Pelvic Floor Dysfunction: Symptoms, Causes & Treatments

The pelvic floor is the area of the body that runs from the pubic bone to coccyx (tailbone) and between the ischial tuberosities (sit bones). It contains various pelvic and lower abdominal organs, nerves, veins, as well as an interwoven network of muscles, ligaments and connective tissue that form a sling-like hammock or bowl in the lowest part of the pelvis. 

When this “muscular layer” of the pelvic floor, known as our pelvic floor muscles, is not working efficiently, both men and women can experience bladder and/or bowel leakage, pain in that area of the body and even constipation, just to name a few. The more we know about common causes of pelvic floor dysfunction and what we can do to help prevent it, the better our chances of limiting or even avoiding future symptoms from occurring.

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Common Symptoms of Pelvic Floor Dysfunction

Some pelvic floor disorder symptoms include:

• Urinary Incontinence – Involuntary loss of urine that can occur with a full bladder, strong sudden urge to use the restroom, physical activity (i.e., exercise, jumping), increased intraabdominal pressure (i.e., coughing, sneezing, laughing) or even at rest.
• Fecal Incontinence – Loss of bowel control that can cause you to leak stool unexpectedly. It can range from leaking a small amount of stool and passing gas, to not being able to control a bowel movement.
• Pelvic Organ Prolapse – This occurs when one or more pelvic organs descend through the vaginal and/or rectal openings from their normal anatomical position. It is more common in older women; however, can affect women of all ages. Symptoms may include pressure/heaviness in the pelvic region, including a sensation as if “something is falling out” of that area of the body.
• Sexual Dysfunction – Inability or difficulty with attempted or completed sexual intercourse or activity due to pain and/or muscle tension.
• Chronic Pain Syndromes – Pain in the area of the lower abdomen and/or pelvis that lasts for more than six months. Its cause can be due to many different conditions and often is poorly understood.
• Chronic Constipation – Difficulty or decreased frequency in ability to pass stool. The pelvic floor muscles can contribute to this if they are too tight and cannot fully relax as required with a bowel movement.

Pelvic Floor Pain as a Warning Sign

Most people, of course, understand that incontinence means there is something wrong. But it doesn’t have to get to that point. One of the first symptoms of dysfunction is chronic pelvic pain, which includes pelvic floor muscle spasms. Those can be immediate and scary, but not always. 

What do pelvic floor spasms feel like? They feel like a sudden sharp pressure in the vagina or rectum. It’s important to pay attention to those, because while they are uncomfortable, we tend to write them off or not want to talk about them. But they can be a symptom of major problems. 

Some other pelvic floor pain includes:

• Pain with wearing certain clothing
• Pain with prolonged sitting
• Pain with intercourse
• Pelvic heaviness, pulling and/or fatigue

Pelvic Floor Pain in Female Athletes

Athletes are a group particularly susceptible to pelvic floor pain and injuries. The pelvic floor muscles also form the inferior border of our “core, ” and are crucial for athletes. They help contribute to the stabilization of the spine, pelvis and kinetic chain during functional movement, helping coordinate movement of the arms, legs and spine commonly seen in athletic competition.

Literature shows the highest prevalence of pelvic floor disorder involves high impact activities, such as track and field, gymnastics and some ball games. Activities such as jumping and running that occur with athletic participation place increased stress onto the pelvic floor. When these muscles, fascia and ligaments are negatively impacted, the female athlete can experience pain, weakness and dysfunction.

Common Causes of Pelvic Floor Dysfunction

Pelvic floor dysfunction includes a wide array of issues that can occur when the pelvic floor muscles are tight, weak and/or overstretched. Some common causes are: 

