Understanding pelvic pain and pelvic floor dysfunction

Apr 1, 2024
Key Takeaways
  • Your pelvic floor muscles, which sit at the bottom of your pelvis, play an essential role. The muscles help with urination, defecation, sexual function, and support internal organs.
  • 90% of women who experience severe menstrual pain have Pelvic Floor Dysfunction (PFD), or tightness in their pelvic floor muscles. PFD can lead to more chronic pelvic pain, pain and other issues with intercourse, and difficulty with daily activities. 
  • Addressing PFD through pelvic floor physical therapy can reduce menstrual pain by up to 70%. Pelvic floor physical therapy usually consists of learning how to connect with and relax your pelvic floor muscles with breathing and some stretching exercises.

Approximately 90% of women who encounter intense menstrual pain are found to have a condition known as Pelvic Floor Dysfunction (PFD), characterized by tightness in the pelvic floor muscles. This tightness can result in pelvic pain, discomfort during intercourse, and challenges in performing daily activities. 

It is possible to alleviate menstrual pain by as much as 70% and improve your quality of life by learning how to relax the pelvic floor muscles. Pelvic floor physical therapy typically involves a series of exercises aimed at stretching the pelvic floor muscles to release tension. Understanding the pelvic floor is the initial step toward addressing and managing PFD effectively.

Understanding pelvic floor muscles

Your pelvic floor muscles are found at the bottom of your pelvis. They stretch across your pelvis (hip bone to hip bone, and pubic bone to tail bone) like a bowl.  When you sit, you are sitting on your pelvic floor. These muscles have a lot of important functions you might not know about: they allow you to control when you urinate and defecate, contract during orgasm, and support your internal organs.

How to find your pelvic floor

Since you can’t see these muscles, you might find it a bit difficult to “feel” your pelvic floor at first. It is important to “find” and understand your pelvic floor muscles, as doing so can have an immense impact on your pain management and quality of life. 

Some exercises can help bring awareness to these muscles. These exercises ask you to contract and relax your pelvic floor muscles, usually called a “kegel." This is critical to the ability to do pelvic floor physical therapy exercises, but daily kegels are not important for everyone. 

Here are a few simple exercises to help you “find” your pelvic floor:

  1. Imagine picking up a blueberry with your vagina
  2. Imagine you have to pee really badly – flex your muscles like you’re trying to hold your urine
  3. Imagine you have to pass gas and want to hold it in 
  4. Imagine you are pulling a handkerchief with your vagina toward your head

Now that you have “found” your pelvic floor muscles, learning how to relax them is important. Given that tightness in these muscles can cause pelvic pain, learning relaxation techniques will be helpful to reduce your symptoms. 

What is pelvic floor dysfunction?

Since the pelvic floor is responsible for several functions, the term “pelvic floor dysfunction” generally refers to the fact that the muscles of your pelvic floor aren’t working properly. Symptoms vary but can include pain or discomfort during intercourse, and pain in the hips, lower back, lower abdomen, or genitals. Muscles that are too lax can contribute to leaking urine (incontinence).

Women with long-term pelvic or menstrual pain have probably experienced some degree of pelvic floor dysfunction, probably because of muscle spasms. Your pelvic floor muscles react to pain by becoming tight and overactive.

Pelvic tightness and pain

Think of how you clench or grind your teeth when you get stung by a bee or touch a hot stove.  Now think about doing that constantly, day after day.  Not only would you have a costly dental bill, but your jaw would get tight and sore - that’s exactly what’s going on with your pelvic muscles.

If you’re in enough recurring pain, your pelvic floor muscles enter a state of permanent “spasm,” or continuous contraction. This permanent contraction can increase your pain levels and compress your nerves. If you have pelvic floor dysfunction, you might feel a stinging, burning, or stabbing pain, and that pain can occur at any time (even when you’re not on your period). 

Pelvic floor physical therapy can help reduce pain by teaching you exercises that help you relax the pelvic floor muscles, gradually loosening that constant contraction in your pelvic floor. It takes time and practice, but it’s worth it.

How pelvic floor physical therapy helps 

Your pelvic floor muscles are no different than your back muscles. Therefore, you can address this pain and tightness by helping your muscles relax through stretching and breathing techniques, just like stretching your back can help with back pain.

Pelvic floor physical therapy is recommended for individuals who have pelvic floor dysfunction. This type of physical therapy might include: 

  • pelvic floor exercises
  • manual therapy, which includes assisted stretching
  • electrical stimulation, to promote pain relief or muscle contraction
  • or vaginal dilators, tube-shaped, plastic devices that can help individuals learn how to relax their pelvic muscles

For those who utilize it, physical therapy has been shown to reduce menstrual pain by up to 70%. Pelvic floor physical therapy can improve other symptoms, too. For example, it can help reduce pain during intercourse, improve bladder problems, and minimize abdominal symptoms like excess bloating. [1,2]

Most importantly, know that your pain is valid, your experiences are shared, and you don’t have to be alone on your journey. Visana clinicians are specially trained to diagnose, treat, and manage a wide range of women's health conditions, including chronic pelvic pain, endometriosis, PCOS, painful periods, heavy menstrual bleeding, and more.  

Nurture your body with patience and practice. Together, we can strive towards a life where pelvic pain no longer defines your days. To begin your path to healing, reach out to us and discover the personalized care that awaits you. 

  1.  “EAU Guidelines: Chronic Pelvic Pain.” Uroweb, 2014, uroweb.org/guideline/chronic-pelvic-pain/
  2. Ortiz, Mario I., et al. “Effect of a Physiotherapy Program in Women with Primary Dysmenorrhea.” European Journal of Obstetrics & Gynecology and Reproductive Biology, vol. 194, 2015, pp. 24–29.
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