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Pelvic Floor Dysfunction, Part 1

A physical therapist gives an overview.

When you think of physical fitness, how much consideration do you give to keeping your pelvic floor in shape? If you’re like most people, probably none, unless something has gone wrong with it. Or maybe you didn’t realize there was anything you could do for the problems pelvic floor dysfunction can cause. These include incontinence, constipation, chronic urinary tract infections, nerve pain so severe that makes it impossible to sit, constipation and hip or back pain. Pelvic floor problems can also lead to painful intercourse and erectile dysfunction.

What is the pelvic floor? The pelvic floor refers to muscles, soft tissue and ligaments that act like a hammock, supporting the internal organs above. As people age, if they do nothing to keep the pelvic floor strong, muscles can atrophy and this can lead to various problems with the bladder, bowel and sexual function.

Dustienne Miller, MSPT, who works at Beyond Basics Physical Therapy in New York City, specializes in helping people who have problems with their pelvic floor. Here is an overview of some of them.

Urinary Incontinence

Urinary incontinence comes in many forms: Stress, urge or over-activity of the bladder. [Editor’s note: Urinary problems and what to do about them will be covered in detail in Part 2 of this series.]

Interstitial Cystitis

Interstitial cystitis, also known as “painful bladder syndrome,” refers to pain above the pubic bone, vaginal pain and nocturia (urinary frequency at night). This condition is usually triggered by a urinary tract infection.


There’s a big link between pelvic pain and constipation. For one thing, the pelvic floor muscles can become so constricted they don’t make the normal excursion to have a complete bowel movement. There can be pain during or after bowel movements as well.

Low Back or Hip Pain

Sometimes tight pelvic floor muscles lead to hip and low back pain, because they pull on connecting muscles further away.

Nerve Pain (Pudendal Neuralgia)

The pudendal nerve is a major source of pelvic pain. Branches of this nerve nourish the penis and clitoris. Cycling injuries, childbirth and chronic infections can lead to inflammation of this nerve.

Prostate Problems

Men with prostatitis can experience difficult urination or pelvic pain. Men can also encounter other problems after prostate surgery that can be addressed through physical therapy.


How Physical Therapy Can Help

It is definitely worth pursuing physical therapy for pelvic pain because it addresses the problem holistically through massage and exercise and can reduce or eradicate the need for drugs and adult diapers. A physical therapist can also help you train your bladder and bowels to function optimally. This training can lead to better sleep because you won’t need to get up to urinate as often. Physical therapists can also show you exercises to reduce pain from muscle imbalances and give you valuable coping advice. Clinicians trained to treat pelvic floor dysfunction can be highly skilled and they can help you with a great deal of compassionate understanding. For more information and finding a physical therapist qualified to treat the pelvic floor, visit: