Throughout life, many different factors can impact pelvic floor muscles, from pregnancy and menopause to heavy lifting and unaddressed tension. When things go awry with the supportive muscles of your pelvis, it can lead to pelvic floor dysfunction or the inability to control the muscles of the pelvic floor.
People of all ages, sexes and genders can suffer from pelvic floor dysfunction. Luckily, there’s much you can do to treat and prevent the condition.
Read on to learn why experts — an ob-gyn, a physical therapist, structural integration specialist and Pilates instructor — are making a case for giving your pelvic floor muscles a little extra attention.
What Are Pelvic Floor Muscles?
They're a group of muscles and connective tissues that sit at the base of your pelvis. “They connect the pubic bone in the front all the way to the coccyx in the back and side to side, providing a hammock of support where the pelvic organs sit,” explains Rebecca Nelken, MD, a urogynecologist and ob-gyn on the board of KindBody.
For women, these are the bladder, uterus, vagina and rectum. That being said, men very much have a pelvic floor too; though instead of a vagina and uterus, it includes a prostate, “which sits with the bladder,” adds Deena Goodman, a physical therapist and pelvic floor specialist.
In addition to holding the aforementioned organs in place, pelvic floor muscles assist with bodily functions, such as peeing, pooping and having sex. They're also A+ team players, joining forces with other key muscle groups in your core to allow your body to absorb outside pressure — such as that from lifting or coughing — in a way that protects your spine and other organs, according to the Cleveland Clinic.
“From a holistic perspective, there’s a lot of energy going on down there,” says Lauren Roxburgh, board certified structural integration practitioner and founder of The Aligned Life Studio. “It’s obviously an area of literal creation because we create life there, but anatomically speaking, it’s also the base of our core, and it’s deeply connected to our body’s entire muscular system.
Women, especially young women, tend to hold a lot of tension in their pelvic floors, explains Dr. Nelken, who likens it to tight shoulder muscles. “If you’re holding tension in your shoulders, it’s going to hurt to turn your neck [and] you won't have the same functioning in that area — it’s the same thing in the pelvic floor.”
Over time, “that tension can lead to nerves being pinched and pain with urination, sex and other discomfort,” she explains. In other words, it can result in pelvic floor dysfunction.
What Is Pelvic Floor Dysfunction?
It's a common condition where you're unable to correctly relax and coordinate the muscles in your pelvic floor to urinate or go number two. It can also negatively impact your sex life, causing pain during intercourse or other sexual dysfunction, according to the Cleveland Clinic.
“Pregnancy is the largest predisposing factor to having pelvic floor dysfunction," says Dr. Nelken. "Vaginal births increase the risk, but even women who deliver by C-section can have pelvic floor dysfunction." Throughout pregnancy, the pelvic floor muscles endure a lot in order to support a growing baby. During delivery, these muscles become strained, especially if it’s a particularly long or difficult labor.
Other factors that can contribute to pelvic floor dysfunction, according to the Cleveland Clinic: a chronic cough or anything that increases the pressure on the pelvic floor, overuse of the pelvic floor muscles (think: going to the bathroom too often or pushing too hard when in there) or a genetic predisposition to the condition. Sometimes orthopedic conditions, such as scoliosis, can impact pelvic floor function, too, adds Dr. Goodman.
Pelvic floor dysfunction can also be brought on by menopause. “At the time of menopause women get a decrease in endogenous estrogen (i.e. the estrogen that your body naturally creates)," explains Dr. Nelken. This drop in hormones can weaken the tissues of the pelvic floor, potentially causing the condition.
Pelvic Floor Dyfunction Symptoms
In addition to knowing the top causes of the condition, being able to spot the following signs and symptoms can help you figure out whether you're dealing with pelvic floor dysfunction.
- Frequently needing to use the bathroom, where you might feel as if you need to "force it out" or have to start and stop many times
- Constipation or straining during bowel movements
- Incontinence (i.e. leaking stool or urine)
- Painful urination
- Pain in your lower back without another cause
- Pain in pelvic region, genitals or rectum — with or without a bowel movement
If you are dealing with any kind of pelvic floor dysfunction, it’s important to work with a professional (such as a urogynecologist or physical therapist) who can help give you the support you need and offer exercises that can rebuild strength and connection.
“It’s not always easy to understand what the pelvic floor is, how to contract or relax the pelvic floor or how it contributes to movement within the body,” says Laura Wilson, a Pilates instructor and founder of Natural Pilates. Sometimes there’s also a level of embarrassment that surrounds discussions of pelvic floor dysfunction because people can feel alone in the diagnosis.
But Wilson, Dr. Nelken and Dr. Goodman all reiterate: Pelvic floor dysfunction is very common, and being able to have these conversations is an important part of destigmatizing any amount of shame that surrounds it. “We feel like it’s abnormal, but it’s not,” says Wilson.
“If you’re holding tension in your shoulders, it’s going to hurt to turn your neck [and] you won't have the same functioning in that area — it’s the same thing in the pelvic floor.” – Rebecca Nelken, MD
Pelvic Floor Dysfunction Treatment
Some good news, per the Cleveland Clinic: Pelvic floor dysfunction can be treated relatively easily in many cases, with biofeedback being the most common treatment. This pain-free method calls upon electronic sensors to gain a deeper understanding of muscle contractions and, in turn, determine different ways to retrain your muscles.
Another typical treatment for pelvic floor dysfunction? Physical therapy, which, BTW, is often done in tandem with biofeedback and usually involves a therapist pinpointing which muscles in your lower back, pelvis and pelvic region are tight. From there, they'll teach you exercises to stretch these muscles to improve their coordination, strength and overall function.
Your PT might also recommend relaxation techniques (e.g. meditation) to help your muscles unwind, and your doc might also prescribe certain medications to keep your system running smoothly. The goal of these meds is to either nix the need for straining on the toilet (which can worsen your condition) or slow down the bowel (and, in turn, address any fecal incontinence), according to Columbia Surgery.
Can You Prevent Pelvic Floor Dysfunction?
There are many things you can do to prevent pelvic floor dysfunction — some of which, you might already be doing. Above all, maintaining a healthy lifestyle with regular exercise and a well-rounded diet is key to prevention. According to UCLA Health, getting proper hydration and including high-fiber foods in your diet can help ease stress on your digestion, thereby lessening any pressure put on your abdomen and any difficulty going number two.
It's also important to incorporate exercises that engage your core muscles, strengthening, lengthening and relaxing these deep core muscles.
Keeping up with pelvic floor muscle training (think: kegels) can also help you steer clear of down-there troubles. Keep in mind, though, that “adherence is key for long term effectiveness,” according to an article published in The BMJ.
Pelvic floor health isn’t just about preventing dysfunction, though. Since all the muscles in the body are connected, “you have to think about the whole body supporting the pelvic floor muscles, too,” says Dr. Goodman. Stress and tension in your day-to-day impacts many parts of the body — and the pelvic floor is no exception.
“Subconsciously, the white-knuckling through life is just baring down on the connective tissue in the pelvic floor, and it’s creating a lot of blockages and congestion, whether energetic, lymphatic or with blood flow,” says Roxburgh.
So while strengthening the pelvic floor muscles is essential for preventing and treating down-there dysfunction, it’s equally important to let the pelvic floor muscles relax — aka don't go overboard with the kegels and make time for mindful bodywork.
If you want to learn more about pelvic floor dysfunction, check out this round-table discussion with Dr. Nelkin, Dr. Goodman and Wilson.