Pelvic Floor Dysfunction

Overview

What is pelvic floor dysfunction?

Pelvic floor dysfunction is a common condition where you’re unable to correctly relax and coordinate the muscles in your pelvic floor to urinate or to have a bowel movement. If you’re a woman or assigned female at birth (AFAB), you may also feel pain during sex, and if you’re a man or assigned male at birth (AMAB), you may have problems having or keeping an erection (erectile dysfunction or ED). Your pelvic floor is a group of muscles found in the floor (the base) of your pelvis (the bottom of your torso).

If you think of the pelvis as being the home to organs like your bladder, uterus or prostate, and rectum, the pelvic floor muscles are the home’s foundation. These muscles act as the support structure keeping everything in place within your body. Your pelvic floor muscles add support to several of your organs by wrapping around your pelvic bone. Some of these muscles add more stability by forming a sling around your rectum.

Your pelvic organs include:

  • Your bladder (the pouch holding your urine).
  • Your uterus and vagina (in women).
  • Your prostate (in men).
  • Your rectum (the area at the end of your large intestine where your body stores solid waste).

Normally, you’re able to go to the bathroom with no problem because your body tightens and relaxes its pelvic floor muscles. This is just like any other muscular action, like tightening your biceps when you lift a heavy box or clenching your fist.

But if you have pelvic floor dysfunction, your body keeps tightening these muscles instead of relaxing them as it should. This tension means you may have:

  • Trouble evacuating (releasing) a bowel movement.
  • An incomplete bowel movement.
  • Urine or stool that leaks.

Symptoms and Causes

What causes pelvic floor dysfunction?

The full causes of pelvic floor dysfunction are still unknown. But a few of the known factors include:

  • Traumatic injuries to your pelvic area (like a car accident).
  • Pregnancy.
  • Overusing your pelvic muscles (like going to the bathroom too often or pushing too hard), eventually leading to poor muscle coordination.
  • Pelvic surgery.
  • Being overweight.
  • Advancing age.

Does pregnancy cause pelvic floor dysfunction?

Pregnancy is a common cause of pelvic floor dysfunction. Often women or people AFAB experience pelvic floor dysfunction after they give birth. Your pelvic floor muscles and tissues can become strained during pregnancy, especially if your labor was long or difficult.

Is pelvic floor dysfunction hereditary?

Pelvic floor dysfunction can run in your family. This is called a hereditary condition. Researchers are looking into a potential genetic cause of pelvic floor dysfunction.

What does pelvic floor dysfunction feel like?

Several symptoms may be a sign that you have pelvic floor dysfunction. If you have any of these symptoms, you should tell your healthcare provider:

  • Frequently needing to use the bathroom. You may also feel like you need to “force it out” to go, or you might stop and start many times.
  • Constipation, or a straining pain during your bowel movements. It’s thought that up to half of the people who experience long-term constipation also have pelvic floor dysfunction.
  • Straining or pushing really hard to pass a bowel movement or having to change positions on the toilet or use your hand to help eliminate stool.
  • Leaking stool or urine (incontinence).
  • Painful urination.
  • Feeling pain in your lower back with no other cause.
  • Feeling ongoing pain in your pelvic region, genitals or rectum — with or without a bowel movement.

Is pelvic floor dysfunction different for men and women?

There are different pelvic conditions that are unique to men (AMAB) and women (AFAB).

Pelvic floor dysfunction in men

Every year, millions of men around the world experience pelvic floor dysfunction. Because the pelvic floor muscles work as part of the waste (excretory) and reproductive systems during urination and sex, pelvic floor dysfunction can co-exist with many other conditions affecting men, including:

  • Male urinary dysfunction: This condition can involve leaking urine after peeing, running to the bathroom (incontinence) and other bladder and bowel issues.
  • Erectile dysfunction (ED): ED is when you can’t get or maintain an erection during sex. Sometimes, pelvic muscle tension or pain is the cause, but ED is a complex condition so this may not be the case.
  • Prostatitis: Pelvic floor dysfunction symptoms closely resemble prostatitis, which is an infection or inflammation of your prostate (a male reproductive gland). Prostatitis can have many causes including bacteria, sexually transmitted infections or trauma to your nervous system.

