How to recognize — and treat — pelvic floor problems

Published: April 06, 2023

Nagging backache. Constipation. Incontinence. Painful intercourse. These symptoms could point to all kinds of problems — including trouble with your pelvic floor.

Your pelvic floor is a set of muscles just beneath your pelvis, at the end of your tailbone. These muscles wrap around your pelvic bone to support your bladder, uterus or prostate, and rectum.

In addition to supporting these organs inside pelvis, the pelvic floor supports:

  • Bowel and bladder health.
  • Reproductive and sexual health.
  • Physical posture and stability.

Because the organs that the pelvic floor supports are all connected, symptoms of pelvic floor dysfunction may overlap. For example, if your pelvic floor is weak, tense, or overactive, you could experience back or hip pain, urine or fecal urgency, leakage or incontinence, constipation, diarrhea, painful defecation, or pain during intercourse.

What causes pelvic floor weakness?

Pregnancy and childbirth are common causes of pelvic floor weakness, since they can strain and overstretch surrounding tissues and ligaments, especially if labor is long or difficult. Women often experience pelvic floor weakness after they give birth.

The hormonal changes of menopause can also cause pelvic floor weakness. Other factors that may lead to a weak pelvic floor include:

  • High-impact exercise.
  • Poor posture.
  • Overusing your pelvic muscles by going to the bathroom too often or pushing too hard.
  • Pelvic surgery.
  • Advancing age.

Overly tense or overactive pelvic floor muscles may also lead to pelvic floor dysfunction. Your pelvic floor muscles may tense or become over-active in response to:

  • Traumatic injuries to your pelvic area, such as falling off a bicycle.
  • Any physical trauma to the area, including pregnancy.
  • Assault or a history of abuse.
  • Anxiety or depression.

Because the pelvic floor stores trauma, its muscles may remain tense and overactive, even if an event occurred in the past. It is important, therefore, to pay attention to your muscles. If you have been clenching for most of your life, then you might not recognize the sensation.

Women of any age may experience pelvic floor dysfunction, although certain problems tend to cluster in particular age groups. For example, tense pelvic floor muscles tend to affect women ages 18 to 25; weak pelvic floor muscles are common in postpartum women ages 25 to 40; and we find hormone-related pelvic floor problems in woman as well as men, ages 40 and older.

Yes, men experience pelvic floor dysfunction too, which typically manifests as:

  • Urine leakage, urgency, or other bladder and bowel issues.
  • Erectile dysfunction.
  • Prostate infection or inflammation.
  • Post prostatectomy.

There is no surgery to treat pelvic floor dysfunction but, fortunately, most pelvic floor dysfunction is treatable through biofeedback, physical therapy, or medication. If you experience any signs of pelvic floor dysfunction, then contact your health care provider. Early treatment can help improve your quality of life and help with inconvenient and uncomfortable symptoms.

Pelvic health physical therapy is a non-surgical way of treating pelvic dysfunction and supporting muscles. Pelvic floor physical therapists are musculoskeletal experts who complete extensive, post-doctoral specialty courses focused on pelvic anatomy and physiology and are trained in assessing and examining all areas associated with the pelvis.

Pelvic floor therapy involves exercises to strengthen core muscles, trigger point and manual release, and breathing and relaxation techniques to help you stretch and relax your pelvic floor muscles. Your provider or physical therapist might also recommend you try meditation, warm baths, yoga, exercise, or acupuncture.

If you are pregnant, then you might prevent pelvic floor dysfunction by seeing a physical therapist who can help you prepare for childbirth. If you know how to push correctly and what will happen during delivery, then you can make better informed decisions that will help you postpartum.

If you have chronic back or hip pain, constipation or incontinence, or pain during intercourse, then you should see a specialist who can evaluate you for pelvic floor dysfunction and therapy.

About the Author

Pauline Mendoza, PT, DPT, is a pelvic floor physical therapist at Stamford Health.

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