KEY TAKEAWAYS:
• Pelvic floor health is essential for women across all life stages, not just postpartum.
• Symptoms like incontinence and pelvic pain are common signs of pelvic floor dysfunction and should not be ignored.
• Modern pelvic floor physical therapy offers effective, personalized treatments in a private setting.
SUMMARY:
Pelvic floor dysfunction affects many women, often silently impacting their quality of life. This article explores the signs, treatment options and the importance of seeking help for pelvic floor health issues. Learn about the myths surrounding Kegel exercises, the role of pelvic floor physical therapy and how to navigate your care journey with confidence.
Many women live with pelvic floor symptoms for years without expressing their challenges. Leaking and bowel discomfort become a normal part of everyday life. At times, it may even affect how often women do activities like running or intimacy. Staying silent and dealing with these symptoms alone is common, but it should not be the standard.
“Lots of these things affect women on a regular basis, and they don’t deal with them because they think they’re normal or just a part of life,” says Nicole Book, MD, a urogynecologist with OhioHealth and the chair of the Department of Women’s Health.
Pelvic floor health is not only a pregnancy or postpartum issue. It matters across life stages, from early adulthood through midlife and menopause. When your pelvic floor muscles and tissues are not working well, symptoms can show up in everyday ways that are easy to dismiss, but important to address.
What conditions can weak pelvic floor muscles lead to?
“The pelvic floor is a group of muscles and connective tissue at the base of the pelvis that holds everything inside,” explains Dr. Book. “It supports three major systems in our body: the urinary health system, the reproductive system and the digestive system.”
Pelvic floor dysfunction is a broad term people often use to describe problems involving the muscles and support structures at the bottom of the pelvis. However, there are many pelvic floor disorders and conditions related to the pelvic floor muscles being weak or too tight — pelvic floor dysfunction is just one of them. These issues can affect bladder control, bowel function, pelvic support, sexual function and comfort.
Pelvic floor concerns typically fit into three main categories:
- Trouble holding urine or passing urine
- Pelvic organ shifting or prolapse, often felt as heaviness or bulging
- Trouble holding stool or passing stool
Beyond postpartum, who experiences pelvic floor problems?
Pelvic floor disorders are often linked with pregnancy and childbirth, but that is only part of the story. Women across all life stages can have pelvic floor-related issues. Younger women can experience stress incontinence during running, jumping or lifting. Women in their reproductive years may notice leakage after having a baby, or pelvic pain that affects exercise or sex. Women in perimenopause and menopause may develop prolapse symptoms or worsening bowel and bladder control as hormones change.
“Across your entire life, pelvic floor health goes with other reproductive changes,” explains Dr. Book. “When you get your first menstrual period, there will be changes to the musculature and coordination. If we have babies, there is a big change. And then, the strength of the pelvic floor decreases tremendously with menopause.”
Surgery can also play a role. Procedures involving the back, abdomen, pelvis or nearby structures may affect how the pelvic floor works.
Symptoms you should take seriously
If symptoms are changing how you live, they deserve attention.
Watch for signs such as:
- Leaking urine when you cough, run, jump, laugh or exercise
- A frequent urge to urinate
- Trouble emptying your bladder
- Pelvic pressure, heaviness or a vaginal bulge
- Constipation or trouble controlling stool
- Pain with intimacy
- Ongoing pelvic pain
- Sleep disruption from repeated nighttime bathroom trips
One of the biggest concerns is when women quietly stop doing things they enjoy. “If people find themselves avoiding things that they want to do on a daily basis — like going to dinner, exercise class or church — because of urinary or bowel concerns or prolapse, then they should talk to their primary care provider,” advise Dr. Book.
She warns that you shouldn’t wait until symptoms become severe to bring this up. Start the conversation with your healthcare provider with clear, simple language like: “I am avoiding activities because of bladder or bowel symptoms” or “I leak urine when I exercise.” Dr. Book notes that a referral is often not required to see a pelvic floor physical therapist, especially if talking with a specialist feels more comfortable.
Kegels don’t fix everything
Kegels can help some women, but they are not a cure-all. In fact, doing them incorrectly can limit progress or even make symptoms worse.
“Kegels are great,” Dr. Book said. “The trouble is it’s such an easy word to say, but a very hard thing to do.” She added that most women do not do their Kegels correctly.
Pelvic floor health is not just about squeezing. It also involves muscle coordination, relaxation, breathing mechanics, posture and core strength.
Some women hold too much tension in these muscles and overusing them can lead to spasm, pain and discomfort. That is one reason pelvic floor physical therapy is often more helpful than trying to manage symptoms alone.
What does pelvic floor physical therapy look like?
For many women, this is the part that feels unknown. The reality is often much less intimidating than expected. “Pelvic physical therapy is done in a one-on-one setting with a therapist,” Dr. Book says. “It’s incredibly private.”
Pelvic floor physical therapy typically starts with a conversation about your symptoms and goals. Then, your physical therapist will do a breathing, posture and movement assessment.
Treatment for pelvic floor concerns can include:
- Stretching or strengthening for the hips, abdomen, back and core
- Education on how to relax and coordinate pelvic floor muscles
- Biofeedback tools that help you see when muscles are tightening or releasing
- Guidance on bladder habits, bowel habits and diet
Care is tailored to each person. Some women need support with muscle weakness. Others need help learning how to release tight muscles. Many need both.
Pelvic floor care is not one-size-fits-all
From physical therapy and medications to non-surgical procedures, treatment for pelvic floor conditions are not one-size-fits-all. “We have lots of different tools in our toolbox to help meet people where they are with their journey and with the different goals that they may have,” says Dr. Book.
You do not have to accept leaking, heaviness, pain or embarrassment as the cost of getting older, staying active or having children. Pelvic floor health across all life stages deserves attention, and support is available.
Frequently asked questions
What is pelvic floor dysfunction?
Pelvic floor dysfunction is a broad term people often use to describe problems involving the muscles and support structures at the bottom of the pelvis. However, there are many pelvic floor disorders and conditions related to the pelvic floor muscles being weak or too tight.
Who is affected by pelvic floor dysfunction or muscle weakness?
Women of all ages, including younger athletes, postpartum women and those in menopause, can experience this condition.
Do Kegels fix pelvic floor dysfunction?
Kegel exercises can help but are easy to do incorrectly and often require professional guidance to be effective.
What does pelvic floor physical therapy involve?
It includes personalized exercises, biofeedback and lifestyle assessments in a private setting.
When should you see a doctor for pelvic floor symptoms?
If symptoms disrupt daily life or cause concern, seeking medical advice is recommended.
