Pelvic Floor Dysfunction: The What, The Why, and How to Deal!

Last Updated: December 20, 2022
Liesel Teen, RN-BSN

By Liesel Teen

BSN, RN, Practicing Labor and Delivery Nurse

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Symptoms of pelvic floor dysfunction affect so many women during pregnancy and after birth, yet it feels like so many women are in the dark about this frustrating problem.

Too frequently are things like peeing when you sneeze and painful sex brushed under the rug or made into a joke.

In reality, they may indicate a much larger issue! And what’s more, these aren’t things you have to live with.

Today we’re going to unpack all things pelvic floor to help more mamas recognize the problem and find the help and support they deserve.

Are you ready? Let’s do it.

Follow @mommy.labornurse on Instagram to join our community of over 640k for education, tips, and solidarity on all things pregnancy, birth, and postpartum!

What is your pelvic floor?

If you follow pregnancy and postpartum accounts on social media, you’ve likely heard the term pelvic floor tossed around. But it seems like it often isn’t really explained.

What the heck IS your pelvic floor?

In short, the pelvic floor is a term used to describe the group of muscles, ligaments, and connective tissues that support your pelvic organs. And in women specifically, the pelvic organs include your bladder, vagina, uterus, and rectum.

This group of muscles and ligaments extends from the pubic bone to the tailbone and has a lot of important jobs to do for your body. Not only do they support those organs, but they’re also in charge of your sexual function and controlling the openings to your vagina, anus, and urethra.

Yep, that means the pelvic floor is what holds pee and poop in, lets it out, and allows your vagina to relax and open.

Pelvic floor dysfunction

So now that you know what we’re actually talking about, let’s get into the important part. Pelvic floor dysfunction.

I say important, because if you’re suffering (knowingly, or more often, unknowingly) from dysfunction in your pelvic floor, it doesn’t just have to be this way!

Pelvic floor dysfunction is a term that’s used when your pelvic floor is not behaving as it should!

Typically, we know this is happening because of signs and symptoms. And for us women, we are at increased risk of pelvic floor dysfunction during pregnancy and after birth.

Generally, pelvic floor dysfunction falls into one of two camps, a weakened pelvic floor or pelvic floor muscles that are too tight. But some women actually experience both at the same time!

My past podcast guest, Nikki Bergen from The Belle Method likened this to when you have a knot in one of your shoulders, but not the other.

That being said, let’s look at each more specifically.

Related Listening: MLN Podcast | Let’s Talk About Pelvic Floor Health with Nikki Bergen

What does it mean to have a weak pelvic floor?

A weak pelvic floor, also known as a hypotonic pelvic floor, happens to a lot of women following pregnancy and vaginal birth. This is because so much tension and stress were put on those muscles to carry the weight of your growing baby, and to bring that baby into this world!

For some women, their pelvic floor can heal from all of that perinatal stress, but many others are left with weakened pelvic floors, which translates to a host of unwanted symptoms.

Symptoms so many of us think we just have to live with, but that can actually be reversed! Let’s look at two of the biggest hallmarks.

Postpartum incontinence

Postpartum incontinence, or during pregnancy for that matter, is one of the best-known signs of a weakened pelvic floor. Basically, incontinence means a lack of bladder control.

This can present itself in a few different ways:

  • Leaking pee when you sneeze, cough, laugh, jump, exercise, or have sex
  • Leaking pee on your way to the bathroom/not making it to the bathroom
  • Being unable to hold in your pee for as long as you used to
  • More frequent urination, or urge to pee (but not a UTI)

Postpartum prolapse

Prolapse in the pelvic floor is when one or more of your organs simply isn’t supported and held in place as it should be and kind of falls or droops into the vagina.

Pelvic organ prolapse can happen to your:

  • Bladder
  • Uterus
  • Small bowel
  • Rectum

If this happens, you will have a feeling of heaviness, discomfort, pulling, dragging, or dropping in the vagina. Sometimes you might feel a physical bulge – described as being similar to sitting on a golf ball (source).

