Pelvic floor disorder (PFD) affects roughly a quarter of all U.S. women, yet the overwhelming silence that accompanies living with it is deafening.
PFD is any condition that affects your ability to contract or relax your pelvic floor muscles, which can contribute to urinary incontinence, constipation, pain during intercourse, sexual dysfunction and even lower-back pain. Yes, it can be embarrassing, and some women feel the need to avoid certain impact exercises such as jumping rope, standing for long periods or even lifting a child.
Pelvic floor issues can present at any point in your life, but Alicia Jeffrey-Thomas, DPT, PT, PRPC, pelvic floor physical therapy manager at Greater Boston Urology in Dedham, Massachusetts, outlines a few common causes:
Pregnancy and childbirth. Unsurprisingly, the weight of a growing baby places extra pressure on your pelvic floor and organs. Childbirth and labor (even in the case of a cesarean section) can injure the muscles and nerves of the pelvic floor.
Menopause. Hormonal changes associated with menopause can cause atrophy (aka, shrinkage or weakening) of the vulva and vagina, as well as in the ligaments and muscles that support your pelvic organs.
Heavy lifting or high-impact athletics. There are several PFDs that can come as a result of these activities. One is length vs. tension: If your muscles are constantly clenched, they aren’t able to respond dynamically, resulting in a limited range of motion. “The pelvic floor needs to be able to absorb the force of the activity,” Jeffrey-Thomas explains. “It’s kind of like dropping an egg on a trampoline: The surface cushions the fall so the egg doesn’t break.” On the flip side, she says, if your pelvic floor muscles are clenched, it’s like dropping an egg on the ground: There is no cushioning response from the surface and the egg will crack.
Another issue is timing, e.g., coordinating when the pelvic floor needs to contract during activity. For instance, in the cognitive stage of motor learning, you may begin by training the pelvic floor to respond to impact by actively contracting your pelvic floor during an activity. Gradually, this may become more of a habit because the pelvic floor muscles have voluntary and involuntary components.
Trauma/Injury. From a fall on your tailbone to sexual assault to birthing a child — any kind of trauma or injury may cause hypertonic pelvic floor dysfunction — a constant spasm in which the muscles do not relax appropriately. In some cases, this may last for years.
It’s important to note, however, that it is not normal to experience pain with sex, when having a pelvic exam or by using tampons. “There are a lot of things that can potentially be causing this, but if your doctor can’t find anything wrong, it could be PFD,” Jeffrey-Thomas says. “If the muscles of the pelvic floor don’t relax appropriately, that tension can cause pain when provoked.”
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