A 26-year-old man is training for a 100-mile cycling race and is training 2-3 hours on his bike several days a week when he starts to notice that he has a difficult time initiating the flow of urine when using the restroom. 

A 40-year-old woman just started a new managerial position at her finance job and is feeling more anxious than usual, she begins to notice that she is having pain with bowel movements and a new onset of constipation. 

A 54-year-old man recently had his prostate gland removed due to his prostate cancer diagnosis, he feels quite a bit of relief due to the success of the procedure but is now experiencing urinary leakage and doesn’t want to leave the house due to fear that he will have an accident. 

A 35-year-old woman is now 2 years postpartum after a traumatic birthing experience and is hoping to be intimate with her wife again, but is experiencing a lot of pain and discomfort during intimacy which is creating feelings of shame and embarrassment. 

What do all of these individuals have in common? They are all experiencing signs and symptoms of pelvic floor disorder! In this blog, we will break down these common pelvic floor disorders in hopes that we can continue to make pelvic floor health a part of the conversation amongst our hustling colleagues, our Saturday bike crew, our postpartum moms, our prostate cancer warriors, and so many more. 

What is the pelvic floor?

The pelvic floor is a group of muscles that sit within the pelvis to support the organs of urination, defecation, and sexual function. Thought often as a “hammock” of muscles that runs from the front of your pelvis back to the tailbone (2), these supportive muscles are integral in the continence mechanism of both bowel and bladder movements. 

Often, the pelvic floor is thought to only be of importance in those with female anatomy due to the impact both pregnancy and labor and delivery can have on this group of muscles (check out the video below). And while the pelvic floor muscles certainly play a major role in both carrying and delivering a baby, they also are equally as important in those with male anatomy. Men could experience urinary incontinence secondary to the removal of a prostate (3), difficulty starting a stream while using the restroom, or pain and discomfort during intimacy; all of which can be impacted by the pelvic floor muscles.

Pelvic floor disorders can be broadly categorized into pelvic floor hypertonicity and pelvic floor hypotonicity with varying symptoms between the two as well as specifications when it comes time to determine an intervention. Let’s dive into each below. 

Pelvic Floor Hypertonicity

Pelvic floor hypertonicity refers to when the muscles of the pelvic floor are in a tense resting state. Those who may experience hypertonicity in their pelvic floor muscles might describe “muscle overactivity”, “muscle spasms”, or “pelvic pain” (4). 

Some causes of pelvic floor hypertonicity can include, but are not limited to: 

• Pelvic surgery
• Traumatic vaginal deliveries
• Pelvic pain
• Chronic stress
• Changes to gait
• Traumatic injury of the back or pelvis
• Sexual trauma

Our bodies process pain and stress in really remarkable ways which can often lead to tissue responses of tension, pain, or sensitivity in associated muscles. The pelvic floor muscles are no different, and the resulting hypertonicity has been known to account for 50-90% of those experiencing pelvic floor disorders (4). 

Symptoms associated with pelvic floor hypertonicity may include, but are not limited to: 

• Urinary urgency or frequency
• Pelvic pain with intimacy
• Constipation, straining, or pain with bowel movements
• Pain with pelvic exams or sanitary products
• Pain or slow stream while urinating
• Incomplete emptying of the bladder
• Hip pain or tailbone pain

Pelvic floor hypertonicity and associated discomfort can greatly impact quality of life! Luckily, research has shown that pelvic floor physical therapy can help tremendously with the reduction of symptoms and improve overall well-being. If you, or someone you know, are experiencing symptoms of pelvic floor hypertonicity, this is your sign to find a pelvic floor PT who can work with you to identify the causes and address the symptoms. Below are a few exercises that may be part of one’s program if dealing with hypertonicity, the goal being guided relaxation of the pelvic floor.

If dealing with pelvic floor symptoms postpartum and have gained clearance to begin rehab, check out our Postpartum Rehab program through the [P]rehab App!

LEARN MORE ABOUT OUR POSTPARTUM REHAB PROGRAM

Our 8-week Postpartum Rehab program is designed to improve your confidence in your pelvic floor, hips, and core, and provides you with the necessary education along the way! Please be sure that you have been cleared to begin the activity by your OB-GYN before beginning our programming.

Pelvic Floor Hypotonicity

Pelvic floor hypotonicity refers to when the muscles of the pelvic floor are in a lengthened resting state and may exhibit poor coordination and control when asked to contract. Those who experience pelvic floor hypotonicity may experience feelings of “pelvic heaviness”, “dragging”, or various types of incontinence (5). 

Some causes of pelvic floor hypotonicity can include, but are not limited to: 

• Pregnancy and labor and delivery
• Obesity
• Straining with bowel movements
• Pelvic Organ Prolapse
  

  LISTEN: IS IT SAFE TO EXERCISE DURING PREGNANCY?

