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What is pelvic floor dysfunction in women?

If you leak urine during daily activities or experience pain during sex, exercise or period, you may have pelvic floor dysfunction. Pelvic floor dysfunction can be an array of disorders in the muscles that make up the bottom of the pelvis. These muscles form a “hammock” that supports your bladder, urethra, vagina and rectum.

“When these muscles spasm, it can cause significant amounts of pain and discomfort during daily activities, sex, exercise and menses,” says Stephanie Tarracciano, D.O., a Piedmont obstetrician and gynecologist. “When these muscles are injured or weakened, it can result in discomfort, urinary incontinence, fecal incontinence, lack of sexual sensation and satisfaction, and prolapse.”

What causes pelvic floor dysfunction?

One of the biggest causes of pelvic floor dysfunction in women is pregnancy and childbirth.

“A vaginal delivery can be very traumatic for the pelvic floor, but women who undergo cesarean sections can also have pelvic floor dysfunction from the stress of carrying a pregnancy,” says Dr. Tarracciano.

Other common causes are:

  • Trauma, such as a fall, an assault or attempting to have intercourse when not properly lubricated

  • Obesity

  • Chronic constipation

  • Chronic lung disease that causes you to cough frequently  

“These conditions can cause weakening or dysfunction of the pelvic floor,” she says.

Pelvic floor dysfunction symptoms

The most common symptoms of pelvic floor dysfunction are:

While pelvic floor dysfunction is rarely dangerous for your health, says Dr. Tarracciano, it can significantly impact your quality of life, which is an important component of health.

“If sex is too painful for you to enjoy, but you have a happy, intimate and fulfilling relationship without sex and it works for you, great,” she says. “There are plenty of ways to be connected to your partner that don’t involve sex. But if it’s a big deal in your relationship or you just miss being able to enjoy it, then take the steps to fix it.”

She adds, “If you’ve accepted that, after kids, you’re going to leak a bit of urine here and there, and trampolines are just not in your list of approved activities, that’s fine. But if you’re leaking every day, are really bothered by it and find yourself avoiding activities with your friends or family because you’re afraid you’re going to need the bathroom or wet your pants? That’s really limiting. There’s help out there, you just need to decide whether or not you want to look for it.”

Some women tolerate pelvic floor dysfunction well and notice a minimal impact on their quality of life.

“They won’t notice it until I specifically ask, ‘Are you able to enjoy sex? Have you been able to use tampons? Do you notice yourself leaking urine?’” says Dr. Tarracciano.

Pelvic floor dysfunction treatment

“Some women just need time, especially to heal after a delivery,” she says. “Doing exercises at home—such as Kegels, pelvic tilts and Pilates—can help strengthen things. Sometimes, women need to engage in self-stimulation and masturbation to help the muscles to relax. Some women need to use dilators to help reduce the spasm. Sometimes, we need medications such as muscle relaxers or vaginal estrogen to help.”

Dr. Tarracciano says many women can benefit from pelvic floor physical therapy (PT), where a trained specialist helps retrain the muscles of the pelvic floor to either relax or engage appropriately.

“I think physical therapy should be ordered for almost every woman after pregnancy—and in some places in Europe, it is,” she says. “Most women come back from pelvic floor PT feeling much better.”

Some women need surgery to help re-support the pelvic floor or reduce issues with incontinence and prolapse (when an organ in the pelvis bulges into the vagina).

“Every case is different,” says Dr. Tarracciano. “But I would say the vast majority of women have some options available that would significantly improve their symptoms.”

You don’t have to live with pelvic floor dysfunction

If talking to your doctor about pelvic floor dysfunction feels uncomfortable, Dr. Tarracciano offers some encouragement.

“This is my job,” she says. “There’s very little you can tell your gynecologist that they haven’t heard before—and if you manage to find something new, congratulations! You’ve just made our day more interesting.”

The bottom line: You don’t have to live with symptoms of pelvic floor dysfunction. If it affects your quality of life, talk to your gynecologist or primary care provider about treatment options. Need to make an appointment with a Piedmont physician? Save time, book online.

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