Pelvic floor basics part two— pelvic floor dysfunction

Pelvic pain

When we talk about problems with pelvic floor muscles, usually the first thing people think of is older women with incontinence. And while this is a super common problem (up to 75 percent of women older than 65 report urine leakage, according to the Mayo Clinic), pelvic floor dysfunction isn’t limited to leaking, and it doesn’t only affect older women.

Nope, pelvic floor dysfunction does not discriminate. It is surprisingly common and can happen to anyone, at any age.

You might be surprised to learn that many young female athletes (who we all assume are in prime physical condition!) also have problems with the muscles in their pelvic region.

But just because pelvic floor dysfunction is common doesn’t mean it’s normal, or acceptable. And it isn’t something you simply have to put up with. With the right help and support the symptoms of weak pelvic floor muscles can be treated, managed, or completely fixed.

Starting with a solid understanding of how your pelvic floor works (or doesn’t work) will help give you confidence to advocate for yourself and get the help you need. Are you here for it? Read on!

What is Pelvic Floor Dysfunction?

Pelvic floor dysfunction is an umbrella term used to describe a range of disorders caused by a pelvic floor that isn’t functioning properly. Simple, right?

Because your pelvic floor has a huge role to play in your day-to-day, such problems can have a major impact on your quality of life. Loss of control over bowel and bladder, pain in the pelvic region, and pain during sex are all pretty typical symptoms of pelvic floor disorders. And it goes without saying that pain, incontinence and a less than stellar sex life doesn’t make for a fabulous you.


We should also mention that because the pelvic floor supports, connects and impacts so many structures, if it isn’t working optimally, it can refer pain to body parts, organs and tissues all the way from your ribs to your knees. So, what you think may be posterior thigh pain or abdominal pain may well be due to your pelvic floor. This is why people with pelvic floor dysfunction can get so many failed diagnoses. Pain felt in one area might actually be due to pelvic floor dysfunction. It can be quite a puzzle!

Pelvic floor dysfunction can happen alongside a wide range of conditions including urinary incontinence, anal and fecal incontinence, pelvic organ prolapse, pelvic pain syndromes, sexual dysfunction, and defecation problems. It can get a little complicated, but simply speaking, most pelvic floor dysfunction usually comes down to one of two things, too loose/weak (hypotonic) or too tight (hypertonic) pelvic floor muscles.

Hypotonic weakness

Hypotonic pelvic floor muscles lead to hypotonic pelvic floor dysfunction. When your pelvic floor muscles (remember the trampoline?) become thin, weak or overstretched, your pelvic organs (bladder, bowel and uterus) aren’t fully supported.

This usually results in a loss of control over bladder and bowel movements. At its most severe, a loose or weak pelvic floor can lead to pelvic organ prolapse. This is where one or more of your pelvic organs (bladder, bowel and uterus) sag down into your vagina.

Symptoms of a weak pelvic floor

It’s not just leakage! Symptoms of a weak pelvic floor can include:

  • Reduced vaginal sensation.
  • Tampons that dislodge easily or fall out.
  • Feeling like you need to urinate more urgently than normal or urinating more often (aka, urge incontinence).
  • Leaking small amounts of urine during high impact or pressure activities like coughing, sneezing, laughing and exercising (aka, stress incontinence).
  • Feeling like you need to defecate more urgently than normal, not quite making it to the toilet or accidentally passing wind (aka, fecal incontinence).
  • Bulging, aching, heaviness, dragging, pulling, discomfort or dropping in your pelvic region or vagina that can feel worse towards the end of the day.
  • Pelvic instability that can present as a loose or stiff feeling in your pelvis. Or you might have clicking, grinding or crunching sensations.
  • Persistent lower back or hip pain.

Hypertonic tightness

Although it’s less common, sometimes pelvic floor dysfunction happens because the pelvic floor muscles are too tight (hypertonic pelvic floor dysfunction). When your pelvic floor muscles are tight, less blood flows through them providing less oxygen to cells and resulting in a buildup of lactic acid, which is as painful as it sounds.

Hypertonic muscle dysfunction isn’t widely known, but it’s super super important to understand. 

Many women believe that going crazy with kegel exercises is the answer to their pelvic floor problems, but if the symptoms are due to a too tight pelvic floor, the wrong exercises can complicate things and potentially make the situation much worse.

