Pelvic Floor Health for Women: What Every Equestrian Should Know

For a female equestrian, the body in the saddle changes throughout life. The 25-year-old rider who is building strength and competing every weekend has a very different physical experience than the 38-year-old mother returning to riding after having a baby or the 52-year-old rider navigating menopause. The horse may be the same, the saddle may be the same and the love of riding may be exactly the same, but the body doing the riding continues to change.

One part of that body deserves more attention than it usually gets: the pelvic floor. The pelvic floor is a group of muscles and connective tissues at the base of the pelvis that help support the pelvic organs and play an important role in bladder and bowel control and sexual function. It also works with the abdomen, back, hips and diaphragm as part of the body's larger system for movement and stability.

For riders balance, coordination, strength and control is the foundation of our sport. Research has shown that the pelvic-floor muscles are active during horseback riding and that their activity changes at different riding paces. That finding does not tell us that riding is either a pelvic-floor exercise or a threat to pelvic health. It tells us that the pelvic floor is one part of the physical system a woman uses when she rides.

Pelvic Floor Health for Women Starts Before You Need to Recover

Pelvic-floor health is not something women need to think about only after pregnancy or once they reach menopause. Young, physically active women who have never been pregnant can experience pelvic-floor symptoms, including urinary leakage during exercise. Research involving female athletes has found urinary incontinence among women who have never given birth, particularly in sports that involve repetitive impact.

For the young equestrian, the goal is not to assume there is a problem or to spend hours doing Kegel exercises. It is to understand how the pelvic floor works and how it fits into the rest of the body. A healthy pelvic floor needs to contract when needed, generate force and coordinate with movement, but it also needs to relax.

This is important because pelvic-floor health is not simply a matter of having stronger muscles. A rider can have difficulty generating enough force, but another woman may have difficulty relaxing muscles that are already overly tense. Building overall strength in the hips, glutes, legs and trunk while learning how to contract and relax the pelvic floor gives a young rider a useful foundation.

Symptoms such as urine leakage, pelvic pressure, pelvic pain or pain during intercourse should not automatically be dismissed because a woman is young, athletic or has never had children. They are worth discussing with a doctor or physical therapist pelvic floor specialist, particularly if they persist or interfere with exercise or daily life.

Pregnancy Changes the Equation

Pregnancy can affect pelvic-floor function long before a woman gives birth. The growing uterus, changes in body weight and center of gravity, hormonal changes and changes in posture all alter the physical demands placed on the body. Urinary incontinence is common during pregnancy and after delivery, and pregnancy itself is an important part of the pelvic-floor story.

Pregnancy also changes what riding feels like. Balance changes as the center of gravity shifts, and the physical demands of staying balanced on a moving horse can change as the pregnancy progresses. Whether a woman continues riding during pregnancy is an individual decision she makes based on and advice from her doctor.

The larger point is that pregnancy is not a single event followed immediately by a return to normal. It is a period of significant physical change followed by another period in which the body has to heal and regain strength.

Childbirth and the Road Back

Vaginal and cesarean births place different demands on the body. Vaginal birth is associated with a greater risk of pelvic-floor disorders, including urinary incontinence and pelvic-organ prolapse, than cesarean birth. Individual outcomes vary considerably, however, and factors such as the number of births, the size and position of the baby, length of labor, perineal injury and instrument-assisted delivery can all play a role.

That does not mean that vaginal birth damages every woman's pelvic floor. It also does not mean that having a cesarean eliminates the need for postpartum recovery. Pregnancy itself places demands on the pelvic floor, while a c-section adds a major abdominal surgery and its own healing process.

The American College of Obstetricians and Gynecologists puts the physical reality of this period simply: “Pregnancy, labor, and birth can be hard on the body, and healing takes time.” For an equestrian who is eager to get back to her horse, that may be one of the most important things to remember.

There is no single postpartum timeline that tells every woman when she is ready for physical activity. A woman who has recovered from an uncomplicated birth may have very different needs from someone who experienced significant tearing, an instrumental delivery, persistent pain, pelvic-floor symptoms or a c-section.

Returning to the Saddle

Getting back on a horse is not the same thing as being ready to resume everything a rider did before pregnancy. A woman may be medically cleared for general activity and still find that certain movements cause pressure, leakage, pain or discomfort. Those symptoms are useful information about how the body is tolerating the physical demand.

Research on postpartum return to sport, mostly from activities other than riding, supports a gradual and individualized approach. For an equestrian, that may mean beginning with walking and basic strength work, progressing to easier riding and gradually increasing duration and intensity before returning to more demanding work such as extended sitting trot, jumping or competition. The exact progression should depend on the individual rider, her birth history, symptoms, strength and recovery.

If symptoms increase with heavier workload, pushing through them is not the only option. A pelvic-health physical therapist can assess what is happening and determine whether the rider needs more strength, better coordination, improved relaxation, core rehabilitation or another approach.

