What Is Pelvic Floor Dysfunction?

And How You Can Reverse It

by Christiane Northrup, M.D.

Featured Blog Pelvic Health

Do you pee when you laugh or cough? If so, you are not alone. Urinary incontinence is just one of the symptoms of Pelvic Floor Dysfunction (PFD). Others types of PFD include pelvic fecal (bowel) incontinence, chronic pain, and pelvic organ prolapse — when the bladder or uterus bulge into the vagina.

Having proper control over your pelvic floor muscles allows your bladder and bowels to function optimally. And, Pelvic Floor Dysfunction is more common than most women, and men, realize. 

The good news is that there are a lot of ways to keep your pelvic floor muscles healthy and avoid or reverse PFD.

Why Are Your Pelvic Floor Muscles Important?

The pelvic floor is a group of muscles, ligaments, and tissue that form a sling, of sorts, to support your pelvic organs and stabilize your pelvic joints. In a woman, the pelvic floor supports the uterus, vagina, bladder, urethra, large bowel, and rectum.

When your pelvic floor muscles are strong and flexible, you are able to control your bladder and bowels by contracting and relaxing the muscles and tissues in your pelvic floor. You also have better orgasms! When these muscles weaken due to habits, such as sitting too much and not moving your hips through their full range of motion, or from muscle tension due to chronic stress or overdeveloping the abdominal and pelvic floor muscles, you can end up with Pelvic Floor Dysfunction.

Men can also experience Pelvic Floor Dysfunction.

Childbirth, Menopause, and Your Pelvic Floor

Pelvic Floor Dysfunction usually does not occur due to one-time events such as childbirth. However, childbirth, repeated heavy lifting, and hip or back injuries can cause your pelvic floor to weaken, increasing the likelihood of PFD. In short, whenever the muscles, tendons, ligaments, or nerves of the pelvic floor are affected, you are at risk for PFD.

Menopause is associated with weakening of the pelvic floor as well, but it is not the cause.  Many women ages 40-59 experience Pelvic Floor Dysfunction at some point—which can be triggered by dropping estrogen levels during perimenopause. But again—low estrogen is not the cause in those who have good muscle function and proper pelvic alignment.

Other factors that can contribute to PFD include:

  • Episiotomy
  • Cesarean section
  • Hysterectomy
  • Obesity
  • Standard American Diet (SAD)
  • Lack of exercise
  • Poor posture
  • Wearing high heels for years
  • Shortened hamstring muscles
  • Tucking your tailbone under you (which is quite common and absolutely the wrong thing to do!!)
  • Straining during bowel movements (which is, again, related to the wrong pelvic positioning)

The good news is there are many ways you can strengthen your pelvic floor and pelvic girdle muscles to avoid PFD and restore continence and overall health to your pelvic area.

Here are my top 10 recommendations for strengthening your pelvic floor:

