POTS and Physical Therapy: What Hoover, AL Patients Need to Know

POTS and Physical Therapy: What Hoover, AL Patients Need to Know

If standing up too fast makes your heart race, your vision blur, or leaves you needing to sit back down — you're not imagining it, and you're not alone. Postural Orthostatic Tachycardia Syndrome, or POTS, affects an estimated 1 in 500 people, most commonly women between their teens and their 40s. And yet many patients spend years bouncing between providers before anyone puts a name to what they're feeling.

If you're in Hoover or the greater Birmingham area and searching for answers, here's what the current research says about POTS — and why physical therapy, done the right way, is one of the most effective tools we have.

What Is POTS, Really?

POTS is a condition of the autonomic nervous system — the part of your body that runs on autopilot, regulating things like heart rate and blood pressure without you thinking about it. When you stand up, your body is supposed to automatically adjust blood flow so your brain stays well-supplied. In POTS, that system misfires. Blood pools in your legs, your heart rate spikes to compensate, and symptoms follow: lightheadedness, rapid heartbeat, brain fog, fatigue, nausea, and sometimes fainting.

It's diagnosed when your heart rate increases by more than 30 beats per minute within 10 minutes of standing, without a drop in blood pressure. Many people living with POTS also have joint hypermobility or a connective tissue condition like Ehlers-Danlos Syndrome (EDS) — more on why that matters below.

Why "Just Exercise More" Feels Impossible (and Isn't the Right Advice)

If you've been told to exercise more and it made you feel worse, that's not a failure on your part — it's a sign the exercise wasn't dosed correctly for a body with POTS. Standard workouts ask your cardiovascular system to fight gravity right away, which is exactly what a dysregulated autonomic system struggles with.

The research-backed approach works differently. It starts you lying down or seated — recumbent bike, rowing, swimming — so your heart doesn't have to work against gravity while it reconditions. Over weeks and months, activity is gradually shifted toward upright positions as your tolerance builds. This isn't a shortcut; it's a deliberate, evidence-based sequence used in programs developed at institutions like UT Southwestern and Children's Hospital of Philadelphia, and it's backed by current systematic reviews identifying exercise as a first-line treatment for POTS.

It's also normal to feel a little worse before you feel better in the first few weeks. That's your nervous system recalibrating — not a sign to stop, but a sign to go slow and stay consistent.

The Daily Habits That Make the Biggest Difference

Alongside exercise, current guidelines point to a few non-negotiables:

• Fluids — most guidelines target around 3 liters a day

• Sodium — roughly 10 grams a day, which is more than most people expect

• Compression — waist-high compression garments to reduce blood pooling in the legs

• Positioning — sleeping with your head slightly elevated, and learning counter-pressure techniques (like crossing your legs or tensing your muscles) for symptom flares

None of these replace a supervised reconditioning program, but they make the exercise progression easier to tolerate.

The Connection Most Providers Miss: POTS, Hypermobility, and Your Pelvic Floor

Here's where our practice's background matters. A growing body of research points to significant overlap between POTS, joint hypermobility (including hypermobile EDS), and pelvic floor dysfunction. If you have POTS and you've been dealing with pelvic pain, bladder urgency, or a pelvic floor that never quite feels "right," those two things may not be separate problems.

In hypermobile connective tissue, pelvic floor muscles often aren't weak — they're overworking, trying to create stability your connective tissue isn't providing on its own. That means the standard advice (strengthen it, do more Kegels) can actually make things worse. What helps instead is retraining how your diaphragm, deep core, and pelvic floor coordinate together — which also happens to support better blood pressure regulation and symptom control for POTS itself.

This is a piece of the puzzle that a general cardiac rehab program or a standard physical therapy clinic usually isn't trained to see.

What This Looks Like in Practice

A well-built POTS program should include:

1. A real assessment — orthostatic vitals, a hypermobility screen, and (when relevant) a pelvic floor and breathing evaluation

2. A recumbent-first exercise progression, individualized to your own baseline rather than a generic chart

3. Education on the fluid, salt, and compression habits that support your progress

4. Ongoing communication with your physician, since POTS management often involves a care team

You Don't Have to Figure This Out Alone

If you're in Hoover, Birmingham, or the surrounding area and you're dealing with POTS symptoms — especially alongside pelvic floor issues, hormonal changes, or joint hypermobility — we'd be glad to talk through what a personalized program could look like for you.

This post is for educational purposes and isn't a substitute for individualized medical advice. Please work with your physician to confirm a POTS diagnosis before starting a new exercise program.

Your Period is a Vital Sign- Here's What it's Trying to Tell You

Your Period Is a Vital Sign — Here's What It's Trying to Tell You

You check your blood pressure. You track your heart rate. You probably know your resting pulse better than you know your own cycle length.

But here's what most women were never taught: your menstrual cycle is a vital sign — just like blood pressure, heart rate, temperature, and respiratory rate. The American College of Obstetricians and Gynecologists (ACOG) has said as much for over a decade. Your cycle is a monthly readout of your overall health — hormonal, metabolic, nutritional, and yes, even musculoskeletal.

And when something's off with a vital sign, we don't ignore it. We investigate.

Myth: "Painful Periods Are Just Normal"

This is one of the most common things I hear in the clinic, and it's one of the most damaging myths in women's health.

Mild cramping in the first day or two of your period? That can be normal — it's your uterus contracting to shed its lining. But pain that:

• Sends you to bed

• Requires you to miss work, school, or workouts

• Doesn't respond to over-the-counter medication

• Comes with nausea, vomiting, or fainting

• Is accompanied by pain with sex, bowel movements, or urination

...is not something you should just "push through." That level of pain is your body signaling something deeper — often involving the pelvic floor muscles, which can become overactive, guarded, or restricted in response to underlying inflammation, endometriosis, or other conditions. As a pelvic floor physical therapist, I see this connection constantly: cyclic pain and pelvic floor dysfunction feed each other in a loop that won't break on its own without the right intervention.

