"Just Live With It": Why Women Wait Years Before Seeking Help for Pelvic Floor Dysfunction
"Just live with it."
In nearly five years of working with women in India, I have heard different versions of these four words countless times.
"It happens after childbirth."
"It's because you're getting older."
"This is what menopause feels like."
"Your mother had it too."
Most of the time, these words are spoken with kindness. They come from mothers, mothers-in-law, sisters, friends, neighbours, and sometimes even healthcare professionals who genuinely believe they are reassuring women. Yet, despite good intentions, these messages often become the greatest barrier to pelvic health care.
What strikes me most as a physiotherapist is that women rarely delay treatment because they are careless about their health. Instead, they delay because they are taught that their symptoms are ordinary. Urinary leakage after coughing or laughing, constipation, pelvic heaviness, tailbone pain, pain during intercourse, or the constant urge to find a toilet are accepted as inevitable consequences of childbirth or ageing. When symptoms are described as "normal," seeking treatment almost feels unnecessary.
Over time, women stop searching for answers and begin changing their lives instead.
They memorize the locations of public washrooms before leaving home. They stop drinking water before travelling. They avoid long bus journeys, religious gatherings, exercise classes, and even laughter because they worry about leaking urine. Some stop lifting their grandchildren because their back or pelvis feels unstable. Others quietly withdraw from activities they once loved, not because they no longer enjoy them, but because their bodies no longer feel predictable.
These adaptations happen so gradually that they become invisible. Family members may notice that a woman no longer dances at weddings or joins morning walks, but they often attribute these changes to ageing rather than recognising them as signs of an untreated pelvic floor condition. Eventually, the adaptations become her new normal.
For many women, this stage of life coincides with another major transition—menopause. While menopause is commonly associated with hot flashes and hormonal changes, it also arrives during a period when life itself is changing. Children leave home, bringing the mixed emotions of the empty nest. Many women begin caring for ageing parents or in-laws while continuing to support adult children, manage households, and maintain demanding careers. Others find themselves redefining their identity after decades of prioritising everyone else's needs before their own.
The physical and emotional demands of this period are deeply interconnected. Declining estrogen affects the bladder, vagina, connective tissues, and pelvic floor, while also influencing sleep, mood, and the body's response to stress. Poor sleep increases fatigue and pain sensitivity. Chronic stress keeps muscles—including the pelvic floor—in a constant state of tension. Together, these biological and emotional changes can contribute to urinary urgency, constipation, pelvic pain, painful intercourse, and reduced confidence in everyday activities.
Yet these concerns are rarely discussed as a whole. Women often seek help for one symptom while quietly carrying several others.
Perhaps the greatest silence surrounds sexual health.
After childbirth, some women experience persistent pain due to scar tissue, muscle overactivity, or fear of movement. During menopause, hormonal changes may contribute to vaginal dryness, reduced tissue elasticity, and discomfort with intimacy. Others notice changes in sexual desire or find it difficult to achieve orgasm, yet never mention these concerns during a healthcare visit. Many assume these experiences are simply another unavoidable part of becoming older. In my experience, women rarely volunteer this information unless they are asked with empathy, privacy, and without judgement.
Even when a woman decides she wants help, another set of barriers often appears.
Access to pelvic health physiotherapy remains limited for many women, particularly in rural and underserved communities. Travelling several hours to see a specialist, arranging childcare or elder care, taking unpaid leave from work, or paying for repeated appointments is not always possible. Some women are uncomfortable discussing intimate concerns if a female healthcare provider is unavailable. Others have never heard of pelvic floor physiotherapy and therefore do not realise that conservative, evidence-based treatment exists.
These challenges are not unique to India. Similar barriers are experienced by women living in remote communities, underserved regions, and low-resource settings across the world. Geography, finances, health literacy, stigma, and limited specialist services continue to influence who receives care and who continues to suffer in silence.
This is precisely why pelvic health physiotherapy has evolved far beyond prescribing Kegel exercises.
Modern rehabilitation begins by understanding the woman, not simply the symptom. An individualized assessment explores bladder and bowel function, pregnancy and birth history, menopause, movement patterns, breathing, stress, sleep, physical activity, and the goals that matter most to her. For one woman, treatment may focus on strengthening weakened pelvic floor muscles. For another, the priority may be learning to relax muscles that are constantly overactive. Others benefit from bladder retraining, bowel management strategies, breathing techniques, pain education, manual therapy, progressive exercise, or coordinated care with other healthcare professionals. There is no universal exercise programme because there is no universal pelvic floor dysfunction.
Perhaps the most important lesson pelvic health has taught me is that women are remarkably resilient. They adapt, they endure, and they continue caring for others even while quietly compromising their own well-being. But resilience should never be mistaken for the absence of suffering.
It is time to challenge one of the most common phrases women hear:
"Just live with it."
Instead, let us begin saying, "Let's talk about it."
Because urinary leakage is not simply an inconvenience. Pain during intimacy is not something women should silently accept. Constipation, urgency, pelvic pain, and tailbone pain are not inevitable consequences of childbirth or menopause. They are health concerns that deserve to be heard, understood, and treated with compassion.
As physiotherapists, we have the opportunity to change not only how pelvic floor dysfunction is managed, but also how it is perceived. Sometimes, the most powerful intervention is not an exercise prescription—it is giving a woman permission to say, perhaps for the very first time, "This isn't normal, and I don't have to live with it."
Meet the Author
Shyamli Vikas Kulkarni, PT, MPT, BPT, Lactation Consultant, Certified Antenatal & Postnatal Exercise Specialist, Certified Pelvic Rehab Specialist
📍 Pune, India
Dr. Shyamli Kulkarni, MPT (Community Physiotherapy), is an Assistant Professor at MAEER's Physiotherapy College, Pune, India, with over seven years of clinical experience and five years of teaching experience. Her clinical and research interests include pelvic health, women's health physiotherapy, maternal wellness, community-based rehabilitation, and healthy ageing. Through her educational platform, MotherWise, she is committed to improving awareness of pelvic floor health and making evidence-based physiotherapy accessible to women, particularly in underserved communities.