  1. Stop sucking in your gut. Sucking in your gut does not create core strength and can actually increase downward pressure on your pelvic floor. This creates a strain on the connective tissue in your abdomen by displacing your abdominal viscera. Many people hold in their bellies without knowing it. If you do this, try to consciously relax your belly while sitting, lying down, or in a cat/cow position on your hands and knees while taking deep, relaxing breaths. And pretend you are a dog or cat with your tail out—not tucked under you. Do this several times per day.
  1. Develop your core. You can develop your core muscles (between your pubic bone and lower rib cage) by doing the following: Take in a deep breath while keeping your shoulders down and pulling your abdomen toward the back of your spine. Notice how this feels like engaging a corset. Hold for the count of 10—keeping all those corset muscles pulled in. Aim for doing this 10-20 times per day. This will pull up and strengthen your abdominals and take pressure off your pelvis. This is not the same as sucking in your gut unconsciously. This is consciously developing your core strength.  Esther Gokhale of the Gokhale Method teaches this as part of ideal posture: Sit with a towel folded lengthwise under your sitz bones. This will automatically tilt your pelvic bowl forward so that your pubic bone is where it should be—under your pelvic contents. Think of your pelvis as a bowl—you want it tilted so water spills out the front. When you sit, make sure your tailbone is out behind you.
  1. Wear loose-fitting clothing. Wearing tight clothing has the same effect as sucking in your gut. Plus, if you regularly wear tight jeans or Spanx, you may be interfering with peristalsis in your gut, which could cause constipation, gas, and bloating. Finally, tight clothing can cause reduced circulation to your lower body and make it difficult to breathe properly.
  1. Breathe from your diaphragm. Your inner core is made up of your pelvic floor, your transversus abdominus and multifidus, and your diaphragm. When everything is working optimally, your diaphragm and pelvic floor move in sync. However, when you suck in your gut, slouch over your computer, or experience chronic tension, this pattern gets disrupted. To practice diaphragmatic breathing, lie down on your back. You can put a pillow under your knees, but you want a neutral spine. Place one hand just above your belly button. Breathe in slowly through your nose, allowing your inhale to expand your belly. Feel your upper belly rise under your hand. Keep your upper chest, shoulders, and neck muscles relaxed as you inhale. Then release your breath without forcing it out. Feel your chest and belly drop. Do this for 1-2 minutes and work up to doing this for 5 minutes and several times per day.
  1. Try squatting. Biomechanical specialist Katy Bowman points out that the gluteal muscles are the ones that are most important for pelvic floor function. Doing regular squats elongates your pelvic floor muscles and makes them more functional. Squats also help re-position your pelvis by balancing out the anterior pull of your sacrum. When you have a flat butt and no curve in the small of your back, that’s a sign that your pelvic floor is starting to weaken. Humans used to squat to eliminate urine and feces. Some cultures still use squat toilets. And, many cultures use the squat as a sitting position instead of using chairs. To do a deep squat (called malasana, or garland pose, in yoga), you may want to start with a towel or yoga mat rolled up under your heels, then lower yourself slowly until your tailbone is as close to the floor as possible with your heels still flat on the floor or your towel. You can practice deep squatting at home, at the gym, or at the yoga studio. You can also practice deep squats while playing with small children (notice how they do this!), gardening, and while using the toilet with the help of a Squatty Potty or something to lift your feet. In addition to strengthening your pelvic floor, you may notice fewer problems with your gut function, and may even avoid hemorrhoids. Note: many Westerners cannot do the deep squats that other cultures are brought up doing. We tend to lose this ability after childhood. Don’t worry about it. Just squat as low as you can while keeping your knees in alignment with your toes. I personally can’t do anywhere near the kind of squat that my 3-year-old granddaughter can do.
  1. Exercise. There are a number of exercises you can do at home or at the gym to help strengthen your pelvic floor. Some of the best exercises include bridge pose, wall squats, jumping jacks, and dead bug crunch. For instructions on how to do these exercises, ask a knowledgeable trainer. You can also search online for video instructions.  I also recommend that you Google Katy Bowman, who has many good resources for pelvic floor exercises.
  1. Practice yoga or Pilates. My Pilates teacher has had countless clients over the years who have healed their urinary incontinence in a few months after starting classical Pilates. And, many pelvic floor physical therapists use Pilates reformers as part of their practices. Both Pilates and yoga can help strengthen your core, which helps improve pelvic floor strength. Pilates targets the deep core and helps you develop both strength and flexibility. You can try a Pilates mat class or seek out an instructor who is well-versed in using the equipment. In yoga class you can practice your root lock, or mula bandha, to target your pelvic floor.
  1. Use vaginal weights. Weightlifting strengthens your muscles. You gain the same effect when you use vaginal weights. Inserting cone-shaped weights into your vagina helps to train your pelvic floor muscles. You simply contract your pelvic floor muscles to keep the weight in place. You can find vaginal weights, such as Yoni Eggs, or Lelo balls, online. I find this approach far superior to the standard Kegel exercises which, in far too many women, just make the one small pubococcygeus muscle tight and don’t do much of anything with the rest of the pelvic floor.
  1. Try Biofeedback. Biofeedback can help you learn how to strengthen or relax your pelvic floor muscles. Using special sensors that track your pelvic floor muscle function, you can learn how to activate the correct muscles to keep your pelvic floor toned. This is typically done in an office setting by a nurse or trained therapist. The sessions are usually about an hour. You sit in a comfortable chair with your clothes on after the sensors have been put in place – usually one on your abdomen and the other in your anal canal. The sensors measure the electrical activity of your pelvic floor muscles – especially the ones that control bladder and bowel function – while you contract and release the muscles. There are also home biofeedback devices you can purchase, but you should still have a pelvic floor assessment by a professional before using.
  1. Get therapy. A women’s health physical therapist (WHPT) can diagnose and treat pelvic floor issues. They often perform manual therapy where the therapist gently massages, stretches and releases the spasms and trigger points in the deep tissue of your vagina. This, alone, can sometimes be enough to resolve symptoms of PFD, including urinary incontinence and pelvic pain. Some WHPTs partner with OB/GYNs, urologists, and other specialists. Your first session may include an internal exam to assess your pelvic floor. Then your therapist will create a program that is right for you. Women who have PFD and have practiced Kegels with little or no results typically benefit from seeing a WHPT. You can search the American Physical Therapy Association website for a licensed WHPT.

