Do I Have Pelvic Floor Dysfunction?

You have found the leading pelvic health physical therapy clinic in Grand Rapids. We specialize in treating pelvic floor dysfunction.

So many of our patients come to us and ask, “do I have pelvic floor dysfunction?” There are certain signs and symptoms related to pelvic floor dysfunction that we’ll detail here.

We have an interview you may like to watch all about pelvic floor dysfunction. If you are wondering “do I have pelvic floor dysfunction?” this interview will give you loads of information:

Dr. Maureen O’Keefe, DPT recently had a fun time meeting with the chiropractors of Rise Chiropractic, here in Grand Rapids to answer the question: what is pelvic floor dysfunction. It was a great conversation that covered a wide range of sign and symptoms a person may have that relate to pelvic floor dysfunction. You may enjoy watching and listening to it here. Please reach out to us here to speak with our knowledgeable and caring staff to get your questions answered and to get started on your healing journey.

What do the Pelvic Floor Muscles Do?

• Provide bladder and bowel control. 
• Serve as postural muscles that automatically work when needed
• Provide support to the organs that sit on top of them (bladder and bowel, uterus or prostate). 
• Provide sexual function

Because pelvic floor muscles influence bladder, bowel, intimacy and pain, pelvic floor dysfunction manifests as problems in any of these areas.

Normal Pelvic Floor Function Explained

Contract and release: When the pelvic floor muscles contract they should be lifting and squeezing to generate closure around the urethra and anus and provide support for your organs. When they relax effectively, they descend and open up the areas around the urethra and anus to allow you to urinate, have a bowel movement or pass gas.

Postural Muscles: The pelvic floor muscles are workhorses because they are activated all the time posturally and they respond to your movements to allow you to move without loss of urine or stool. When working posturally, they are in a happy, middle ground and are responsive quickly to your movements. They give you just enough contractility to keep you from losing urine or stool with your daily movements and providing stability through the pelvis so your back, hips, legs and the rest of your body can function well.

Delay in activation & greater, non-effective, activity of the muscles occurs with stress incontinence: Research has found that women who experience stress incontinence specifically have a delay in the postural activity of the pelvic floor when women are rapidly swinging their arms. This reflects that the muscles do not turn on quickly enough to prevent loss of urine. Although the pelvic floor muscles come on with delayed timing, for women who have stress incontinence their postural pelvic floor activity was actually greater than women who do not have unexpected loss of urine. What? Explain this. Let me say it again: if you have stress incontinence, we know that your pelvic floor muscles are slow to respond to your body movements and once they respond they come on extra-hard to try to hold in urine. We see this all the time in our patients: their muscles have gone into overdrive and become stiff from trying too hard to stop the loss of urine. What ends up happening is that urine loss persists because with pelvic floor dysfunction these muscles arrive too late to the party to stop the loss of urine and when they do arrive they are all tensed up.

Support to Organs: The pelvic floor muscles hold up the organs that are above these muscles. Women have the vaginal opening that allows for the passage of a baby when necessary. Women and men also have the anus opening to allow for defecation. Unfortunately, some of us will experience a problem with pelvic organ prolapse, a condition where there is descent of pelvic organs through these passageways. The pelvic floor muscles are an important contributor to supporting these organs to prevent a prolapse. When people have pelvic organ prolapse, working to resolve your pelvic floor dysfunction is helpful to improving the prolapse symptoms. We also find our patients have fascial tension in the abdomen, hips and pelvic floor that can be contributing to the propensity to develop a prolapse. This is why our patients who have prolapse always receive full-body, holistic care that includes manual therapy, fascial release, scar tissue mobilization and trigger point release. We find my restoring the fascial and muscular integrity throughout the entire abdomen, spine and pelvis, their pelvic organ prolapse symptoms can alleviate.

