It may feel awkward to discuss symptoms of pelvic floor dysfunction with a healthcare practitioner, but the rewards are many. The difficulty of controlling the pelvic floor muscles can cause many symptoms that can be attributed to something else. For example, it's estimated that 50% of those with persistent constipation also have pelvic floor dysfunction (PFD)(1). Many physicians and other healthcare practitioners are not aware of PFD, so will suggest stool softeners or a change in diet without looking any deeper for a less obvious cause. Yet, pelvic floor dysfunction is very common, with nearly 1 out of 3 women experiencing PFD-related symptoms (2). However, that doesn't mean PFD is not a concern for men, and the notion that this condition only affects women may keep men from seeking help.
It is important to identify potential pelvic floor dysfunction because, if caught in the early stages, it is much easier to address, and it may even be possible to reverse it completely. So, knowing the signs and symptoms of PFD is crucial. Temecula Center for Integrative Medicine (TCIM) doctors and healthcare practitioners highly encourage patients to have these honest conversations with us, so we can help reduce pain, restore function, and preserve dignity.
What is Pelvic Floor Dysfunction (PFD)?
Think of the pelvic floor as a set of muscles and tissues that attach to the pelvic bones and form a type of cup, helping to keep the organs of the lower torso in place. These layers of muscle and tissue wrap around exits for the body: the urethra as an exit for urine and the rectum as an exit for stool. This complex mesh of muscle and tissue engages in a coordinated dance, relaxing to let urine and stool move out of the body but returning to a tightened state to cut off the flow. It's counterintuitive, but the "normal" state is tightened to keep urine and stool in the body, making it necessary to consciously relax those muscles and allow the wastes out. When the coordination of this group of muscles and tissues gets impaired, it's called pelvic floor dysfunction (3).
The organs supported by the pelvic floor (bladder, rectum, the prostate in men and the uterus and vagina in women) can all be affected by PFD. That means some reproductive functions can be affected in addition to difficulty passing stool or urine. More importantly, some of the affected reproductive functions can negatively impact sexual health, such as pleasure and satisfaction.
Symptoms of Pelvic Floor Dysfunction
Since male and female anatomy is different, PFD can result in different symptoms for men and women. The biggest red flag for PFD is chronic (long-term) constipation.
Common symptoms for males and females (3):
Constipation, especially chronic conditions
Straining to achieve a bowel movement
Having to shift positions on the toilet to get the "right" angle to release stool
Needing to assist stool to come out manually
Bowel movement or urine flow that stops and starts uncontrollably
Urine or stool leakage
Pain in the pelvic region with (or without) urination or passing stools
Feeling of urgency or needing to use the bathroom frequently; a bladder that is "overactive"
Feeling of incomplete evacuation of the bowel or bladder
Lower back pain in the absence of an identifiable cause
Male-specific symptoms (3):
PFD symptoms can closely resemble symptoms of inflammation of the prostate (prostatitis). PFD may also co-exist with other conditions, such as having difficulty maintaining an erection or experiencing inflammation of the prostate (3). A proper diagnosis would rule out other causes for the following symptoms (3):
Leaking after urination
Erectile dysfunction- trouble obtaining or preserving a firm erection
Prostatitis- inflammation of the prostate, resulting in disrupted urine flow
Female-specific symptoms:
There can be many other root causes for the following female-specific symptoms, so an investigation is necessary to rule out other possible causes for these (3-5):
Painful sexual intercourse
Pain upon vaginal penetration
Difficulties achieving orgasm or producing lubrication
Prolapse of the pelvic organs (bladder, uterine)
Causes of Pelvic Floor Dysfunction
There are many known causes of PFD, yet sometimes a cause cannot be identified. (It's essential to have an experienced doctor investigate the matter.) Some of the known causes of PFD include (3, 5):
Getting older
Being overweight
Having been pregnant, given birth (especially to large babies), or surgery for a successful delivery
Injuries to the lower trunk (from a car wreck or other accident)
Bearing down too hard or too frequently (when passing stool or having a chronic cough)
Certain diseases or conditions (pelvic inflammatory disease, hyperthyroid, multiple sclerosis, many others)
Surgery in the pelvic area or pelvic muscles and tissues
Who is Most at Risk for Developing Pelvic Floor Dysfunction?
Pregnancy is the most common condition that gives the highest risk of developing PFD (3, 5). Simply being female increases PFD risk; approximately 1 out of 3 women 20+ years old mention some PFD symptoms to their healthcare providers (2). Having a family member with PFD may increase your risk, though researchers have not identified a specific set of genes that pass the risk. Increasing age, trauma, surgery (in and around the pelvic floor), and being overweight are other elements that increase PFD risk (3).
Does Pelvic Floor Dysfunction Resolve On Its Own?
Unfortunately, PFD does not typically resolve on its own. Instead, the condition tends to worsen over time if left untreated (3), making it increasingly difficult to treat as the seriousness progresses.
Can pelvic floor dysfunction be prevented?
Many strategies help reduce the risk of developing PFD.
Achieve and maintain a healthy weight. Extra weight puts pressure on the pelvic floor, which reduces its strength over time.
Alter the diet. Get enough fiber and fluids. Strategies that prevent constipation double as prevention for PFD. Eliminating caffeine may help immensely, as it can cause spasms in the pelvic floor muscles in some people. Eliminating inflammatory foods or food allergies from the diet can also help significantly.