Have you ever experienced Pelvic Floor Dysfunction (PFD)? If so, what have you done to resolve it? Please leave your stories in the Comments section below.

Last Updated: July 24, 2018

Christiane Northrup, M.D.

Christiane Northrup, M.D.

Christiane Northrup, M.D., is a visionary pioneer and a leading authority in the field of women’s health and wellness. Recognizing the unity of body, mind, and spirit, she empowers women to trust their inner wisdom, their connection with Source, and their ability to truly flourish.

Comments

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  1. Donna Bianco
    2 months ago

    OMG I have it so bad can you help me, having rectocele repaired for 2nd time along with bladder lift oct 24 dr. Acher-Welch Ehlers Danlos Syndrom is also one of the diagnosis I have causing lots of elasticity to my skin. Saw you on IIN Talk love your style and information, our whole class is talking about how they love you. Just wanted to let you know, I’m still finishing the video but loving every bit of it as did my classmates. You are spot on in everything I know or am learning. Go Dr. N

  2. Nikki
    2 months ago

    Great article thank you. I notice urinary leaking occurs after about mid morning (so i always exercise first thing in the morning) and then can be either worse or non existent during the month. I’m assuming hormones are at play but havent worked out if a pattern exists … yet. I think I’ve dealt with it but then it’s back!! Look forward to implementing these points.

  3. Sharvari P Joshi
    2 months ago

    Thanks for sharing the useful information. It is really a great blog.

  4. Judy
    3 months ago

    When I told my Dr. I had urine leakage issues she prescribed Premarin cream to insert into my vagina. Anyone have any thoughts about this? Thanks

    1. Christiane
      2 months ago

      The outer 3rd of the urethra is very estrogenic tissue. And many times estrogen cream helps thicken the tissue. Worth a try. Let me give you a good alternative. My Pueraria mirifica vaginal moisturizer… works extremely well and does similar things to estrogen. But no presription required!! Check it out http://www.amatalife.com

  5. Isa Herrera
    3 months ago

    Dr. Northrup, I LOVE-LOVE ( yes double love)– this article and I’m sharing it with all the women in my tribe. Thank you so much for all that you do for the continued healing of the divine feminine. Instead of burning our bras we should all #BurnOurPantyliners.

    1. Christiane
      2 months ago

      This is a GREAT high five ccoming from you, the Queen Pelvic Floor healer! Thank you!!

  6. Anne
    3 months ago

    Thank you Dr. Northrup for sharing great information about pelvic floor dysfunction. I am a physical therapist and board-certified women’s clinical specialist. I’ve been practicing pelvic physical therapy since 1999. Over the years I have realized that we as women to not have basic information to take care of our bodies and never discuss the ‘secret’ pelvic area. I have such a passion for bringing this information forward that I wrote a book Pelvic Zone Coach, Every Wonan’s Guide To Pelvic Health and Sexual Vitality (available on Amazon).
    In my practice I have found women are so grateful for information and help for their issues. BTW Dr Northrup you are my mentor and my hero. Thank you

    1. Christiane Northrup
      2 months ago

      Bless you for your good work. And for posting here. I really appreciate it!