Myth: "Irregular Periods Are Just Your Body Being Weird"

A predictable cycle is a sign that the finely tuned communication between your brain, ovaries, thyroid, and adrenal glands is working the way it's supposed to.

When cycles become irregular — significantly longer or shorter than your norm, unpredictable, or absent altogether — it's often a sign of something worth investigating: thyroid dysfunction, PCOS, perimenopause, over-exercising, under-eating, or chronic stress overwhelming your HPA axis.

Irregularity isn't a personality trait of your body. It's data.

Your Period Shouldn't Run Your Life

A period that derails your week — physically or emotionally — every single month is not something to just plan around forever. Between symptom management, hormone regulation, and yes, pelvic floor rehabilitation, there is almost always something that can meaningfully change your experience of your cycle.

You deserve to move through your month without dread.

Why Tracking Matters

You can't investigate a pattern you're not tracking. Cycle tracking gives you (and any provider you work with) real data instead of vague impressions of "sometimes it's bad."

At minimum, track:

• Cycle length (day 1 of bleeding to day 1 of the next period)

• Flow (light, moderate, heavy, clots)

• Pain (location, intensity, what helps or worsens it)

• Associated symptoms (mood, bloating, headaches, bowel or bladder changes, breast tenderness)

• Ovulation signs, if you're tracking fertility or hormone patterns

A few months of consistent tracking will tell you more about your hormonal health than a single lab draw ever could — and it arms you with specifics instead of guesswork when you sit down with a provider.

When to Ask for Help

If your cycle involves pain that limits your life, unpredictability that worries you, or symptoms that just don't add up — that's your body asking for a closer look, not something to white-knuckle through indefinitely.

At Sharp Ortho & Pelvic Physical Therapy, this is exactly where I come in. Cyclic pelvic pain, pain with intercourse, bladder and bowel changes tied to your cycle, and the muscular guarding patterns that often accompany hormonal shifts are all things we assess and treat directly — often alongside your OB-GYN or other providers, not instead of them.

Your cycle is talking. Let's find out what it's saying.

Ready to get answers about your cycle? Contact Sharp Ortho & Pelvic Physical Therapy at 205-515-0258 or visit sharpphysicaltherapy.com to schedule an evaluation.

Postpartum Tailbone Pain: When to Worry (and When It’s Normal)

If you had a baby and now can't sit through a meal, a car ride, or a nursing session without wincing, you're not imagining it — and you're not alone. Tailbone pain after childbirth is common, but that doesn't mean you have to just wait it out.

Why Childbirth Affects the Tailbone

During vaginal delivery, the coccyx (tailbone) has to move out of the way to make room for the baby to pass through the pelvis. In most deliveries, it flexes and returns to its normal position without lasting issue. But in some cases:

• The coccyx is bruised or strained from the pressure of delivery

• It becomes excessively mobile or shifts out of alignment

• In rarer cases, it fractures or dislocates

• The surrounding pelvic floor muscles tighten and guard in response to labor, referring pain to the tailbone even when the bone itself is fine

That last point is one people miss most often. Postpartum tailbone pain isn't always about the tailbone — it's frequently about the pelvic floor muscles that attach around it.

What's Normal in the First Few Weeks

Some tenderness and discomfort sitting during the first two to six weeks postpartum is common as tissues heal. Ice, supportive cushions, and avoiding long stretches of sitting on hard surfaces can help in this early window.

When It's Worth Getting Evaluated

Consider a pelvic floor physical therapy evaluation if:

• Tailbone pain is still significant beyond six to eight weeks postpartum

• Sitting pain is getting worse rather than better

• You notice pain radiating into the hips, low back, or with bowel movements

• Standing up from sitting is sharply painful

• You feel like something "shifted" during delivery and hasn't felt right since

These aren't signs to push through — they're signs a proper evaluation can identify what's actually going on and get you on a faster path to relief.

What a Pelvic Floor Evaluation Looks At

A thorough postpartum tailbone assessment considers the coccyx itself, but also:

• Pelvic floor muscle tone and symmetry

• Scar tissue from delivery (including perineal or C-section scarring, which can refer tension to the pelvic floor)

• Sitting posture and weight-bearing patterns

• Core and hip strength as they relate to pelvic support

Treatment is typically hands-on and gradual — manual therapy, guided breathing and relaxation work for the pelvic floor, scar mobilization when appropriate, and a return-to-activity plan that doesn't aggravate the area.

The Bottom Line

Tailbone pain after childbirth is common, but "common" doesn't mean you have to live with it for months. If it's not improving on its own, a pelvic floor physical therapy evaluation can pinpoint the cause and get you moving — and sitting — comfortably again.

Learn more about tailbone pain and coccydynia treatment at Sharp Ortho & Pelvic Physical Therapy, or call 205-515-0258 to schedule an evaluation.

Sharp Ortho & Pelvic Physical Therapy Kaye Sharp, MPT, WHC | 2481 Valleydale Rd, Hoover, AL 35244 | 205-515-0258 | sharpphysicaltherapy.com

Is It a UTI- or Something Else? What Every Woman Should Know About Chronic Bladder Pain

Women's Health · Pelvic Floor · Bladder Pain

Is It a UTI — or Something Else? What Every Woman Should Know About Chronic Bladder Pain

Urgency, frequency, pelvic pressure — and antibiotics that never quite work. There's a name for this, and there's help.

Kaye Sharp, MPT, WHC · Sharp Ortho & Pelvic Physical Therapy · Hoover, AL

You've had the burning. The urgency. The feeling that you absolutely cannot wait another minute. You've taken the antibiotic, felt slightly better — and then a few weeks later, it's back again. Your doctor says the culture is negative this time. And you're left wondering: what is actually happening?

For millions of women, the answer is not a urinary tract infection at all. It's Interstitial Cystitis, also called Bladder Pain Syndrome (IC/BPS) — a chronic condition of the bladder and nervous system that mimics UTI symptoms but doesn't respond to antibiotics, because bacteria aren't the cause.