  

Symptoms of pelvic floor hypotonicity can include but are not limited to: 

• Urinary incontinence
• Fecal incontinence
• Bulging at the vaginal opening
• Lack of control to make it to the restroom in time
• Difficulty voiding entirely 

The following are exercises that may benefit someone dealing with hypotonicity:

It’s important to mention that symptoms of both pelvic floor hypotonicity and hypertonicity can be present at the same time. Sometimes an individual may experience pelvic pain and discomfort while also experiencing leakage, or difficulty emptying the bladder in addition to noticeable bulging. A pelvic floor physical therapist can identify the root of the problem and work to address the issues, whether it be hypertonicity, hypotonicity, or both!

READ: PELVIC ORGAN PROLAPSE AND EXERCISE

How does this impact you?

More like…how doesn’t this impact you? Truth is, we’ve all got a pelvic floor and we’ve all got a pelvic floor that is loaded daily whether it be with simple activities like sneezing or coughing or more extreme activities such as pelvic surgery, baby delivery, or sitting in a bike saddle for extended periods. Our pelvic floor muscles work for us in just about everything that we do, and if you are experiencing any of the above symptoms, you are not alone!

Closing Thoughts

Pelvic floor disorders are common and we need to continue to make them a part of the conversation. The symptoms listed above do not always occur in isolation, and a pelvic floor physical therapist can further help to identify the root of the symptoms and work to address and eliminate them. 

Maybe this blog speaks directly to you, your colleague, your biking teammate, your postpartum sister- in- law, or your next-door neighbor who just underwent prostate surgery. Whomever it is, let’s offer a listening ear and a supportive hand (and pelvic floor muscles…pun intended) as we make pelvic floor disorders a part of the conversation. 

LEARN MORE ABOUT OUR POSTPARTUM REHAB PROGRAM

1. Good MM, Solomon ER. Pelvic Floor Disorders. Obstet Gynecol Clin North Am. 2019 Sep;46(3):527-540. doi: 10.1016/j.ogc.2019.04.010. PMID: 31378293.
2. Raizada V, Mittal RK. Pelvic floor anatomy and applied physiology. Gastroenterol Clin North Am. 2008 Sep;37(3):493-509, vii. doi: 10.1016/j.gtc.2008.06.003. PMID: 18793993; PMCID: PMC2617789.
3. Milios JE, Ackland TR, Green DJ. Pelvic floor muscle training in radical prostatectomy: a randomized controlled trial of the impacts on pelvic floor muscle function and urinary incontinence. BMC Urol. 2019 Nov 15;19(1):116. doi: 10.1186/s12894-019-0546-5. PMID: 31729959; PMCID: PMC6858748.
4. van Reijn-Baggen DA, Han-Geurts IJM, Voorham-van der Zalm PJ, Pelger RCM, Hagenaars-van Miert CHAC, Laan ETM. Pelvic Floor Physical Therapy for Pelvic Floor Hypertonicity: A Systematic Review of Treatment Efficacy. Sex Med Rev. 2022 Apr;10(2):209-230. doi: 10.1016/j.sxmr.2021.03.002. Epub 2021 Jun 12. PMID: 34127429.
5. Grimes WR, Stratton M. Pelvic Floor Dysfunction. 2023 Jun 26. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 32644672.

About The Author

Lyndsay Centrowitz, PT, DPT

[P]rehab Writer & Content Creator

Dr. Lyndsay Centrowitz graduated from Colorado State University with a BS in Health and Exercise Science and a concentration in Sports Medicine. After multiple personal sports-related injuries and discovering a passion for healing through movement, Lyndsay attended Creighton University to receive her Doctorate of Physical Therapy. An avid runner herself, she has a particular interest in working with high school, recreational, and elite endurance athletes and has undergone specialty training in pelvic floor rehabilitation, postpartum care, and management of the female athlete to better serve her clientele. Through this specialty training, she has acquired a Certificate of Achievement in Pelvic Health Physical Therapy through the American Physical Therapy Association.  Lyndsay now owns her own practice StrongHER in Park City, UT where she specializes in female athletics and care of pregnant and postpartum individuals. Additionally, Lyndsay is BSPTS C2 certified in scoliosis specific exercises and has found a niche working with adolescents with scoliosis to improve overall spinal health. No, you’re not seeing double! Lyndsay is an identical twin to Lauren Lynass, one of our [P]rehab rockstars. A native of Colorado, Lyndsay is an adventure seeker who loves to hike, camp, and race her twin sister on the mountain trails. When she isn’t exploring Park City’s outdoor playground, you can find her curled up with a cup of tea and a good book. Follow along @strongher_dpt on Instagram!

Disclaimer – The content here is designed for information & education purposes only and is not intended for medical advice.