Pelvic Floor Problems

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A healthy pelvic floor is strong and flexible, and can contract and relax easily. Pelvic floor strength and flexibility vary from person to person. Some people go through life without problems, while others experience troublesome symptoms because their pelvic floor muscles are too weak, too tense, too inflexible, poorly coordinated, or a combination of these.

Pelvic floor problems can be divided into two broad categories: Low Tone Pelvic Floor Dysfunction (weakness of the pelvic floor), and High Tone Pelvic Floor Dysfunction (painful, tense pelvic floor). There are concrete steps you can take to prevent or treat either type of problem.

Low Tone Pelvic Floor Dysfunction

Low Tone Pelvic Floor Dysfunction occurs when the pelvic floor becomes weak from disuse, damaged by surgery, or stretched without being reconditioned soon after. The muscles become too weak to sufficiently hold up the pelvic organs and to hold in urine and stool. Orgasms feel smaller or shorter, and the muscles tire more easily.

  • Women who have had one or more babies, and do not regularly do Kegels.
  • Individuals who have had pelvic surgery, particularly with access through the perineum, which can damage the pelvic floor muscles.
  • Individuals who do not have regular orgasms, because orgasmic contractions help keep the pelvic floor strong.
  • Individuals who carry a lot of body weight, which can stress the pelvic floor muscles.
  • Athletes who experience injury to the perineum from water-skiing, bicycle racing, or equestrian sports.
  • Women with a family history of pelvic organ prolapse.
  • Individuals who have had radiation treatment to the pelvic region.

  • Weak or absent orgasms
  • Stress incontinence (losing urine or stool when you sneeze, laugh, cough, lift, or exercise)
  • Pelvic organ prolapse or drop (uterus, bladder, or rectum)

Learning to do Kegel exercises will help treat symptoms of a weak pelvic floor, prevent them from occurring in the future, and increase orgasmic intensity. These exercises, named Kegel exercises after the doctor who developed them, increase the strength of the pelvic floor muscles by intentionally contracting and relaxing them in a series of repetitions.

High Tone Pelvic Floor Dysfunction occurs when the pelvic floor muscles are overly tense, inflexible, or in spasm. The muscles are unable to move and stretch with daily activities. This causes uneven stress on the bones where they are attached, as well as uncomfortable stretching of the muscles themselves. The term “high tone” refers to the presence of high tension in the muscles. This can occur with either strong or weak pelvic floor muscles, and can cause a wide range of problems.

  • Individuals who do Kegels without adequate relaxation both during and in between exercises.
  • Athletes, gymnasts, and Pilates enthusiasts who work out with a focus on core strength without adequate focus on core flexibility and relaxation.
  • Women transitioning through menopause. Estrogen supports muscle function, and estrogen levels decrease during menopause, causing some menopausal women to gradually lose their pelvic floor flexibility.
  • Women who experience infrequent vaginal penetration. Relaxing to allow penetration helps keep the pelvic floor muscles flexible.
  • Individuals with high-stress lifestyles and/or difficulty coping with stress, because this increases the likelihood of carrying tension in the pelvic floor muscles.
  • Individuals who’ve had trauma to their pelvic floor either from surgery or sexual abuse.

  • Pain as sexual arousal builds
  • Pain with vaginal penetration
  • Pain with orgasm
  • Inability to tolerate wearing tampons or getting a pelvic exam
  • Constipation and/or pain with bowel movements
  • Painful urination and/or increased frequency of urination
  • Ache in the pelvis from constant muscle stress on the lower spine and tail bone

There are many conditions that are easily confused with High Tone Dysfunction, so we recommend you see your health care provider to obtain an accurate diagnosis. Once a medical diagnosis of pelvic floor dysfunction is made, a Physical Therapist (PT) or Occupational Therapist (OT) who specializes in the pelvic floor can do a thorough assessment and determine the exact portions of the pelvic floor that need attention. The therapist can perform treatment as well as teach you a series of individualized exercises you can do at home, either alone or with the help of a partner, to facilitate normal coordination and flexibility of pelvic floor muscles. We recommend working with a therapist rather than attempting to treat this condition on your own.

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