IC/BPS is estimated to affect up to 8 million women in the United States, yet it takes an average of 4–7 years to diagnose. Women are frequently dismissed, overtreated with antibiotics, or told their symptoms are stress-related — when in fact there is a real, treatable physiological condition driving every single symptom.

As a pelvic floor physical therapist with 30 years of experience, I've seen this pattern more times than I can count. The good news: with the right treatment approach, most women experience significant, lasting improvement. This post is a starting point for anyone who suspects IC/BPS might be part of their story.

What Is IC/BPS?

Interstitial Cystitis/Bladder Pain Syndrome is a chronic condition defined by bladder pain or pressure, urinary urgency, and frequent urination — without any active bacterial infection or structural abnormality to explain it.

Two overlapping problems drive the condition:

A compromised bladder lining. The healthy bladder is coated with a protective glycosaminoglycan (GAG) layer that prevents urine from irritating the bladder wall. In IC/BPS, this layer becomes thin or "leaky," allowing acidic urine to inflame the tissue underneath — producing pain and urgency even with a small amount of urine.

A sensitized nervous system. IC/BPS involves central sensitization — the nervous system becomes hypersensitive, turning up the volume on bladder signals until even minor bladder filling feels like an emergency. This is why symptoms persist even when the bladder appears structurally normal on imaging.

Common IC/BPS symptoms

Bladder pain or pressure that worsens as the bladder fills

Urinary urgency — needing to go right now

Frequent urination: 8–12+ times per day

Pelvic, hip, or low back pain

Pain with or after sexual intercourse

Nocturia — waking at night to urinate

Flares after certain foods or drinks

Negative urine culture — no bacteria found

IC/BPS vs. UTI: How to tell the difference

Feature	UTI	IC/BPS
Urine culture	Positive (bacteria present)	Negative (no bacteria)
Response to antibiotics	Usually resolves	Does not improve
Duration	Days to weeks	Months to years
Pain pattern	Burning on urination	Pressure or pain throughout the day
Food/drink triggers	Uncommon	Very common (caffeine, citrus, alcohol)
Pelvic floor tenderness	Uncommon	Common — often a key finding

Important: IC/BPS is a diagnosis of exclusion — meaning other causes (infection, cancer, structural issues) are ruled out first. If you have persistent bladder symptoms with consistently negative urine cultures, a referral to urology and/or a pelvic floor PT evaluation is appropriate next step.

Who Gets IC/BPS?

IC/BPS affects women across all ages and life stages — not just older women. That said, certain groups have higher rates of diagnosis and distinct contributing factors worth understanding.

Women of reproductive age IC/BPS often begins in the 20s–40s, frequently following a pelvic infection, childbirth, or period of prolonged stress. Hormonal fluctuations across the menstrual cycle can drive symptom flares.

Postpartum women Pelvic floor changes during pregnancy and delivery, combined with disrupted sleep and elevated stress, create conditions where IC/BPS can emerge or worsen significantly.

Perimenopause & menopause Declining estrogen affects the bladder lining, urethral tissue, and pelvic floor directly — often triggering new IC symptoms or dramatically worsening existing ones.

Women with other pelvic conditions IC/BPS commonly co-exists with endometriosis, vulvodynia, IBS, fibromyalgia, and pelvic organ prolapse. Treating it in isolation often misses the bigger picture.

The menopause connection: Estrogen maintains the protective GAG layer of the bladder and the health of urethral and vaginal tissues. As estrogen declines, bladder reactivity increases — which is why many women first develop or dramatically worsen IC symptoms during perimenopause. If this applies to you, ask your gynecologist about local vaginal estrogen as a complement to pelvic PT care.

Why Your Pelvic Floor Matters — and Why Kegels Are Not the Answer

Here's the part most women don't expect to hear: the pelvic floor in IC/BPS is almost always too tight, not too weak.

In response to chronic bladder pain and urgency, the pelvic floor muscles brace and guard — for months, then years. Over time, this creates myofascial trigger points: tight, tender knots within the pelvic floor, hip, and abdominal muscles that generate their own pain and urgency signals, entirely separate from the bladder itself.

Kegel exercises — repeated contractions of the pelvic floor — significantly worsen this pattern. The American Urological Association's 2022 Clinical Guidelines give a Grade A (strongest) recommendation to avoid pelvic floor strengthening in IC/BPS. What the pelvic floor actually needs is release, downtraining, and hands-on manual therapy to deactivate trigger points. That is exactly what a trained pelvic floor physical therapist provides.

The pelvic floor doesn't need to be stronger in IC/BPS. It needs to be trusted to let go. Teaching that release — and watching the urgency and pain follow — is one of the most rewarding parts of this work.

— Kaye Sharp, MPT, WHC

Five Pillars of IC/BPS Relief

Effective IC/BPS treatment is multimodal — it addresses the bladder, the pelvic floor, the nervous system, diet, and lifestyle at the same time. The following five pillars form the foundation of care:

PILLAR 1Dietary Modification

Acidic and irritating foods directly inflame the bladder lining. The most common culprits: caffeine, alcohol, carbonated drinks, citrus, tomatoes, spicy foods, and artificial sweeteners. A 2-week elimination trial followed by systematic reintroduction identifies your personal triggers. Prelief® (calcium glycerophosphate) can be taken before trigger foods as a rescue tool to neutralize acidity.

PILLAR 2Pelvic Floor Physical Therapy

Hands-on manual therapy — targeting trigger points in the pelvic floor, hip, abdomen, and inner thighs — is the strongest evidence-based physical treatment for IC/BPS. 360° core breathing (expanding the ribcage in all directions, coordinated with pelvic floor release) forms the foundation of home practice. No Kegel exercises. The goal is release, not contraction.

PILLAR 3Bladder Retraining

Gradually increasing the interval between voids — starting where you are, adding 15 minutes per week — retrains the bladder-brain connection. Urge suppression techniques (slow deep breathing, distraction, avoiding "just in case" voiding) reduce the perceived urgency over time and restore confidence in the bladder's ability to wait.