• Injury – Vaginal childbirth, undergoing pelvic surgery or experiencing trauma (i.e., fracture, sexual abuse, etc.) to the pelvic region can result in painful tight (overactive) muscles that can also lead to other bowel/bladder/nerve concerns.
• Voluntary Holding of Urine or Stool – We all have our reasons: can't break at work to use the restroom, don't want to use a public toilet, trying to prevent bladder/bowel leakage. No matter what yours is, intentionally tightening or clenching your pelvic floor muscles on a consistent basis can lead to muscle spasms and dysfunction.
• Increased Frequency of Urination – Urinating too often or “just in case” (i.e., when leaving the house, arriving at work, etc.), can cause issues with your bladder. Urinating when the bladder is not full can cause you to push or strain in attempts to fully empty. This can result in the pelvic floor muscles becoming overstretched and weakened, or in some cases, lead to improper pelvic floor muscle function where the muscles contract when they are supposed to relax.
• Increase in Intra-abdominal Pressure – Obesity, pregnancy or improper lifting mechanics can lead to increased pressure inside the abdomen. This puts stress and strain onto the pelvic floor muscles below and can weaken those muscles over time.
• Low Back and/or Pelvic Girdle Impairment – Injury or misalignment of the coccyx, hip joints, sacroiliac joints and/or low back can impact pelvic floor muscle length and activity, which can lead to pain, weakness and symptoms of pelvic floor dysfunction.

Prevention Tips

Kari Ziemba, MPT, Senior Director of Women’s Health Services, gives us some tips to help prevent symptoms of pelvic floor muscle dysfunction:

• Avoid Going to the Bathroom “Just in Case” – Peeing “just in case” because you are leaving the house, going shopping, heading into a work meeting, etc. can lead to bladder issues. The bladder is impressionable and could trick you into thinking it is full when it really isn’t. Pay attention to how often you are urinating. Normal urination frequency typically is between every 2-4 hours, except when sleeping at night. Try to only use the restroom to urinate when you have a sensation to void that is within the ideal timeframe as noted. No more “JIC’ing.”
• Use Deep Breathing to Release Tension – The pelvic floor muscles work in conjunction with your diaphragm. When you take a deep diaphragmatic breath (“belly breath”), your pelvic floor muscles should instinctively lengthen and relax. This can be very helpful in decreasing pelvic floor muscle tension that can be a source of pain or dysfunction. In addition, deep breathing is an excellent technique to assist in stress management. 
• Hydrate Your Bladder – The bladder loves water. Limiting water intake may cause the fluid inside the bladder to become more acidic and thus irritate your bladder. When this occurs, the bladder itself may become more active and send signals to you to urinate when not full. It is typically recommended to drink eight 8 oz glasses of water/fluid throughout your day (not all at once) to properly hydrate your bladder.
• Do Not Hover – Yes, you heard me correctly. Women should not hover over the toilet to urinate. Hovering when peeing causes the pelvic floor muscles to contract/tighten when they are supposed to relax to allow the urine stream to flow smoothly without pushing or straining. Be sure to sit on the toilet seat to enable your pelvic floor muscles to fully relax as required during urination and to prevent possible pelvic floor muscle dysfunction.
• Proper Posture is a Must – Pay attention to your posture throughout your day. Sit or stand tall keeping your spine in “neutral,” lifting upwards through your rib cage and gently lifting the top of your head towards the ceiling. With slouching, there is increased pressure onto the muscles of the pelvic floor, which over time can weaken and overstretch them. In addition, slouching and tucking your pelvis can also cause the pelvic floor muscles to become tight, which can lead to pain and other concerns.

Physical Therapy for Pelvic Floor Dysfunction 

Sometimes pelvic floor dysfunction needs a more focused treatment plan, and that’s where a physical therapist can help. Some treatment options include:

• Specific and individualized postural, dietary and behavioral education
• External and internal muscle and fascial release techniques
• Flexibility training and stretching of surrounding muscles of lumbar spine, pelvis and lower extremities
• Instruction in proper pelvic floor muscle contraction and relaxation
• Appropriate strengthening exercise and muscle awareness activities
• Biofeedback, electrical stimulation and transcutaneous electrical nerve stimulation (TENS)
• Hot and cold therapy
• Home pelvic floor exercise program instruction to help advance progress during and maintain following treatment

To learn more about how pelvic floor physical therapy may help with your symptoms of pelvic floor dysfunction, visit our Women's Health page.  

When weighing your treatment options for pelvic floor muscle dysfunction, consider physical therapy. Physical therapy offers a wide variety of treatment options including strengthening, stretching, and sustainable home exercise programs. Find an ATI location near you or schedule an in-clinic or online appointment today.