Pelvic Floor Dysfunction: Symptoms, Treatments, and When to See a Doctor

Let's remove the shame.

Women holding hands

Getty Images / Luis Alvarez

Everyone's motivation to workout stems from a different source. Generally, we workout to maintain a healthy heart, reduce stress, and sleep better. Our sessions in the gym also help us improve the tone of our quads, arms, and abs. The muscles that we visibly see improving over time are confirmation that those hours in the gym are paying off. 

But as much as we pay attention to the appearance of our outer body, we should be devoting equal effort to improving our pelvic floor muscles. When you’re using the bathroom and contract to pause your urination, those muscles you engage are located in your pelvic floor. We don’t see them (most of us neglect them), but they get weak over time and can lead to a condition called pelvic floor dysfunction. 

Chief of Obstetrics and Gynecology at Yale Health Dr. Monique Rainford, MD, says that pelvic floor dysfunction just happens to you. "It hits you because you'll begin to lose urine and won’t be able to control the flow," she says. "Or, you realize that you're losing feces, and you can't properly control that function either.” There are even instances where some begin to feel pressure or see a bulge in their vaginal area. "You would just know, this is not normal; you'll will notice something doesn't feel quite right," she adds.

You may be thinking, Kegels to the rescue? Not necessarily. Though it has proven to stave off uncontrollable urine and feces leakage (among other benefits), it’s not always the answer for this disorder. Because there are different types of pelvic floor dysfunction, there are also different kinds of treatments to be aware of. Ahead, we break down everything you need to know about pelvic floor dysfunction. 

Understanding Your Pelvic Floor

The muscles that support the vagina, rectum, uterus, and bladder are known as the pelvic floor. When functioning correctly and in coordination with each other, the muscles promote normal bowel movements and bladder control.

The pelvic floor muscles stretch from the bottom-most part of the spine (or the tailbone) to the pubic bone. The makeup of the pelvic floor is different for those with a vagina—it's larger because of the space needed for baby development in the uterus, the area connected to the vagina through the cervix and referred to as the birth canal. 

The pelvic floor also moves. The muscles expand to make room for the organs to move up or down when we breathe. So, when we inhale, our diaphragms go inward towards our chest, make room for air to come into our lungs, our abdominal muscles expand, and the pelvic floor goes down and expands. Exhaling then moves the pelvic floor back to its original position. 

What Is Pelvic Floor Dysfunction?

Pelvic floor dysfunction is more common than you think. It affects roughly 25% of people with vaginas in America. Dr. Rainford says the chances of getting the disorder increase the older we get due to lower estrogen levels—the hormone responsible for keeping the ligaments in the pelvic floor strong. According to Dr. Rainford, the disorder happens "when the pelvic floor is not functioning in the optimal manner" or becomes weak because of strenuous breathing, obesity, vaginal childbirth, radiation treatments, or your genetic makeup. "At times, some women experience it without a specific, diagnosed reason," she adds. 

There are three common types of the disorder: "Urinary incontinence, where urine leaks without control," says Dr. Rainford. "Fecal incontinence, where you can’t control your bowel, and then there’s prolapse, where the vaginal organs, the uterus, or the cervix, or the bladder seem to be bulging out from the vagina."

When you’re laughing, sneezing, or coughing, and urine is released, that’s a telltale sign of urinary incontinence. Fecal incontinence is similar but involves your inability to control the release of your stool. Dr. Rainford points out that the opposite can occur too, where you cannot empty your bladder or feces because the muscles have tightened beyond your control. With prolapse, the pelvic organs become visible externally. The uterus, bladder, or rectum muscles are so weak the organs begin to push against or out the vagina.

Symptoms

There are no definitive causes or common symptoms across the board for pelvic floor dysfunction because it shows up differently in some. Those with the disorder may experience the following:

  • Frequent urination
  • Discomfort during sex
  • Constipation
  • Pain or pressure in the vagina

“Take urinary tract infections, for example," Dr. Rainford says. "One day, you get this burning sensation, then the next you have a frequency in going to the bathroom. Well, pelvic function dysfunction shows up like that. One day, you realize you cannot control your bladder or that when your partner is attempting to go in during sex, there's more tightening up in the opening of the vagina that you cannot control. It’s not one of those things you can miss.” 

When To See A Doctor

Dr. Rainford says a gynecologist must confirm the specific type of disorder someone is experiencing before being referred for treatment. "Don’t wait to see your doctor if you experience any symptoms associated with having a weak pelvic floor," she says. "Don’t be afraid to say out loud that you’re losing feces and urine. Or that when you cough, urine comes out. It may sound embarrassing, but it’s what we’re here for."

If you don't seek medical attention, the symptoms will increase over time. "Left untreated, you'll begin to experience general discomfort in the vaginal area or get yeast infections," Dr. Rainford explains. "They may then feel like they must limit their daily activity because of the shame and fear."

Not seeing a doctor could also affect your relationships and sex life, according to Dr. Rainford. "Some become incontinent during intercourse. And of course, they're not going to want to have sex if they're embarrassed about losing urine during intercourse," she says. Dr. Rainford also pointed out that not seeing your doctor can also lead to "dangerous emotional and psychological side effects that can affect your self-esteem and well-being."

Treatment

After you’ve seen a doctor, physical therapy is usually the first-line treatment for pelvic floor disorders, Dr. Rainford tells us. Think about it this way: When you have a torn ligament or sprained ankle, you need some form of rehabilitation, and the first step to recovery is usually physical therapy. The same holds true for pelvic floor muscles.

Depending on the case and the doctor’s recommendation, a therapist’s typical treatment plan includes: 

  • Pelvic floor exercises such as squats, bridges, bird dogs (and yes, Kegels) help with muscle training. These exercises relax the muscles, stretch tight ones, and strengthen weak ones.
  • Massaging and stretching of the external pelvic areas help with blood circulation.
  • Vaginal dilators, a plastic tube-shaped device, helps women relax their pelvic muscles for easier penetration. “The dilators are progressive in size,” says Dr. Rainford, because it helps to loosen the tightened tissues gradually. 
  • Biofeedback is when the therapist inserts a small device into a woman’s vagina to examine what’s going on inside digitally.

Dr. Rainford says not to perform any pelvic floor exercises on your own when experiencing vaginal discomfort. "Go to your clinician right away if you notice something isn’t right, and don’t be embarrassed to say, ‘I have a problem with this,'" she says. Your clinician needs to listen to you and address it immediately. And if you have a dismissive clinician, that's not the best clinician for you."

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