Keep Calm and Strengthen Your Core: Understanding Pelvic Floor Dysfunction
- Sital Bhargava DO, MS
- 2 hours ago
- 4 min read
Keep calm and strengthen your core.
Why?
Well, for a lot of reasons. But today we're going to talk about one that doesn't get nearly enough attention: pelvic floor dysfunction.
What Are Your Core Muscles?
When most people hear the word "core," they picture six-pack abs. Unfortunately, despite years of effort, my six-pack remains under construction—much like the expressways in Chicago (I’m looking at you, 294).
But your core is much more than abdominal muscles. It is a group of muscles that wrap around your torso and work together to provide stability, support, and movement.
Your core includes:
1. Transversus Abdominis
Think of this as the corset you never asked for. It wraps around your abdomen and helps prevent that stubborn lower belly "pooch."
2. Rectus Abdominis
The famous six-pack muscle. Some of us have one. Some of us have one hidden beneath several layers of snacks and life experiences.
3. Oblique Muscles
The muscles along the sides of your abdomen. They're responsible for rotation and side bending and are the reason I have a complicated relationship with side planks.
4. Paraspinal Muscles
These muscles run along your spine and literally support your backbone.
5. Diaphragm
Your primary breathing muscle sits beneath your lungs and moves up and down like a jellyfish, helping regulate pressure throughout your torso.
6. The Pelvic Floor
The often-forgotten member of the core muscle team—and today's topic.
What Is the Pelvic Floor?
The pelvic floor is a group of 14 muscles located at the bottom of your pelvis. These muscles support your bladder, rectum, and reproductive organs.
Imagine a hammock or sling stretching across the bottom of your pelvis. That supportive hammock is your pelvic floor.
When it's functioning well, you probably don't think about it.
When it's not, you'll know.
What Does the Pelvic Floor Do?
Honestly?
A better question might be: What doesn't it do?
Your pelvic floor helps:
Prevent urine leakage
Prevent stool leakage
Keep you from accidentally passing gas at socially inconvenient moments
Support your posture
Hold your pelvic organs in place
Support a growing fetus during pregnancy
Assist with vaginal delivery
Contribute to sexual sensation, vaginal contractions, and orgasm
No pressure, pelvic floor. Just carrying more than half the responsibilities of adulthood.
What Is Pelvic Floor Dysfunction?
Pelvic floor dysfunction (PFD) occurs when the pelvic floor muscles aren't functioning properly.
There are two main types:
Low-Tone Pelvic Floor Dysfunction
This occurs when the muscles are weak, stretched, or underactive.
Symptoms may include:
Urinary incontinence
Stool leakage
Pelvic organ prolapse
A feeling of heaviness or pressure in the pelvis
Reduced sexual sensation
High-Tone Pelvic Floor Dysfunction
This occurs when the muscles are overly tight, tense, or in spasm.
Symptoms may include:
Constipation
Frequent urination
Difficulty emptying the bladder
Pelvic pain
Painful sex
What Causes Pelvic Floor Dysfunction?
One major contributor during perimenopause and menopause is hormonal change.
As estrogen and testosterone levels decline, the body produces less collagen, elastin, and hyaluronic acid. These changes can reduce blood flow, decrease muscle strength, and affect tissue flexibility throughout the pelvic region.
But hormones aren't the only factor.
Other contributors include:
Chronic constipation
Endometriosis
Interstitial cystitis (bladder inflammation)
Chronic yeast infections
Hip and back injuries
Sacroiliac dysfunction (raising my hand here)
Repetitive straining
Aging-related muscle changes
And let's not forget childbirth. Those babies with giant heads and a determination to exit the world sunny-side up do not exactly leave the pelvic floor untouched.
How Is Pelvic Floor Dysfunction Treated?
Pelvic Floor Physical Therapy
If there is one takeaway from this article, it's this:
A skilled pelvic floor physical therapist is worth their weight in gold.
Physical therapy can help:
Strengthen weak muscles
Relax overactive muscles
Improve muscle coordination
Reduce pain
Address trigger points
Improve bladder and bowel control
Increase body awareness
And yes, Kegels may be involved.
But contrary to popular belief, not everyone needs more Kegels. Some women actually need to learn how to relax their pelvic floor muscles.
Muscle Relaxants
For women with high-tone pelvic floor dysfunction, muscle relaxants can sometimes help reduce muscle spasms and improve comfort during therapy.
Vaginal Dilators
Dilators may help gently stretch vaginal tissues and pelvic floor muscles when used alongside physical therapy.
Botox
That's right.
Botox doesn't just smooth wrinkles.
In some cases, it can be injected into pelvic floor muscles to help relieve chronic muscle spasm and pain associated with high-tone pelvic floor dysfunction.
The Bottom Line
For many women, pelvic floor dysfunction becomes one more thing added to the growing list of bodily surprises that arrive during perimenopause and menopause.
The leaking when you sneeze (Leak proof underwear is the investment I never knew I needed.)
The sudden urge to pee when you're three minutes from home (Leak proof underwear for the win again.)
The pelvic heaviness.
The painful sex.
The constipation that appears out of nowhere (Am I the only one with a 7pm Miralax alarm?)
These symptoms are common.
But they are not something you simply have to "live with."
The pelvic floor is just another group of muscles. And like every other muscle in the body, it can become weak, tight, injured, or dysfunctional.
The good news is that help exists.
So if you've been silently crossing your legs every time you cough, avoiding intimacy because it's uncomfortable, or wondering why your bladder suddenly seems to be running the show, know this:
You're not broken.
You're not alone.
And your pelvic floor might just be asking for a little attention.
And you deserve to give it that attention.