^ Bernard, Stéphanie; Ouellet, Marie-Pier; Moffet, Hélène; Roy, Jean-Sébastien; Dumoulin, Chantale (April 2016). "Effects of radiation therapy on the structure and function of the pelvic floor muscles of patients with cancer in the pelvic area: a systematic review". Journal of Cancer Survivorship. 10 (2): 351–362. doi:10.1007/s11764-015-0481-8. hdl:1866/16374. ISSN 1932-2259. PMID 26314412. S2CID 13563337.
Pelvic floor dysfunction is an umbrella term for a variety of disorders that occur when pelvic floor muscles and ligaments are impaired. Although this condition predominantly affects females, up to 16% of males suffer as well.[1] Symptoms include pelvic pain, pressure, pain during sex, incontinence, incomplete emptying of feces, and visible organ protrusion.[2] Tissues surrounding the pelvic organs may have increased or decreased sensitivity or irritation resulting in pelvic pain. Underlying causes of pelvic pain are often difficult to determine.[3] The condition affects up to 50% of women who have given birth.[4]

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The information presented on The American Society of Colon and Rectal Surgeons (ASCRS) website is solely intended to provide you with information that will help educate you on various conditions. No information provided on this website or otherwise offered by ASCRS is intended to replace or in any way modify the advice of your health care professional.
^ Masterson, Thomas A.; Masterson, John M.; Azzinaro, Jessica; Manderson, Lattoya; Swain, Sanjaya; Ramasamy, Ranjith (October 2017). "Comprehensive pelvic floor physical therapy program for men with idiopathic chronic pelvic pain syndrome: a prospective study". Translational Andrology and Urology. 6 (5): 910–915. doi:10.21037/tau.2017.08.17. PMC 5673826. PMID 29184791.
In order for the processes of urination and defecation to go smoothly, the various muscles within the pelvis need to act in a coordinated manner. In some cases, the muscles contract when they should be relaxing, or the muscles do not relax sufficiently to facilitate coordinated movement. Problems with the pelvic floor muscles can lead to urinary difficulties and bowel dysfunction. PFD is experienced by both men and women.

If you think of the pelvis as being the home to organs like the bladder, uterus (or prostate in men) and rectum, the pelvic floor muscles are the home’s foundation. These muscles act as the support structure keeping everything in place within your body. Your pelvic floor muscles add support to several of your organs by wrapping around your pelvic bone. Some of these muscles add more stability by forming a sling around the rectum.
Neural mobilization as the name implies, involves the restoration of neural structures back to their normal mobility: to glide and slide. Neural structures that cannot move properly can cause pain that can radiate down an extremity or into the trunk and can give the sensation of burning, zinging, and stabbing. Some orthopedic therapists practice this type of mobilization; common examples include the sciatic nerve in the leg and the ulnar nerve in the arm. Pelvic floor PTs focus on these nerves when they cause issues, but they also pay attention to nerves that innervate the perineum and genital region (bicycle seat area), such as the pudendal, iliohypogastric, obturator, ilioinguinal, genitofemoral and the femoral cutaneous nerves. By allowing these nerves to move freely, symptoms such as vulvovaginal, penile, rectal, clitoral and testicular pain, itching and burning can be greatly improved.

If you think of the pelvis as being the home to organs like the bladder, uterus (or prostate in men) and rectum, the pelvic floor muscles are the home’s foundation. These muscles act as the support structure keeping everything in place within your body. Your pelvic floor muscles add support to several of your organs by wrapping around your pelvic bone. Some of these muscles add more stability by forming a sling around the rectum.
^ Masterson, Thomas A.; Masterson, John M.; Azzinaro, Jessica; Manderson, Lattoya; Swain, Sanjaya; Ramasamy, Ranjith (October 2017). "Comprehensive pelvic floor physical therapy program for men with idiopathic chronic pelvic pain syndrome: a prospective study". Translational Andrology and Urology. 6 (5): 910–915. doi:10.21037/tau.2017.08.17. PMC 5673826. PMID 29184791.
Ultrasound uses high-frequency sound waves applied through a wand or probe on your skin to produce an internal image or to help treat pain. Real-time ultrasound can let you see your pelvic floor muscles functioning and help you learn to relax them. Therapeutic ultrasound uses sound waves to produce deep warmth that may help reduce spasm and increase blood flow or, on a nonthermal setting, may promote healing and reduce inflammation.
If an internal examination is too uncomfortable for you, your doctor or physical therapist may use externally placed electrodes, placed on the perineum (area between the vagina and rectum in women/testicles and rectum in men) and/or sacrum (a triangular bone at the base of your spine) to measure whether you are able to effectively contract and relax your pelvic floor muscles.
Paradoxical Puborectalis Contraction: The puborectalis muscle is part of the control muscles that control bowel movements. The puborectalis wraps like a sling around the lower rectum.   During a bowel movement, the puborectalis is supposed to relax to allow the bowel movement to pass. If the muscle does not relax or contracts during paradoxical contraction, it may feel like you are pushing against a closed door.
As many as 50 percent of people with chronic constipation have pelvic floor dysfunction (PFD) — impaired relaxation and coordination of pelvic floor and abdominal muscles during evacuation. Straining, hard or thin stools, and a feeling of incomplete elimination are common signs and symptoms. But because slow transit constipation and functional constipation can overlap with PFD, some patients may also present with other signs and symptoms, such as a long time between bowel movements and abdominal pain.
^ Vesentini, Giovana; El Dib, Regina; Righesso, Leonardo Augusto Rachele; Piculo, Fernanda; Marini, Gabriela; Ferraz, Guilherme Augusto Rago; Calderon, Iracema de Mattos Paranhos; Barbosa, Angélica Mércia Pascon; Rudge, Marilza Vieira Cunha (2019). "Pelvic floor and abdominal muscle cocontraction in women with and without pelvic floor dysfunction: a systematic review and meta-analysis". Clinics. 74: e1319. doi:10.6061/clinics/2019/e1319. ISSN 1807-5932. PMC 6862713. PMID 31778432.
There is not a surgery to treat pelvic floor dysfunction because it is a problem with your muscles. In rare circumstances, when physical therapy and biofeedback fail to work, your provider might recommend you see a pain injection specialist. These doctors specialize in localizing the specific muscles that are too tense or causing pain, and they can use a small needle to inject the muscle with numbing medication and relaxing medication. This is called trigger point injection.
Strengthening weak pelvic floor muscles often helps a person gain better bowel and bladder control. A physical therapist can help you be sure you are doing a Kegel correctly and prescribe a home program to meet your individual needs. Diet modifications can also reduce urinary and fecal incontinence. Bladder re-training can decrease urinary frequency and help you regain control of your bladder.

Visceral mobilization restores movement to the viscera or organs. As elucidated earlier in our blog, the viscera can affect a host of things even including how well the abdominal muscles reunite following pregnancy or any abdominal surgery. Visceral mobilization aids in relieving constipation/IBS symptoms, bladder symptoms, digestive issues like reflux, as well as sexual pain. Visceral mobilization can facilitate blood supply to aid in their function, allow organs to do their job by ensuring they have the mobility to move in the way they are required to perform their function, and to allow them to reside in the correct place in their body cavity. Evidence is beginning to emerge to demonstrate how visceral mobilization can even aid in fertility problems.
Increases bladder and bowel control. The pelvic floor muscles are directly responsible for controlling urine and bowel movements. If these muscles are weak, you’re more likely to experience constipation, urinary incontinence, struggle to control flatulence, or experience urine leakage from forceful activities like when sneezing, coughing, or laughing (called “stress incontinence”). Strengthening your pelvic floor can improve your bowel and bladder control.
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