Pelvic floor dysfunction in women

Pelvic floor dysfunction can interfere with a woman’s reproductive health by affecting the uterus and vagina. Women who get pelvic floor dysfunction may also have other symptoms like pain during sex.

Pelvic floor dysfunction is very different than pelvic organ prolapse. Pelvic organ prolapse happens when the muscles holding your pelvic organs (uterus, rectum and bladder) in place loosen and become too stretched out. Pelvic organ prolapse can cause your organs to protrude (stick out) of your vagina or rectum and may require you to push them back inside.

Is pelvic floor dysfunction related to interstitial cystitis?

Interstitial cystitis is a chronic bladder condition that causes pain in your pelvis or bladder. Pain from your bladder can cause pain in your pelvic floor muscles and then loss of muscle relaxation and strength, which is pelvic floor dysfunction. So, having one of these conditions increases your risk of having the other.

If you’re taking certain medications for interstitial cystitis, including antidepressants, these might cause constipation. Constipation can lead to the worsening of your pelvic floor dysfunction symptoms. Check with your provider in case your prescription might be causing this problem.

Diagnosis and Tests

How is pelvic floor dysfunction diagnosed?

A healthcare provider will usually start by asking about your symptoms and taking a careful medical history. Your provider may ask you the following questions:

Your provider may also do a physical exam to test how well you can control your pelvic floor muscles. Using their hands, your provider will check for spasms, knots or weakness in these muscles. They may also need to give you an intrarectal (inside of your rectum) exam or vaginal exam.

You may also be given other tests, including:

  • Surface electrodes (self-adhesive pads placed on your skin) can test your pelvic muscle control. This might be an option if you don’t want an internal exam. The electrodes are placed on the perineum (the area between the vagina and rectum in women, and between the testicles and rectum in men) or on your sacrum (the triangular bone at the base of your spine). This test isn’t painful.
  • Anorectal manometry (a test measuring how well your anal sphincters are working) can test pressure, muscle strength and coordination. This test isn’t painful.
  • A defecating proctogram is a test where you’re given an enema of a thick liquid that can be seen with an X-ray. Your provider will use a special video X-ray to record the movement of your muscles as you attempt to push the liquid out of your rectum. This will help show how well you’re able to pass a bowel movement or any other causes of pelvic floor dysfunction. This test isn’t painful.
  • A uroflow test can show how well you can empty your bladder. If your flow of urine is weak or if you have to stop and start as you urinate, it can point to pelvic floor dysfunction. Your provider may order this test if you have problems while urinating. This test isn’t painful.

Management and Treatment

How do you treat pelvic floor dysfunction?

Fortunately, pelvic floor dysfunction can be treated relatively easily in many cases. If you need physical therapy, you’re likely to feel better, but it may take a few months of sessions. Pelvic floor dysfunction is treated without surgery. Nonsurgical treatments include:

  • Biofeedback: This is the most common treatment, done with the help of a physical therapist. Biofeedback isn’t painful and helps over 75% of people with pelvic floor dysfunction. Your physical therapist might use biofeedback in different ways to retrain your muscles. For example, they may use special sensors and video to monitor your pelvic floor muscles as you try to relax or clench them. Your therapist then gives you feedback and works with you to improve your muscle coordination.
  • Pelvic floor physical therapy: Physical therapy is commonly done at the same time as biofeedback therapy. Your therapist will determine which muscles in your lower back, pelvis and pelvic floor are really tight and teach you exercises to stretch these muscles so their coordination can be improved.
  • Medications: Daily medications that help to keep your bowel movements soft and regular are a very important part of treating pelvic floor dysfunction. Some of these medications are available over-the-counter at the drugstore and include stool softeners such as MiraLAX®, Colace®, senna or generic stool softeners. Your primary care doctor or a gastroenterologist can help to advise you which medications are most helpful in keeping your stools soft.
  • Relaxation techniques: Your provider or physical therapist might also recommend you try relaxation techniques such as meditation, warm baths, yoga and exercises, or acupuncture.

Will I need surgery to treat pelvic floor dysfunction?

There isn’t a surgery to treat pelvic floor dysfunction because it’s an issue with your muscles. In rare circumstances, when physical therapy and biofeedback don’t work, your provider might recommend you see a pain injection specialist. These doctors specialize in localizing the specific muscles that are too tense or causing pain. They can use a small needle to inject the muscle with numbing medication and relaxing medication. This is called trigger point injection.