PILLAR 4Pain Neuroscience Education

Understanding that IC/BPS is a sensitized nervous system — not a damaged or failing bladder — is itself a therapeutic intervention. Research shows that reframing chronic pain reduces fear-avoidance behaviors and improves treatment outcomes. Stress, poor sleep, and anxiety directly amplify IC symptoms, and addressing these is part of comprehensive care.

PILLAR 5Hormonal & Lifestyle Support

For women at any hormonal life stage — postpartum, cycling, perimenopausal, or postmenopausal — addressing hormonal contributors can significantly shift the treatment baseline. Sleep quality, stress management, movement, and (when appropriate) hormonal support all have direct clinical relevance to IC/BPS outcomes.

What to Expect from Treatment

A typical course of pelvic PT for IC/BPS runs 10–12 weeks of weekly sessions. Most patients notice meaningful change by sessions 4–6. The first visit includes a comprehensive assessment of pelvic floor function, symptom history, dietary patterns, and contributing factors — followed by a personalized plan.

Pelvic PT works best as part of a coordinated team. Depending on your presentation, this may include urology (to rule out Hunner lesions or evaluate medication options), gynecology (hormonal support), and in some cases a CBT therapist for pain-related anxiety.

You don't need a referral. In Alabama, you can schedule directly with a pelvic floor physical therapist without a physician referral. If you're unsure whether IC/BPS is contributing to your symptoms, an evaluation is the right first step.

Common Questions

Can IC/BPS be cured?

IC/BPS is chronic, but that doesn't mean symptoms are permanent or unmanageable. Most patients who engage with a comprehensive treatment program reach a point where symptoms are minimal and well-controlled with lifestyle habits. The goal is getting your life back — not waiting for a cure.

Can I exercise with IC/BPS?

Yes, with modification. High-impact activities can aggravate symptoms during flares, but walking, swimming, yoga, and modified Pilates are generally well tolerated. Part of pelvic PT is building a sustainable movement practice around your bladder — not eliminating movement altogether.

Is IC/BPS related to interstitial nephritis or kidney disease?

No — despite the similar name, IC/BPS is a bladder condition and is unrelated to kidney disease or nephritis. The "interstitial" in IC refers to the tissue between the bladder's inner lining and its muscle layer.

Do I need a formal IC diagnosis before starting pelvic PT?

No. If you have pelvic floor tenderness and bladder symptoms — regardless of formal diagnosis — pelvic PT evaluation is appropriate. We can work alongside your medical providers as the diagnostic picture clarifies.

How many sessions will I need?

A typical IC/BPS course of care is 10–12 weekly sessions of 45–60 minutes. Some patients improve significantly by session 6; others need longer. You'll receive a personalized plan at your initial evaluation based on your specific presentation.

You Don't Have to Keep Rearranging Your Life Around Your Bladder

If you're in the Hoover or Birmingham area and experiencing bladder pain, urgency, or pelvic floor symptoms, schedule a comprehensive evaluation with Kaye Sharp, MPT, WHC.

Book Your Evaluation → 205-515-0258 · sharpphysicaltherapy.com · Hoover, AL

KS

Kaye Sharp, MPT, WHC

Women's Health Certified · 30 Years of Orthopedic & Pelvic PT Experience

Kaye is the owner of Sharp Ortho & Pelvic Physical Therapy in Hoover, Alabama. She specializes in pelvic floor dysfunction, IC/BPS, and women's health across the lifespan — including postpartum recovery, hormonal transitions, and menopause. She holds the Women's Health Certification (WHC) from the Integrative Women's Health Institute.

Interstitial Cystitis Bladder Pain Syndrome IC/BPS Pelvic Floor PT Bladder Health Chronic Pelvic Pain Women's Health Hoover AL Birmingham AL Menopause Postpartum

Sharp Ortho & Pelvic Physical Therapy
2481 Valleydale Road · Hoover, AL 35244 · 205-515-0258 · sharpphysicaltherapy.com

This post is for educational purposes and does not constitute medical advice. Based on AUA IC/BPS Guidelines 2022.

That aching outer hip isn't just "getting older" — here's what's really going on (and how to fix it)

Why are your hips hurting??

That aching outer hip isn't just "getting older" — here's what's really going on (and how to fix it)

If you're a woman in your 40s, 50s, or beyond and you've been dealing with persistent pain on the outside of your hip — especially when you lie on that side at night, climb stairs, or sit for too long with your legs crossed — there's a good chance your gluteus medius tendon is involved.

Gluteus medius tendinopathy is one of the most under-diagnosed causes of lateral hip pain in women, and menopause is one of the biggest reasons it develops. At Sharp Ortho & Pelvic Physical Therapy, we treat this condition every week — and the good news is that with the right approach, it responds very well.

What is the gluteus medius, and why does it hurt?

The gluteus medius is the muscle on the outer part of your pelvis that keeps you from wobbling side to side when you walk. Its tendon attaches to the bony point on the outside of your hip (the greater trochanter). When that tendon becomes overloaded or compressed, it becomes painful and irritated — a condition called tendinopathy.

Why menopause makes this so much more common

This isn't random timing. After menopause, estrogen — which directly supports tendon strength and collagen production — drops dramatically. That means the tendon becomes less resilient, more vulnerable to overload, and slower to recover. Combine that with natural muscle loss (sarcopenia), changes in body composition, and shifts in how we move, and the gluteus medius tendon is under real stress.

As a Women's Health Coach and pelvic PT with 30 years of orthopedic experience, I also see something many providers miss: the connection between hip pain and the pelvic floor. The muscles and fascia that surround the hip are directly linked to the pelvic floor. When the hip isn't working well, the pelvic floor often isn't either — and vice versa. That's why our treatment always looks at the whole picture.

