Your pelvic floor health can significantly impact your quality of life, affecting your bladder, bowel and sexual function. Erika Warren, PT, DPT, CDNT, a pelvic health physical therapist at Atrium Health Women's Care Sexual Health, explains the symptoms you shouldn’t ignore.
“Pelvic floor dysfunction impacts quality of life more than we talk about,” says Warren.
What is pelvic floor dysfunction?
The muscles in your pelvic floor serve several essential functions. They support all the organs that sit inside the pelvis. Additionally, the muscles need to be able to quickly contract so you have support to prevent urine leakage when you cough, sneeze or lift something heavy. Healthy pelvic floor muscles should also be able to relax.
Warren emphasizes that it’s possible for your pelvic floor muscles to be weak and too tight at the same time.
“Just because the muscle is tight doesn’t mean it’s strong,” Warren says. “We need the muscles to relax and lengthen, which is important for being able to have a bowel movement, empty your bladder and reduce pain during sex or having a pelvic exam at the gynecologist.”
Pelvic floor dysfunction occurs when these muscles are too tight or too weak. Symptoms can include:
- Urine leakage when coughing, sneezing or lifting something heavy
- Stool leakage
- Constipation or incomplete bowel movements
- Pain during sex
- Pain during gynecologic exams
- Frequent trips to the bathroom
- Starting and stopping while you pee
- Painful urination
- Pain in your rectum or vagina
“As women, we’ve been told that if we’ve had a baby, it’s normal to pee our pants when we cough or sneeze or that it’s normal for sex to be painful,” says Warren. “But pelvic pain isn’t normal. Sex should never be painful if you have proper lubrication. You may feel a stretching of your muscles, but you shouldn’t feel sharp pain.”
What causes pelvic floor dysfunction?
Pelvic floor dysfunction can be caused by:
- Pregnancy and childbirth
- Trauma
- Stress
- Anxiety
- Lack of sleep
- Shallow breathing patterns
- Pelvic surgery, such as a hysterectomy
- Straining your pelvic muscles
- Connective tissue disorders
- Hormonal changes during perimenopause and menopause
How can women improve or maintain pelvic health?
While Kegel exercises (tightening and relaxing your pelvic muscles) are often touted as the gold standard for improving pelvic floor health and strength, they aren’t right for everyone. And, depending on the cause of your pelvic floor symptoms, they could make matters worse.
“Kegels are helpful for strengthening your muscles but being able to relax and lengthen your pelvic floor muscles is equally important,” says Warren.
She highly recommends meeting with a pelvic health physical therapist to learn the best approach for improving or maintaining your pelvic floor function.
“If you’re having issues, I don’t recommend trying to fix them on your own,” says Warren. “A physical therapist can give you a tailored program of exercises and breathwork you can do at home. While some people need frequent physical therapy sessions, there is a lot you can do at home to support your pelvic floor health, but getting evaluated by a physical therapist is a good starting point.”
What to expect during a pelvic floor physical therapy appointment
At your first appointment, your pelvic floor physical therapist will talk with you about your stress levels, breathing patterns, posture and potential back and hip issues. They’ll also ask about your health history and current symptoms. They can do an internal exam (similar to a pelvic exam at the gynecologist) to assess your pelvic floor function. If you prefer not to have an internal exam, your therapist can assess your pelvic floor muscles externally.
After the assessment, your physical therapist will develop your individualized treatment plan, usually a combination of in-office physical therapy sessions and exercises you can do at home.
Depending on your insurance plan, you may be able to make an appointment directly with a physical therapist. If you need a referral, ask your gynecologist.
When to seek medical care for pelvic floor issues
“We’ve normalized a lot of things that don’t have to be normal,” says Warren. “You don’t have to pee your pants when you cough or sneeze. You don’t have to have pain with sex. That’s why it’s important to talk about these things.”
Warren encourages people to trust their instincts and see their gynecologist or a pelvic floor physical therapist if something doesn’t seem right.
“If you feel like something is wrong, if something doesn’t feel normal, it’s probably not normal,” Warren says. “Please ask about it. Nobody knows your body better than you do. You have to advocate for yourself.”
Schedule an appointment at Atrium Health Women's Care Sexual Health.
