Pelvic Floor Dysfunction, Conditions, Causes and Treatments


Pelvic Floor Dysfunction (PFD)

Pelvic floor dysfunction (PFD) is a condition that refers to a number of pelvic floor disorders that affect the pelvic floor muscles and the surrounding area. Dysfunction occurs when you are unable to appropriately relax, contract, or coordinate the pelvic floor muscles. This could look like frequent bathroom trips, leaking, being unable or having difficulty with urination or bowel movements, pain with sex, infertility, low back pain, pelvic pain, and abdominal pain.


What is the Pelvic Floor?

The pelvic floor indicates the collection of muscles, ligaments, and connective tissue that sit in the base of the pelvis between the hip bones and assist with urination, defecation, sexual and reproductive activity, and support the reproductive organs, bladder, and rectum. The pelvic floor acts like a sling or hammock preventing organs from falling down and assisting organs to function properly.

Both men and women have a pelvic floor, but there are some differences in how they function and the disorders that can occur. For this article and as it relates to vaginal dilators, ‘pelvic floor’ will refer to the female anatomy.

Image courtesy of Cleveland Clinic

What Causes Pelvic Floor Dysfunction (PFD)?

Pelvic floor dysfunction is commonly caused by the inability of the pelvic floor muscles to relax and contract at the range of motion and strength required to do their daily jobs. Under active (hypotonic) or over active (hypertonic) pelvic floor muscles may be caused by anxiety, trauma, pregnancy, scar tissue, genetics, and lifestyle factors, but research is ongoing. Heavy lifting, smoking, stress, constipation, coughing, surgery, nerve damage, diet, weight, and access to medical care can all play a role in pelvic floor dysfunction.

Under Activity (Hypotonic Pelvic Floor) and Weakened Pelvic Floor Muscles

Under activity is related to weakened pelvic floor muscles and can also be due to torn muscles. Incontinence (leaking) of urine or feces, decreased sexual response, and prolapse are all disorders typically associated with a weakened pelvic floor. A prolapse occurs when the uterus, rectum, bladder, or intestines begin to fall downward and press into the vaginal walls creating pressure or bulging.

Over Activity (Hypertonic Pelvic Floor)

Over activity of the pelvic floor can lead to increased tension, and the inability to fully relax the pelvic floor. Common disorders caused by a hypertonic pelvic floor include pain syndrome such as vulvodynia, vestibulodynia, vaginismus, endometriosis, pelvic/hip/low back pain, urinary urge and frequency, urinary retention, interstitial cystitis (IC), constipation, pain with sex (dyspareunia), and difficulty with sexual function.

Is Pelvic Floor Dysfunction Treatable?

Yes! All pelvic floor disorders are different and each person is unique so the treatment should be tailored to you. Pelvic floor dysfunction can often be treated with lifestyle/behavior modification and pelvic floor physical therapy. Other providers that are also possible members of a pelvic floor care team are gynecologist, gastroenterologists, occupational therapists, etc.

Under active and over active pelvic floor disorders can be treated with pelvic physical therapy in both women and men. When choosing a physical therapist (PT) always seek out a PT with specific training and qualification in pelvic floor therapy.

Photo courtesy of Australasian Birth Trauma Association

Possible treatment options may include lifestyle education, relaxation training, strength training, biofeedback, manual therapy, yoga, coordination or body awareness and postural training, and the instruction in use of vaginal dilators, myofascial and muscle release tools and balls, pelvic wands, vaginal weights, and more.

Vaginal dilators, such as the VWELL Dilators, are most commonly used to treat over active pelvic floor conditions such as pelvic pain, scar tissue tension, difficulty with penetration, and vaginal atrophy. Dilators can improve tolerance to touch, stretch, and penetration by relaxing muscles and calming the nervous system.


Post written by Dr. Cassandra Sharp PT, DPT


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