Although many centers are familiar with retraining techniques to improve pelvic floor dysfunction, few have the multidisciplinary expertise to teach patients with constipation how to appropriately coordinate abdominal and pelvic floor muscles during defecation, and how to use bowel management techniques, along with behavior modification, to relieve symptoms. Because pelvic floor dysfunction can be associated with psychological, sexual or physical abuse and other life stressors, psychological counseling is often included in the evaluation process.
A defecating proctogram is a test where you’re given an enema of a thick liquid that can be seen with an X-ray. Your provider will use a special video X-ray to record the movement of your muscles as you attempt to push the liquid out of the rectum. This will help to show how well you are able to pass a bowel movement or any other causes for pelvic floor dysfunction. This test is not painful.
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.
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).
Home exercise and therapy is also a mainstay of PFD rehabilitation. Because the goal of PFD therapy is to learn to control and, especially, relax the pelvic floor, therapists will teach you techniques for use at home to build on the therapies they do in their offices. This usually begins with general relaxation, stretching the leg and back muscles, maintaining good posture, and visualization—part of learning to sense your pelvic floor muscles and to relax them.
As you can now see, there is so much out there that can be done for people suffering with pelvic floor dysfunction. This blog is by no means extensive, and there are even more options you and your physical therapist can explore to help manage your pain or other pelvic issues. Pelvic floor dysfunction requires a multidisciplinary approach for most of our patients. Hopefully, this blog helped to paint a picture of what you will experience with a pelvic floor physical therapist. We advise that you seek out an expert and experienced pelvic floor physical therapist in order to help better your life and improve your function.

Once patients with pelvic floor constipation have these basic tools, they can begin retraining the pelvic floor muscles with biofeedback. Based on the principle of operant conditioning, biofeedback provides auditory and visual feedback to help retrain the pelvic floor and relax the anal sphincter. Biofeedback training is the treatment of choice for medically refractory pelvic floor constipation, with some studies showing improvement in more than 70 percent of patients. Patients also learn to identify internal sensations associated with relaxation and long-term skills and exercises for use at home.
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.
I’m not sure this diagnosis is correct; how is it confirmed? I’ve been recommended by my new GYN to go to this therapy with this new diagnosis. I have pain during sex. I HATE the muscle feelings of doing Keegles- absolutely hate those feelings. Doc says I won’t be doing Keegles. Have been athletic entire life, and continue to play tennis, do Zumba, garden, snorkle, kayack, still, as I’m a very healthy 57 year old, with left side internal pain during sex, sometimes what feels like a broken pelvic BONE pain. How is this diagnosis confirmed?
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.
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.
It’s highly unlikely that someone will head into a therapist’s office for a stand-alone “vaginal massage.” Why not? “It’s one small aspect of the whole therapy,” says Laura Y. Huang, MD, assistant professor of physical medicine and rehabilitation at the University of Miami Miller School of Medicine. She notes that pelvic floor muscle training, biofeedback, soft tissue release, and education are some of the many pelvic floor physical therapy treatments used to relieve pain or retrain muscles. Learning techniques and strategies to manage the condition at home is also part of treatment.
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.

Home exercise and therapy is also a mainstay of PFD rehabilitation. Because the goal of PFD therapy is to learn to control and, especially, relax the pelvic floor, therapists will teach you techniques for use at home to build on the therapies they do in their offices. This usually begins with general relaxation, stretching the leg and back muscles, maintaining good posture, and visualization—part of learning to sense your pelvic floor muscles and to relax them.


Patients may meet individually with a dedicated nurse educator who provides a focused session on bowel management techniques. Central to the process is a daily regimen that combines an evening dose of fiber supplement with a morning routine of mild physical activity; a hot, preferably caffeinated beverage; and, possibly, a fiber cereal followed by another cup of a hot beverage — all within 45 minutes of waking. This routine augments early morning high-amplitude peristaltic contractions by incorporating multiple colon stimulators.
By definition, postpartum pelvic floor dysfunction only affects women who have given birth, though pregnancy rather than birth or birth method is thought to be the cause. A study of 184 first-time mothers who delivered by Caesarean section and 100 who delivered vaginally found that there was no significant difference in the prevalence of symptoms 10 months following delivery, suggesting that pregnancy is the cause of incontinence for many women irrespective of their mode of delivery. The study also suggested that the changes which occur to the properties of collagen and other connective tissues during pregnancy may affect pelvic floor function.[7]
I’ve had problems with my lumbar spine all of my adult life, including spina bifida occulta. I underwent a lumbar fusion about 6 years ago. I was diagnosed with PFD about a year ago with extremely tight pelvic floor muscles. Three months after my diagnosis I underwent more back surgery including removing the original hardware and another fusion, including fusion of my pelvis. Since the second surgery I’ve experienced increased pain in my pelvis, hips and lower back, and a lack of mobility that I can only attribute to the surgery. How does having a fused pelvis affect therapeutic solutions for PFD?
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.
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.
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]

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.


^ 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.


Biofeedback uses electrodes placed on your body (on the perineum and/or the area around the anus) or probes inserted in the vagina or rectum to sense the degree of tenseness in your pelvic floor muscles. Results displayed on a computer or other device provide cues to help you learn to relax those muscles. Usually, patients feel relief after six to eight weeks of therapy. You may be able to buy or rent a unit to use at home.
The muscles of the pelvic floor must work together and in coordination to perform specific tasks. The pelvic floor has to contract, elongate and relax in very precise ways to perform basic functions like urination, defecation, support the pelvis and organs, and sexual function and pleasure. If your pelvic floor muscles and/or nerves fail to do what they are supposed to do at the right time, problems like painful sex, erectile dysfunction, constipation, and incontinence can occur.

As you can now see, there is so much out there that can be done for people suffering with pelvic floor dysfunction. This blog is by no means extensive, and there are even more options you and your physical therapist can explore to help manage your pain or other pelvic issues. Pelvic floor dysfunction requires a multidisciplinary approach for most of our patients. Hopefully, this blog helped to paint a picture of what you will experience with a pelvic floor physical therapist. We advise that you seek out an expert and experienced pelvic floor physical therapist in order to help better your life and improve your function.
The pelvic floor muscles support various pelvic organs, including the bladder, prostate, rectum, and female reproductive organs. The muscles themselves are also involved in the functioning of the urinary and anal sphincters. When they are functioning normally, you are able to control your bowel and bladder movements by contracting and relaxing these muscles.
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.
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.
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.
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

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.


The therapist may do manual therapy or massage both externally and internally to stabilize your pelvis before using other kinds of treatment. Manual therapy takes time and patience, and may require one to three sessions per week, depending on the technique used and your response to treatment. You may feel worse initially. However, many patients see improvement after six to eight weeks.
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.
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.
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