Do you leak urine when you sneeze or cough? Have you noticed heaviness, pressure, or discomfort in your pelvic area, especially after standing? Do you have occasional loss of bowel control or difficulty controlling intestinal gas?
At least a third of women will experience these or other symptoms of pelvic floor dysfunction during their lifetimes. Yet, many are reluctant to discuss these embarrassing problems, even with their doctors.
This is unfortunate because there are effective therapies for both the prevention and treatment of pelvic floor dysfunction. Untreated, however, they tend to get worse over time.
What Exactly Is the Pelvic Floor?
The pelvic floor is something we all have and rely on countless times throughout our day. It does the grunt work by supporting us when we cough, sneeze, laugh, pick up our child or heave the grocery bags onto the counter. But we also typically take our pelvic floor for granted, until it —falters—then we notice!
The pelvic floor consists of the muscles, ligaments, and other connective tissues that support the pelvic organs. Like a hammock spanning from the pubic bone to the tailbone and both sides of the pelvic bone, the pelvic floor not only holds these essential organs in place but also plays an important role in bladder and bowel control and sexual function.
The muscles of the pelvic floor:
- Support the bladder, urethra, bowel, rectum, anus, uterus, vagina (in women), and prostate (in men).
- Regulate continence by tightening and relaxing so you can control urination, bowel movements, and gas.
- Relax and contract during intercourse and orgasm in both men and women, enhancing sexual function and enjoyment.
- Work in coordination with other core muscles to support and stabilize the torso.
When your pelvic floor becomes compromised and doesn’t function in a healthy, coordinated way you may experience some distressing symptoms. This can be a result of your pelvic floor becoming too weak or too tight.
What Causes a Weak Pelvic Floor?
Weakness in the pelvic floor can be a result of:
- Injury or childbirth. Pregnancy and vaginal delivery obviously stretch and, in some cases, damage the pelvic floor. Studies suggest that the likelihood of developing pelvic floor dysfunction increases with each birth.
- Age. All our muscles get weaker with age, and the pelvic floor muscles are no exception.
- Menopause. Estrogen not only supports vaginal and urinary health but also stimulates the formation of collagen in the connective tissues of the pelvic floor. The dramatic drop in estrogen during the menopausal transition is believed to be a factor in pelvic floor dysfunction.
- Surgery. Hysterectomy, other abdominal surgeries, and radiation treatments to the pelvic area can damage muscles and nerves and contribute to pelvic floor problems.
- Obesity. Excess weight increases the risk of pelvic floor dysfunction by putting an extra load on the bladder, bowel, reproductive organs, and the muscles that support them.
- Stress/strain on the pelvic floor. Repeated heavy lifting, chronic coughing, constipation, and straining during bowel movements place undue pressure on the pelvic floor muscles.
- Diabetes and other conditions that can impair nerve function.
- Other disorders that affect the quality of your ligaments and connective tissues such as Ehlers-Danlos Syndrome.
What Causes Pelvic Floor Muscles to Be Too Tight?
Pelvic muscles can become tight as a result of:
- Sexual trauma or other types of trauma or accidents
- Surgery from C-section, perineum tear or episiotomy during childbirth or from a hysterectomy, bowel surgery, endometriosis surgery, Bartholin’s abscess removal can all create scar tissue and adhesions
- Vaginal childbirth
- Other gynecological conditions
Most Common Types of Pelvic Floor Dysfunction
Pelvic floor dysfunction most commonly develops when the muscles and connective tissues of the pelvic floor are injured or weakened. These conditions present in three main and often overlapping ways:
- Urinary tract. Stress incontinence, the most common type of urinary incontinence, occurs when you sneeze, cough, laugh, run, jump, or otherwise put pressure on the bladder. If the pelvic floor muscles that support the bladder and control the release of urine are weakened, urine may leak out.
- Bowel. Loss of bowel control is usually due to weakened anal sphincter muscles, which permit the accidental leakage of gas or stool.
- Pelvic organ prolapse. In some cases, the supporting structures weaken to the point that organs drop out of place and descend downward into and even out of the vagina. Pelvic organ prolapse may involve the bladder (cystocele), rectum (rectocele), uterus (uterine prolapse), or the top of the vagina (vaginal vault prolapse).
Most pelvic floor dysfunction is associated with weakened or damaged pelvic floor muscles. However, if your pelvic floor is too tight, you may also notice:
- Constipation. Struggling to relax and pass stool.
- Pelvic pain as well as painful intercourse.
- Back, leg or hip pain. Your pelvic floor muscles, or scar tissue and adhesions, can entrap the nerves passing through your pelvic floor, activating them and causing pain.
- Difficulty passing urine as well as urinary urgency or frequency.
How to Test Your Pelvic Floor Muscles
You can bring awareness to your pelvic floor muscles by squeezing the 3 openings in your pelvic floor where your vagina, urethra and anus pass through.
Test your urethra. Visualize yourself peeing and contract your muscles like you would if you wanted to stop your pee midstream. Great! You just engaged the anterior part of your pelvic floor muscles.
Test your anus. Squeeze your bum as you would if you were trying to hold in gas. Great! You just engaged the posterior part of your pelvic floor muscles.
Test your vaginal opening. Insert a clean finger or two inside your vaginal opening and try to squeeze your finger. You want to feel an even clench around all sides of your fingers and you want to gauge the strength of that squeeze. The lighter the squeeze, the weaker your pelvic floor muscles are.
This is something that your gynecologist should have you do as part of your physical exam during your PAP test so ask for feedback from your provider as well. You can also ask for feedback from your partner by trying to squeeze or hold your partner’s penis in place during sex (like tug-o-war!). If you are squeezing and they don’t feel the squeeze or can easily slip out, your pelvic floor muscles could use some TLC.
