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How Do I Know If I Need Pelvic Floor Therapy?

Hello friends! You have probably seen information about the pelvic floor on apps like TikTok or Instagram. Thanks to social media the pelvic floor is becoming mainstream and less taboo. This is great because it is helping many individuals get the help they need but did not know was available; however, social media can be overwhelming and get you thinking. Do I have pelvic floor dysfunction? Are my symptoms normal? Do I need to see a pelvic floor therapist? This week we’ll talk about some common signs that your pelvic floor muscles may not be working optimally or the way they were designed to.


Keep in mind that this is not medical advice and should be used for educational purpose only. It is important to discuss any concerns with your individual healthcare provider.


Before we start discussing specific symptoms that can be a sign of pelvic floor muscle dysfunction, let’s review what the pelvic floor does. The pelvic floor has 4 main functions: support, sphincteric, stability, and sexual.


  • Support: The pelvic floor muscles work like a hammock, attaching from the pubic bone in the front and the tailbone in the back, to support the pelvic organs and assist in keeping them in the pelvic cavity.

  • Sphincteric: The pelvic floor muscles securely wrap around the exit canals. They squeeze to keep urine and waste matter inside the body and relax to let them out. In females there are three exit canals: the urethra for urine, the anus for poop and gas, and the vagina. In males there are two exit canals: the urethra for pee and semen and the anus for poop.

  • Stability: The pelvic floor is the bottom of the internal girdle, or core, that works to keep everything on the inside strong, stable, and secure. The core is made up of four muscle groups: the deep abdominals in the front, the deep low back muscles in the back, the diaphragm on top, and the pelvic floor muscles on the bottom.

  • Sexual Function: The pelvic floor muscles are active during sex and orgasms. They help with increased blood flow and they help to maintain erections of both the penis and the clitoris. The muscles help to provide tone and increased sensation for each partner to improve sexual satisfaction.



Now let’s talk about some common symptoms of pelvic floor muscle dysfunction.


Leakage of pee: Having urinary leakage with common activities like laughing, coughing, sneezing, and jumping are signs of stress urinary incontinence. This happens when the pelvic floor muscles are too weak and/or uncoordinated and are unable to keep urine in with changes in pressure. While this leakage can be normal after having a baby or as we get older, it is not normal and it is a sign that things are not functioning properly.


Frequent urination and strong, sudden urges: The normal individual should have at least 2 hours in between trips to the bathroom to pee. If you are going multiple times each hour or get strong sudden urges causing you to run to the bathroom this may be a sign of an overactive bladder. This can lead to urge urinary incontinence which is the leakage of pee with the urge to go.


Bedwetting (nocturnal enuresis): This can be especially common in children. Many times, bedwetting is caused by constipation and incoordination of the pelvic floor muscles.


Constipation: While there are many things that affect digestion and the ability to poop, the pelvic floor muscles need to be able to lengthen and relax to allow poop and gas to exit. If the pelvic floor muscles are tight they can make it difficult for poop to exit the body. Tightness in the abdominal tissue can slow down the movement of stool through the body and contribute to constipation.


Anal incontinence (leakage of gas or poop): While the pelvic floor muscles need to be able to relax and lengthen to let gas/poop out they also need to be able to squeeze to keep gas/poop in until it is an appropriate time to release (like when we are sitting on the toilet). If these muscles are weak or uncoordinated we can have the leakage of gas or poop at inappropriate times.


Hemorrhoids: Hemorrhoids can happen as a result of chronic straining and pushing due to constipation. This can be a sign of pelvic floor muscle dysfunction. Since hemorrhoids often make pooping painful, this can make it harder for the pelvic floor muscles to lengthen and relax to let poop out.


Pelvic pressure/heaviness or vaginal bulging: These can be signs of pelvic organ prolapse. This is when one or more of the pelvic organs begins to fall into or through one of the exit canals of the body.


Pain with sex: Pain with intercourse, whether or not there is penetration, can be a sign that the pelvic floor muscles are not functioning properly. A condition called vaginismus causes a spasm of the muscles surrounding the vagina making penetration extremely painful and physically difficult.


Sex “doesn’t feel the same”/difficulty achieving orgasm: The pelvic floor muscles need to be able to lengthen and stretch to allow for penetration, but if the muscles are weak and lack good tone, this can decrease pleasure with intercourse and make achieving orgasm difficult.


Erectile dysfunction and premature ejaculation: Since the pelvic floor muscles are important in maintaining an erection and providing tone for sensation, overactive or weak pelvic floor muscles can impact penile sexual function.


Pain with wearing tight clothing: Pain while wearing tight clothing can be a sign of vulvodynia or vestibulodynia. This causes the feeling of light touch and other sensations to become painful. This pain often feels like a burning sensation.


Pelvic pain and low back pain: While there are many conditions and diseases that can cause pelvic pain, the pelvic floor muscles are often a common cause especially if other tests and imaging have come back negative. The pelvic floor muscles can become tight and painful just like other muscles in the body. The good news is they respond well to different exercises and hands on techniques the same way these other muscles do.


Tailbone pain: The pelvic floor muscles attach to the tailbone. This means that tight or weak pelvic floor muscles can pull on the tailbone causing pain. Pain in your tailbone with sitting or moving can be a sign of pelvic floor dysfunction.


Hip pain: Since the hip joint sits very close to the pelvic floor, pelvic floor dysfunction can impact the way the hip joint moves and functions. If regular treatments for hip pain have been unsuccessful, there’s a good chance the pelvic floor muscles are part of the cause.


When the pelvic floor muscles are not functioning properly there can be feelings of hopelessness, embarrassment, frustration, and fear. There is hope and help! You can laugh without leaking, leave pain behind, and love better sex!


A pelvic floor therapist can assess the functioning of the pelvic floor muscles and surrounding areas to give you an individualized treatment plan to improve your symptoms. Talk to your provider about your symptoms and ask for a referral to a pelvic floor therapist. You can find a pelvic floor therapist near you at www.mypfm.com/find-a-pt. If there are no pelvic therapists in your area or there are other barriers to your access, check out our self-paced online courses here.



Here are some great resources to help you learn more about your pelvic floor muscles:


For providers, check our online courses to help your clients. Consider joining our Ambassador Program and most of our courses are included with your membership!

Written by Emily Reul, PT, DPT

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