  7. Jennifer Slattery
    3 months ago

    Isa Herrera in NYC was my physical therapist for almost three years! She has a great book. It is just as important to learn to relax the muscles as it is to strengthen them. I still use many of the exercises she taught me.

    1. Christiane
      2 months ago

      Yep!! She is a colleague! Thank you for giving her work a shout out!

  8. Jane
    3 months ago

    Every since my hysterectomy 4 years ago I have chronic pain. I’m now 46 years old and have tried everything. They say my muscle tone is good, as I do Kegals daily and my estrogen and testosterone are low but could be worse. The doctor says I have scar tissue on the vault that pushing on nerve endings. I can’t take gabapintin nor lyrica as they are too strong and I hate how it feels. I’ve had pelvic PT and use those skills. They now want to give me steroid shots a the top of the vault. Actually this wk but I’m about to chicken out. It seems everything tried makes it more agitated. Im at my wits end.
    I went from running marathons to being afraid to exercise at all. Any advice would be welcome.

  9. Maureen
    3 months ago

    Has anyone heard of or used the Apex / ApexM, by InCONTROL,? It is a hand held, powered muscle stimulator to strengthen the pelvic floor. I was so excited to see the info so I got one. When I read the cautions, the contraindications, and warnings, I was quite nervous. I haven’t tried it yet.

    1. Christiane Northrup
      2 months ago

      I haven’t heard of it. But it certainly makes sense. Let me know how you do.

  10. Norma
    3 months ago

    After reading your article, I have PFD. I recently had an operation for rec ta cile and have been told that it went great. I have a gyn Dr. who also thinks it went well.

  11. Alexia
    3 months ago

    Great tips, Linda.
    Thank you.

  12. Julie
    3 months ago

    I am 61 and was diagnosed last year with pelvic floor tension after months of pain. Let me first recommend an article from prevention magazine 2014 titled “why it hurts down there”. I am healthy, thin, on no medications, I walk 2miles and do lots of gardening. I went to my gynecologist (male) and he prescribed an antibiotic for a urinary tract infection, which upon culture I did not have, but he never told me that. The pain never went away. He prescribed a 2nd round of antibiotic, the pain never went away. He sent me to a urologist( a female) who Did a pelvic exam and diagnosed PFT. She sent me to specialty physical therapy and 4 sessions later I was pain free.

    1. Cheryl
      3 months ago

      Never had correct diagnosis of any female related issues going to male doctors. Years on meds for bladder infections, labs say I never had until switched to female doctor with immediate result, diagnosed 3rd degree prolapse, seriously. Thank you to all the female doctors who examine and listen and more importantly, believe. And, then help resolve and prevent.

  13. Deniese
    3 months ago

    Dr Northrup, what are your thoughts on the laser procedures to give you a head start on improving my PFD? I am considering Mona Lisa.

    1. Christiane Northrup
      2 months ago

      I’ve had the Thermiva treatment because a friend of mine was learning to be a tech– I volunteered to be her guinea pig. I loved it and got good results. ( But didn’t have any problems to begin with). I believe that these heat or laser treatments have a place and can be very effective.

  14. Marilyn
    3 months ago

    This is all nice info, but I’m wondering why there is zero mention of THERMIVA? You recommended it a couple years ago, and it completely healed me of any bladder leakage. I’d never use anything else! And no need for any lubrication mess any longer. Did You Forget?

    1. Christiane Northrup
      2 months ago

      Just mentioned it above. So glad it worked for your bladder leakage. Thanks for this!! Good point!

  15. Mary
    3 months ago

    I don’t understand How/Why my two C-sections in 1970s (first d/t ‘frank breech’)
    contribute to my Pelvic Floor Dysfunction (and perhaps dysbiosis?) now?