Signs you may have gluteus medius tendinopathy

• Aching or sharp pain on the outside of one or both hips

• Pain that worsens when lying on your side — or on the opposite side

• Discomfort when sitting with your legs crossed or in low chairs

• Hip pain going up stairs, walking hills, or standing on one leg

• Pain that seems to come and go but never fully resolves

What does treatment actually look like?

Contrary to what many women are told, rest is not the answer. Tendons need the right kind of movement to heal. Our evidence-based program progresses through three stages:

• Phase 1: Gentle isometric exercises that calm pain without aggravating the tendon — no stretching, no compression

• Phase 2: Progressive strengthening to restore hip and pelvic control, including retraining how your body moves in daily life

• Phase 3: Functional loading — building tendon capacity for walking, stairs, exercise, and everything you want to do

We also address posture habits, sleep positions, and — because this is a postmenopausal issue — nutritional factors like protein intake, collagen support, and vitamin D that directly affect how well your tendon can heal.

You don't have to just live with this

Lateral hip pain is incredibly common in women after menopause, but it isn't inevitable — and it's very treatable. Most of our patients see meaningful improvement within the first 3–4 weeks when they commit to the program.

If you're dealing with outer hip pain and want answers, we'd love to help. Sharp Ortho & Pelvic Physical Therapy serves women at every stage of life from our Hoover, AL clinic. Call us at (205) 515-0258 or visit sharpphysicaltherapy.com to schedule your evaluation.

Tags: lateral hip pain, gluteus medius, menopause and hip pain, pelvic floor physical therapy, women's health Hoover AL, postmenopausal pain, hip tendinopathy

Is Leaking During Menopause Normal? A Hoover, Al PT Answers

Sharp Ortho & Pelvic Physical Therapy Hoover, Alabama · Women's Health Specialist

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Menopause & Bladder Health

Is Leaking During Menopause Normal? A Hoover, AL PT Answers

By Kaye Sharp, MPT, WHC | Sharp Ortho & Pelvic Physical Therapy · Hoover, AL | 9 min read

It is one of the questions I hear most often in my Hoover, Alabama clinic: "Is it normal to start leaking now that I'm in menopause?" The honest answer is: it's common — but common and normal are not the same thing, and it is absolutely not something you have to accept as permanent. Here's what is actually happening in your body, and what you can do about it.

Why Does Menopause Cause Leaking?

The short answer is estrogen. During perimenopause and menopause, estrogen levels drop significantly — and estrogen does far more in your pelvis than most women realize.

Estrogen maintains the thickness and elasticity of the tissue lining the bladder and urethra. It supports the health and responsiveness of pelvic floor muscles. It affects the sensitivity of the nerves involved in bladder control. When estrogen declines, all of these systems change — often at once.

The result is a bladder that holds less before signaling urgency, a urethra that can't maintain as tight a seal under pressure, and pelvic floor muscles that may have lost tone or coordination. This is the physiological backdrop behind most cases of menopausal urinary incontinence.

Key point: Leaking during menopause is a physiological change — not a character flaw, a sign of aging "badly," or something to hide. It is a musculoskeletal and hormonal event that responds well to the right treatment.

The Two Main Types of Menopausal Leakage

Not all leaking is the same — and the type you're experiencing significantly shapes what treatment will be most effective. In my clinical experience, menopausal women most commonly present with one or both of the following:

Stress Incontinence

Leaking that occurs with physical effort — sneezing, coughing, laughing, jumping, running, lifting. The leakage happens because intra-abdominal pressure spikes and the pelvic floor can't respond fast enough to maintain continence. This is primarily a muscle coordination and strength issue.

Urge Incontinence

A sudden, compelling urge to urinate — sometimes followed immediately by leakage before you reach the bathroom. This is driven more by bladder overactivity and nerve sensitivity changes. The "key in the door" urgency spike that many women describe is a classic presentation.

Many women in menopause experience mixed incontinence — a combination of both stress and urge components. This is important because effective treatment addresses whichever type is driving the symptoms, and sometimes each requires a different approach within the same patient.

How Common Is This?

Extremely. You are not alone — not by a long stretch.

70%

of postmenopausal women experience some form of urinary incontinence

50%

wait more than 5 years before seeking treatment — often longer

>80%

of women report significant improvement with pelvic floor PT

The delay in seeking care is something I see constantly in my Hoover clinic. Women assume leaking is inevitable, that there's nothing to be done short of surgery, or that pads are simply their new reality. None of these assumptions are accurate.

What Makes It Worse

Beyond the hormonal baseline, several factors can worsen menopausal urinary incontinence — and many of them are modifiable:

• Caffeine and alcohol are bladder irritants that increase urgency and frequency
• Chronic constipation puts sustained pressure on the pelvic floor and bladder
• High-impact exercise without pelvic floor support can exceed what a weakened floor can manage
• Weight changes during menopause increase intra-abdominal pressure on the bladder
• Dehydration and concentrated urine irritate the bladder lining and trigger urgency
• Protective behaviors like going to the bathroom "just in case" actually train the bladder to hold less over time

One of the most counterintuitive facts in pelvic health: going to the bathroom frequently "just in case" — to prevent accidents — trains your bladder to signal urgency at smaller volumes. Over time, this worsens urgency, not improves it. Bladder retraining is a key part of what we address in PT.

How Pelvic Floor PT Helps Menopausal Incontinence

Pelvic floor physical therapy is one of the most evidence-based, guideline-recommended treatments for urinary incontinence — including the menopausal variety. Multiple clinical trials show it reduces incontinence symptoms significantly, and in many cases outperforms medication with no side effects.

Here's what we actually address in treatment:

💪

Pelvic floor muscle strength and coordination — not just contracting, but timing the response correctly for your specific leakage pattern

🧠

Bladder retraining — gradually increasing the time between bathroom visits to restore normal bladder capacity and reduce urgency signals

🏃

Activity modification — identifying which movements or situations trigger leakage and building the capacity to handle them

🌿

Lifestyle and nutrition guidance — bladder irritants, hydration strategies, and bowel health are part of the picture

🔧

Postural and load management — alignment, breathing mechanics, and how you move all affect pelvic floor loading

🌸

Hormone health education — understanding the role of estrogen loss and how it interacts with treatment (as a Women's Health Coach, this is part of how I practice)

Important nuance: Effective pelvic floor PT for menopausal incontinence is not a generic Kegel program. The evaluation first determines whether your pelvic floor is underactive, overactive, or uncoordinated — because each requires a completely different treatment approach. Many women with urgency incontinence have a pelvic floor that is already too tight, and Kegel exercises can worsen their symptoms.

