What is Pelvic Floor Dysfunction?

What is Pelvic Floor Dysfunction?

Here at Purple Mountain PT we specialize in diagnosing and treating individuals who have pelvic floor dysfunction. The pelvic floor muscles influence the muscle function of your pelvis, hips, abdomen, thighs and low back. They also contribute to the ability to keep the bladder and bowel under control. When these muscles don’t work well, they can contribute to a variety of problems in joints, ligaments, connective tissue, nerves, the bladder, bowel, intimacy and more.

Pelvic Floor Dysfunction refers to the muscles at the bottom of your pelvis not working correctly.

That is the most succinct way of defining pelvic floor dysfunction. When the muscles are not functioning optimally you may experience symptoms that worsen your quality of life.

Pelvic floor dysfunction symptoms can be related to:

• Your pelvic organs, especially bladder and bowel control:(also prostate and uterus). Symptoms of pelvic floor dysfunction might include overactive bladder, hesitant urinary stream, constipation, straining to have a bowel movement, pelvic organ prolapse, overactive bladder, urine leakage, fecal incontinence, urge urinary incontinence (you cannot get to the bathroom quickly enough, and lose urine on the way).
• Sexual dysfunction: including pain with penetration or orgasm, painful intercourse (dyspareunia), pain after arousal, poor arousal and pain after orgasm; some patients report inability to urinate after sexual intimacy, for example.
• Pain, anywhere in your trunk, lower back, hips, pelvis and inner thighs: Many pain conditions also involved an underlying pelvic floor dysfunction. These may include lower back pain, hip pain, SI joint pain, symphysis pubic dysfunction, chronic lower abdominal pain, chronic prostatitis pain syndrome, interstitial cystitis, endometriosis, orchialgia, symphysis pubis dysfunction (SPD), penile pain, pudendal neuralgia, chronic pelvic pain syndrome, sciatica and more. You don’t have to live this way, there is high quality treatment from a licensed pelvic health physical therapist to help you overcome these problems.

Dysfunction of the pelvic floor usually involves a series of issues such as:

• Timing: The muscles are delayed when they contract, so they don’t “turn on” quickly enough.
• Coordination: The muscles don’t function well with the rest of your core muscles. You may have troubles with your abdominal, lower back muscles, glutes, hip flexors, adductors or other muscles.
• Stiffness: The muscles don’t have the length and ability to effectively move up and down to open and close the urethra and anus.
• Weakness of the pelvic floor muscles themselves: The muscles lack the strength to effectively generate enough tension to close the urethra and hold in urine or close the anus to hold in stool.
• Posture: There are a variety of things that influence posture and pelvic floor function. These might include a tilted pelvis, slouched posture, forward head posture, low back spasms, leg length discrepancy. Each of these will alter the function of your pelvic floor.
• Weakness of all the muscles associated with the pelvic floor. These include the lower back, abdominals, hip muscles, breathing muscles and even the neck. The diaphragm and breathing habits are usually non-optimal, as well.
• Fascial tension: One thing that is giving us our structure and form that seems to be under-appreciated is our connective tissue, or fascia. Connective tissue can become restricted, as well as muscles. Fascia surrounds muscles and, if we have fascia restrictions, the muscles are affected as well.
• Inability to relax the pelvic floor muscles: Stiffness, trigger points and overactivity in the pelvic floor can contribute to the muscles not being able to freely lengthen or relax. Another cause is a learned habit to tighten the muscles instead of releasing them. In fact, this is the hallmark of one condition called dyssynergic defecation. For dyssynergic defecation a licensed physical therapist who specializes in pelvic floor dysfunction will help you to correct the abnormal coordination of the abdominal, rectal and anal sphincter muscles to facilitate your capacity and awareness of how to relax the pelvic floor, open the passage way, and complete a full evacuation of your stool. Inability to relax the pelvic floor muscles also contributes to symptoms of overactive bladder, poor urinary stream, pain when urinating, symptoms similar to a urinary tract infection when you don’t have one, urinary incontinence, pelvic and abdominal pain and more. The inability to relax these muscles is quite common.
• Nerve dysfunction: Men or women may experience “pinched nerves”, intrapelvic nerve entrapment, nerves that don’t fire optimally, irritated nerves, herniated discs, degenerative disc disease, arthritis of the spine, strained hamstrings (and sciatica, for example) or any number of other injuries to nerves that can compromise the pelvic floor muscles. If a nerve to a muscle doesn’t fire well, then the muscle won’t work well. A licensed physical therapist who specializes in pelvic floor dysfunction knows how to assess and treat all of the nerves related to your spine and pelvis. If you have connective tissue tightness, muscle spasm, ligament tension or a pelvis that is out of alignment, we would treat each to restore your pelvic floor muscles and nerves. The Pudendal nerve is the main nerve discussed that influences the pelvic floor. A good pelvic health physical therapist will check a number of your nerves and work to free up their passageway so that you can have less pain and better function of your entire pelvis. These nerves might include the genitofemoral nerve, ilioinguinal nerve, iliohypogastric nerve, lateral femoral cutaneous nerve, obturator nerve, cluneal nerves, posterior femoral cutaneous nerve, femoral nerve and others.