  16. Miriam Rossman
    3 months ago

    Thank you so much for this wonderful information. It makes me crazy how our society and women seem to accept incontinence. Women need to realize this is not normal and feel empowered to do something about it. I applaud your open honesty.

  17. Anne
    3 months ago

    I am curious – I was married for 35 years (half my life) to a man who had a very, very large penis. I am now experiencing incontenence since he left our marriage. Is there a correlation?

  18. RB
    3 months ago

    Thank you for shedding light on this issue. I’ve been coping with it for years. This post focuses primarily on weak and loose pelvic floor muscles. But note, some folks like me experience weak and tight pelvic floor muscles.
    The “prescription plan” for tight and weak muscles is different than loose and weak. I recommend going to a Pelvic Floor Physical Therapist (do a google search) or Doctor specializing in Pelvic Floor issues (Most OB/GYNs are NOT knowledgeable of this issue) to get a proper diagnosis. Otherwise, you might do the wrong thing for your condition and make it worse.

    Note, symptoms for tight and week might include: PAINFUL SEX, discomfort around the groins (where your underwear touches your inner thigh), skinny or loose bowels.

  19. Marlene
    3 months ago

    Would interrupting urinary flow help these muscles?

  20. Joanne
    3 months ago

    Had a myomectomy years ago and now exhibiting some symptoms of PFD. This article could not have come at a better time for me. Thank you for this wealth of information!!!!!

  21. Linda
    3 months ago

    I have been on this earth almost eighty years, no meds, and have not had these symptoms–yet. I had 5 pregnancies, and one episiotomy birthing one large baby, no hysterectomy. I am not overweight nor do I have a flat butt. Here are some things I’ve done over the years and now am wondering if it may have helped. I don’t know if this was developing core muscles, but when I was a kid, and through most of my life, when I went to bed I would hold my stomach in until I went to sleep. Odd, I know, but I have never had back problems. A strong stomach keeps your back strong. I garden, and have always done squats, still can, although lately I squat without thinking about it and notice it’s less easy to get back up. By doing most things my self I get plenty of exercise and I walk daily. Exercise and diet helps constipation problems. I think as we get older we don’t empty our bladder fully. If you have to lean forward, to the sides, or back or bounce a little, do it. And, true confession, I have a tiny extra bathroom where I can place my feet on the wall–works great for a Squatty Potty. Lastly, keep having orgasms.

    1. Jo ann
      3 months ago

      Yes. I want to be you. I am 67 and no meds . I am a bit active and can’t get up from squats but want. I have a newish relationship with a wonderful person and want to keep that fresh so I assume more activity would benefit. I am a writer and sit a lot . I’m going to keep trying.

    2. Denise
      3 months ago

      Thank you, Dr. Northrup, for this article &, Linda, above, for your sharing! At age 65, it has been an issue for me & recently I have been wondering if there is anything I can do to help myself. I find myself always needing to be aware of where a close bathroom is. This information is timely! I will take your advice!

    3. Barbara Swansen
      3 months ago

      Linda, you inspire me! Thank you. And Dr. Northrup, thank you for all this great information. I so appreciate your approach to women’s health.

    4. Beverly
      3 months ago

      Yes to all that Linda (almost 80) says, including the last sentence…”Keep having orgasims”! I am 78 years young , am in excellent health, no medications, (use homeopathy) and do most of the things Linda mentions..Including the last!
      It’s amazing how the life force within us naturally heals and keeps us healthy, radiant and whole, all through life! What a gift! Younger people, our children and grandchildren, would be surprised at one key “secret” ingredient in our toolbox for reducing
      stress and remaining fit and energised! Thank you, Linda, for sharing…and thanik you Dr.Northrop for all the wonderful, valuable information you give us…
      Beverly

      1. Christiane Northrup
        2 months ago

        Yes to orgasms as the fountain of youth!!

    5. Ora
      3 months ago

      Thank you very much for sharing with others your honest story.

    6. Christiane Northrup
      3 months ago

      What a brilliant, brilliant comment. So much wisdom here! Thank you SO much for holding the torch high for so many others.

    7. Annette
      3 months ago

      good for you!

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