What Is Pelvic Floor Dysfunction?

Pelvic floor dysfunction is a broad term used to describe when the pelvic floor muscles are not working in a coordinated, functional way.

This does not always mean weakness.

A pelvic floor can be:

• Too weak

• Too tight or overactive

• Poorly coordinated

• Delayed in its response

• Unable to relax fully

Many people have a combination of the above.

Pelvic floor dysfunction affects people of all genders and ages, and is especially common:

• After pregnancy or birth

• During menopause

• With chronic pain conditions

• With bladder, bowel or sexual symptoms

What Does the Pelvic Floor Actually Do?

The pelvic floor is a group of muscles, connective tissue and nerves that form a supportive base inside the pelvis.

Its roles include:

• Supporting the bladder, bowel and (in women) uterus

• Maintaining continence (bladder and bowel control)

• Allowing emptying of the bladder and bowels

• Contributing to sexual function

• Working with breathing, posture and the diaphragm

For these roles to occur, the pelvic floor must be able to both contract and relax.

Strength alone is not enough.

Common Symptoms of Pelvic Floor Dysfunction

Pelvic floor dysfunction can present in many different ways.

Bladder‑related symptoms

• Urinary leakage (with coughing, sneezing, exercise or urgency)

• Needing to rush to the toilet

• Difficulty starting the flow of urine

• Incomplete emptying

• Frequent urination

Bowel‑related symptoms

• Constipation or straining

• Incomplete emptying

• Faecal leakage or staining

• Difficulty controlling gas

Pain‑related symptoms

• Pain with intercourse

• Pelvic, vulval or vaginal pain

• Tailbone pain

• Pain with tampon use or internal exams

Support‑related symptoms

• Sensation of heaviness, bulging or pressure

• Symptoms that worsen later in the day or with fatigue

Not everyone experiences all symptoms, and symptoms can change over time.

Can the Pelvic Floor Be Tight and Weak?

Yes — and this is one of the most misunderstood aspects of pelvic health.

A pelvic floor can be:

• Tight at rest

• Fatigued or weak with activity

• Poorly coordinated

In these cases, strengthening alone may worsen symptoms.

This is why blanket advice such as “just do your Kegels” is not always appropriate.

What Causes Pelvic Floor Dysfunction?

Pelvic floor dysfunction rarely has a single cause.

Common contributing factors include:

• Pregnancy and birth (vaginal or caesarean)

• Hormonal changes (including menopause)

• Chronic holding of bladder or bowels

• Recurrent urinary tract infections

• Pelvic surgery

• Pain conditions or trauma

• High‑intensity exercise without adequate recovery

• Stress and nervous system overload

How Is Pelvic Floor Dysfunction Assessed?

Pelvic floor dysfunction is best assessed individually.

Assessment may include:

• A detailed symptom history

• Bladder or bowel diaries

• Posture, breathing and movement assessment

• External pelvic floor observation

• Internal pelvic floor assessment (with consent)

• Ultrasound or biofeedback (where appropriate)

Not all assessments are internal, and alternatives can be discussed.

Assessment allows the clinician to determine:

• Tone (tight vs lax)

• Strength

• Endurance

• Coordination

• Ability to relax

This information guides safe and effective treatment.

Evidence‑Based Management Options

Management depends entirely on the type of dysfunction present.

Common approaches include:

• Pelvic floor muscle training (where appropriate)

• Pelvic floor relaxation and down‑training

• Breathing and nervous system regulation

• Bladder and bowel retraining strategies

• Manual therapy

• Education and lifestyle modification

No single approach is suitable for everyone.

Where Do Pelvic Floor Tools and Devices Fit?

Pelvic floor tools can be useful when used appropriately and in the right context.

They are not a replacement for assessment or treatment, but may support specific goals.

Examples include:

• Pelvic floor weights (for confirmed weakness)

• Pelvic wands (for pelvic floor tension or pain)

• Dilators (to reduce/maintain muscle relaxation and retrain pain with penetration) 

• Toilet stools and bidets (to support bowel health and emptying)

Each tool has specific indications and contraindications.

They are not suitable for everyone.

(For a full breakdown, see: Pelvic Floor Tools & Devices – What Helps, What Doesn’t, and For Who)

This information is not intended to:

• Replace individual assessment

• Diagnose medical conditions

• Suggest that one approach suits everyone

If symptoms are severe, worsening, or associated with pain, bleeding, neurological symptoms, or sudden changes, medical review is recommended.

 

Frequently Asked Questions

Do I need to do Kegels if I have pelvic floor symptoms?

Not always. Some people benefit from strengthening, while others require relaxation, coordination or different strategies entirely.

Can pelvic floor exercises make things worse?

Yes — if exercises are not appropriate for your presentation, symptoms may worsen.

Is pelvic floor dysfunction permanent?

In many cases, symptoms can be significantly improved with appropriate care.