Pelvic Floor Dysfunction: Symptoms, Causes, Treatments, and Exercises

Let’s be honest: It’s easy to take pelvic floor muscles for granted. You sort of know where they are, and kind of know what they do. But they don’t get the same billing as, say, your biceps and quads. Until they stop working as they should and you find yourself leaking pee when you sneeze (incontinence) or straining extra hard to poop (constipation). These are signs of pelvic floor dysfunction, a condition that involves pelvic floor muscle tightness, weakness, or difficulty coordinating your muscles, which can lead to problems with urination, bowel movements, and sexual function. 

But there are steps you can take to help regain control and ease symptoms. Read on to learn about pelvic floor dysfunction, symptoms and causes, the benefits of pelvic floor physical therapy, and the best exercises and lifestyle tips to manage it.

Interested in getting a personalized exercise therapy plan for your pelvic symptoms? Learn more about Hinge Health’s digital physical therapy program and see if you’re eligible.

What Is Pelvic Floor Dysfunction?

Your pelvic floor is a group of muscles and tissues that stretch like a hammock from your pubic bone in front to your tailbone in the back. It helps support your pelvic organs and plays a role in bladder and bowel control and sexual function.  

Muscles are meant to contract and relax. For a healthy pelvic floor, you need to be able to tighten (contract) the muscles and fully release (relax) them. That’s how you control bowel movements, urination, and some sexual functions.

Pelvic floor dysfunction happens when pelvic floor muscles are too tight (hypertonic), too weak, or have coordination problems, says Jacquelyn White, PT, DPT, a Hinge Health pelvic floor physical therapist. This can contribute to urinary incontinence, constipation, painful sexual intercourse, and other symptoms.

Symptoms of Pelvic Floor Dysfunction

Pelvic floor dysfunction symptoms vary for each person and may include:

• Urinary urgency and frequency (aka overactive bladder, or feeling like you need to pee right after you go)

• Urinary incontinence (leaking urine)

• Fecal incontinence (leaking stool)

• Chronic constipation

• Straining or needing to change position to pass stool

• Pelvic pressure, bulging, or a feeling of heaviness in your vagina (prolapse)

• Difficulty fully emptying your bladder or bowels

• Pain during urination or bowel movements

• Unexplained lower back or hip pain

• Unexplained pain in the pelvis, genitals, or rectum (the last part of the large intestine)

• Pain during sex, or dyspareunia

• Pain while inserting a tampon or during gynecological exams

Causes of Pelvic Floor Dysfunction

Various factors can contribute to pelvic floor tightness and weakness in women, and lead to pelvic floor dysfunction. Common causes include:

• Pelvic floor muscle strain during pregnancy

• Trauma or injury to the pelvic floor from surgery or childbirth

• Obesity or being overweight

• Chronic coughing or a habit of holding your breath while lifting

• Pelvic organ prolapse (when organs in your pelvis move from their original position and put pressure on other structures)

• Muscle tightness or weakness in nearby muscles (e.g., hips, glutes) that causes pelvic floor muscles to compensate

• Hormone changes with aging and menopause that impact your pelvic floor

• Bathroom habits that tax your pelvic muscles, such as often delaying urination or bowel movements, straining too hard when going to the bathroom, or making a habit of “hover-peeing” (squatting above the toilet to urinate, which can make it difficult for your pelvic floor muscles to relax)

• Carrying tension due to stress or anxiety in your pelvic floor muscles (just as you might hold tension in your neck, shoulders, or back muscles) 

• Breathing patterns (a habit of shallow or chest-breathing that reduces the normal movement of the pelvic floor during breathing)

• Sexual trauma

• Certain neurological disorders (such as multiple sclerosis and Parkinson's disease) or other medical conditions

Physical Therapy for Pelvic Floor Dysfunction

The main treatment for pelvic floor dysfunction is pelvic floor physical therapy. Depending on your symptoms, a pelvic floor physical therapist (PT) will recommend treatment options that can include targeted exercises, relaxation techniques, and behavioral modifications, such as:

• Pelvic floor exercises. Exercise therapy can help improve muscle coordination, strength and flexibility; pelvic floor function; and symptoms, says Dr. White. Exercise for pelvic health is much more than just Kegels (exercises that contract pelvic floor muscles). Kegels can be helpful for some pelvic floor issues, but they’re not for everyone. Trying to strengthen tense or overly tight pelvic floor muscles can exacerbate symptoms. Instead, a physical therapist will recommend exercises and stretches to relax and lengthen the muscles before strengthening them.

