Why Do I Have a Pelvic Floor Issue?

How does one develop pelvic floor dysfunction?

Well, really, there are a lot of variables and the reason is different for every body so I’m going to hit the big ones.

1.  Anatomic Predisposition – Sometimes you are born with your bones, ligaments, muscles connected in such a way that you are primed to appreciate a dysfunction.  I use the word “appreciate” because it sounds sophisticated, but I am sure you don’t “appreciate” dysfunction like you “appreciate” a glass of wine.  This doesn’t mean that you will inevitably develop a dysfunction, it just means that if you should have a fall or have a job that requires that you sit for a really, really long time every day, then you probably could end up with a pelvic floor issue.  However, if you are lucky enough to avoid anything that could provoke an issue for you, then you could get off scott free.

2.  Infection – Infections are basically an assault on your body.  They are an insult that your body responds to by trying to fight off the culprit and in response your muscles and fascia will likely tense up to protect your most vital parts.  I’m saying that if you have a urinary tract infection, yeast infection, fungal infection, prostate infection, sexually transmitted disease, etc. then your pelvic floor muscles, your abdominal muscles, your inner thigh muscles – they all want to protect your genital area.  They’re saying “Hey, if these reproductive parts get attacked – we can’t reproduce.”  It doesn’t matter how old you are or what sex you are or if you even want to reproduce.  This is how our bodies respond in the most primitive way.  So, if you are unlucky enough to have several infections in a row or unlucky enough to be misdiagnosed or inappropriately diagnosed, then your muscles and fascia really over did themselves in trying to protect you.  Not to mention the pelvic inflammation these infections likely caused.  When you go through a period of time with an overactive pelvic floor, then you are going to need help relaxing the pelvic floor.  It’s not going to happen all by itself now.  It used to happen all by itself, but now your pelvic floor just doesn’t trust you anymore.  As a result of this constant state of overactivity, you could feel pain, bladder symptoms, ano/rectal symptoms, urinary incontinence, fecal incontinence.  Some of these symptoms may feel like another infection, but if you actually get tested for an infection, the results may be negative.  It is so important for you to get properly tested every single time you think you have an infection.  If your doctor wants to write you a prescription for something without testing you first, please ask to come in and be tested.  If you do not have an infection, do not treat yourself.  You could be over-treating or mistreating yourself and this wreaks havoc on your pelvic floor.

3.  Trauma – Falling hard on your bottom could be enough to start a pelvic floor dysfunction, especially if you ignore any pain that you have.  What I typically see is that a patient will have a fall or a car accident and they’ll break their tailbone or just have tailbone pain.  The doctor will say there is really nothing to be done about this pain and with time it will go away.  Well, yes and no.  The tailbone will heal on it’s own if it’s broken, but that doesn’t mean it will always stop hurting on it’s own.  When you insult the tailbone, (I use insult also because it’s really a fun word – like our bones are people and need to be respected – it’s true, they deserve respect!) I digress, when you insult the tailbone, you also insult the muscles attaching to the tailbone.  For example, the coccygeus muscle.  These muscles are going to respond just as I mentioned in the section about infections.  They are going to spasm and become overactive in an attempt to protect you.  But, with chronic pain, they don’t always learn to calm down and this could mean that the coccygeus will shorten and since it’s attached to the tailbone, it’s going to pull the tailbone along with it.  Think of it like a dog and it’s walker.  The coccygeus is the dog and it’s determined to chase a squirrel.  The tailbone is the owner walking the dog, but because of this strong force, it’s pulled very strongly into whatever direction the dog wants to go, ie. the tailbone can be pulled excessively forward or to the left or the right or even excessively forward and left or right.  If you experience this for long enough, you are going to start to experience a host of other pelvic pain symptoms. That could look like sitting pain, pain with sitting to standing transitions, back pain, hip pain and constipation.

Trauma can also irritate a very special nerve in the pelvic floor – the pudendal nerve. The pudendal nerve is like the Queen of England.  It controls almost everything in the pelvic floor.  It’s responsible for motor and sensory functions.  This means that it has a large role in controlling whether you can squeeze or relax your muscles and it controls how little or how much you feel – this can even mean you feel way, way too much and you won’t “appreciate” that, trust me.  With trauma, the nerve can be stretched, or as a result of overactivity of the pelvic floor muscles, the nerve can basically be pinched between the muscles and/or ligaments.  From this you could get pain, itching, symptoms of infections, bladder symptoms, ano/rectal symptoms, incontinence, constipation and a host of other issues.

4.  Surgery and Procedures – Surgery is technically an insult, right?  It does traumatize the surrounding musculature and creates inflammation.  But, I believe it deserves it’s own section because, unfortunately, some people go into a urological or gynecological surgery feeling fine and wake up with pelvic pain.  Sure, some degree of pelvic pain is expected after a pelvic surgery, but when you wake up with extreme pain that is unrelenting and ignores all the pain medications you are taking, then something is wrong and this needs to be addressed immediately.  Your doctor may examine you and say that everything looks fine, so this can be very confusing.  Trust your gut.  If you should be feeling better and you are not, you need to further investigate what’s going on.  This can happen after a hysterectomy, mesh placement, biopsy, colposcopy, pap smear, etc.  If something gets nicked or stretched or trapped, it’s very possible to develop a pelvic floor dysfunction.

5.  Varicosities – A varicosity is when the blood vessels become too lax and they aren’t supporting just one way movement of your blood flow.  Your veins have a valve in them to basically stop backwards movement, called reflux.  Both men and women can have varicosities in their pelvis.  The excessive width of the veins and the retirement of the valves in the veins can create quite a large vein and that vein can put pressure on parts of your pelvis, even possibly on some nerves and the bladder, and this can be uncomfortable.  Typically, if this is an issue for you, you might even have some leg discomfort, you might feel worse at the end of the day, you might feel better lying down, if you’re a female you might have painful periods or painful sex.  This issue can be addressed by an interventional radiologist.