How to Improve Pelvic Floor Weakness with Exercise
First of all, visit your gynecologist and/or a physical therapist who specializes in pelvic floor care. It is incredibly important to make sure you are appropriately diagnosed and supported. If you have been assessed and have confirmed pelvic floor weakness or dysfunction/lack of coordination, the following suggestions can be helpful.
Your pelvic floor muscles are part of your core, so core muscle exercises help strengthen them. Planks, bridges, and leg raises are just a few of the exercises you can do at home to strengthen these muscles. Be cautious, though, because some core exercises, like crunches, can exacerbate a weakened pelvic floor by increasing abdominal pressure that strains the pelvic floor. Before doing any strengthening exercises, it’s ideal to get some biofeedback from your provider, to make sure you are engaging your pelvic floor muscles correctly before you try to strengthen them.
To specifically target your pelvic floor muscles, you also need to do Kegels—with or without vaginal weights (yoni eggs or kegel balls). You’re probably familiar with the basics, which involve squeezing and relaxing the pelvic floor muscles. But it takes some practice to get the hang of them, so don’t be shy about asking for your doctor’s help to make sure you’re doing them correctly. Several websites also provide detailed Kegel exercise instructions.
Kegels are best known for preventing and improving urinary symptoms in women, but they are also helpful for men and for other pelvic floor disorders, including bowel control problems.
From experience, the key to improving your pelvic floor health is to stick with it, be consistent and prioritize proper form over anything else. Like any new exercise program, it is going to feel like work to commit the time and move through any discomfort. They may seem like little muscles and little movements but even the little repetitive movements (like Kegels) that engage your pelvic floor and core can easily feel exhausting and take dedication and perseverance to stick with. Only continue with the exercises in a way that you can maintain proper form. Also, prioritize the relaxation phase, not just contraction.
How to Treat Pelvic Floor Dysfunction Naturally
Exercise isn’t the only natural therapy for the prevention and treatment of the urinary and fecal incontinence that can accompany pelvic floor dysfunction.
Eliminating triggers such as alcoholic, caffeinated, and carbonated beverages is recommended for anyone dealing with urinary leakage or urgency. If nocturia (frequent urination at night) is an issue, reducing fluid intake late in the day often helps. Diet changes that may improve bowel incontinence include avoiding alcohol, caffeine, dairy products, drinks containing fructose, and greasy and spicy foods.
Getting a handle on constipation should also be a priority. Straining during bowel movements stresses and weakens the muscles and increases the risk of all pelvic floor disorders. A whole-foods diet with lots of fiber-rich plant foods and plenty of fluids are top treatments for constipation.
Weight loss can also make a difference. A clinical trial published in The New England Journal of Medicine found that the frequency of urinary incontinence in overweight and obese women who lost more than 5% of their body weight was reduced by at least 50%! Find a weight loss program that works for you and stick with it.
Supplements for Symptoms of Pelvic Floor Dysfunction
Several natural ingredients have proven benefits for urinary and bowel symptoms.
- Urinary incontinence. Low levels of vitamin D are associated with an increased risk of urinary incontinence. Because so many people are deficient in this essential vitamin, supplementation is recommended. I also suggest trying Urox, a proprietary blend of three herbs that supports collagen and connective tissue formation and improves bladder tone and function. In a placebo-controlled study, volunteers who took 840 mg of Urox daily for eight weeks had a 60% reduction in episodes of urinary leakage and urgency. They also had fewer nighttime visits to the bathroom and a reduced use of pads.
- Constipation and loss of bowel control. Psyllium, chia seeds, and other sources of supplemental fiber are mainstay treatments for both constipation and fecal incontinence, along with plenty of fruits and vegetables. I do not recommend herbal laxatives. It’s easy to develop a dependency, making it hard to have a bowel movement without them. Instead, try a magnesium supplement such as magnesium citrate, which softens stools and increases regularity. Probiotics are also great for overall gut health.
- For pelvic organ prolapse, acupuncture and electro stimulation can be helpful. Additionally, Chinese herbal medicine specific to your individual symptoms can be helpful to tonifying spleen qi and kidney qi and raise yang. Homeopathic Sepia (30c) is indicated for stress incontinence and prolapse of the uterus with a bearing down sensation, so that could be a simple, non-invasive option to try.
It's also important to nourish the tissue of your pelvic floor. Try a collagen supplement that can replenish the collagen that naturally decreases as we age (I like to choose a grass fed brand and add it to my coffee or tea).
If You Need Extra Help
Don’t let embarrassment or other factors stop you from talking to your doctor about these issues. There are many noninvasive therapies for strengthening the pelvic floor and improving symptoms, including pelvic floor rehabilitation, behavior therapies, pessaries, internal massage, and medications.
There are even surgical options, although they are generally reserved for more serious pelvic organ prolapse.
Take Action Now
When it comes to the health of our pelvic floor it is like goldilocks and the three bears, we don’t want it to be too loose (weak) or too tight (hypertonic), balance is the key and we want it just right!
Make core and Kegel exercises a habit sooner rather than later and keep core muscle and pelvic floor engagement in mind as you go about your day. Be mindful of proper body posture that supports your pelvic floor when you are lifting heavy objects. Gently exhale out the pressure and focus on engaging your floor muscles and core by bringing your belly button in and away from the front of your shirt.
Eat a healthy, high-fiber diet, drink lots of water, and take other steps to optimize digestion and elimination.
And if you are already dealing with any type or degree of pelvic floor dysfunction, don’t wait to seek medical attention. I understand the reluctance to talk about problems of such an intimate nature, but wouldn’t you rather feel a little embarrassed than deal with incontinence and other symptoms?
Take action now and enjoy a better quality of life for years to come!