The pelvic floor is a group of muscles that have a role in urinary, flatal, and fecal continence as well as help to support the organs of sexual function (1). These muscles work with the diaphragm to help control intra-abdominal pressure.  Pelvic floor dysfunction is when your pelvic floor muscles are unable to coordinate or relax properly in order for processes like urination or defecation to occur appropriately (2).  Pelvic floor dysfunction is common in female athletes with 19.1-76% of females participating in sports experiencing incontinence (3). Sports involving high impact activities like running and jumping cause increases in intra-abdominal pressure, which then will increase stress on the pelvic floor muscles.  When our pelvic floor muscles are weak, they are unable to retain urine once the excess stress is placed on them, thus causing urine leakage.  Other ways we can experience an increase in intra-abdominal pressure include things like coughing, sneezing, or laughing. 

Dyspareunia, or pain with intercourse, is also a common symptom of pelvic floor dysfunction. There are multiple causes for dyspareunia.  One potential cause for painful intercourse is the inability for pelvic floor muscles to relax during intercourse.  Through various relaxation exercises, it is possible to train your muscles to relax during intercourse.  Other potential causes for dyspareunia include endometriosis, pelvic inflammatory disease, scarring from gynecological surgeries such as hysterectomies or Cesarean sections, or episiotomy scarring (4). It is important to consult with your physical therapist or primary care provider to learn what may be causing your specific pain.  

Though there may be some discomfort, fear or embarrassment in talking about these subjects with your physical therapist, please know that there are ways to address these issues to help you live more comfortably.  

Written by Evie Tate, PT, DPT

Citation:

1 Fitzgerald CM, Hynes CK. Current Therapy in Pain.; 2009

2 Pelvic Floor Dysfunction: Symptoms, Causes & Treatment. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/14459-pelvic-floor-dysfunction. Accessed July 7, 2020.

3 Teixeira, R.V., Colla, C., Sbruzzi, G. et al. Prevalence of urinary incontinence in female athletes: a systematic review with meta-analysis. Int Urogynecol J 29, 1717–1725 (2018).

4 Wurn LJ, Wurn BF, King CR, Roscow AS, Scharf ES, Shuster JJ. Increasing orgasm and decreasing dyspareunia by a manual physical therapy technique. MedGenMed. 2004;6(4):47. Published 2004 Dec 14.