The pelvic floor muscles are important to our sexual function: Pelvic floor muscles serve us for sexual function, as well. Vaginismus and dyspareunia are common problems our patients experience. These women have pain with attempts at penetrative sex. We find that often their pelvic floor dysfunction is manifesting as tightness, trigger points or spasms. Alleviating these things is hugely helpful for these women. Women experience contractions of the pelvic floor muscles that contribute to sexual arousal and sensation. For men, the pelvic floor muscles are important for both erections and ejaculation. We find in our men that they often tend towards significant stiffness and muscle guarding in their pelvic floor. They end up with pain at the tip of their penis, in the perineum, after ejaculation or with sitting.

Pelvic Floor Muscles are Amazing During Pregnancy: Imagine a growing baby inside a uterus and all of the weight of the baby, placenta and everything else that goes along with a pregnancy. The pelvic floor muscles provide support for the baby when a woman is pregnant. These same muscles need to lengthen and open during labor and delivery to allow for the birth of the baby. At Purple Mountain PT we teach our pregnant patients how to do this. Connect with us here to get your questions answered.

Signs and Symptoms related to pelvic floor dysfunction 

Pelvic floor dysfunction comes with certain signs and symptoms. If you have any of these things, then you likely have pelvic floor dysfunction:

Pelvic Pressure: This symptom commonly occurs when there is abnormal descent of the bladder, uterus or rectum. When this descent is present, often a person will also experience urinary or fecal incontinence and pelvic organ prolapse.

Pelvic Pain: This is pain located anywhere from the lower abdomen to the pelvic floor, low back and hips. Pelvic pain includes things like symphysis pubis dysfunction (SPD), SI joint pain, hip pain, gluteal pain, pelvic floor spasms, anal pain, pain with or after intimacy, pain in the genitals (orchialgia, perineal pain) or deep pain inside the pelvic region. Some patients describe a deep ache, others have “lightning” crotch, some people have sharp, stabbing pain. The pain could be mild and worse with sitting, or sometimes it is ok when sitting, but hurts when standing. Our evaluation will uncover what is causing your pain and our treatments holistically work on reducing these problems by using manual therapy, exercises, education and more.

Pelvic Floor Weakness: Signs of pelvic floor weakness include many things. Here is an incomplete list:

• Unexpected loss of urine (both stress incontinence and urge urinary incontinence)
• Unexpected loss of gas
• Fecal smearing, fecal incontinence
• Pelvic organ prolapse.

Unfortunately for us women, research has found that about 50% of women who are 50 years old or older have weakness of the pelvic floor. I think we all know women who complain about losing urine when they laugh. This is a symptom of pelvic floor dysfunction. Weakness of these muscles is a major health issue for women and should be a priority for any person who has a problem. We must address these problems so that our quality of life can improve and because as we age we know the problem is likely to get worse, not better. In a woman’s life she has an 11.1% risk of needing an operation for pelvic organ prolapse or urinary incontinence. And, unfortunately, about 30% of women who have one surgery will require another surgery in years to come.

Urinary incontinence: The unexpected loss of urine, whether it is stress urinary incontinence or urge urinary incontinence are both symptoms of pelvic floor dysfunction. While your muscles may be weak, as we explained above, the weakness is often due to them working too hard/too much and being delayed. Therefore, kegels don’t solve the problem and can actually worsen it. Keeping from losing urine is a complex neuromotor process; we work with women & men to recover the timing of their pelvic floor activation, coordination with their abdominals and breathing and posture alignment. Our program to resolve bladder dysfunction is very effective. Here’s an article that details how we approach helping a person recover bladder function.

Urinary disorders: The pelvic floor muscles can contribute to urinary frequency and urgency, hesitancy in your stream, incomplete emptying, nocturia (peeing at night) and dysuria (pain with urinating). If the muscles are not functioning optimally, the bladder can become unhappy. When this is the case, we work with our patients to calm down the bladder and optimize its ability to fill up with urine, quietly store urine and release urine completely. Our treatment is holistic and we find that patients need both external manual therapy to the spine, hips, abdomen and thighs as well as internal work to resolve the pelvic floor dysfunction. We include exercises as needed to balance the core, breathwork and hips. We also address scar tissue that may be making your bladder overactive.

