Pelvic floor dysfunction is the inability to correctly relax and coordinate your pelvic floor muscles to have a bowel movement. Symptoms include constipation, straining to defecate, having urine or stool leakage, and experiencing a frequent need to pee. Initial treatments include biofeedback, pelvic floor physical therapy and medications.
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:
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:
The full causes of pelvic floor dysfunction are still unknown. But a few of the known factors include:
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.
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.
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:
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:
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.
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.
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:
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:
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.
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.
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.
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.
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.
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.
Visit our Butts & Guts Podcasts page to learn more about digestive conditions and treatment options from Cleveland Clinic experts.
Last reviewed by a Cleveland Clinic medical professional on 05/26/2020.
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