You're a few miles into a run on the Stowe Rec Path, or halfway through a set of deadlifts, or climbing out of the saddle on the road toward Smugglers' Notch, and something in your pelvis aches, burns, or feels heavy. You tell yourself it's nothing, that you probably just need to warm up better or push through it. Many active people do exactly that for months, even years, because pelvic pain during exercise is rarely talked about and easy to dismiss as a normal part of training or getting older.
At Summit Physical Therapy & Performance, we work with runners, lifters, cyclists, skiers, and active adults across the Stowe area, and we see how often pelvic pain gets quietly worked around instead of addressed. This guide explains why pelvic pain shows up during activity, the symptoms worth paying attention to, the warning signs that call for medical care right away, and when physical therapy can help.
Why Pelvic Pain Shows Up During Activity
The Pelvic Floor and Movement
The pelvic floor is a group of muscles that spans the base of the pelvis, supporting the bladder, bowel, and reproductive organs while working together with your deep abdominal muscles, diaphragm, and hips to stabilize your trunk. Every time you run, jump, lift, or brace for a hard effort, these muscles are working behind the scenes, absorbing force and helping transfer power between your upper and lower body. When the system works well, you never think about it. When it doesn't, pain and other symptoms can show up in surprising places.
When the System Gets Overloaded
Pelvic pain during activity usually develops when the pelvic floor and the muscles around it aren't sharing the load well. Some people carry too much tension, with muscles that stay tight and can't fully relax. Others have muscles that are weak or poorly timed, which forces the hips, back, or pelvic joints to compensate. Habits like holding your breath, over-bracing your core during lifts, or a sudden jump in training volume can all tip the balance and bring symptoms to the surface.
Common Signs and Pelvic Floor Dysfunction Symptoms
Pelvic floor dysfunction symptoms look different from person to person, and not all of them feel like pain in the pelvis. Some of the most common include an aching, burning, or sharp sensation in the pelvis, lower abdomen, tailbone, or groin during or after exercise. Others notice a feeling of pressure or heaviness that builds as a run or workout goes on, or leakage of urine when running, jumping, coughing, or lifting. Some people experience a strong, sudden urge to urinate during activity, discomfort from sitting for long periods or on a bike saddle, or pain during intimacy. Low back or hip pain that doesn't respond to the usual treatment, constipation or straining, and a general sense that your core feels unstable during hard efforts can also trace back to the pelvic floor.
If any of this sounds familiar, the important thing to know is that these symptoms are common among active people, and they are treatable. They are not something you have to simply manage around forever.
You might be interested in: Signs of Pelvic Floor Dysfunction During Exercise (and What to Do)
What Can Cause Pelvic Pain During Exercise?
Overactive or Tight Pelvic Floor Muscles
When the pelvic floor stays in a near-constant state of tension, it loses some of its ability to contract and relax efficiently. This often shows up as pain, pressure, or discomfort rather than weakness, and it's common in runners, cyclists, and people who habitually clench or brace through their workouts and their days.
Weak or Poorly Coordinated Muscles
The opposite pattern is just as common. Muscles that are weak, or that don't fire at the right moment during a stride, lift, or landing, can leave the pelvis under-supported. That's when leakage, heaviness, and instability tend to appear, and when other areas like the low back and hips start picking up the slack.
Hip, Low Back, and Pelvic Joint Contributors
Pelvic pain isn't always coming from the pelvic floor itself. The hips, the lower back, and the sacroiliac joints all share space and function with the pelvic floor, and a problem in any of them can create or amplify pain. This is one reason self-diagnosis is so difficult, since the same symptom can come from several different sources.
Life Stages and Other Contributing Factors
Pregnancy and childbirth, menopause, abdominal or pelvic surgery, and long hours in the saddle can all change how the pelvic floor functions. Chronic constipation, a persistent cough, and heavy lifting without good breathing habits can add strain too. None of these mean something is wrong with you, but they are worth mentioning when you seek care.
Conditions That Need Medical Evaluation
Some causes of pelvic pain fall outside what physical therapy can treat on its own, including infections, hernias, endometriosis, kidney stones, and prostate-related conditions. That's why a proper evaluation matters, and why a good physical therapist will refer you to a physician when something looks like it needs medical attention rather than rehabilitation.
You might be interested in: How to Tell if Your Pelvic Floor Is Weak or Tight
Signs It's Time to Seek Help
There's no prize for training through pelvic pain, and waiting rarely makes it go away. A few signs suggest it's time to get evaluated:
The pain lasts more than a couple of weeks, or it comes back every time you do the same activity, whether that's running, lifting, cycling, or even sitting through a long workday.
You leak urine during exercise. It's common, especially among active people, but it isn't something you simply have to accept, and it often responds well to treatment.
You're changing how you live to avoid symptoms, such as skipping certain workouts, timing bathroom stops around runs, or avoiding long drives and meetings.