What About Surgery?

Surgery is sometimes appropriate for severe stress incontinence or prolapse — but it is rarely the appropriate first-line treatment, and it should almost always be preceded by a trial of conservative care including PT. Most surgical procedures for incontinence work best when the surrounding muscles are optimized, and PT before surgery significantly improves outcomes.

For the majority of women I see with menopausal leakage, conservative treatment — PT combined with lifestyle adjustments and, where appropriate, local estrogen therapy coordinated with their OB-GYN — produces excellent results without surgery.

The Thrive Through Menopause Approach

At my Hoover clinic, women dealing with menopausal bladder changes are also often dealing with other simultaneous symptoms — pelvic pain, painful intimacy, joint aches, core weakness, sleep disruption, weight shifts. These are not separate problems. They are connected threads in the same hormonal and musculoskeletal story.

My Thrive Through Menopause 12-week program addresses that whole picture: pelvic floor PT, personalized exercise programming, nutrition guidance, and hormone health education — designed specifically for women navigating this transition in the Hoover and Birmingham area.

When Should You Seek Care?

The honest answer: sooner than you think you need to. I see women who have been managing with pads for five, eight, ten years before coming in. In almost every case, they wish they had come sooner — not because the problem is harder to treat after a long delay, but because those years of limitation, careful wardrobe planning, and activity avoidance were unnecessary.

You do not need to be soaking through pads to seek care. If leaking is affecting your exercise, your confidence, your social life, or your sleep, that is reason enough. Call my office and let's figure out what's driving it and whether PT can help — and in my experience, it almost always can.

Finding Menopause Pelvic PT in Hoover and Birmingham

I am located at 2481 Valleydale Road in Hoover, Alabama — convenient to women across the Birmingham metro area including Vestavia Hills, Mountain Brook, Homewood, and Pelham. Alabama allows direct access to PT, meaning you can call and schedule without a referral.

As a physical therapist with 30 years of orthopedic experience and a Women's Health Coach credential from the Integrative Women's Health Institute, I see menopause as a specialty — not a side note. If you have been quietly managing leakage and wondering if there's another option, there is.

The question is not whether pelvic floor PT can help menopausal incontinence — the evidence is clear that it can. The question is when you decide you deserve to stop just managing and start actually getting better.

You Don't Have to Keep Managing. Let's Talk.

Serving Hoover, Vestavia Hills, Mountain Brook, Homewood, and greater Birmingham.

Call 205-515-0258

Schedule an Evaluation

No referral needed · Direct access PT

📞 205-515-0258

Sharp Ortho & Pelvic Physical Therapy
2481 Valleydale Road
Hoover, Alabama 35244

In This Article

• Why menopause causes leaking
• Stress vs. urge incontinence
• How common is this?
• What makes it worse
• How PT helps
• What about surgery?
• The Thrive program
• When to seek care
• Finding care in Hoover/Birmingham

Related Reading

Pelvic Floor PT in Hoover, AL: What Women Should Know Menopause PT & Thrive Through Menopause Program Pelvic Floor PT FAQ

About the Author

KS

Kaye Sharp

MPT, WHC · Owner

Kaye Sharp is a physical therapist with 30 years of orthopedic experience and a Women's Health Coach credential from the Integrative Women's Health Institute. She owns Sharp Ortho & Pelvic Physical Therapy in Hoover, Alabama, and runs the Thrive Through Menopause program.

Sharp Ortho & Pelvic Physical Therapy · 2481 Valleydale Road, Hoover, AL 35244
205-515-0258 · sharpphysicaltherapy.com
This content is for informational purposes only and does not constitute medical advice. Consult a qualified healthcare provider for diagnosis and treatment.

Hormones and the Pelvic Floor: What is Going on DOWN THERE?

Hormonal changes are an inevitable part of being a woman. Beginning with puberty, hormones are the driving force behind every phase of life…. affecting not only your reproductive organs (ovaries and uterus), but also the musculoskeletal system (muscles and joints), the cardiovascular system (heart and lungs), the brain (cognition and emotions), the immune system, and just about every process in the body.

Hormones reach their peak in the reproductive years (20’ and 30’s) then slowly start to slide chaotically downhill as you reach perimenopause and menopause (40’, 50’s, 60’s and beyond). Some research shows that women spend about 10 years in the perimenopausal phase ; reporting multiple physical, emotional, cognitive, and autoimmune changes in their bodies. Many women become over medicated with pharmacological remedies that act as a bandaid but do not really improve longevity or quality of life.

Many women experience major pelvic floor issues during this time including :vaginal dryness, atrophy, pelvic pain, chronic UTIs, interstitial cystitis, urinary/fecal leakage, constipation, prolapse, pain with intercourse and low desire. More often than not, these symptoms go untreated and undiagnosed for 2 reasons:

1. Women have come to believe that this is a normal part of aging so they do not talk to their doctor about it

2. Doctors do not know enough about hormone changes or pelvic floor dysfunction to offer viable treatments beyond pharmaceuticals

How do hormonal changes cause problems DOWN THERE? Vaginal tissues have a huge amount of hormone receptors, especially estrogen and testosterone. Hormones keep the muscles and tissues of the pelvic floor vibrant, juicy, and flexible so they can perform their many functions in the body. As hormone levels drop during perimenopause and menopause these muscles and tissues become weaker , making it difficult to function properly. This leads to organ prolapse , leakage, and many other symptoms.

The pelvic floor is actually 3 layers of muscles that form a bowl that supports the organs in the body as part of the core.