Hypertonic dysfunction can sometimes also be referred to as Levator ani syndrome (vaginismus or pelvic floor myalgia), which is a condition involving a muscle spasm in the pelvic muscles. It can make it painful, difficult, or impossible to have sexual intercourse, to undergo a gynecological exam, and to insert a tampon. Hypertonic dysfunction can also cause dyspareunia, which is persistent or recurrent genital pain that occurs just before, during or after intercourse. Vulvodynia (vestibulodynia, vulvar vestibulitis syndrome and localized provoked vulvodynia) is a condition where there is pain, burning and discomfort in the vulva that cannot be linked to a specific cause.

Symptoms of a tight pelvic floor

  • Pain during tampon insertion or sex.
  • Pelvic pain that can present as stabbing, aching or throbbing sensations either when you move or all the time.
  • Sensations of burning or rawness in the pelvic area.
  • Persistent lower back, abdominal or hip pain.
  • Finding it difficult to empty your bladder or bowel.
  • Feeling the need to urinate more urgently or frequently than normal.
  • Constipation, hemorrhoids and rectal fissures (tears in the anal area).

Weak and tight pelvic floor

And just in case your mind wasn’t already swimming trying to determine what might be affecting your pelvic floor, sometimes a person’s pelvic floor can be both too weak and tight at the same time.

When you get an assessment of your pelvic floor muscles, they will be evaluated for strength either by finger test or using an EMG (or electromyograph). Too tight muscles will often register as “weak” or having no strength because it’s unable to generate force due to the fact that it is already at its tightest and shortest position. We told you it could get complicated!

A pelvic floor that is assessed as weak is generally treated with strengthening exercises, but if it’s already tight those exercises can make the problem worse, not better. That’s why developing an understanding of your body and feeling confident to advocate for yourself if a treatment isn’t working for you is so important.

What causes pelvic floor dysfunction?

For most people, their pelvic floor dysfunction isn’t caused by one-time events like pregnancy or an accident but by lifetime habits and circumstances, basic stuff we’re all exposed to like:

  • stress
  • sitting for long periods of time
  • straining on the toilet
  • poor posture
  • the wrong technique when doing heavy lifting
  • constantly sucking in our tummies
  • poor diet
  • poor breathing technique
  • aging

All that being said, there are certain risk factors for developing both a weak or a tight pelvic floor.

Causes of a weak pelvic floor

Being a woman is one of the biggest risk factors for pelvic muscle weakness, particularly if you’ve given birth to another human. The stretching and changes that happen to your body during pregnancy, and the weight of the baby bearing down on your pelvis for nine long months, can impact your pelvic floor. Giving birth vaginally adds another layer of risk for pelvic floor weakness, especially if a trauma like perineal tearing has occurred.

But it’s not just women who have had babies that are at risk. Menopausal and perimenopausal women, men who have undergone prostate cancer treatment, and anyone with a long history of high impact exercise also report higher incidences of pelvic floor weakness.

Causes of a tight pelvic floor

There are so many things that can increase the risk of developing a too tight pelvic floor (on top of the things we’ve already mentioned!) including, but definitely not limited to:

  • infections
  • previous surgeries (and not just pelvic surgery but hip, abdominal, c-section, back or knee surgery too)
  • childbirth
  • falls, trips or other accidents (even if they seem small at the time)
  • nerve injuries
  • yeast infections (and other types of infections too)
  • genetics
  • muscle spasms
  • allergies or irritation to chemicals or other substances
  • hormonal changes
  • history of sexual abuse
  • frequent antibiotic use
  • hypermobility
  • cancer treatment
  • bladder or bowel dysfunction.

Pelvic floor muscles can sometimes also tighten in response to chronic pain conditions for example:

  • endometriosis
  • pudendal neuralgia
  • interstitial cystitis (painful bladder syndrome), and
  • pelvic congestion syndrome.

What should I do if I think something is wrong?

If you’re a woman, we recommend a guide to Restoring the Pelvic Floor for Women, from one of our favorite physical therapists, who specializes in pelvic health, Dr. Amanda Olson. 

Don’t let anyone tell you you have to put up with pain and symptoms of pelvic floor dysfunction! We’ve said it before and we’ll say it again (and again, and again) pelvic floor dysfunction is common but it is not normal. Treating pelvic floor dysfunction is possible through pelvic floor physical therapy. Don’t have a medical support system yet? Find a pelvic health specialist in your area!


Pelvic floor basics part one— the pelvic floor what it is, what it does and why you should care

Pelvic floor basics part three— how to treat and prevent pelvic floor problems

Pelvic floor basics part four— breathing, you’re doing it wrong