The Body Keeps Changing

Pregnancy and childbirth may be major events in a woman's pelvic-health history, but they are not the only things that matter. Aging is accompanied by gradual changes in muscle, connective tissue and other pelvic structures. Those changes happen over years rather than appearing on a particular birthday.

For riders, this is also a period when maintaining strength becomes increasingly important. Muscle mass, recovery, mobility and overall conditioning can change with age, and the physical demands of riding do not necessarily become easier simply because a woman has been riding for decades. The experienced rider may have excellent balance and feel for the horse while still benefiting from updating the way she trains her own body.

Pelvic-floor symptoms can also change during this period. Urinary leakage, urgency, pelvic pressure, changes in bowel control, pelvic pain and sexual symptoms are all worth paying attention to rather than automatically passing it off as just getting older.

Perimenopause and Menopause

Perimenopause brings another significant transition. As estrogen levels fluctuate and eventually decline, women can experience changes involving the vulva, vagina, urethra and bladder. The American College of Obstetricians and Gynecologists lists symptoms such as vaginal dryness, reduced elasticity, painful sex, increased urinary frequency and recurrent urinary tract infections among the possible changes associated with menopause.

These symptoms are not necessarily evidence that a woman's pelvic-floor muscles weaken. Hormonal changes can affect the tissues of the genitourinary system even when the muscles themselves are functioning well. This is important because treating every menopausal pelvic symptom as a strength problem can mislead women toward the wrong solution.

Pelvic-floor physical therapy may be part of the answer for some women, but it is not the only tool available. Treatment can involve strengthening, relaxation, coordination, breathing strategies, mobility and core rehabilitation, while some menopausal symptoms may also require medical treatment.

As pelvic-floor physical therapist Pauline H. explained in Mayo Clinic Press, “There's more to pelvic floor health than doing Kegel exercises.” For women who have been told that they simply need to do more Kegels, that is an important reminder that pelvic-floor care should be based on what is actually happening in the body.

What Do We Know About Riding?

This is one area where the research is interesting but still limited. Studies have measured pelvic-floor muscle activity during horseback riding and found different patterns at different paces. A 2025 study involving women who participated in show jumping found no significant differences in reported bladder, bowel, pelvic-organ prolapse or sexual-function symptoms compared with women who did not ride.

A separate 2026 study of 100 female horseback riders in Poland found that 36% of the participants reported symptoms of stress urinary incontinence. Age, body mass index and childbirth history were associated with symptoms in that study, while riding frequency, riding duration and type of training generally were not.

These findings are important, but they need to be read with care. The study does not mean that 36% of all female equestrians have urinary incontinence, nor does it establish that horseback riding causes the condition. It provides information about one group of riders and adds to a relatively small body of research looking specifically at women in equestrian sport.

What the research shows is that pelvic-floor muscles are involved when women ride. Female riders can experience pelvic-floor symptoms and there is still a lot researchers do not know about how riding, especially over many years, affects pelvic-floor function.

The Hysterectomy Rider

Hysterectomy is another point in a woman's life when recovery deserves careful consideration. Removing the uterus does not remove the pelvic floor, and recovery depends on the type of surgery, any additional procedures performed, the woman's individual healing and her physical condition before surgery.

Research has found associations between hysterectomy and several pelvic-floor disorders over time, although an association doesn't prove that the surgery itself caused those conditions. Pelvic-floor rehabilitation following hysterectomy may have benefits, particularly for some aspects of sexual function, although evidence for other outcomes is less certain.

For a rider, returning to the horse after surgery should be guided by the surgical team and an individualized rehabilitation plan. An incision that looks healed on the outside does not necessarily mean that every part of the body is ready for the demands of riding, particularly jumping or other high-impact activity.

Ride for the Long Term

Pelvic-floor health is not about protecting women from riding. It is about helping women understand the bodies they are asking to ride.

A strong rider needs more than strong pelvic-floor muscles. She needs a body that can stabilize, relax, absorb movement, produce force and recover from physical demands. That may look different at 25 than it does at 45, and it may look different again after having a baby, undergoing surgery or moving through menopause.

Most importantly, women do not have to simply accept urinary leakage, pelvic pressure, pain, bowel-control problems or painful sex as the price of motherhood, aging or riding. These symptoms are the way our body communicates with us and raises a flag so we pay attention and, when appropriate, seek medical advice and guidance.

A pelvic-health physical therapist, urogynecologist, gynecologist or other qualified health professional can help determine what is actually happening. Sometimes the answer is strengthening. Sometimes it is learning to relax. Sometimes it involves coordination, core rehabilitation, medical treatment or several approaches together.

The goal is not for a woman to think about her pelvic floor every time she gets in the saddle. The goal is for her to understand enough about her body to recognize when something has changed, give herself appropriate time to recover and know when she needs help.

The goal is not to ride well today. It is to keep riding well, comfortably and confidently for life.