You experience pain or discomfort with intimacy, bowel movements, or urination, which can point to muscle tension or coordination problems worth addressing.
You feel heaviness, pressure, or a bulging sensation in the pelvis, particularly toward the end of the day or after exercise.
Low back, hip, or groin pain hasn't responded to the usual treatment, including strength training, dry needling, or standard physical therapy.
The pain is getting worse, spreading, or becoming more frequent, even if it's still mild.
Mild, intermittent symptoms are usually the easiest to resolve, so there's no need to wait until the problem is severe.
Red Flags: When to Get Medical Care Right Away
Some symptoms need prompt medical attention rather than a physical therapy evaluation. Contact your doctor or seek urgent care if you have sudden, severe pelvic or abdominal pain, pelvic pain with a fever, blood in your urine or stool, unexplained vaginal bleeding, difficulty urinating, or sudden severe testicular pain. If you develop new numbness in the groin or saddle area along with loss of bladder or bowel control, treat it as an emergency and go to the nearest emergency room. When in doubt, it's always reasonable to check with a physician first.
You might be interested in: Managing Chronic Pelvic Pain: When to See a Specialist
What to Expect From Pelvic Floor Therapy
The Evaluation
Pelvic floor therapy starts with a conversation about your symptoms, your training, and your goals, followed by a movement and strength assessment that looks well beyond the pelvic floor in isolation. Your therapist will observe your posture, breathing, hips, core, and the movements that trigger your symptoms, such as your running gait or lifting mechanics. An internal exam isn't always needed, and it only happens when it's appropriate for your situation and with your clear understanding and consent.
Treatment Approaches
Treatment is built around what the evaluation reveals. For tight, overactive muscles, care often includes hands-on manual therapy and breathing techniques that teach the pelvic floor to fully release, not just contract. For weakness or poor coordination, treatment focuses on targeted strengthening that connects the pelvic floor with your deep core and hips, so it fires at the right moment during real movements. Most people need some combination of both, since tension and weakness often coexist.
Getting Back to Full Activity
The goal isn't just to calm symptoms for a few days; it's to rebuild a system that can handle the loads of your sport. That means a gradual, structured return to the activities that were causing symptoms, with home exercises between visits so the changes carry over into your training.
What You Can Do in the Meantime
While you're waiting for an appointment, a few simple steps can help. Modify rather than stop completely, for example by reducing impact or intensity so you stay active without aggravating symptoms. Pay attention to your breathing and avoid holding your breath or over-bracing during efforts. Keep a short log of when symptoms appear, what you were doing, and how long they lasted, since patterns help your therapist narrow down the cause. And resist the urge to do endless Kegels on your own, because if your muscles are already overactive, tightening them more can make things worse.
Summary
Pelvic pain during activity is common among active people, but it isn't something to simply push through. It can come from tight or weak pelvic floor muscles, the hips and low back, or conditions that need medical evaluation, which is why an accurate assessment matters. Persistent pain, leakage, pressure, or symptoms that change how you train are all good reasons to seek help, and physical therapy that addresses the underlying cause helps most people return to full activity with more comfort and confidence.
Frequently Asked Questions
Is pelvic pain during exercise normal?
It's common, but it isn't something you should have to accept. Pain, pressure, or leakage during exercise is a sign that something in the system isn't working as well as it could, and it's usually very treatable.
Do I need to stop exercising if I have pelvic pain?
Usually not completely. Most people benefit from modifying their activity, such as lowering impact or intensity, while the underlying cause is addressed. A physical therapist can help you stay active in a way that doesn't aggravate your symptoms.
Is pelvic floor therapy only for women or new mothers?
No. Everyone has a pelvic floor, and dysfunction is common among men and women, athletes and non-athletes, and people who have never had children. Pelvic floor therapy treats people of all backgrounds and activity levels.
Will I need an internal exam?
Not always. Many pelvic floor issues can be assessed through conversation, movement testing, and external techniques. Your therapist will explain what's appropriate for your situation before anything happens, and nothing is done without your understanding and consent.
How many sessions of pelvic floor therapy will I need?
It depends on the cause and how long symptoms have been present. Many people notice meaningful changes within the first several visits, with continued progress as they return to full activity. Your therapist will give you a clearer picture after your evaluation.
Do I need a referral to see a pelvic health physical therapist?
No. Vermont allows direct access to physical therapy, so you can schedule an evaluation with us without seeing a physician first. If we find something that needs medical attention, we'll refer you to the right provider.
Train Without Pain Holding You Back
Don't let pelvic pain quietly shrink the activities you love. If you're dealing with pain, pressure, or leakage during exercise and want a plan built around your goals, our team at Summit Physical Therapy & Performance works with active people across the Stowe area every day to help you move with strength and confidence. Call 802-328-8217 to schedule a pelvic health evaluation.