If you have pelvic floor dysfunction, often the muscles are stiff. We use a variety of words to describe this stiffness: high tone pelvic floor dysfunction, tight pelvic floor, muscle spasm, taut muscles, tight muscles, non-relaxing pelvic floor. 

On examination, we find stiffness, connective tissue tightness and muscular trigger points are the driving cause of a person’s weakness, pain, urinary incontinence or bowel problems. When stiffness occurs, a person cannot relax the pelvic floor muscles when needed. When stiffness is present, the bladder may tend toward overactive bladder, urinary urgency and frequency. When stiffness is present, intimacy can be painful. When stiffness is present, stress urinary incontinence happens easily. When stiffness is present all of the items listed above may be present: discoordination, impaired nerve firing, timing problems, inability to relax, fascial tension, weakness, etc.

If I have pelvic floor dysfunction, are my muscles weak and do I need to do kegel exercises?

Here is the best answer: if you have pelvic floor dysfunction you need to have a proper assessment by a licensed pelvic health physical therapist to figure out what is going on with your muscles. The dysfunction of these muscles is more complex than simply doing kegel exercises. In fact, we have worked with countless people who did kegels and worsened their problem or were doing them wrong the whole time. You may have weakness, but the stiffness might be the reason for the weakness; if this is the case, kegels are not warranted.

Symptoms of pelvic floor dysfunction include things related to bowel and bladder (organ) function such as:

• Constipation
• Straining to defecate
• Flatulence (farting) unexpected loss
• Urinary incontinence related to coughing, laughing, sneezing (stress urinary incontinence)
• Urge urinary incontinence (having to rush to the bathroom)
• Incomplete urinary or bowel emptying
• Urinary frequency and urgency
• Nocturia (getting up at night to pee)
• Urinary tract infections: Your pelvic floor dysfunction may be a cause of those infections
• Feeling like you have a urinary tract infection (UTI), but you don’t. This is classic pelvic floor dysfunction. The muscles can cause pain, urgency and frequency.
• Painful urination
• Slow stream, split stream or stream hesitancy
• Hemorrhoids and anal fissures

Symptoms of pelvic floor dysfunction also include pain:

• My vagina hurts. I feel it squeezing. I feel it is tight. It spasms.
• My perineum hurts, burns, aches, throbs. feels sore.
• My whole pelvis hurts
• My tailbone hurts
• My SI joint hurts
• My abdomen hurts. This is a very common symptom of pelvic floor dysfunction. In fact, the abdominals and pelvic floor muscles co-contract together, so most conditions that cause abdominal pain (such as endometriosis and interstitial cystitis) also cause pelvic floor dysfunction because when the abdominals get tense the pelvic floor comes along for the party.
• My hip hurts
• Sex hurts
• Genital pain: Men experience testicular pain, tip of penis pain, pain at the base of the penis. Women experience clitoral pain and vulvar pain.
• Sit bone pain
• My lower back hurts: The low back muscles, like the abdominals, also work in coordination with the pelvic floor. If a person has low back pain we know that they usually also have pelvic floor dysfunction.
• Vaginal pressure: Pressure is a common symptom of pelvic organ prolapse and also of pelvic floor dysfunction. With pelvic organ prolapse there is descent of the organs above the pelvic floor and they generate a downward pressure on the pelvic floor muscles. In response to this problem, the muscles commonly get over-worked and try extra-hard to hold everything up. Over time, what happens is the muscles become stiff and tight and can generate pain. We also find that there is tension on the ligaments, joints, fascia, nerves and abdominal wall. By assessing and treating all of these areas, we can often alleviate pelvic organ prolapse symptoms and pelvic floor dysfunction.