Exercise the pelvic floor. Many disciplines reach the deep muscles of the pelvis, such as yoga and pilates. Simply doing specific exercises for the pelvis can significantly improve function. Kegel exercises, named after the American gynecologist Dr. Arnold Kegel, specifically tighten and release pelvic floor muscles, helping gain control over urinary and bowel incontinence. If videos and written information leave you with questions, engage a physical therapist specializing in pelvic floor rehabilitation. (Please note, in some states, a referral from a doctor is required to visit a physical therapist.)
Get screened by an experienced doctor. Sharing your pelvic floor symptoms with a knowledgeable doctor can limit the energy, time, and cost needed to resolve the condition. TCIM can screen for PFD during an Executive Physical upon request, with the least amount of invasiveness possible.
Quickly address a chronic cough or stubborn constipation. Coughing and straining to pass stool both put stress on the pelvic floor. Taking steps to resolve these issues quickly can increase your chances of avoiding PFD.
How is PFD Treated?
Depending on how the PFD is expressed, specific treatments may be more effective than others or more focused on resolving a particular symptom. A doctor with extensive experience and skill can determine the best combination of customized therapies for the patient. Notice that many of the prevention items above can be used as therapy. Common treatments may also include the following:
1. Medications - If appropriate, a prescription medication may be suggested. For example, some medications calm an overactive bladder or soften stool for easy passing (3).
2. Biofeedback - Many physical therapists have devices that provide a sound or visual clue that reflects the use of a particular muscle or group of muscles. This feedback enables the patient to hone in on effective exercises.
3. Physical therapy focused on the pelvic floor - Numerous exercises can help strengthen pelvic floor muscles, often referred to as "pelvic floor muscle training" or PFMT (6). While many doctors can give superb instruction, some physical therapists specialize in pelvic floor rehabilitation. Many of these experts guide the patient with biofeedback while performing specific exercises.
4. Behavioral modification - Changing behavior can address PFD (1). Some behavioral changes might be scheduling visits to the bathroom, training the bladder (to affect flow, frequency, or urgency), incorporating relaxation techniques, or even changing the diet.
5. Acupuncture, chiropractic care, and massage - These three therapies address PFD in different ways but achieve similar results: increased circulation to the pelvic floor muscles, reduced pain, and relaxation of muscle tension. These therapies can be done safely in conjunction with other treatments, including medication.
6. Pulsed Electromagnetic Field (PEMF) sessions - PEMF devices deliver small bursts of low-level electromagnetic energy through the skin, reaching underlying muscles, tendons, bones, intervertebral discs, and organs. This non-invasive therapy is known to give quick pain relief, reduce inflammation, and speed the healing of tissues.
7. Internal and external devices - The newer devices on the market attach to the outside of the body and stimulate the pelvic floor muscles to contract using low-level doses of electrical current. These devices are similar to the torso devices that work stomach muscles for a flatter stomach, but are designed to fit in the pubic region so they can reach the pelvic floor muscles. Some devices electrically stimulate the pelvic floor muscles from within the body, causing them to contract and release. Lastly, there are also low-cost mechanical devices that are used internally and rely on the conscious squeezing of muscles for the workout. A doctor, healthcare practitioner, or pelvic floor expert can suggest something appropriate.
Complementary Healing & Executive Physicals
If you've already been diagnosed with PFD by a urologist, gynecologist, or other healthcare practitioner, TCIM provides many complementary healing modalities that can be used in conjunction with other therapies. Doubling up on healing therapies can shorten recovery time and help restore function quickly.
However, if you are experiencing PFD symptoms and have yet to investigate the matter, consider setting an appointment for an Executive Physical with TCIM. Our experienced physicians can confirm PFD even in the early stages, allowing early intervention and a faster (and more complete) resolution. There is no need to live with PFD's painful or embarrassing symptoms. A few brief moments of a difficult conversation with an understanding doctor can result in a complete turnaround in your body, restoring normal pelvic function and comfort to your life.
Jonathan Vellinga, MD is an Internal Medicine practitioner with a broad interest in medicine. He graduated Summa cum laude from Weber State University in Clinical Laboratory Sciences and completed his medical degree from the Medical College of Wisconsin.
Upon graduation from medical school, he completed his Internal Medicine residency at the University of Michigan. Dr. Vellinga is board-certified with the American Board of Internal Medicine and a member of the Institute for Functional Medicine.
info@tcimedicine.com
951-383-4333
Sources:
1. Treating patients with pelvic floor dysfunction - Mayo Clinic [Internet]. 2020. Available from: https://www.mayoclinic.org/medical-professionals/physical-medicine-rehabilitation/news/treating-patients-with-pelvic-floor-dysfunction/mac-20431390
2. Weiss C. Pelvic floor disorder awareness. Mayo Clinic News Network [Internet]. 2022 Jun 30; Available from: https://newsnetwork.mayoclinic.org/discussion/pelvic-floor-disorder-awareness/
3. Professional CCM. Pelvic floor dysfunction [Internet]. Cleveland Clinic. Available from: https://my.clevelandclinic.org/health/diseases/14459-pelvic-floor-dysfunction
4. Jenkins S. Sex And Your Pelvic Floor. National Association for Continence [Internet]. 2023 Jan 31; Available from: https://nafc.org/bhealth-blog/sex-and-your-pelvic-floor/
5. PharmD JC. What to know about pelvic floor dysfunction [Internet]. 2023. Available from: https://www.medicalnewstoday.com/articles/327511
6. Fernandes ACNL, Palacios‐Ceña D, Pena CC, Duarte TB, De La Ossa AMP, Ferreira CHJ. Conservative non-pharmacological interventions in women with pelvic floor dysfunction: a systematic review of qualitative studies. BMC Women’s Health [Internet]. BioMed Central; 2022 Dec 12;22(1). Available from: https://doi.org/10.1186/s12905-022-02097-y