The mystery of pelvic floor dysfunction.

There is not much focus on the pelvic floor muscles, even less on pelvic floor dysfunction in medical training in the US. That may seem surprising, but it is common.

I have had the privilege to be trained at some awesome institutions. I loved my medical school. My residency training was intense and taught me about bedside manner, evaluating women, operating, and managing pregnancies. It is hard for me to summarize everything I learned in one sentence – it was a lot. But, I didn’t really learn about the pelvic floor until my fellowship in Female Pelvic Medicine and Reconstructive Surgery. With our system’s lack of training and knowledge, these muscles aren’t routinely evaluated and examined. 

This is a problem. The pelvic floor muscles work closely with the bladder, the rectum, the vagina, and the related sphincters. These muscles can be too tight or too weak. And when there is pelvic muscle dysfunction, it can lead to many different symptoms.

 When there is pelvic muscle dysfunction, you can have:

• Urine leakage
• Trouble emptying your bladder
• The need to pee all the time
• Needing to pee and feeling like you will leak before you get there.
• Pain with peeing
• Feeling like you have a urinary tract infection
• Pain with intercourse that lasts for a while
• Movements like getting in a car can be painful.
• Riding a bike or horse may cause pain.
• Pelvic pain
• Pain with having a bowel movement
• Trouble having a bowel movement
• Pain and then relief with a bowel movement

You can have some of these symptoms or all of these symptoms. It all depends on where and how the muscles are impacted. While pelvic floor dysfunction may not be the COMPLETE answer to your symptoms, it is often part of the answer. 

A good pelvic floor physical therapist can help you reverse your muscle dysfunction. If you think you have some pelvic floor dysfunction and are having trouble getting an evaluation, many insurances don’t require a referral for PT. So you may be able to go directly to a pelvic floor physical therapist. You can use this PT finder (https://www.voicesforpfd.org/find-a-provider/) 

 Since many doctors don’t think about the pelvic floor, women often don’t get treated in a timely fashion. The Women’s Bladder Doctor is trying to normalize this issue by teaching women about pelvic floor problems, making it easier to have or start that conversation with their doctors.