What Is Pelvic Floor Dysfunction? Not Something You Have to Accept

Content medically reviewed by Erin Maetzold, MD

At the base of your core, a group of muscles, connective tissue, and bones called the pelvic floor supports not just your pelvic organs, but also important aspects of your health. Problems with the pelvic floor, especially its muscles, are known as pelvic floor dysfunction.

“When you get the urge to go to the bathroom, you use the pelvic floor muscles to hold urine until you reach the bathroom, and then you relax those muscles to release urine,” said Dr. Erin Maetzold, a urogynecologist at Essentia Health. “Those muscles are also supposed to relax during sex, but if they’re tense and tight, that can cause pelvic pain. In addition, if the pelvic floor muscles aren’t properly coordinating, you may experience problems with bowel movements, including constipation or stool leakage.”

Pelvic floor dysfunction isn’t a natural part of aging. Treatment can give you peace of mind so you can work, exercise, and enjoy time with the people you love without worrying about symptoms intruding.

Common Types of Pelvic Floor Dysfunction

An umbrella term, pelvic floor dysfunction includes various pelvic floor disorders. Many are defined by whether the pelvic floor muscles are overly tight or weakened.

Weak pelvic floor muscles, for example, cause problems including –

• Urinary incontinence. Leaking urine can occur due to pressure on your bladder, which is called stress incontinence. Another type of urine leakage, known as urge incontinence or overactive bladder, happens due to frequent, sudden urges to urinate.
• Fecal incontinence. Weak or damaged muscles can lead to accidental bowel leakage.
• Pelvic organ prolapse. If the pelvic floor muscles are weak or injured, the bladder, uterus, and other pelvic organs may prolapse, or drop into or out of the vagina. 

One in 5 women in the U.S. has at least one of these three pelvic floor disorders, according to the Office on Women’s Health.

On the other hand, high-tone pelvic floor dysfunction occurs due to muscle tightness, according to Dr. Maetzold. This can lead to chronic pelvic pain and painful bowel movements.

Risk Raisers

Several factors can increase your risk for pelvic floor dysfunction.

“We don’t know which elements are the most impactful, but we know pregnancy and childbirth definitely play a role in how the pelvic muscles change,” Dr. Maetzold said. “Genetics can also contribute. There are likely some genes related to pelvic floor looseness or genes that affect the connective tissue.”

Additional risk factors for pelvic floor dysfunction include – 

• Aging
• Constipation
• Having a higher body weight
• Having had pelvic surgery
• Repeated heavy lifting

Be on the Lookout for the 3 B’s 

To recognize signs of potential pelvic floor dysfunction, women should watch for the three B’s –

• Bladder: Are you experiencing sudden urgency or leaking urine when you cough or sneeze?
• Bulge: Do you feel a bulge in your vaginal area or pain in your pelvis?
• Bowel: Do you frequently have constipation or need to push or strain to have a bowel movement?

If pelvic floor symptoms affect your quality of life, seek help from a medical provider so the situation doesn’t worsen, causing other issues.

“I see many patients who have urinary incontinence when they do physical activities, so they stop doing those activities,” Dr. Maetzold said. “That can lead to weight gain and other medical issues.”

Treating pelvic floor dysfunction benefits far more than your pelvic health.

Treating Pelvic Floor Dysfunction: Getting Started

Pelvic floor dysfunction treatments have varying degrees of effectiveness for different patients. The key is to find one that gives you relief from symptoms. Start by seeing your primary care provider (PCP) or women’s health provider. They can rule out other conditions and recommend initial treatments.

“Initial therapy may be as simple as losing weight or avoiding bladder irritants, such as certain foods or drinks,” Dr. Maetzold said. “My go-to initial recommendation for patients is pelvic floor physical or occupational therapy. Physical and occupational therapists specialized in the pelvic floor can help get your muscles and tissues functioning appropriately again.”

How a Urogynecologist Can Help Treat Pelvic Floor Dysfunction

If initial therapies aren’t successful, you may benefit from seeing a urogynecologist like Dr. Maetzold. With additional training focused on the pelvic floor, urogynecologists specialize in treating pelvic floor disorders and other urogynecological disorders, such as cysts in the vagina or urethra. Listen to Dr. Maetzold discuss urogynecology and reconstructive pelvic surgery in season 3, episode 11 of our “Dare to Ask” podcast.

Dr. Maetzold takes an in-depth look at muscle spasms, tightness, weakness, and other pelvic floor problems to determine their source, which is key to recommending the most appropriate treatment. Often, she said, she sees patients who frequently do Kegel exercises, which are intended to help weak pelvic muscles, without success. Typically, she finds these patients have the opposite problem—tight muscles—and need a different treatment.

“Medications and neuromodulation can treat conditions such as overactive bladder,” Dr. Maetzold said. “We also offer urethral bulking or urethral slings for urinary leakage caused by weakened pelvic floor support.”

Most of all, Dr. Maetzold said, women with pelvic floor dysfunction should know they’re not alone. Don’t be afraid to speak up about symptoms. With so many treatments available, there’s no reason to stay silent.