• Biofeedback. This can help improve pelvic floor muscle control by teaching you how to contract and relax your muscles correctly. Biofeedback uses devices with sensors to provide real-time feedback on muscle activity. This can aid in strengthening, relaxation, and muscle engagement, which may reduce pelvic pain, explains Dr. White.

• Pelvic myofascial release therapy. Also known as trigger point therapy, myofascial release (MFR) is a type of gentle, constant massage that helps release tightness or restrictions in the fascia, or connective tissue, that surrounds and supports the muscles, says Dr. White. It also improves blood flow to the pelvic area, which can help alleviate pelvic pain. You can see an in-person provider for MFR, or use a pelvic wand (an S-shaped tool to massage tight, spasming, or tender pelvic floor muscles) for self-massage.

• Relaxation techniques. Deep breathing and progressive muscle relaxation techniques may help reduce stress that contributes to pain and other symptoms of pelvic floor dysfunction.

• Urge suppression. These are techniques to suppress the urge when you experience a sudden sensation to empty your bladder or bowels. You might perform Kegel exercises to help you hold it in, take calming belly breaths, or count backward as a distraction technique. Practicing urge suppression can help you regain control of your bladder and bowels.

• Bladder and bowel retraining. Just like you train your muscles at the gym, you can train the muscles that control your bladder. Retraining techniques involve keeping a bowel and bladder diary and then using the information to gradually increase the time between elimination to help decrease frequency, reduce leakage, and better manage symptoms.

Pelvic floor physical therapy is a comprehensive treatment that may include education, behavioral and lifestyle strategies, movement and exercise, and manual therapy. 

You can see a physical therapist in person or use a program like Hinge Health to access a PT who specializes in pelvic health via telehealth video visit.

The above exercises recommended by Hinge Health pelvic floor physical therapists can help stretch and strengthen pelvic floor and surrounding muscles to improve coordination and function, and relieve symptoms. TK

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Do You Need a Pelvic Trainer for Pelvic Floor Dysfunction?

A pelvic trainer is a biofeedback tool that helps you practice Kegel exercises. Kegels — or pelvic floor muscle contractions — can help strengthen your pelvic floor to improve bladder control, sexual function, and more. But a pelvic trainer isn’t for everyone. If your pelvic floor muscles are too tight, relaxing them is more important than strengthening. Your healthcare provider or physical therapist can evaluate your symptoms and discuss if a pelvic trainer is right for you. 

Hinge Health offers pelvic trainers as part of a holistic pelvic health program. See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

More Ways to Manage Pelvic Floor Dysfunction

A physical therapist or healthcare provider may recommend lifestyle modifications to help manage or prevent pelvic floor dysfunction, including:

• Relax your pelvic floor muscles with deep breathing, yoga, or meditation.

• Avoid straining while using the bathroom and use healthy positioning during urination and bowel movements.

• Stay hydrated and get enough fiber intake to help avoid constipation.  

• Exercise regularly to promote healthy bowel movements and circulation.

• Maintain a healthy weight to reduce pressure on your pelvic organs.

• Avoid bladder irritants such as caffeine and alcohol (if these are a problem for you) to reduce pelvic symptoms.

PT Tip: Awareness Is the First Step

“Many women with pelvic floor dysfunction don't get physical therapy or other effective treatment because they simply don't know it exists,” says Jacqueline White, PT, DPT, a Hinge Health pelvic health physical therapist. “Once you know that simple at-home exercises and lifestyle changes can often make a big difference in your symptoms, you can take the next step to seek care from a pelvic floor physical therapist and get a tailored treatment plan for your symptoms.”

How Hinge Health Can Help You

If you have pelvic pain or symptoms that are affecting your quality of life, you can get the relief you've been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

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3. Bradley, M. H., Rawlins, A., & Brinker, C. A. (2017). Physical Therapy Treatment of Pelvic Pain. Physical Medicine and Rehabilitation Clinics of North America, 28(3), 589–601. https://doi.org/10.1016/j.pmr.2017.03.009

4. Grimes, W. R., & Stratton, M. (2021). Pelvic Floor Dysfunction. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK559246

5. Pelvic Floor Disorders (PFDs). (2020, January 8). Https://Www.nichd.nih.gov/. https://www.nichd.nih.gov/health/topics/pelvicfloor

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7. van Reijn-Baggen, D. A., Han-Geurts, I. J. M., Voorham-van der Zalm, P. J., Pelger, R. C. M., Hagenaars-van Miert, C. H. A. C., & Laan, E. T. M. (2021). Pelvic Floor Physical Therapy for Pelvic Floor Hypertonicity: A Systematic Review of Treatment Efficacy. Sexual Medicine Reviews, 10(2). https://doi.org/10.1016/j.sxmr.2021.03.002

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