’s part of a larger system that includes breathing, movement, strength, stress levels, sleep, hormones, and overall health. We often reduce pelvic floor health to Kegels, but it’s really about how the whole body functions together. The conversation is becoming more open, but there’s still so much room for women to understand that pelvic floor health is an important part of lifelong health, not just something to think about after having babies.

If pelvic floor symptoms, hormonal shifts, or other changes in your body during perimenopause have left you feeling like you’re just supposed to push through, you don’t have to figure it out alone. This is exactly the kind of thing the 5 Foundations was built to address.

To connect with Dr. Allison Oswald, visit allisonoswald.com.