How do we manage these changes? The goal of optimizing health as a woman is to glide through this time of hormonal chaos with ease and grace. The way you eat, move, think, and sleep are the primary drivers to managing your health. You will find that the things you did in your 20’s and 30’s don’t work anymore. Finding the right lifestyle plan for your body is the key. Having a pelvic floor assessment is the best way to determine the root cause of your symptoms DOWN THERE. Health coaching is a great way to determine exactly where you are in your journey and determine a plan to move forward. Getting advice on menopausal hormone therapy to not only mitigate symptoms, but to protect your heart, muscles, bones, and brain from the horrible effects of low estrogen (yes- I’m talking about heart disease, muscle atrophy, osteoporosis, and dementia).

Scheduling your pelvic floor assessment is a great first step in your journey to reclaim your health and live a longer life with less dis-ease!

What is a pelvic floor assessment? What should I expect?? As a physical therapist with 30 years of patient care experience including orthopedics, women’s health and nutrition coaching, longevity training, and pelvic floor rehab…. I perform a holistic and comprehensive assessment of each and every patient. This includes evaluating posture and alignment, muscle asymmetries, and fascial restrictions in the whole body. We also discuss nutrition, life stressors, exercise, sleep habits, and family support. An internal assessment is performed to determine muscle tone and function of the pelvic floor muscles (this is optional depending on patient comfort level). All of this information is molded together to determine your specific pathway to healing. Recommendations may include: relaxation techniques, strengthening and stretching exercises, natural supplements and adaptogens, nourishing foods, hydration, and sleep hygiene.

If you have questions about hormonal balance and what is going on DOWN THERE then contact me today for a complementary 15 minute phone consultation :)

Could it be Menopause?

Menopause has been called “puberty in reverse” by many practitioners in the medial community. Just like puberty, menopause can be a confusing and often painful time in life, but we all get through it! There is a lot we still do not understand about women’s health, but there are some things we know FOR SURE!

EVERY WOMAN WILL GO THROUGH MENOPAUSE- EVEN IF YOU HAVE HAD YOUR UTERUS AND/OR OVARIES REMOVED

This transition begins slowly in the mid 40’s (perimenopause) then symptoms gradually progress over time until full menopause is reached and hormone levels drop to an all time low.

The average age of menopause is 51.

WOMEN LIVE WITH SYMPTOMS OF MENOPAUSE FOR 10 YEARS OR MORE!

Unfortunately for most women, the symptoms they report to their doctors during this time are not recognized as “menopausal” and they are treated with pharmaceutical drugs for multiple and various “diagnoses” (anti- anxiety meds, sleeping pills, statins, pain medications, etc). Before you know it, you wake up at age 65 and you’re taking handfuls of pills twice a day to maintain your low level of “health”. And yet, you can’t lose weight, can’t sleep, struggle with memory loss, and can barely walk up a flight of stairs without pain.

MENOPAUSE IS A FULL BODY EXPERIENCE… IT AFFECTS EVERY PROCESS IN THE FEMALE BODY INCLUDING: METABOLISM, REPRODUCTION, CARDIOVASCULAR, MOVEMENT, BRAIN HEALTH, DIGESTION

Could you be entering into menopause? You may recognize some of these symptoms:

1. Fatigue/ low motivation

2. Night sweats/ Hot flushes or flashes/ sweating

3. Osteoporoses / joint pain/ stiffness/ musculoskeletal pain

4. Difficulty going to sleep/staying asleep

5. Pain with intercourse

6. Vaginal dryness/ atrophy/ reduced sex drive

7. Anxiety/ heart palpitations

8. Memory loss/ brain fog

9. Irritability/moodiness

10. Weight gain/ belly fat/ weight lose resistance

Many women begin the transition slowly in their mid 40’s and may not even recognize that they are loosing sleep, loosing their mind, and losing their mojo until years later. Is a blood test required to diagnose menopause? No, not really. Would you do a blood test to diagnose your cranky, smelly, moody preteen kid to see it they were in puberty ? Probably not. Recognizing the signs and symptoms can help you to identify were you are in the process. Lifestyle and nutrition changes can go a long way to mitigate symptoms and optimize health and longevity!

IT IS HELPFUL TO DO SPECIALIZED TESTING TO MAXIMIZE ADRENAL AND THRYOID HEALTH

The million dollar question: What can we do about it? How can women lead a full, healthy, happy, joyful life while struggling through this unavoidable transition ?? What changes can we make to not only live longer, but improve our quality of life???

OPTIMIZE YOUR NUTRITION, GET THE RIGHT KIND OF EXERCISE, PERSONALIZED SUPPLEMENTS AND ADAPTOGENS , GET RID OF TOXINS IN YOUR BODY, MANAGE YOUR STRESS, AND ENHANCE YOUR SLEEP

I have been on the menopause struggle bus myself for 10 years. This has inspired me to learn more about the most updated information on women’s health and menopause…. and to share it with you!! I have been certified in Perimenopause and Menopause Health Coaching through the Integrative Women’s Health Institute and would be honored to help you navigate this transition with great health and improved quality of life. ~ Kaye Sharp MPT, WHC, ERYT

Contact Kaye for a health coaching session to learn how to make these changes in your life and feel great in your own body again!

What is the "Unlocking Your Pelvic Floor Workshop"?

I am so excited to be offering this deep dive into a VERY important aspect of women’s health….the PELVIC FLOOR! This workshop will be offered at several different locations in the Birmingham, Al area including:

Rest & Digest Wellness 10/15/23 2-3:30pm

Yoga Lab Bham 11/12/23 1:30-3:30pm (provides CEU’s for Yoga Alliance)

Essential Mvmt Pilates TBA

and more in the works…let me know if you have suggestions!!

Who is this workshop appropriate for?

Any person with a pelvic floor!

Actually, men have pelvic floors, too :) But, my particular passion and focus for this workshop is on the vagina-owning community.

