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Pelvic Floor Dysfunction
The pelvic floor supports bladder, bowel, sexual function, and posture. We look at tension and strength, breathing, pressure management, the nervous system, hormones, and fascia.
What you may be noticing
Leaking when you cough, laugh, or jump. Urgency that sends you rushing to the bathroom. A heavy, dragging sensation in the pelvis. Pain with intercourse, tampon use, or sitting. Constipation or difficulty fully emptying. Low back, hip, or tailbone pain that lingers. After a pregnancy, a midline bulge or doming of the abdomen when you sit up.
New pelvic pain with fever, bleeding, or urinary retention, or loss of bladder or bowel control with back pain or saddle numbness, needs urgent medical care. A painful mass, a bulge, or persistent scar pain after cesarean deserves prompt evaluation.
Why it is rarely one thing
The pelvic floor is a group of muscles forming the base of the core. With every breath, it moves in partnership with the diaphragm, rising and lowering together, while the deep abdominal muscles and the multifidus manage pressure, support the organs, and coordinate bladder, bowel, and sexual function.
Pelvic floor dysfunction can mean muscles that are weak, muscles that hold too much tension, or muscles that do not coordinate well. Pregnancy and birth, menopause, chronic constipation, heavy lifting, high-impact exercise, chronic stress, and trauma are common contributors. Hypermobility affects connective tissue support. Falling estrogen thins pelvic tissues. Trigger points in the obturator internus, adductors, glutes, hip flexors, abdominal wall, and the fascia of the low back often refer pain into the pelvis.
The nervous system is central. The pelvic floor responds to threat, and a nervous system in protection mode can hold it tight, creating pain and urgency. Sexual function, too, depends on clear communication among the brain, spinal cord, pudendal and autonomic nerves, circulation, and a felt sense of safety. Painful sex is common, and it is never something you simply have to accept. Strengthening alone may worsen a tight pelvic floor, which is why assessment comes first.
Patterns we look for
- Breathing mechanics, rib mobility, and diaphragm coordination.
- Posture, core pressure management, and abdominal doming or coning.
- Strength, endurance, tension, and relaxation capacity of the pelvic floor.
- Trigger points through the hips, abdomen, and low back.
- Constipation and bowel habits.
- Estrogen status and menopause.
- Hypermobility and connective tissue.
- Birth history, scars, and trauma.
- Chronic stress, anxiety, and pain sensitization.
How I evaluate it
The comprehensive functional neurological exam assesses breathing mechanics, rib mobility, posture, core coordination, sensation in the pelvis and lower limbs, reflexes, and autonomic balance. I coordinate internal pelvic floor assessment with a pelvic floor physical therapist, including tone, tenderness, strength, endurance, coordination, relaxation, and trigger point mapping.
Functional labs may include sex hormones, vitamin D, magnesium, a thyroid panel, and markers of inflammation and blood sugar as indicated. A bladder and bowel diary adds detail. I coordinate with your gynecologist or urologist when prolapse or other structural concerns are present.
How we address it
- Coordinate with a pelvic floor physical therapist for internal assessment and treatment.
- Restore diaphragm and pelvic floor coordination with breathing that lets the pelvic floor soften and descend on the inhale.
- Strengthen or release, depending on what your pelvic floor needs.
- After pregnancy, rebuild the deep core in order, pressure management first, judging progress by function and midline tension rather than gap width alone.
- Release trigger points and fascial restrictions around the pelvis.
- Address constipation and bladder irritants.
- Support hormonal health with your physician, including local estrogen options in menopause.
- Calm the nervous system to release protective tension.
Your pelvic floor is part of your whole body and nervous system. It can rebuild strength and ease.
Book your Comprehensive Functional Medicine Eval/Neurological Exam today to discover what the contributing root causes are that are underlying your health concerns.