What Is Pelvic Floor Dysfunction—And How Can You Treat It?
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Medically reviewed by Kiarra King, MD
Pelvic floor dysfunction is the abnormal function of the pelvic floor muscles, and can occur due to damage or weakening of the pelvic floor. It is common among females, especially those who have given birth. However, it can also affect males.
The pelvic floor is a group of muscles, ligaments, and nerves located at the bottom of the pelvis (between the hips). These muscles support the bladder, rectum, prostate in males, and vagina and uterus in females. They also offer general support to other organs in the abdomen.
When pelvic floor muscles contract and relax, they help control bowel movements, urination, and parts of sexual functions.
Pelvic floor dysfunction can happen for several reasons, and it can lead to issues in bladder control and sexual health. Fortunately, there are ways to treat pelvic floor dysfunction through physical therapy, medications, and more.
What Causes Pelvic Floor Dysfunction?
There are several conditions and circumstances that may weaken or damage the pelvic floor. These include:
Pregnancy and childbirth: During pregnancy, the growing baby's weight can put pressure on the pelvic floor muscles causing them to weaken. During childbirth, the muscles stretch and sometimes tear.
Pelvic trauma: This includes surgery, radiation in the pelvis, and history of sexual abuse.
Age: Your muscles naturally weaken with age.
Chronic constipation or coughing: Long-term constipation (inability to poop) or coughing can strain the pelvic floor muscles.
Obesity: Being overweight can put added pressure on the pelvic floor muscles.
Neurological disorders: Multiple sclerosis, Parkinson's disease, or spinal nerve injuries can affect the nerves that control the pelvic floor muscles.
Health conditions: Underlying conditions such as irritable bowel syndrome (IBS), endometriosis, and interstitial cystitis may contribute to pelvic floor pain.
What Are the Symptoms of Pelvic Floor Dysfunction?
Pelvic floor dysfunction symptoms vary for each person and may include:
Urinary (peeing) problems: This may involve urinary incontinence (inability to control peeing or leakage) or an overactive bladder (increase in urge and frequency).
Bowel movement (pooping) problems: This may involve bowel strain, constipation, incomplete or painful bowel movements, and stool incontinence (inability to control pooping which can cause leakage).
Rectal pain: The rectum is the last part of the large intestine. This sudden pain may wake you up at night. It can last for a few minutes before going away.
Pelvic pain: Pain or pressure in the pelvis is a common symptom that may come and go. Some people develop chronic (more than three to six months) pelvic pain.
Sexual dysfunction: This might involve difficulty getting an erection or having an orgasm. Painful sex can also be a symptom of pelvic floor dysfunction (for females).
How To Treat Pelvic Floor Dysfunction
Treatment of pelvic floor dysfunction varies depending on the underlying cause and symptom severity.
Physical Therapy and Exercises
Pelvic floor physical therapy is the most common treatment for pelvic floor dysfunction. A pelvic floor physical therapist will work with you to relax pelvic muscles and increase muscle function.
The physical therapist will recommend a regimen specific to your underlying condition. The plan might involve one or a combination of the following:
Pelvic floor exercises: Kegels are one of the most popular pelvic floor exercises. They target the pelvic floor muscles that help control urine flow (peeing) and bowel movements (pooping).
Biofeedback: In this painless method, the physical therapist will place electrode sensors in the form of sticky patches around your lower abdomen. In some cases, they will also place a small sensor in the anus. The sensors along with video monitoring provide real-time feedback to ensure you are engaging the correct muscles.
Massage: The physical therapist will locate and treat any muscle knots as well as perform deep tissue massage, pelvic floor massage, joint mobilization, and skin rolling.
Electrical stimulation: This non-painful technique uses electrical probes in or around the vagina and rectum. It helps desensitize the nerves that cause muscle contraction and relaxation.
Ultrasound: Although most often used as a diagnostic tool, ultrasound can also be a form of therapy. It creates warmth which reduces muscle spasming and stimulates blood flow.
Once you start therapy, it can take four to six weeks to notice symptom relief. It can take several months to see significant improvement.
Kegels involve tensing and relaxing the muscles around the vagina, anus (where poop exits), and urethra (the tube that carries pee out of the body).