In this workshop, you can expect a supportive and inclusive environment where you will feel comfortable discussing and exploring your pelvic floor health. The instructor, Kaye Sharp MPT, WHC, E-RYT, is trained in pelvic floor physical therapy and has extensive experience working with individuals with various pelvic floor conditions.

This workshop is suitable for individuals of all ages and fitness levels, including those who are pregnant, have recently given birth, experienced trauma, or are simply looking to improve their pelvic floor health. Whether you are a beginner or have some prior knowledge of pelvic floor exercises, this workshop will provide you with valuable tools to optimize your health and UNLOCK your pelvic floor!

What to expect:

1. Understand the anatomy and function of the pelvic floor highlighting the pelvic floor muscles and their role in supporting the pelvic organs, controlling urinary and bowel function, and maintaining sexual health.

2. Identify and address common signs and symptoms of pelvic floor dysfunction, such as pelvic pain, urinary incontinence, and pelvic organ prolapse. You will learn how to recognize these issues and explore strategies to address them effectively.

3. Many individuals experience tightness and tension in their pelvic floor muscles, which can contribute to pain and dysfunction. This workshop will introduce you to specific exercises and stretches that can help you release tension and improve flexibility, manage pressure, and calm your nervous system .

4. Building strength in the pelvic floor muscles is crucial for maintaining their function and preventing issues like urinary incontinence and pelvic organ prolapse. You will go through a series of exercises that target these muscles, helping you develop strength and control in the hips and pelvis.

5. Integrate mindfulness and breath work which plays a significant role in pelvic floor health. We will explore techniques that promote relaxation and improve mind-body connection, allowing you to develop a deeper understanding and awareness of your pelvic floor.

Physical Therapy for the Things Women DON’T Want to Talk About…but SHOULD!

Women’s health issues can be difficult to talk about. Discussing embarrassing symptoms with a partner, spouse, or doctor can be traumatic for a lot of women, causing many conditions to become chronic and difficult to treat. But that doesn’t need to be the case. Are you struggling with?

• Urinary or fecal leakage

• Constipation

• Pain with intercourse

• Bladder issues or interstitial cystitis

• Bowel issues including IBS

• Endometriosis

• Pregnancy related issues

• Postpartum pain/tearing/diastis recti/cesarian recovery

• Perimenopausal changes/dysregulated sleep

• Low back or hip pain

• Pelvic pain of any kind

If you are experiencing these symptoms you are not alone. Nearly every woman will experience at least one of these issues at some point. When this happens, the underlying issue is the health of the pelvic floor. The pelvic floor plays a crucial role in several bodily functions, including bladder and bowel control, sexual function, and stability in movement. However, issues such as pelvic pain, incontinence, and sexual dysfunction can have a significant impact on quality of life. Fortunately, physical therapy effectively and holistically addresses pelvic health symptoms and typically leads to a symptom free life.

Understanding Pelvic Health

The pelvis is a complex network of muscles, ligaments, and connective tissues that support the organs within it. When these structures become weakened, strained, or imbalanced, various pelvic health issues can arise. Common conditions include pelvic floor dysfunction, urinary or fecal incontinence (leakage when you laugh, cough, or sneeze is NEVER normal!), pelvic pain syndromes, and sexual dysfunction. These conditions can affect women of all stages of life including prenatal , postpartum , and perimenopausal. Other symptoms can manifest as IBS, chronic constipation, abdominal pain, lower back and hip pain, and other issues that don’t seem to resolve with conventional treatments.

How Can Physical Therapy Help?

Pelvic floor physical therapy focuses on assessing and addressing the musculoskeletal components of pelvic dysfunction as well as the nervous system. As a trained pelvic health physical therapist , I will perform a thorough evaluation to identify the root causes of your symptoms. Utilizing external and internal assessments to evaluate muscle strength, flexibility, and coordination within the pelvic region, together we will develop an individualized treatment plan tailored to your specific needs.

How are Pelvic Floor Issues Treated?

1. Pelvic Floor Muscle Training: Weak or tight pelvic floor muscles are often at the core of pelvic health issues. Breath work is used to affect the nervous system along with targeted exercises to strengthen or relax these muscles, depending on your condition.

2. Manual Therapy Techniques: Hands-on techniques, such as myofascial release or trigger point release, are used to address tight or painful areas within the pelvic region. Other treatments include dry needling and cupping to promote blood flow and healing.

3. Biofeedback: This technique helps you to gain awareness and control over your pelvic muscles by providing visual or auditory feedback on muscle activity. It aids in retraining the pelvic floor muscles to function optimally.

4. Education and Lifestyle Modifications: Learn valuable information regarding posture, body mechanics, dietary changes, and bladder/bowel habits. These lifestyle modifications can have a significant impact on pelvic health and overall well-being.

What are the Benefits of Pelvic Floor Therapy?

1. Improved Pelvic Floor Function: By targeting the underlying causes of your pelvic health issues, you will gain control over your pelvic floor muscles, leading to improved bladder and bowel control, decreased pain, and increased sexual satisfaction.

2. Enhanced Quality of Life: Pelvic health issues can significantly impact daily activities and personal relationships. Physical therapy offers a non-invasive and holistic approach to manage these issues, restoring your quality of life and overall confidence.

3. Prevention and Education: Pelvic health physical therapy is not only for those already experiencing issues; it can also serve as a preventative measure. By receiving proper pelvic health treatment and preventive exercises, women can maintain optimal pelvic health throughout their lives.

Pelvic health is an integral part of overall well-being, and physical therapy plays a vital role in addressing pelvic health concerns. By offering a comprehensive approach that combines education, targeted exercises, and lifestyle modifications, pelvic health physical therapy empowers individuals to regain control over their symptoms and return to the life they love! If you are experiencing any pelvic health issues, don't hesitate to contact Kaye Sharp MPT, WHC for a comprehensive evaluation and specialized care. Remember, investing in your pelvic health is an investment in your overall well-being!

Kaye Sharp MPT, WHC

Pelvic Health Specialist