Pelvic Floor Dysfunction

What is pelvic floor dysfunction?

Pelvic floor dysfunction is a common condition where you can’t correctly relax and coordinate the muscles in your pelvic floor to urinate (pee) or have a bowel movement (poop). Think of your pelvis as being home to organs like your bladder, uterus, prostate and rectum. Your pelvic floor muscles are the home’s foundation. They’re the support structure keeping everything in place.

Normally, you’re able to go to the bathroom without issue because your body tightens and relaxes your 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. This tension means you may have:

• Trouble evacuating (releasing) a bowel movement.
• An incomplete bowel movement.
• Pee or poop leakage.

If you’re female, pelvic floor dysfunction may also cause pain during intercourse. If you’re male, you may have problems getting or keeping an erection (erectile dysfunction).

What are the symptoms of pelvic floor dysfunction?

The following signs and symptoms can let you know you might have a pelvic floor issue:

• Frequent bathroom visits.
• Having to frequently start and stop when you’re trying to pee.
• Straining or pushing to pass a bowel movement.
• Having to change positions on the toilet or use your hand to eliminate stool.
• Constipation (Experts estimate that up to half of the people with long-term constipation also have pelvic floor dysfunction).
• Leaking stool (fecal incontinence).
• Leaking urine (urinary incontinence).
• Painful urination.
• Unexplained low back pain.
• Ongoing pain in your pelvic region, genitals or rectum — with or without a bowel movement.

What causes pelvic floor dysfunction?

Experts don’t know the exact cause of pelvic floor dysfunction. But, a few known factors may play a role. These include:

• Traumatic injuries to your pelvic area (like a car accident or a fall from a high place).
• Overusing your pelvic muscles (straining to go).
• Prior pelvic surgery (like a hysterectomy or prostatectomy).
• Pregnancy and childbirth (especially difficult deliveries).
• Aging (muscles naturally weaken somewhat over time).
• Stress and anxiety.
• Connective tissue disorders.

What conditions can be mistaken for pelvic floor dysfunction?

Pelvic floor dysfunction can exist alongside (and be mistaken for) many other conditions, including:

• Interstitial cystitis: This condition causes pain in your pelvis or bladder. The pain can lead to loss of muscle relaxation in your pelvic floor muscles. So, having one of these conditions increases your risk of having the other.
• Irritable bowel syndrome (IBS): IBS is a group of symptoms that affect your digestive tract. While researchers haven’t identified a link between IBS and pelvic floor dysfunction, they share certain symptoms. These symptoms include constipation and trouble emptying your bowels completely.
• Pelvic organ prolapse (POP): POP happens when the muscles holding your pelvic organs (uterus, bladder and rectum) in place loosen and become too stretched out. The weaker muscles can cause your organs to stick out of your vagina.
• 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. This is an infection or inflammation of your prostate. Prostatitis can have many causes, including bacteria, sexually transmitted infections (STIs) or trauma to your nervous system.
• Constipation: Constipation can mimic pelvic floor dysfunction or vice versa. Constipation and straining can also lead to pelvic floor dysfunction.
• Anorectal conditions: Conditions that affect your anus (butthole) and rectum, like fissures or fistulas, can share features of pelvic floor dysfunction.

How is pelvic floor dysfunction diagnosed?

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

• Do you strain to poop?
• Are you able to empty your bladder?
• Do you feel empty after a bowel movement?
• How often do you poop or pee?

If you’re female, they may ask about prior pregnancies and if you’re experiencing pain during sex.

What tests will be done to diagnose pelvic floor dysfunction?

Your provider may 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. Your provider will also perform a rectal exam and (if you’re female) a pelvic exam.

You may also need other tests, including:

• Anorectal manometry. This test measures how well your anal sphincters are working. It measures the pressure in your muscle contractions that help you poop. Providers often perform an electromyography (EMG) at the same time to test the coordination of your pelvic floor muscles.
• Defecating proctogram. Your provider may order this test to see how well you can start a bowel movement and empty your bowels. It can show how different organs are working when you poop. Providers also use it to check for prolapse and other anatomic abnormalities of your pelvic floor organs.
• Urodynamics. Your provider may order urodynamic testing if you have problems peeing. This test can show how well you can empty your bladder. A weak pee flow and having to start and stop to pee can be signs of pelvic floor dysfunction.

How do you treat pelvic floor dysfunction?

Healthcare providers can treat pelvic floor dysfunction without surgery. Treatments include:

• Pelvic floor physical therapy: A physical therapist can help you identify which pelvic floor muscles are too tense. They can teach you exercises to stretch these muscles and improve their coordination.
• Biofeedback: This is the most common treatment for pelvic floor dysfunction. It usually occurs alongside physical therapy. During your appointment, your physical therapist may use sensors and video to monitor your pelvic floor muscles as you relax or clench them. They’ll give you guidance to improve your muscle coordination.
• Medications: You may need daily medications to keep your bowel movements soft and regular. Some of these medications are available over the counter (OTC) and include stool softeners such as MiraLAX®, Colace®, senna or generic stool softeners.
• Relaxation techniques: Your provider or physical therapist might recommend relaxation techniques such as meditation, warm baths, yoga and exercises, or acupuncture to relieve tension in your pelvic floor muscles.
• Trigger point injections: If physical therapy and biofeedback don’t help, your provider may recommend you see a pain injection specialist. These doctors can pinpoint the specific muscles that are overly tense. They’ll use a small needle to inject numbing medications to relax them.

Can you restore your pelvic floor?

It may take a few months of physical therapy sessions to notice symptom improvements. But most people do eventually notice a difference. Biofeedback helps over three-quarters of people with pelvic floor dysfunction gain better muscle control.

Does pelvic floor dysfunction go away on its own?

Unfortunately, no. Pelvic floor dysfunction symptoms (like an overactive bladder) typically stay or become worse if they’re not treated. Pelvic floor dysfunction is treatable, but you’ll need to see a provider who can diagnose and treat the symptoms.

How do I take care of myself?

Not giving up is the most important part of living with pelvic floor dysfunction. It can take several months of routine bowel or urinary medications and pelvic floor physical therapy before symptoms start to improve. But most people who stick to their care plan notice improvements.

In the meantime:

• Don’t skip taking your meds or therapy appointments. Forgetting to take your medicine can cause your symptoms to continue and possibly get worse. Also, skipping physical therapy appointments or not practicing exercises can slow healing.
• Avoid activities that increase tension or pain in your pelvic floor. Any activity that has this effect can worsen your symptoms. For example, heavy weightlifting or repetitive jumping can increase your pelvic floor tension and actually worsen symptoms. Listen to your body. Check with your provider or physical therapist about which activities to avoid.
• Drink plenty of water and follow a meal plan that’s healthy for you. Drink more than eight glasses of water a day to prevent constipation. Eat foods that don’t cause unpleasant symptoms. For example, high-fiber foods or fiber supplements may worsen bloating symptoms or gas pains. Avoid them if your symptoms worsen. Your provider can recommend nutritious foods that don’t cause discomfort.