Painful sex. Urinary leakage. Constipation. Weak orgasms. What do these unpleasant experiences have in common?
They can all be symptoms of a pelvic floor dysfunction in women, says Sara Reardon, a pelvic floor physical therapist who has been in the field for nearly two decades. She is the author of Floored: A Woman's Guide to Pelvic Floor Health at Every Age and Stage, published in June.
The pelvic floor is a basket of muscles that sits at the bottom of your pelvis and has an important role, Reardon says. It supports organs like your bladder, bowels and reproductive system. It also works with your abdominal muscles to support your spine.
But for as much as we use our pelvic floor, "many of us don't know these muscles exist," she says. "Therefore, if a problem arises, [we don't know] how to evaluate it and get treatment for it."
One in three women will experience a pelvic floor disorder in her lifetime, according to research, including young women and postmenopausal women who have never given birth, Reardon says.
Pelvic floor physical therapy, such as certain exercises and stretches, can be an effective way to address some of these issues, she says. Studies have shown it can improve bowel and bladder control, make sex more enjoyable, decrease lower back pain and improve postpartum recovery.
Reardon talked to Life Kit about what people with vaginas should know about their pelvic floor and what to do if you have pelvic floor pain. This interview has been edited for length and clarity.
Here are some facts from the book that I think people might find surprising: Orgasms are pelvic floor muscle contractions.
Yes, those muscles are the ones that contract and relax during an orgasm, and so if you have a pelvic floor muscle issue, it could cause the inability to orgasm, pain with orgasms and weak orgasms.
Pushing out your pee is not great for you.
Yeah. Just say no to power peeing. You want to sit, relax and let it flow. Relaxing your pelvic floor allows your bladder, which is a muscle, to push the urine out, and that's really how you're supposed to pee. Sit instead of hovering, breathe and chill, and then your bladder muscle contracts.
Tense pelvic floor muscles can cause constipation.
Correct.
Let's talk about some of the symptoms that can indicate pelvic floor dysfunction. What are common signs you might have pelvic floor tension or tightness?
Your muscles have to relax fully to empty your bowels. If they're not relaxing because they're overly tight or tense, you can have straining with bowel movements, hemorrhoids, fissures, incomplete emptying and even feeling like your stools are really thin.
Tightness can also lead to having a hard time starting your urine stream. You may feel like your bladder isn't emptying completely.
Another common symptom is painful intercourse. It can feel like something can't enter the vagina. You may also feel that with inserting tampons or during pelvic examinations.
What can you do to prevent or address pelvic floor tension?
Watch your posture. A lot of us sit too much throughout the day. Vary your movements. If you are sitting, keep your feet flat or cross at the ankles. Also, unclench your butt.
Take some big, deep breaths throughout the day to soften your pelvic floor muscles; then work on stretching with a deep squat or yoga poses like child's pose or happy baby pose.
There are also devices you can use at home for internal massage to the muscles, such as a therapy wand or vaginal dilators to help relax the muscles internally.
The other sign of pelvic floor dysfunction is weakness. What does that look like in the body?
Some of the things we commonly see are urinary leakage when coughing, sneezing, running and jumping.
Another is pelvic organ prolapse, where the pelvic organs aren't as supported by that hammock of muscles as we'd like them to be, so they start to drop or push into the vaginal canal.
If you feel less sensation with intercourse or urinate during intercourse or orgasms, those can be other signs of weak pelvic floor muscles.
How can we strengthen our pelvic floor muscles?
Work on pelvic floor strengthening exercises. Do quick Kegel contractions and longer-hold five- or 10-second Kegel contractions in different positions and during exercises like lunges and squats.
Tighten those muscles before activities that cause leakage. I always say, "Kegel before you cough," or "Squeeze before you sneeze."
The biggest thing is to stop straining [when you go to the bathroom], because that can weaken your pelvic floor over time. For bowel movements, I recommend using a stool under your feet to put you in the squatting position [and make it easier to go].
If you are having these symptoms, what should you do?
In every state in the United States, you can access a pelvic floor therapist for an evaluation without a referral from a physician.
Your insurance may require [a referral], but you can at least have an evaluation, and they can tell you whether you have a pelvic floor muscle issue and connect you with a medical provider who can see you and/or write a prescription to continue treatment.
If you have common signs of infection of the urinary tract or the vagina, your first stop should be checking with a medical provider and getting things [like a urinary tract infection or a yeast infection] ruled out.
What should you look for in a pelvic floor physical therapist?
They should be trained and qualified to do a pelvic floor muscle internal assessment to evaluate the pelvic floor muscles. They should not just hook you up to devices like Kegel or electric stimulation machines.
The treatment should be a combination of exercise, manual therapy and education. They should also give you things at home to work on so you can do some self-treatment.
You want to look for somebody with training and compassion who is a really good listener. We're talking about vulnerable and intimate issues, and if you don't feel comfortable having these conversations and talking about your symptoms with your therapist, I would find a new therapist.
This story was edited by Malaka Gharib. The visual editor is Beck Harlan. We'd love to hear from you. Leave us a voicemail at 202-216-9823, or email us at LifeKit@npr.org.
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