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Is Your Lower Abdominal Pain Due to Pelvic Floor Dysfunction?

Four things men and women need to know about the common, but often-missed, condition

Mature woman with stomach pain.
SCIENCE PHOTO LIBRARY

If you’ve seen a doctor for constipation, pain during intercourse, or uncomfortable urination or incontinence, you may have been diagnosed with any number of lower-body disorders — vulvodynia, painful bladder syndrome or irritable bowel syndrome, to name a few. Meanwhile, an often-missed condition could be to blame.

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Pelvic floor dysfunction “is super common,” says Sangeeta Mahajan, M.D., head of the Division of Female Pelvic Medicine and Reconstructive Surgery at University Hospitals Cleveland Medical Center. The Mayo Clinic estimates that as many as 50 percent of people with chronic constipation have pelvic floor dysfunction. “It is also one of those things that are horribly underdiagnosed,” Mahajan says.

8 Warning Signs of Pelvic Floor Dysfunction

Pelvic floor dysfunction can cause a number of symptoms, including:

  • Needing to use the bathroom often, or stopping and starting many times when you go
  • Constipation
  • Straining hard to pass a bowel movement
  • Leaking stool or urine (incontinence)
  • Painful urination
  • Lower back pain with no other cause
  • Ongoing pain or discomfort in your pelvic region
  • Pain during sex (for women)

Source: Cleveland Clinic

The pelvic floor is a bowl of muscles that supports the bladder, the rectum and, in women, the uterus and the vagina. In men, it supports the prostate. When these muscles become too tight and are unable to relax, a number of symptoms can arise. Urine may leak out, or you may have trouble making a bowel movement. Sex can become painful for women, and lower back pain can ensue.

That’s because “the organs, the muscles and the nerves of the pelvic floor communicate with each other,” explains Darren Brenner, M.D., a gastroenterologist at Northwestern University Feinberg School of Medicine. And a problem in one area can easily affect another one nearby.

But with proper treatment — most often specialized physical therapy, but also acupuncture, meditation and even, in extreme cases, Botox — pelvic floor dysfunction can be a manageable condition.

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Here are four things to know about pelvic floor dysfunction, including how to tell if you might have it and how to treat it.

1. Men can suffer from pelvic floor dysfunction

While it’s often associated with women (largely because pregnancy is a common cause), men can suffer from pelvic floor dysfunction, too. Globally, millions do each year, the Cleveland Clinic says.

Some men might have pain in their penis or hesitancy with urination, says Carrie Pagliano, a pelvic health physical therapist in Arlington, Virginia. Other times, it might present as testicular pain, explains Alicia Jeffrey-Thomas, a Boston-based physical therapist with a TikTok account that often addresses pelvic floor issues.

“The tendency will be to look only at the testicles, when really, a lot of times it is referred pain from the muscles themselves,” she says.

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Any treatment for male pelvic floor issues should begin with a prostate exam to rule out other issues like prostate cancer, Pagliano adds.

2. Pain during intercourse is a common symptom

While pelvic floor dysfunction can cause an array of symptoms, “the biggest tip-off for me, is [women having] pain with intercourse,” Mahajan says. Other typical symptoms include a feeling of pelvic pain or pressure, pain as urination finishes or pain with a pelvic exam, she adds.

Constipation can also be misdiagnosed. “I see patients all the time going, ‘Obviously, I have irritable bowel syndrome, and I’m not responding to any other therapies,’ ” Brenner says. “And I say, ‘Maybe it isn’t just irritable bowel syndrome. Maybe the muscles in your pelvic floor don’t work.’ ”

Incontinence — peeing when you laugh or sneeze, or having to race to the bathroom so you don’t leak in your underwear — can be another sign of pelvic floor issues, said Erin T. Carey, M.D., a gynecologist who specializes in pelvic floor disorders at the University of North Carolina School of Medicine.

Many physicians, though, are not used to checking pelvic floor muscles during a pelvic exam, so they will miss the reason for the pain or discomfort. “They’ll just think that [patients are] being overly reactionary,” Mahajan says.

If you ask your physician to do a pelvic floor muscle exam, they should be able to assess your muscle tone by pushing with their fingers on the muscles of the vagina, Carey says. For men, the exam would involve the rectum. “Even a good amount of pressure should not be painful,” Carey says.

3. Treating yourself could make things worse

Do not try to treat pelvic floor dysfunction yourself, says Jeffrey-Thomas. You could, for example, end up strengthening muscles that are already tight by trying to treat incontinence with Kegel exercises.

“For some people, Kegel exercises can be helpful in terms of building coordination and awareness and strength, but in some people that can make the problem worse,” she says.

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Also, don’t buy a vaginal wand or other type of over-the-counter object without direction from a physical therapist, Carey says. It could potentially exacerbate your problem.

Your best bet is to find a physical therapist who specializes in pelvic health. The American Physical Therapy Association has an online locator where you can find someone near you. Even if you can only afford one or two appointments, it’s worth it, Carey says. “You want to make sure you’re doing the exercises correctly,” she adds.

Other treatments include meditation, yoga, “any kind of relaxation where [patients are] unclenching their pelvic floor muscles,” Mahajan says. Some of her patients do acupuncture for their pelvic floor; some are given muscle relaxants. For extreme cases, there are Botox injections, she says.

4. Pelvic floor dysfunction is often a result of trauma

Wondering how you ended up with this condition? Pelvic floor dysfunction is often the result of trauma — physical trauma to the muscles, or emotional trauma, often from childhood.

It’s not uncommon for women to develop pelvic floor dysfunction following childbirth, Carey says. Other physical causes include pelvic floor surgery, chronic constipation (constant pushing can create pelvic floor issues, which can then make the constipation worse), injuries to the pelvic floor area (such as from a car accident), obesity and aging. The condition can also be hereditary.

Brenner, the gastroenterologist, said when a patient comes in complaining of constipation and he suspects pelvic floor dysfunction, he asks about trauma. If pelvic floor muscles are clenching due to subconscious, emotional reactions, patients also need to do specialized clinical therapy, he says. “If you have a history of trauma or abuse and you don’t address that trauma or abuse, the pelvic floor physical therapy is invariably ineffective,” he explains.

Pelvic Floor Disorder vs. Dysfunction

Both conditions are common, both affect the pelvic area, and both have similar symptoms and causes. But pelvic floor disorders are different from pelvic floor dysfunction. A pelvic floor disorder, like pelvic organ prolapse, occurs when the muscles or connective tissues of the pelvic area weaken or are injured. Pelvic floor dysfunction is a result of tight muscles that won’t relax. The good news: Both can be treated once diagnosed.

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