When POTS and Pelvic Floor Dysfunction Collide: What You Need to Know

If you live with POTS or dysautonomia, you already know that your body doesn’t always play by the rules. The racing heart, dizziness, fatigue, and lightheadedness can be hard enough — but many of my patients are surprised when I tell them that their pelvic symptoms might be connected, too.

As a pelvic physical therapist, I see this overlap all the time. People come in with bladder urgency, pelvic pressure, constipation, or pain — and somewhere along the way, they mention feeling faint when standing, or having been told they might have POTS. Once we start connecting the dots, things make a lot more sense.

Let’s talk about what’s going on, why these conditions are connected, and what you can do to start feeling better.

What Are Dysautonomia and POTS, in Simple Terms?

Your autonomic nervous system is like your body’s autopilot — it controls things like heart rate, blood pressure, digestion, and even how your bladder and bowels function.

When that system isn’t regulating things properly, we call it dysautonomia.

POTS (Postural Orthostatic Tachycardia Syndrome) is one specific type. It happens when your heart rate jumps abnormally high when you stand up — often making you dizzy, tired, or lightheaded.

Because this same “autopilot” system also talks to your pelvic organs and muscles, it’s not surprising that when it’s off-balance, the pelvis can be affected too.

How the Nervous System and Pelvic Floor Are Connected

Your pelvic floor is a team of muscles that support your bladder, uterus or prostate, and rectum. These muscles also help with peeing, pooping, and sexual function — and they’re guided by your nervous system.

In POTS or other forms of dysautonomia, those signals can get a little scrambled. You might experience things like:

• Trouble fully emptying your bladder

• Feeling like you have to pee all the time (urgency)

• Constipation or incomplete bowel movements

• Pelvic heaviness, aching, or pain

• Pain with sex or pelvic exams

When your body is in a constant “fight or flight” state (which is common in dysautonomia), your pelvic floor muscles can stay tight and guarded. On the flip side, if you have joint hypermobility or Ehlers-Danlos syndrome, your tissues may be more elastic — so the pelvic floor might also be weak or unstable.

It’s not always one or the other; sometimes it’s both.

Why POTS and Pelvic Floor Dysfunction Often Show Up Together

Here are a few reasons we see this connection so often in the clinic:

1. Circulation and Blood Pooling

In POTS, blood tends to pool in the legs and pelvis instead of moving efficiently back to the heart. That can leave you feeling heavy, swollen, or achy in your lower body — especially after standing.

2. Muscle Tension and Guarding

Your body works hard to keep you upright and prevent dizziness. Sometimes, that extra effort shows up as tension in the hips, core, or pelvic floor, which can cause pain or difficulty relaxing those muscles.

3. Connective Tissue Laxity

People with hypermobility (or connective tissue disorders like Ehlers-Danlos syndrome) often have looser ligaments and fascia, which can make the pelvic organs less supported — leading to prolapse symptoms or instability.

4. Autonomic Nervous System Imbalance

When the “automatic” part of your nervous system isn’t communicating properly, it can affect how your bladder and bowels contract, relax, and sense fullness — leading to frequency, urgency, or retention.

What Treatment Looks Like (and How We Can Help)

The great news is that with the right strategies, you can absolutely make progress. Here’s how I approach it in my pelvic health practice:

1. Gentle, Individualized Pelvic Floor Therapy

We don’t just strengthen muscles — we help you learn how to relax, coordinate, and control them. That might include:

• Breathing techniques to calm your nervous system

• Manual therapy to release tension or improve mobility

• Gradual strengthening to build stability and support

• Bladder and bowel training strategies that fit your lifestyle

For many of my POTS patients, less is more — we start slow, stay gentle, and focus on nervous system regulation as much as muscle training.

2. Nervous System Regulation

Your pelvic floor won’t relax if your body doesn’t feel safe. I often teach simple tools to help your system shift out of “fight or flight,” like:

• Diaphragmatic breathing (deep belly breathing)

• Restorative yoga or gentle stretching

• Mindful movement or grounding techniques

• Warm compresses and self-massage for pelvic relaxation

3. Circulation and Movement Support

Low-impact, horizontal movement (like recumbent biking, swimming, or gentle Pilates) can improve blood flow and help with both POTS and pelvic congestion.

Compression garments, hydration, and pacing activity levels can also make a big difference.

4. Team Approach

You don’t have to manage this alone. The best outcomes happen when your care team works together — your pelvic PT, cardiologist or neurologist, and sometimes a GI or urology specialist. When everyone’s on the same page, your body has a much better chance to regulate and heal.

A Few Encouraging Takeaways

• You’re not imagining it. Pelvic symptoms are common in people with dysautonomia and POTS.

• These issues are real, explainable, and treatable — with patience and the right approach.

• Recovery doesn’t mean “fixing everything overnight” — it means learning how to support your body’s unique needs.

• Small, consistent steps toward stability and nervous system balance can create big changes over time.

A Final Word

If you’ve been struggling with bladder, bowel, or pelvic pain symptoms alongside POTS or dysautonomia, please know this: you’re not broken, and you’re not alone.

Your body is doing its best with a complicated set of instructions — and with the right care, it can learn new patterns. Working gently with your nervous system and pelvic floor can help you find more comfort, stability, and confidence in your body again.

If you’re ready to explore this kind of care, our pelvic floor physical therapists at Intrinsic Physical Therapy & Wellness are ready to help! You deserve care that sees the full picture — not just the symptoms.

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