Pelvic floor dysfunction can be more than just a physical challenge—it can affect your daily life in ways you might not expect. From discomfort during routine activities to struggles with bladder or bowel control, it’s a condition that is often misunderstood. However, with treatment such as specialized physical therapy, pelvic floor dysfunction symptoms can be eliminated.
What is Pelvic Floor Dysfunction?
Your pelvic floor muscles are a group of interconnected muscles and tissues at the base of your pelvis. These muscles provide support to your bladder, rectum, and, for those assigned female at birth, the uterus and vagina, or for those assigned male at birth, the prostate. They help maintain the proper positioning of these organs while allowing them to function.
In addition to structural support, your pelvic floor muscles control things such as urination, bowel movements, and sexual activity. They contract and relax to allow for the release of urine and stool and play a key role in sexual arousal, sensation, and childbirth. These muscles also work closely with your core, hip, and back muscles to provide overall stability and balance for your body.
When these muscles are not working as they should—whether they are too tight, weak, or poorly coordinated—you might experience a wide range of symptoms. This includes problems like bladder leakage, bowel irregularities, pain during sexual activity, or chronic discomfort in your pelvis, hips, or lower back. Since the pelvic floor muscles are so deeply connected to other systems in your body, their dysfunction can impact far more than just the pelvic area.
For some people, these symptoms can interfere with everyday life, making once-simple activities feel daunting.
What are the Symptoms of Pelvic Floor Dysfunction?
- Urinary Incontinence: Leakage during activities such as laughing, sneezing, coughing, or exercise (stress incontinence) or sudden, strong urges to urinate (urge incontinence).
- Frequent Urination: Needing to urinate more often than usual without increased fluid intake.
- Urinary Urgency: A persistent feeling of needing to urinate immediately.
- Hesitancy: Difficulty starting the flow of urine.
- Weak Urine Stream: A reduced flow during urination.
- Incomplete Emptying: Feeling that the bladder is not fully emptied after urinating.
- Nocturia: Waking up multiple times during the night to urinate.
- Pain During Urination: Discomfort, burning, or pressure while urinating.
- Constipation: Straining or difficulty passing stools, often accompanied by a feeling of blockage.
- Incomplete Evacuation: The sensation that stool remains after a bowel movement.
- Fecal Incontinence: Inability to control bowel movements or gas.
- Pain During Bowel Movements: Discomfort or pressure in the rectum.
- Rectal Pain: Persistent pain in or around the rectum, not necessarily related to bowel movements.
- Chronic Pelvic Pain: Ongoing pain in the lower abdomen or pelvic region.
- Pain in the Perineum: Discomfort or pressure between the genitals and the anus.
- Lower Back Pain: Pain radiating to or originating from the lower back.
- Hip or Groin Pain: Aching or sharp pain in the hips or groin.
- Tailbone Pain: Discomfort or pressure at the base of the spine (coccyx).
- Pain During Sexual Activity: Discomfort during penetration, arousal, or ejaculation.
- Reduced Sensation: Decreased sensitivity in the pelvic region.
- Difficulty Achieving Orgasm: Delayed or absent orgasm due to pelvic muscle dysfunction.
- Postcoital Pain: Pain after sexual activity.
- Erectile or Arousal Dysfunction: Difficulty achieving or maintaining an erection or arousal.
- Pelvic Muscle Spasms: Involuntary tightening or cramping of the pelvic floor muscles.
- Poor Posture: Changes in alignment due to muscle imbalance or weakness.
- Difficulty with Core Strength: Challenges engaging abdominal muscles during physical activity.
- Heaviness or Dragging Sensation: A feeling of pressure or weight in the pelvic area, often worsening with prolonged standing or physical activity.
- Sensation of a Bulge: Feeling or seeing a bulge in the pelvic area (e.g., vaginal or rectal prolapse).
- Pressure or Fullness: A persistent sensation of heaviness in the pelvis.
- Difficulty Inserting or Removing Items: Challenges with tampons, menstrual cups, or rectal suppositories.
- Nerve Pain: Tingling, shooting, or burning sensations, often associated with pudendal nerve involvement.
- Radiating Pain: Pain extending to the thighs, buttocks, or lower abdomen.
- Numbness or Tingling: Loss of sensation or abnormal sensations in the pelvic region.
- Fatigue: Generalized exhaustion due to chronic pain or muscle dysfunction.
- Bloating or Abdominal Distension: A feeling of fullness or pressure, often unrelated to gastrointestinal issues.
- Pain When Sitting: Discomfort or worsening pain when sitting for long periods.
What Causes Pelvic Floor Dysfunction?
Pelvic floor dysfunction doesn’t just happen without a reason. In fact, there are several things that can contribute to the condition.
- Trauma to the Pelvic Area: Accidents or injuries, such as a fall or a car crash, can damage the muscles and nerves in your pelvic region, leading to dysfunction.