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What does it mean to have a tight pelvic floor?

The other type of pelvic floor dysfunction is a pelvic floor that is too tight. This is called a hypertonic pelvic floor and involves a pelvic floor that is very tense and unable to relax (source).

If your pelvic floor is too tight, you may suffer from:

  • Constipation
  • Weak urine stream
  • Urine hesitancy
  • Painful sex
  • Pelvic pain
  • Tension in the surrounding muscles, like the hips and hamstrings

In perinatal women, birth trauma and scar tissue can contribute to a hypertonic pelvic floor. Sometimes your pelvic floor will tighten as a response to pain and scar tissue.

In other cases, women only tear on one side of their pelvic floor. When this happens, the other side often overcompensates leading to overactivity and tightness (source).

Painful sex after birth

I want to expand a little bit on painful sex, especially after birth. When I had Pelvic Floor Therapist, Jeanice Mitchell on The Mommy Labor Nurse Podcast, she explained that sex ideally should not be painful at all.

Painful sex (especially when accompanied by other signs on this list) can indicate pelvic floor dysfunction. Often, it is associated with a tight pelvic floor – but remember an overly tight and weakened pelvic floor can co-exist.

It’s important to note that sometimes painful sex has more to do with vaginal dryness – which may be from pelvic floor dysfunction, but could be a hormonal issue or something else.

Related Listening: MLN Podcast | Pelvic Floor Sexual Health

How to tell if you have pelvic floor dysfunction

When reading this article, some of this might definitely resonate with you. However, the single best way to determine if you have pelvic floor dysfunction is by seeing a pelvic floor physical therapist!

You see, it’s estimated that somewhere between 1 in 3 to 1 in 4 women are affected by pelvic floor problems (source). That same research study goes on to show that pelvic floor disorders worsen (and become more prevalent) as you age, so paying attention to this really matters!

Because postpartum care here in the US rarely routinely encompasses pelvic floor health, it is best for EVERY mama to be seen by a pelvic floor physical therapist at least once. They can determine what you’re dealing with and help you reverse and heal the problems.

Let’s unpack this a little more.

What is pelvic floor therapy?

Pelvic floor therapy is exactly what it sounds like! Physical therapy that targets the muscles in your pelvic floor. It is used to rehab those muscles after injury or in the event of dysfunction.

Pelvic floor therapy is a specialized form of PT and is practiced by licensed physical therapists and physiotherapists with a special certification in pelvic floor therapy.

How to find a pelvic floor physical therapist?

Of course, you can head to trusty Google to find a pelvic floor physical therapist near you, but there are some other suggestions to help you find someone that you can trust:

  • Ask your OB or midwife for a referral: It’s likely that they have an affiliation with someone they know and trust, and by getting the referral your care may be covered by insurance
  • Call your insurance provider (or use the online portal): By doing this, you will first find out if pelvic floor PT is covered and how to get it covered. Secondly, you can easily find (or ask) about providers in your network
  • Ask other moms: Talking about the need for pelvic floor PT may sound taboo, but as the stats showed you above, these struggles are SO common. Try asking your mom friends, in local Facebook groups, or at the next breastfeeding/new mom group you attend

What can I do for my pelvic floor at home? Pelvic floor therapy resources

I am not a perinatal fitness expert or pelvic floor PT, so this is not my area of expertise – but fortunately, there are a lot of wonderful resources out there to help you out!

If going to PT isn’t possible, or you’re wanting to supplement/start working on things right away, here are some wonderful accounts and resources:

Additional sources:

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Liesel Teen, RN-BSN

Liesel Teen

BSN, RN, Practicing Labor and Delivery Nurse

As a labor and delivery nurse, I’ve spent countless hours with women who felt anxious — even fearful — about giving birth. I want you to know it doesn’t have to be that way for you!

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