Understanding the Core-Pelvic Floor Relationship in Rehab
When we think about the core, most people picture abdominal muscles. But true core stability goes much deeper — and the pelvic floor plays a central role. These two systems aren’t separate; they’re part of an integrated team that supports movement, posture, and pressure regulation within the body.
READ: Pelvic Floor Therapy for Incontinence: What the Research Says
The deep core system includes the diaphragm (your primary breathing muscle), the transversus abdominis (your deepest abdominal layer), the multifidus (small stabilizing muscles along the spine), and the pelvic floor. Together, they form a pressure-managing cylinder that supports your spine and internal organs.
Each time you breathe, laugh, lift, or move, these muscles respond to maintain balance and control. The pelvic floor doesn’t just hold things “in place” — it coordinates with your core to manage intra-abdominal pressure and stabilize your trunk.
When the core and pelvic floor work well together, you move with ease, strength, and control. But when that system becomes disrupted — whether from pregnancy, surgery, or everyday habits — dysfunction can develop, leading to issues like back pain, leaking, or poor posture.
What Happens When This System Falls Out of Sync
When the core and pelvic floor stop working together efficiently, the body often finds ways to compensate — and those compensations can lead to discomfort, dysfunction, or long-term issues.
For example, if the pelvic floor is overactive or tight, it may not relax properly during breathing or movement. This can increase pressure on the bladder or lower back and contribute to symptoms like leaking, pelvic pain, or a feeling of heaviness. It can also disrupt core function, making it harder to stabilize your trunk during daily activities or exercise.
On the other hand, a weak or poorly coordinated core may shift excess strain to the pelvic floor, especially during lifting, coughing, or high-impact movement. Over time, this can lead to pelvic organ prolapse, low back pain, or visible signs like coning or doming through the abdominal wall.
These imbalances are particularly common after pregnancy, when the body is adjusting to major structural and hormonal changes. But they can also affect anyone — regardless of age or birth history — who experiences poor posture, stress, chronic breath-holding, or movement habits that overload one part of the system.
The good news? These patterns can be addressed and improved with intentional, guided rehab.
The Role of Breathing in Core–Pelvic Floor Function
Breathing is something we do all day without thinking — but in rehab, how you breathe matters, especially when it comes to coordinating the core and pelvic floor.
At the center of this system is the diaphragm, your primary breathing muscle. When you inhale, the diaphragm moves downward, and the pelvic floor should respond by gently lengthening. As you exhale, both the diaphragm and pelvic floor rise, helping to stabilize the trunk and manage pressure within the abdomen.
READ: From Leaks to Lifting: Rebuilding Function After Pregnancy
This breath-to-pelvic-floor connection is essential. When breathing is shallow or chest-driven, the diaphragm doesn’t move properly — which means the pelvic floor doesn’t either. Over time, this lack of coordination can lead to excessive tension, poor support, and symptoms like leaking or low back pain.
Diaphragmatic breathing, also called belly breathing, retrains this system. It helps regulate pressure, supports movement, and creates a strong, responsive foundation for everything from walking to lifting to returning to exercise postpartum.
At VT Moms Physical Therapy, we often start with breathwork as a foundational step — not because it’s easy, but because it’s powerful. Restoring this natural rhythm is often the first sign that your core and pelvic floor are reconnecting the way they were designed to.
How Physical Therapy Addresses Core–Pelvic Floor Imbalances
When symptoms like leaking, core weakness, or pelvic discomfort appear, they’re often signs that the deep core system is out of balance. Physical therapy helps identify where that breakdown is happening — and guides the process of rebuilding function from the inside out.
At VT Moms Physical Therapy, we begin with a comprehensive assessment. This includes evaluating posture, breathing mechanics, core engagement, pelvic floor coordination, and how all of these systems respond to movement. We look for compensation patterns — like gripping the abs, breath-holding, or pelvic floor bracing — that can interfere with natural muscle function.
Once we understand how your body is functioning, we design a plan that supports gradual, intentional reconnection. This often includes:
Posture retraining to improve alignment and reduce pressure on the pelvic floor
Diaphragmatic breathing and core activation drills to re-establish proper coordination
Mobility work to address tension in the hips, back, and ribcage
Neuromuscular re-education to help your brain and body relearn efficient movement patterns
Rather than focusing solely on strengthening or stretching, our approach emphasizes coordination and control — because that’s what creates lasting function and symptom relief.
Signs You Might Benefit from a Core–Pelvic Floor Evaluation
Many people assume that symptoms like leaking or core weakness are just part of life — especially after pregnancy. But these signs are not normal, and they don’t have to be permanent. Often, they indicate a disconnect in the deep core system that physical therapy can help resolve.
You might benefit from a core–pelvic floor evaluation if you experience:
Urinary leaking during exercise, sneezing, or laughing
Pelvic heaviness or pressure, especially after standing or lifting
Low back, hip, or tailbone pain that worsens with activity
Coning or doming in the abdomen when doing core exercises
Difficulty engaging your core, or feeling disconnected from your body after childbirth
Pain during intimacy or chronic tension in the pelvic floor
Even if symptoms are mild or inconsistent, they’re worth addressing. Left untreated, these issues can affect your quality of life, confidence, and ability to return to the activities you love.
READ: What to Expect at Your First Pelvic Floor PT Appointment
Early intervention with a pelvic floor physical therapist helps you restore proper coordination, rebuild strength, and prevent future complications.
How VT Moms Physical Therapy Helps You Reconnect and Rebuild
At VT Moms Physical Therapy in Middlebury, we specialize in helping women restore their core and pelvic floor connection — whether you're newly postpartum, years into motherhood, or simply looking to move with more confidence and comfort.
Our approach is individualized, evidence-based, and whole-body focused. We don’t just treat symptoms — we uncover their root cause. Through detailed evaluations, movement-based assessments, and hands-on care, we guide you through each stage of recovery with education, empathy, and expertise.
We help you relearn how to breathe, move, and activate your core from the inside out. Our programs are designed to fit your lifestyle, support your goals, and build a foundation that lasts — not just for now, but for the long term.
Whether you're managing pelvic floor dysfunction, rebuilding strength after birth, or simply want to feel more connected to your body, we’re here to help you reconnect, rebuild, and thrive.