Pelvic Organ Prolapse: Our pelvic health physical therapy at Purple Mountain PT is routinely helping to improve a person’s pelvic organ prolapse symptoms. There is a lot that we can do to help you, so please do not feel that you are stuck with this problem and there’s nothing you can do. We utilize a combination of hands-on treatments and exercise based treatments to help you improve your ability to control your intra-abdominal pressure, reduce tension in your muscles and fascia, and optimize support to your organs. Some women may benefit from surgery to correct their prolapse. We have worked with hundreds of women pre & post-operatively for their reconstructive surgery. We find that these women have underlying pelvic floor dysfunction and addressing this dysfunction can optimize their surgical recovery and set them up for success long-term. You don’t want your pelvic floor muscles working poorly and relying simply on the surgeons stitches to hold everything up.

Fecal or flatulence Incontinence: These are both symptoms of pelvic floor dysfunction. Fecal incontinence may be a small smearing of fecal matter that you only notice when you wipe yourself and you expected to be clean. Fecal incontinence may only happen with liquid stool or small stool that’s easier to pass/loose. In pelvic physical therapy we can work with you to help you restore your fecal continence. There’s so much we do to retrain your rectum, sphincter and pelvic floor muscles so they can effectively close the door and keep stool inside.

Constipation or Difficulty Emptying the Bladder or Rectum: When the pelvic floor muscles are not functioning properly, they may not “open the gates” well to allow you to empty your bladder or bowel. Some of our patients have developed habits of squeezing tight their muscles when they are trying to have a bowel movement, instead of relaxing these muscles. This can show up as hemorrhoids, anal fissures, pain with defecation, a sense of everything being tight and narrow stool shape. If you are having trouble emptying your bladder or bowel, this is a symptom of pelvic floor dysfunction and may be a symptom of other problems as well (prostate enlargement and neurogenic bladder, for example). Our physical therapy is very holistic and works to restore your ability to effectively void.

What Causes Pelvic Floor Disorders?

There are many well known risk factors for pelvic floor dysfunction. In a recent study, 23.7% of women surveyed had at least one symptom of pelvic floor dysfunction. Let’s look at the risk factors:

• Pregnancy
• Multiple pregnancies
• Older age
• Connective tissue disorders
• Being menopausal
• Obesity
• Smoking
• Chronic obstructive pulmonary disease (because you are coughing all the time and straining to breathe, thereby straining and weakening the pelvic floor)
• There is a relationship between having had a vaginal delivery and developing pelvic floor dysfunction, but many women have vaginal deliveries and do not develop pelvic floor dysfunction

We also know that sports that involve running and jumping often have pelvic floor dysfunction, even in adolescent years. The pelvic floor muscles have autonomic nervous system input (think fight/flight & rest/digest); as a result if you have a lot of stress or anxiety the pelvic floor may have dysfunction.

We must do better to prevent pelvic floor dysfunction! We are noticing a possible global shift towards preventing pelvic floor dysfunction! Yay!

This would be a good thing, if we could educate women and birthing providers about things that can be done to prevent pelvic floor dysfunction. Recently, in the United Kingdom there was a draft guidance that girls at 12 years of age and up should be taught about pelvic floor exercises as part of their school curriculum. This guidance is specifically with the goal of preventing pelvic floor dysfunction and surgery for females. If you are reading this, have you ever been educated on even 5 things you can do to optimize your pelvic floor health? I’m going to guess that no, you have not. In America, our professional societies devoted to pelvic health are also having conversations about what we can do to reduce the incidence of pelvic floor dysfunction. Here at Purple Mountain Physical Therapy, we treat women, men and kids who have pelvic floor dysfunction. Children can really struggle with gaining urinary and bladder control. Here is information about how we treat children and help them learn how to effectively use the toilet, without straining, without anxiety, without pain and without living in fear of an embarrassing accident. Contact us here to speak with our knowledgeable and caring staff.