Treatment options for pelvic floor dysfunction:

A licensed pelvic health physical therapist will provide you a thorough evaluation that uncovers what is going on with your pelvic floor. If you need to see another medical provider, in addition to a physical therapist, we usually know the people in your community who can also help you. For individuals who experience chronic pelvic pain, physical therapy is often your best option forward. Pregnant or postpartum women having pelvic floor dysfunction symptoms, such as pelvic girdle pain, urinary leakage, constipation or tailbone pain, should seek a pelvic physical therapist at the earliest sign of symptoms. For men, a highly qualified pelvic health physical therapist will uncover the causes for and treatments needed to help resolve chronic prostatitis pain, testicular pain, overactive bladder or urinary frequency and urgency. Anyone who has endometriosis related pain, interstitial cystitis, painful sex (dyspareunia) or urinary leakage would benefit from seeing a pelvic physical therapist.

Your treatment for pelvic floor dysfunction will be customized to your findings.

Some commonly used treatment methods include manual therapy such as trigger point release, myofascial mobilization, connective tissue mobilization, joint mobilization, and pelvic balancing. Some physical therapists use dry needling to relieve trigger points or biofeedback to help you learn to control your muscles. You can expect to be given specific exercises to help pelvic floor dysfunction. These may be a combination of things that stretch muscles, open your hips and pelvis, restore your breathing mechanics, teach you to drop & lengthen your pelvic floor, train your deep abdominals and pelvic floor or strengthen your lower back or glutes/hips. Many pelvic physical therapists are trained in advanced manual therapy to treat connective tissue and fascia restrictions that may be impairing nerves or pelvic floor muscles. We also work to restore blood flow/circulation so that nerve, fascia and muscles have optimal blood flow circulation and nutrition. Each treatment builds on the last treatment. Give us a call at (616) 516-4334 or connect with us here to speak with our knowledgeable staff and get your questions answered!

Because pelvic floor muscles work in coordination with other muscles, a pelvic health physical therapist will treat you holistically. 

A highly trained pelvic health physical therapist will treat you holistically so that any area of your body that is throwing off your pelvic floor (such as your stiff ankle or your shoulder blades) will be treated. We know that the organs of the bladder, bowel and uterus have connections through the spinal cord to various areas in your body far away from the organs. Through assessing and treating these areas, we find that we can calm down an overactive bladder, for example, and help restore your pelvic floor function. If your treatment is solely directed to your pelvic floor, our experience has taught us that it will be difficult to fully resolve your pelvic floor dysfunction. You need the holistic treatment to best resolve your problems.

We hope this gives you an idea of what pelvic floor dysfunction is, how you can identify symptoms related to pelvic floor dysfunction and what treatment options that might help you.

Peace,

Dr. Maureen O’Keefe, DPT 

 

The physical therapists of Purple Mountain Physical Therapy, located in Grand Rapids, Michigan, are pelvic health specialists. We offer every patient a private, one-on-one appointment, upto 55 minutes long. If you are interested in working with one of the highly trained pelvic physical therapists at Purple Mountain Physical Therapy, we pledge to give you a thorough evaluation and customized treatment plan.

You can call 616.516.4334 to learn more. Or you can fill out this online inquiry and we will reach out to you. We offer telehealth for individuals who prefer the convenience of online appointments or are too far away to receive in person treatment. If you want to read more about the benefits of physical therapy check out this other blog we wrote!