Pelvic floor dysfunction is a broad term used to describe a number of different issues usually related to pelvic pain, sexual dysfunction, painful intercourse, and bowel and bladder dysfunction. It may even encompass hip or low back pain which is sometimes referred to as pelvic girdle dysfunction. These issues are often the result of underlying factors such as biomechanical alterations, posture dysfunctions, stress, medications, infections, diet and lifestyle changes, injuries, surgeries, or even due to changes that occur during different stages of life such as puberty, pregnancy or menopause.
While all of these issues are considered pelvic floor dysfunction, the solution to each problem can vary dramatically. In this blog, as well as in the upcoming blogs, we want to help you understand the different types of pelvic floor dysfunction and what the general course of treatment entails so that you have the resources you need to feel better and get back to what you love.
Tight vs. Weak Pelvic Floor Muscles: The Great Debate
To keep it simple, we can categorize pelvic floor dysfunctions into two categories - tight muscles and weak muscles. Sometimes you will hear this referred to as ‘hypertonic’ or ‘high-tone’ (tight) disorders or ‘hypotonic’ or ‘low-tone’ (weak) disorders. See the table below for a list of diagnoses and conditions that are generally associated with each type. Unfortunately, like many things, it’s just not that simple and regardless of the problem you are experiencing, it all comes back to the underlying causes that are resulting in your symptoms. What many people don’t realize is that some of these issues, particularly incontinence and sexual dysfunction can be due to tight muscles, not weak muscles. Furthermore, there may be both issues going on. This may seem a bit confusing, but if we look at how the muscular system works, it makes more sense.
Muscles work best when they are at their baseline resting state. So, if a muscle is already contracted, or shortened, like when it is tight or in a spasm, the muscle cannot contract anymore and the function is reduced. I like to call this “functionally weak.” Meaning, in the current state, it cannot contract anymore and do its job, resulting in what we think of as weakness. Now, if you relax that muscle and get it back to its resting state, the strength comes back. For example, imagine if you walked around holding a 10-15 lb barbell at your chest, then you went to the gym to work out your arms, you may not perform as well because the muscles are fatigued and tight from holding the barbell. But say you took a few days to rest, you stretched and went back to the gym, your performance would be better.
The pelvic floor muscles are no exception. This group of muscles are pretty incredible because they are active all the time, otherwise, we’d be losing our pee and poop all day long! However, if they are too active or too tight, problems arise. Urinary incontinence or erectile dysfunction are good examples of issues that many would feel kegels would be appropriate, but oftentimes it's not a true strength issue, it's due to other factors like poor timing and control or muscles that are too tight.
There are some other factors to consider when you think you need to strengthen your pelvic floor and begin doing hundreds of kegels. Your pelvic floor muscles may not be coordinating with your other core muscles, there may be poor pressure management - like bearing down or straining during pooping or weight lifting, or they may truly be weak and lax (stretched out) which can occur with chronic straining, pregnancy, or hormone deficiencies in menopause contributing to prolapse issues.
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Conditions Associated By Type of Dysfunction |
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High-Tone Pelvic Floor Dysfunction |
Low-Tone Pelvic Floor Dysfunction |
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Generally, those with weak pelvic floor muscles should do strengthening exercises which we will talk about below, but before starting any exercise program, should consult with a PT to best understand their individualized needs.
Kegels Aren’t for Everyone!
Most people that have heard the term ‘pelvic floor’ probably have heard of kegels. If you haven’t, kegel exercises are simply contracting the pelvic floor muscles, usually repeatedly with the purpose of strengthening the pelvic floor muscles. Kegel exercises were first described by Dr. Arnold Kegel in 1948 to help strengthen the pelvic floor muscles to prevent pelvic organ prolapse and urinary incontinence. While these types of exercises are appropriate for these conditions, people now also perform kegels because they feel this may improve sexual functioning, delay orgasms (purposely), or improve their orgasms.
Pelvic floor PT’s and some healthcare providers are more vocal about the use of kegels, and that while they are a tool, they are NOT for everyone. In fact, they may make some types of pelvic floor dysfunction worse, or even contribute to the onset of pelvic floor dysfunction. The answer to this is that it depends on what is causing the issue. The pelvic floor muscles do not work alone and need to work together with other muscles and many times people are performing the exercises incorrectly, therefore, if you feel kegels are important for you, please see a pelvic floor therapist to ensure you are doing them correctly.
High-Tone Pelvic Floor Dysfunction
The majority of pelvic pain sufferers along with sexual dysfunction and constipation are likely issues of tight muscles not weak muscles. Though as I mentioned above, they may not be functioning properly causing issues such as leakage or what may seem like weak pelvic floor muscles. In general, tight pelvic floor muscles benefit from a combination of therapies including pelvic floor physical therapy, relaxation exercises, improving the underlying biomechanical issues, pain management, addressing trauma, and exercises involving stretching or lengthening these muscles. In many of these conditions, pelvic floor relaxation exercises are prescribed, along with recommendations of vaginal or rectal dilators and pelvic wands as part of your home program.
In addition to pelvic floor PT and an individualized exercise program, some of these conditions require a multidisciplinary team as there are usually several factors involved and most benefit from a team approach. We will be highlighting some of the main pelvic pain conditions in the upcoming blogs to provide you with more detailed information on what these conditions are and the treatment approaches that are effective. However, we know that in all of these conditions the pelvic floor is impacted. Oftentimes specialists will recommend different types of stretching, muscle trigger point release and myofascial release. The end goal is to provide you with tools to help you understand your pain and to be able to self-manage once you are discharged from their care.
Your healthcare provider may recommend various tools such as dilators or wands to complement the work you do in the clinic. NewFlora offers both vaginal dilators as well as pelvic wands for both men and women, designed specifically to address these issues. Click below to check out what makes us unique!