You can do Kegel exercises sitting or lying down by following these steps:
Tense the pelvic floor muscles around the vagina, anus, and urethra (you can simulate this by pretending to hold in urine or gas)
Hold this tension for 10 seconds and then relax for 10 seconds
Do 10 repetitions three to five times daily
Be careful not to over-exercise as this can worsen muscle fatigue and urinary leakage.
Related:3 Exercises for Pelvic Pain To Make Intercourse Less Painful
Lifestyle Modifications
Your health care provider may recommend certain lifestyle modifications to help prevent worsening pelvic floor dysfunction.
Lifestyle changes for pelvic floor health include:
Avoid straining while using the bathroom and avoid heavy lifting and jumping. Also, try to treat coughs quickly as chronic coughing can cause strain.
Drink plenty of water and eat fiber to help avoid constipation. A warm cup of tea or coffee and fiber cereal within the first 45 minutes of waking up may also help.
Stay active to encourage healthy bowel movements and strengthen the leg, hip, and core muscles.
Maintain a healthy weight and good posture to keep pressure off the pelvic organs.
Perform pelvic floor exercises (even if you are not experiencing symptoms). Pilates can also help you strengthen your pelvic floor.
Relax the pelvic floor muscles with a warm bath, meditation, yoga, acupuncture, or massage.
Try talk therapy if your pelvic floor dysfunction is from stress or abuse or if you need help with behavior modification.
Many of these habits can also help preserve pelvic floor health and reduce the risk of pelvic floor dysfunction.
Medications
Sometimes, healthcare providers may suggest medications to manage or prevent symptoms of pelvic floor dysfunction. These include:
Stool softeners such as Colace (docusate) to avoid constipation
Laxatives such as Miralax (polyethylene glycol) to stimulate bowel movements
Bulking agents (fiber) to prevent constipation
Anticholinergics such as Ditropan (oxybutynin) to treat an overactive bladder
Topical vaginal estrogen creams such as Premarin (estradiol). This increases urinary sphincter muscle tone to decrease incontinence, reduces vaginal thinning, and helps prevent painful sex.
Surgeries and Procedures
Some people require surgery for underlying problems or symptoms. An example is a pelvic organ prolapse (pelvic organ drops from its usual position into the vagina) in females. Those with prolapse may need one of the following surgeries to put the organs back in place.
Vaginal sacrospinous ligament fixation (SSLF): Secures the top of the vagina to a ligament in the lower tailbone.
Vaginal uterosacral ligament suspension (ULS): Anchors the ligament connecting the lower uterus and tailbone.
Vaginal colposleisis: Closes the vagina. This is typically not recommended for females who are still sexually active.
Abdominal sacrocolpopexy: Insertion of surgical mesh and stitches to anchor the vagina to the sacrum (bone at the bottom of the spine).
Some surgeries help with urinary incontinence by putting the urethra and bladder in better positions.
Mid-urethral sling: A mesh strap that helps support the urethra.
Colposuspension: Procedure that helps support the tissue surrounding the urethra.
Other possible procedures that may help with symptoms or underlying problems include:
Botox (botulinum toxin A) injections for an overactive bladder
Sacral or tibial nerve stimulation to help with bowel or bladder control
Acupuncture to help with pain management
Nerve blocks which are injections of numbing or anti-swelling medications into pelvic nerves to decrease inflammation and pain. (This is done while you are under sedation so you will not feel it.)
Transvaginal trigger-point injections of numbing medication into the pelvic floor muscle trigger points. (This is done after an epidural so you won’t feel it.)
A Quick Review
Pelvic floor dysfunction is the damage or weakening of the pelvic floor (muscles that support the organs between your hips).
Pregnancy and childbirth, aging, pelvic trauma, chronic constipation, obesity, and neurological disorders can all damage or weaken the pelvic muscles.
Common treatments for pelvic floor dysfunction are physical therapy, pelvic floor exercises, and medications. In some cases, surgery can help correct the pelvic floor or relieve symptoms.
Once therapy begins, it can take four to six weeks to notice symptom relief. It may also take several months to see significant improvement.
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