Here are Some Things to Optimize Your Pelvic Floor Health:

• Maintain Your Ideal Weight: Obesity is a risk factor for dysfunction.
• Learn to Breathe effectively using your diaphragm: Your pelvic floor muscles and diaphragm are dancing partners. They work in coordination. The pelvic floor follows the lead of the diaphragm. If you are always breathing in an ineffective or shallow manner that does not effectively engage the diaphragm, then you are contributing to pelvic floor dysfunction.
• When pregnant learn how to open your pelvic floor to prepare for birth: Pregnancy is an important time to get connected to your pelvic floor. During labor and delivery it, your body may very well want to tighten up your pelvic floor when the baby is coming through the birth canal. This is not ideal. The better way to birth is to learn to open and release your pelvic floor during those crucial moments of birth.
• When in the push stage of labor, use warm compresses: There is good evidence that a warm compress held to the perineum between contractions can reduce your risk for perineal tearing. The compress can bring blood to the area and make it more supple.
• Address any pelvic floor dysfunction symptoms as soon as they start: A recent study of adolescent athletes found urinary incontinence to be routinely present in young girls who play sports. In fact, rates were 80% of 16 year old girls who were in the sport of trampolining had incontinence! If you are a mom of a young athlete, please talk to her about this and ask her if she experiences incontinence. We can get it treated, using external-only methods.
• Posture is Important: The way the bony pelvis sits is important, because it is supposed to be angled in such a way that it provides a natural support or shelf for our organs, so the muscles don’t have to do all the work. If you are in the habit of tucking your bottom underneath you, you are not in optimal alignment and can be straining your pelvic floor muscles all day long, because they will have to work extra-hard to support the organs.
• Do Not Do Kegels All the Time: This may surprise many of you, but Kegels are not the be-all, end-all to optimize pelvic floor health. In fact, most of our patients do not benefit from Kegels and Kegels would make their problem worse. This is because we find our patients often have stiff and tight pelvic floor muscles. Our work together aims to get the pelvic floor less stiff and less tight. If I had these patients doing Kegels I would be asking them to tighten up their pelvic floor, which makes no sense. The other thing we see with our patients is that they don’t perform Kegels correctly. They think they are tightening their pelvic floor, but they are actually pushing it out instead of lifting and squeezing it up. Another consideration against doing Kegels all the time, is that these muscles are supposed to be working in coordination with your breathing and abdominals; If you are doing Kegels and focusing only on the pelvic floor, you are probably doing it all wrong. My best advice for you is to get an annual check up of your pelvic health with a qualified pelvic health physical therapist to learn what is actually going on with your ability to engage your pelvic floor muscles.

Purple Mountain Physical Therapy is a specialty pelvic health clinic located in Grand Rapids, MI. We offer expert care to help children, women and men overcome pelvic floor dysfunction and bladder, bowel or pain related problems. We hope this gives you some insight into the complex problem of pelvic floor dysfunction! This field is our specialty and it takes years to get good at treating it. We have a variety of methods to improve pelvic floor dysfunction including hands-on manual therapies, very specific and targeted exercises, behavioral modifications, breathing techniques, neural calming and other interventions. We know how to help you recover continence, how to resolve pelvic pain, how to ease pelvic organ prolapse, how to improve your sexual health. To begin treatment, we start with an evaluation; here is a link to an article that explains what to expect during an evaluation.

If you are wanting expert care for your pelvic floor dysfunction, we would consider it an honor to work together. You can contact us here by phone or here online to learn more about our treatment and see if your needs are a good fit for our methods. This work is truly a calling for the Purple Mountain Physical Therapy Team of providers.

Peace,

Maureen O’Keefe, DPT