Understanding Pelvic Floor Dysfunction: Causes, Symptoms, and Solutions
- Katherine Koch, PT, DPT
- Jul 16
- 5 min read
Understanding Pelvic Floor Dysfunction: Causes, Symptoms, and Solutions
Katherine Koch, PT, DPT
As a pelvic floor physical therapist, I’ve had the privilege of working with individuals who, often quietly and courageously, struggle with a deeply personal and frequently misunderstood set of health issues: pelvic floor dysfunction. Though rarely discussed openly, pelvic floor disorders affect millions of people—of all genders—and can profoundly impact quality of life. Whether you’re dealing with urinary incontinence, pelvic pain, or unexplained core instability, understanding the role of the pelvic floor is the first step toward healing.
In this post, I’ll walk you through what pelvic floor dysfunction is, the causes and symptoms, and—most importantly—the solutions that can help you get your life back.
What Is Pelvic Floor Dysfunction?
The pelvic floor is a group of muscles, ligaments, and connective tissues that form a hammock-like structure across the bottom of the pelvis. These muscles support vital organs—including the bladder, bowel, and uterus or prostate—and play an essential role in continence, sexual function, and core stability.
Pelvic floor dysfunction (PFD) occurs when these muscles don't work properly. They might be too tight (hypertonic), too weak (hypotonic), or poorly coordinated. Dysfunction in this area can result in a wide range of symptoms, some of which may not seem obviously connected to the pelvic region.
Common Causes of Pelvic Floor Dysfunction
Pelvic floor dysfunction can stem from a variety of physical, neurological, or psychological causes. Here are some of the most common contributors I see in the clinic:
1. Pregnancy and Childbirth
Pregnancy significantly stresses the pelvic floor, and childbirth—especially vaginal delivery—can stretch or tear these muscles. Forceps or vacuum deliveries, prolonged pushing, and large babies increase the risk of pelvic trauma.
2. Surgery or Trauma
Pelvic surgeries such as hysterectomy or prostatectomy can alter pelvic muscle function. Physical trauma, including car accidents or sexual assault, can also result in PFD.
3. Chronic Straining
Conditions like constipation, chronic coughing, or even improper lifting techniques can overload the pelvic floor over time.
4. High-Impact Exercise
Long-term participation in high-impact sports (like running, gymnastics, or weightlifting) without proper pelvic floor conditioning can contribute to dysfunction.
5. Aging and Hormonal Changes
Menopause leads to a natural decline in estrogen, which affects pelvic tissue elasticity. Aging also brings muscle weakening and changes in coordination.
6. Psychological Stress and Trauma
The pelvic floor is closely tied to our nervous system. Emotional stress, anxiety, or a history of trauma can lead to chronic muscle guarding in the pelvic region, contributing to pain and dysfunction.
Symptoms of Pelvic Floor Dysfunction
Pelvic floor dysfunction can present in surprising ways. Many people live with symptoms for years, believing they are just something to “deal with,” or feeling too embarrassed to seek help. Here are some of the most common signs:
Urinary Issues
Urinary incontinence (leaking when coughing, sneezing, or exercising)
Urgency or frequency
Incomplete bladder emptying
Pain with urination
Bowel Problems
Constipation or straining
Fecal incontinence
Painful bowel movements
Pelvic Pain
Pain during or after intercourse
Pain in the lower abdomen, tailbone, or hips
Unexplained vaginal or rectal pain
Sensation of heaviness or a "falling out" feeling (pelvic organ prolapse)
Core Instability
Difficulty activating the core muscles
Lower back pain without a clear orthopedic cause
Bulging abdomen with exercise or effort (especially postpartum)
If you experience one or more of these symptoms, you are not alone—and you are not without options.
The Role of Pelvic Floor Physical Therapy
Many people are surprised to learn that physical therapy is one of the most effective, non-invasive treatments for pelvic floor dysfunction. As pelvic floor therapists, we are trained to assess not only the muscles of the pelvic floor but also their coordination with the rest of your body.
Here’s what you can expect from pelvic floor PT:
Comprehensive Evaluation
Your first visit includes a detailed history and physical examination. This may involve external and internal assessment of your pelvic floor muscles to evaluate tone, strength, endurance, and coordination. We also look at posture, breathing, abdominal muscle function, and spinal mobility.
Customized Treatment Plan
No two pelvic floors are the same, so your treatment will be tailored to your specific needs. A program might include:
Manual therapy to release muscle tension or trigger points
Biofeedback to improve muscle awareness and control
Targeted exercises for strengthening or relaxing the pelvic floor
Breathwork to improve core and diaphragm coordination
Education on toileting habits, posture, lifting techniques, and ergonomics
Common Misconceptions About Pelvic Floor Dysfunction
Let’s take a moment to address some myths that often prevent people from seeking help:
Myth 1: Kegels are the solution for everyone.
Truth: While Kegels (pelvic floor contractions) can help some people, they’re not a one-size-fits-all fix. For people with tight or overactive pelvic floor muscles, Kegels can make symptoms worse. That’s why an assessment is so important.
Myth 2: These issues only affect women.
Truth: Men experience pelvic floor dysfunction too, including pain, incontinence, and erectile dysfunction. It’s just as important for men to seek care when symptoms arise.
Myth 3: It's just a normal part of aging or postpartum life.
Truth: While pelvic floor issues are common, they are not inevitable or untreatable. With the right support, you can regain control and comfort.
Myth 4: Surgery is the only solution.
Truth: In many cases, conservative care like physical therapy can significantly reduce or eliminate symptoms—without surgery.
Real-Life Success Stories
I’ve worked with patients who came in feeling defeated—avoiding social outings due to incontinence, experiencing pain with every step, or grieving intimacy due to pelvic pain. But with education, support, and consistent therapy, many of them regained their freedom.
One patient, a mother of two, arrived feeling embarrassed about leakage every time she ran. With proper core and pelvic retraining, she was back to running 5Ks within four months—dry, strong, and confident.
Another patient, a man recovering from prostate cancer surgery, struggled with incontinence and pelvic pain. With pelvic floor and core retraining, he not only restored continence but also found significant relief from pain that had interfered with sleep and intimacy.
When to Seek Help
If you’re experiencing symptoms—whether mild or life-altering—don’t wait. Pelvic floor dysfunction rarely resolves on its own and can worsen over time. Here are signs it's time to see a pelvic floor PT:
You've had a baby (recently or years ago) and still feel disconnected from your core.
You leak urine when laughing, jumping, or lifting.
You feel pressure, heaviness, or bulging in your pelvis.
You have pain with sex, tampon use, or sitting.
You're experiencing chronic constipation or bowel incontinence.
You feel like no one has really listened to what you’re going through.
Pelvic floor issues are real, valid, and treatable.
Final Thoughts
Understanding pelvic floor dysfunction is the first step toward healing. These muscles matter—far more than we give them credit for. They affect how we move, how we connect with others, and how we feel in our own bodies. Pelvic floor physical therapy offers a safe, effective, and empowering path toward recovery.
If any part of this resonates with you, I encourage you to reach out. Whether it’s booking an appointment, asking your doctor for a referral, or simply learning more—taking that first step is an act of self-care.
You deserve to feel strong, supported, and symptom-free.
If you have questions about pelvic floor therapy or want to learn more, feel free to reach out to our clinic or book a consultation. Your pelvic health is our priority.