What makes pelvic floor dysfunction worse?

It can take several months of routine bowel or urinary medications and pelvic floor physical therapy before symptoms of pelvic floor dysfunction start to improve. The most important part of treatment is to not give up. Forgetting to take your medications every day will cause your symptoms to continue and possibly get worse. Also, skipping physical therapy appointments or not practicing exercises can slow healing.

Any activity that increases the tension or pain in your pelvic floor muscles can cause your symptoms to get worse. For example, heavy weightlifting or repetitive jumping can increase your pelvic floor tension and actually worsen symptoms.

If you have problems with constipation due to hard bowel movements or abdominal bloating and gas pain, then you should consult with your doctor and watch your diet closely. It’s important to drink plenty of water daily (> eight glasses) and eat a healthy diet. Foods that are high in fiber, or fiber supplements, may worsen your bloating symptoms and gas pains. These foods should be avoided if your symptoms get worse.

Who treats pelvic floor dysfunction?

Depending on your symptoms and how much pain you feel, you might be treated by your regular provider, a physical therapist, a gynecologist, a gastroenterologist, a pelvic pain anesthesiologist or a pelvic floor surgeon.

Outlook / Prognosis

Does pelvic floor dysfunction go away on its own?

Pelvic floor dysfunction symptoms (like an overactive bladder) typically stay or become worse if they’re not treated. Instead of living with pain and discomfort, you can often improve your everyday life after a visit with your provider.

Is pelvic floor dysfunction curable?

Fortunately, most pelvic floor dysfunction is treatable, usually through biofeedback, physical therapy and medications. If you start to experience any of the symptoms of pelvic floor dysfunction, contact a healthcare provider. Early treatment can help improve your quality of life and help with inconvenient and uncomfortable symptoms.

Living With

Is pelvic floor dysfunction a disability?

Pelvic floor dysfunction isn’t currently listed as a U.S. Social Security disability. However, depending on your symptoms you may be able to claim disability under the Disability Evaluation Under Social Security Section 6.00, Genitourinary (genital and urinary) Disorders. For more information, check with your provider and Social Security contact.

A note from Cleveland Clinic

Although pelvic floor dysfunction is a common condition, it can be embarrassing to discuss your pelvic floor dysfunction symptoms — especially your bowel movements. The good news is that many pelvic floor dysfunction symptoms are easy to treat.

If you think you might have pelvic floor dysfunction, make sure you see your provider early, especially if you have pain when going to the bathroom. Remember, the more open and honest you are with your provider, the better your treatment will be.

Resources

Cleveland Clinic Podcasts

Visit our Butts & Guts Podcasts page to learn more about digestive conditions and treatment options from Cleveland Clinic experts.

Medically Reviewed

Last reviewed by a Cleveland Clinic medical professional on 05/26/2020.

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References

  • American Society of Colon and Rectal Surgeons. Pelvic Floor Dysfunction Expanded Version. (https://www.fascrs.org/patients/disease-condition/pelvic-floor-dysfunction-expanded-version) Accessed 5/28/2020.
  • Disability Evaluation Under Social Security, Section 6.00, (https://www.ssa.gov/disability/professionals/bluebook/6.00-Genitourinary-Adult.htm) Genitourinary (genital and urinary) Disorders. (https://www.ssa.gov/disability/professionals/bluebook/6.00-Genitourinary-Adult.htm) Accessed 5/28/2020.
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development. Pelvic Floor Disorders: Condition Information. (https://www.nichd.nih.gov/health/topics/pelvicfloor/conditioninfo/Pages/default.aspx) Accessed 5/28/2020.
  • International Foundation for Functional Gastrointestinal Disorders. Pelvic Floor Dyssynergia. (https://aboutgimotility.org/disorders-of-the-pelvic-floor/pelvic-floor-dyssynergia.html) Accessed 5/28/2020.
  • Merck Manual Professional Version. Overview of Pelvic Organ Prolapse (POP). (https://www.merckmanuals.com/professional/gynecology-and-obstetrics/pelvic-organ-prolapse-pop/overview-of-pelvic-organ-prolapse-pop?query=pelvic%20floor%20dysfunction) Accessed 5/28/2020.

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