- Overuse of Pelvic Muscles: Straining too hard during bowel movements or other activities can overwork these muscles, causing tightness and dysfunction that builds over time.
- Previous Pelvic Surgeries: Procedures like hysterectomy or prostate surgery can weaken or disrupt the pelvic floor, leading to issues with muscle control.
- Pregnancy and Childbirth: Carrying a baby puts significant strain on your pelvic floor, and a difficult delivery can add extra stress, leaving these muscles weaker or injured.
- Natural Aging Process: Like all muscles in your body, the pelvic floor muscles can lose strength as you get older, which might affect their ability to function properly.
- Stress and Anxiety: Chronic stress can cause muscle tension throughout your body, including your pelvic floor, which might lead to pain or dysfunction.
- Connective Tissue Disorders: Conditions that affect the strength or elasticity of connective tissues can also impact the pelvic floor, making it more prone to weakness or injury.
Which Conditions Are Sometimes Confused with Pelvic Floor Dysfunction?
There are many conditions that are often mistaken for pelvic floor dysfunction:
- Anorectal Conditions: Issues like hemorrhoids or anal fissures can cause pain and discomfort similar to pelvic floor dysfunction. Both can lead to difficulties with bowel movements and perineal pain.
- Constipation: Chronic constipation can result from or contribute to pelvic floor issues. However, it can also exist independently, making it important to distinguish between primary constipation and symptoms related to pelvic floor dysfunction.
- Prostatitis: In individuals assigned male at birth, prostatitis—an inflammation of the prostate gland—can mimic pelvic floor dysfunction with symptoms like pelvic pain and urinary difficulties.
- Erectile Dysfunction (ED): Pelvic floor dysfunction can lead to ED due to impaired muscle function. However, ED can also stem from vascular, neurological, or psychological factors unrelated to the pelvic floor.
- Pelvic Organ Prolapse: This condition involves the descent of pelvic organs, leading to a sensation of pressure or bulging. While it can coexist with pelvic floor dysfunction, prolapse has distinct anatomical causes that require specific treatments.
- Irritable Bowel Syndrome (IBS): IBS presents with abdominal discomfort, bloating, and altered bowel habits. These gastrointestinal symptoms can overlap with pelvic floor dysfunction, complicating the diagnostic process.
- Interstitial Cystitis (IC): IC, also known as painful bladder syndrome, causes bladder pressure and pelvic pain. Its symptoms often resemble those of pelvic floor dysfunction.
Given the symptom overlap, a thorough evaluation by a healthcare professional is important to accurately diagnose and treat pelvic floor dysfunction and distinguish it from other conditions.
How is Pelvic Floor Dysfunction Diagnosed?
Diagnosing pelvic floor dysfunction involves a combination of discussing your symptoms, reviewing your medical history, and conducting a physical examination. Your physical therapist will evaluate how your pelvic floor muscles function and determine if they are contributing to your symptoms.
- Symptom Discussion: Your provider will ask detailed questions about your symptoms, such as when they started, how they affect your daily life, and any triggers that make them worse. Sharing information about past surgeries, injuries, or childbirth experiences can also help with diagnosis.
- Physical Examination: A pelvic exam allows your provider to assess the strength, coordination, and tone of your pelvic floor muscles. For those assigned female at birth, this might involve a vaginal or rectal examination; for those assigned male at birth, it usually involves a rectal examination. The goal of the exam is to identify tightness, weakness, or areas of discomfort.
- Observation of Muscle Function: You might be asked to contract and relax your pelvic floor muscles during the exam. This helps determine how well your muscles are working and if there’s any difficulty in controlling them.
Tests Used for Diagnosing Pelvic Floor Dysfunction
Depending on the severity of symptoms, your physical therapist at Beyond Basics might recommend additional tests to get a clearer picture of what’s happening:
- Pelvic Floor Ultrasound: This imaging test uses sound waves to create a picture of your pelvic organs and muscles, helping to identify abnormalities like prolapse or muscle tears.
- Defecography: A specialized X-ray or MRI that evaluates how your pelvic floor muscles function during a bowel movement. This can pinpoint issues with coordination or incomplete evacuation.
- Urodynamic Testing: This test measures how your bladder holds and releases urine. It can identify issues like urinary incontinence or hesitancy linked to pelvic floor dysfunction.
- Electromyography (EMG): EMG evaluates the electrical activity in your pelvic floor muscles, identifying areas of overactivity or weakness.
- Cystoscopy: If urinary symptoms are prominent, this procedure involves using a thin scope to examine the inside of your bladder and urethra to rule out other conditions.
- MRI or CT Scan: These imaging tests provide detailed views of your pelvic anatomy and can identify structural problems contributing to dysfunction.
How Do You Treat Pelvic Floor Dysfunction?
