Most people really don’t want to talk about “down there,” even with their healthcare professional. Let's face it — issues with urination and sexual dysfunction often feel embarrassing.

Pelvic floor dysfunction often results in leaking urine. It can also cause problems in our sex lives. It's a condition that often contributes to, and is linked to, acute and chronic low back pain, as well. These problems make us feel physically uncomfortable at best, and deeply ashamed at worst.

Did you know that 10 million individuals in the US have urinary incontinence?

It's really not that weird, and definitely not shameful! Neither is having sexual difficulties from pelvic floor dysfunction. Sometimes it's just a part of life we need to deal with. Pelvic pain and spasms, or urinating without intention during sneezing or coughing aren't a life sentence. Therapeutic interventions like chiropractic can really help.

What causes pelvic floor dysfunction?

Pelvic floor weakness, spasm, and/or pain has a few causes. It can result from childbirth, trauma to your coccyx (tailbone), or neurologic dysfunction.

The pudendal nerve controls the parasympathetic innervation of the bladder, as well as muscles of the pelvic floor. Pudendal neuralgia is long-term pelvic pain that originates from damage or irritation of the pudendal nerve. Damage to this nerve can result in referred low back pain, sexual dysfunction, and urinary incontinence.

You’re more likely to get relief when you share your pelvic pain with us.

I treated a female patient in her early 40s. This patient had no children and no childbirth experience. She officially saw me for non-specific low back pain, but confided in me that she has experienced pelvic pain and spasms every day for the last 10 years.

She tearfully confided that she and her husband were no longer able to have sex because it was so painful for her. After some questioning, I learned that she had taken a significant fall on her tailbone in her teens. I could feel her tailbone significantly tucked inside her pelvic cavity as a result of her fall. No wonder she had such severe pain!

I performed a sacrotuberous ligament release. I also performed gentle Activator adjustments on her coccyx and sacrum. Then we worked on the surrounding musculature that I could reach externally — including the coccygeus muscle and piriformis muscle. Next, I referred her to a pelvic floor PT trained in internal release to further decrease her pelvic floor spasm and pain.

I was so glad she confided in me! We are here to help our patients get out of physical and emotional pain, and I was so glad to help this patient feel better.

What are the symptoms of pelvic floor dysfunction?

Pelvic floor dysfunction can show up in many different ways:

• Pain with urination
• Difficulty urinating
• A feeling of incomplete voiding during peeing or pooping
• Urinating without intention during sneezing, coughing, etc.
• Pain with sex
• Inability to reach orgasm
• Low back pain that isn’t responding to adjustments of the lumbar spine

If you’re experiencing any of these symptoms, please don’t be too shy to see us for your pain and discomfort. Make an appointment online so we can help you determine the cause and get you the treatment you need.

How does chiropractic help with pelvic floor dysfunction?

How do we diagnose pelvic floor dysfunction?

We consider your age, gender, life history and lifestyle. We also consider how your pain presents, and your related symptoms.

If one of your symptoms is incontinence, it could be due to:

• pelvic floor weakness (called stress incontinence)
• issues with the prostate (Benign Prostatic Hypertrophy or BPH)
• urinary tract infections
• a medical emergency such as Cauda Equina Syndrome

If your incontinence is due to a weak pelvic floor, we as chiropractors may be able to help. If it’s due to prostate growth or infection, we cannot help, and would refer you to a urologist.

We may also refer our patients to a pelvic floor physical therapist for added support and care.

A word from Dr. Goldi on post-childbirth care with a pelvic floor physical therapist:

“It’s my opinion that every woman after childbirth should have a consultation and treatment with a pelvic floor PT. It’s that important! 

"I started seeing a pelvic floor PT when I was 14 years postpartum. I was experiencing chronic low back pain, as well as other more embarrassing symptoms I’ll keep to myself, and found significant relief with this treatment. If you are suffering from any of this, just know, it’s not too late to get help!”

How does chiropractic treat pelvic floor dysfunction?

We perform chiropractic adjustments of the sacrum to affect the pudendal nerve, which is composed of spinal nerves S2, S3, and S4.

By restoring neurologic function to the pudendal nerve, we help your brain communicate with the pelvic floor to return to homeostasis.

We may also adjust the tailbone or coccyx. This action will aid in:

• decreased pain in your pelvic floor
• decreased low back pain
• increased comfort with sex
• better urination control
• activation of your parasympathetic nervous system for more relaxation and calm

How many chiropractic visits do you need for pelvic floor dysfunction?

We’ll likely suggest a trial of 8 chiropractic visits done at the same time as pelvic floor physical therapy. We'll then re-exam to check your progress. Most patients see improvement well before 8 visits.

Can massage help with pelvic floor dysfunction?

A massage therapist can help with your overall stress and tension. When you’re going through such a difficult condition, added relaxation can be beneficial to your treatment plan. We can discuss massage with you as we discuss your best treatment approach.

What is the best self-care for pelvic floor dysfunction?

If you have weakness, Kegel exercises strengthen a weak pelvic floor.

How to do Kegel Exercises:

• Empty your bladder
• Sit or lie down
• Tighten your pelvic floor muscles and count 3-5 seconds
• Relax and count 3-5 seconds
• Repeat 10 times, 3 times a day

How do you know if you're using the right muscles when you do Kegels?

“Envision you have a straw in your vagina, and you’re trying to pull fluid up through the straw,” suggests Dr. Levin of Penn Medicine.

If you have pain and spasms, pelvic wands aid in self-release.

Researchers from Stanford University School of Medicine in California did a study on pelvic wand use. They found that even when chronic pelvic pain wasn’t responding to standard therapies, pelvic wands offered a marked improvement. The results were positive for both men and women. 

Detailed information on how and why a pelvic wand works can be found at this link. 

If you’re curious about getting and using a pelvic wand, this blog post by Intimate Rose has some very valuable information. 

Reminder: Females should be sure to schedule annual pelvic exams with an OBGYN, Nurse Midwife, or other relevant healthcare provider.

A final word on pelvic dysfunction.

Remember: low back pain, urinary incontinence and/or pelvic pain that disrupts your sex life are most likely treatable with the right team. Put your embarrassment aside, and come see us. We’ll help you get back to confidence and enjoying your life more fully.