Treatment for pelvic floor dysfunction focuses on restoring the muscles and tissues of your pelvic floor to their optimal function. While several approaches might be used, physical therapy is at the heart of effective treatment, offering a personalized and hands-on method to address the root causes of your discomfort and symptoms.
Pelvic Floor Physical Therapy
Physical therapy for the pelvic floor goes beyond simple exercises—it’s a comprehensive approach to retrain and restore muscle function. It involves:
- Manual Therapy: This includes both external and internal techniques to release tight muscles, mobilize tissues, and reduce pain. By working directly on the pelvic floor muscles, physical therapists can help you regain control and relieve discomfort.
- Strengthening Exercises: Weak pelvic muscles can be retrained with specific exercises. Your physical therapist will guide you through movements designed to build strength and coordination over time.
- Stretching and Relaxation: If your pelvic floor muscles are too tight, stretching and relaxation techniques are used to help release the tension. Learning to relax these muscles can significantly reduce symptoms like pain and muscle spasms.
- Biofeedback Therapy: This is often part of physical therapy and uses sensors to monitor your muscle activity. Biofeedback helps you understand how your muscles are working and teaches you to contract and relax them.
- At-Home Exercises: Your therapist will give you specific exercises to continue at home. These movements are designed to reinforce the work done in your physical therapy sessions, teach your body better movement patterns, and maintain progress between visits.
Additional Approaches
While physical therapy is the cornerstone of treatment, other methods might complement it:
- Relaxation Techniques: Stress can sometimes exacerbate pelvic floor dysfunction, so therapies like mindfulness, deep breathing, and guided relaxation exercises might be part of your plan.
- Medication: In some cases, medication is used to manage symptoms such as pain, inflammation, or bowel and bladder issues. These are typically part of a broader treatment strategy.
What To Expect During Your Initial Pelvic Floor Physical Therapy Appointment
Your first appointment with our physical therapy team at Beyond Basics will begin with us asking questions in order to learn more about you and provide us with the context we need to understand your body and any symptoms you are experiencing.
We’ll also conduct a physical exam, which is a hands-on evaluation based on your symptoms. This might involve evaluating external and internal muscles, with the purpose being to trace your issue to its source(s) in order to alleviate pain.
These internal manual techniques are applied to structures of the pelvis. This includes the pelvic floor muscles, nerves, and bones. We want you to be as comfortable as possible during the session – you have the right to refuse any treatment at any time without explanation.
Your PT will also provide you with exercises to begin at home to address your symptoms and ease your pain. These at-home exercises are customized specifically based on your needs.
What To Expect During Your Additional Appointments
At Beyond Basics, each pelvic floor physical therapy appointment is one hour long. Your physical therapist will spend 45 minutes or more with you performing manual therapy and the remaining time discussing your progress, answering questions, and providing at-home exercises when necessary.
Our sessions are intentionally structured this way, as we have found this is the ideal amount of time for the clarity, consistency, and results we are looking to help you obtain.
Your symptoms should begin to improve within 4 to 8 weeks (or sooner).
Will Pelvic Floor Dysfunction Improve Without Treatment?
Pelvic floor dysfunction is very unlikely to improve on its own. Unlike minor muscle soreness or strain that might resolve naturally with rest, pelvic floor issues often persist or worsen over time without proper care. As mentioned, the pelvic floor muscles support your bladder, bowel, and reproductive organs, as well as contribute to core stability. When these muscles are tight, weak, or uncoordinated, they need specific therapeutic treatment to function.
Ignoring symptoms like urinary incontinence, pain, or bowel difficulties (among others) can lead to more significant problems. For example, untreated pelvic floor dysfunction could cause chronic pain, worsening muscle imbalances, and increased difficulty with daily activities like sitting, walking, or exercising. It can also take a toll on your mental health.
Beyond Basics: We Can Help
At Beyond Basics, we are committed to treating pelvic floor issues with sensitivity to each individual’s needs, regardless of sex, race, identity, age, or orientation – we treat the whole person with a comprehensive, caring biopsychosocial approach.
Since 2003, Beyond Basics has been a place of hope and healing for our patients. We believe skilled and compassionate healing can restore your body’s harmony and balance. Founder, Amy Stein, and co-founder, Corey Hazama are renowned experts and leaders in pelvic floor PT.
The skilled physical therapists at Beyond Basics receive extensive training to qualify them to be the world’s leaders in pelvic floor rehabilitation. All of our therapists have been carefully selected to work at Beyond Basics because they possess the right expertise, kindness, and empathy to allow them to excel at our practice. Our therapists have completed hundreds of additional hours outside of their doctorates both internally and externally through institutes such as Herman and Wallace and the American Physical Therapy Association, to help hone their practice and provide exceptional treatment efficiently and compassionately. In addition to being the world’s first and foremost experts in pelvic floor dysfunction, our individual therapists have cultivated additional skills unique to their own personal interests. Read more about each one of our therapists here.
