Pelvic Floor Issues, Symptoms & Conditions: Your official cheat sheet

I would like to preface this with the understanding that if you roll into my office for a pelvic floor physio appointment and you don’t know the specific pelvic floor issues, symptoms or conditions you’re dealing with, or what specific anatomical names are - that is a complete NON-ISSUE.

What’s more important than knowing all the medical jargon, is describing your experiences, sensations, concerns and issues.

MY JOB is to explain what that means from a health perspective and develop a plan to fix it and achieve your goals. 

As far as this list goes, though… we are talking straightforward, jargon-free definitions of many pelvic floor issues, symptoms and conditions to help you understand what you’re dealing with.

I’ll keep updating this list over time - so bookmark this as your cheat sheet for all things pelvic.

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Without further ado, here is a non - exhaustive list of female pelvic floor issues, symptoms & conditions. 

• Anal fissures

  • Small crack or tear on the tissues that line the anal canal or on the anus - butthole- itself

  • Can cause bleeding and pain with pooping

• Anismus or dyssynergic defecation

  • Functional pooping disorder

  • When muscles and / or nerves in pelvic floor fail to coordinate to allow a bowel movement aka your butthole isn’t co-operating for pooping purposes 

  • Can happen with chronic constipation as well

• Anodyspareunia

  • Pain with anal sex

• Coccydynia

  • Tailbone pain 

  • Pain at base of spine can be felt with sitting and leaning back 

• Diastasis Recti or Abdominal Separation

  Partial or complete separation of your 6 pack muscles (rectus abdominus).

  Can result from needing to make room for baby in pregnancy. Often will close on it's own but when it doesn't it's referred to as DR.

  Think of it as an "undone zipper" at the front of your abdominal wall.

• Dyspareunia

  • Genital pain that can be experienced before, during, or after sex

• Fecal incontinence

  • Aka bowel leakage, leaking poop, poop coming out with cough, sneeze or lifting something heavy

  • Can be presented as skid marks in your unders or worse

• Hemorrhoids

  • Aka piles, are swollen veins in the anus and lower rectum

  • Similar to varicose veins and can be either internal or external and can cause pain or bleeding with bowel movements

• Interstitial cystitis

  • A chronic condition causing bladder pressure, bladder pain and sometimes pelvic pain

  • Inflamed bladder wall that can cause scarring - reduces volume of urine you’re able to hold over time as the bladder can’t stretch out as it did before

• Levator ani syndrome

  • Aka chronic pelvic pain syndrome where the pelvic floor muscles are chronically contracted causing pain and dysfunction sometimes lasting briefly or up to days in duration

• Lichen sclerosus

  • Rare skin disease that can cause white, wrinkled, patchy thin skinned areas on genitals

  • Can be prone to injury and tearing and itching

• Nocturia

  • Getting up to pee too often in the night 

    Norms for menopausal women and pregnant women is <1 time per night, otherwise, 0 times per night 

• Overactive bladder

  • Can be referred to as having a “small bladder”

  • Similar to urinary urgency but also with an increased frequency of emptying bladder

  • Norms for pee breaks per day (in a 24 hr period) are 5-8 or every 2-3 hours- more than that may indicate overactive bladder, especially if it comes with strong urge

• Painful orgasm or masturbation

  • Pretty self explanatory

  • Pain either with manual self pleasuring or with a vibrator

  • Pain can be during the entirety, one part or during climax or orgasm

• Pelvic floor muscle dysfunction

  • Can refer to a variety of conditions that affect sex life, leaking pee, athletic performance, core weakness, any kind of pain in the back, hips, abdomen, genitals, anus or pelvis. 

  • Muscles can either be uncoordinated, weak, too tight / holding tension or a combination of those

• Pelvic organ prolapse

  • When one of your pelvic organs droops down from original position and can put pressure on the vaginal wall or in the vagina itself

    Types: 

    • Apical prolapse: after hysterectomy, top of vagina moves down into vaginal canal

    • Uterine prolapse: uterus slips down into vagina and you can usually see the cervix close to the vaginal entrance

    • Cystocele: anterior or front wall of the vagina is bulging into vaginal canal due to pressure from the bladder 

    • Rectocele: posterior or back wall of the vagina is bulging into vaginal canal due to pressure from the rectum (or poop inside the rectum)

    • Enterocele: similar to rectocele in presentation where the posterior or back wall of the vagina is bulging into vaginal canal due to pressure from the small intestine

    • Urethrocele: the urethra (pee hole) bulges into the vagina

• Persistent genital arousal disorder

  • Persistent, unwanted genital arousal, unresolved by orgasm

  • Can also include buzzing, tingling, twitching or itching of genitals

  • History of more than 3 months of these symptoms

• Post-void dribbling

  • Stand up from the toilet and one last drip of pee comes out unintentionally, or shortly thereafter

  • Not usually with cough, sneeze or increase of abdominal pressure

• Proctalgia fugax

  • Sharp or stabbing but short lived pain in your butthole or rectum 

  • Can happen during menstruation

• Pudendal neuralgia

  • Damage, injury, irritation or inflammation of the pudendal nerve 

  • Causes chronic pelvic or genital pain, irritation, or itchiness in the area that the pudendal nerve innervates

• Rectal prolapse

  • Not the same as a rectocele

  • Rectal prolapse is when one part of rectum bulges out of the anus - usually after bowel movement

• Sexual dysfunction

  • Any issue you have with sex such as pain, issues with orgasm or various discomforts

  • If you’re not enjoying sex AND this causes you concern or distress

• Stress urinary incontinence

  • Leaking urine with cough, sneeze, laugh, exercise, heavy lifting or other big movements in the body

  • Can happen at any time in life from pre pubescent to post menopausal 

• Urinary urgency and Urge urinary incontinence

  • The inability to hold pee after the first, intense urge to empty bladder

  • Aka mad rush to the bathroom

  • May result in leaking pee on way to bathroom (incontinence)

• Vaginismus

  • The vagina is the hallway to the uterus - think internal

  • Vaginismus is the involuntary or unintentional tensing or spasm of the hallway which usually causes pain and reduces ability to insert something - such as a tampon or dildo / vibrator 

• Vestibulodynia

  • The first point of entrance into the vagina is called the vestibule (yes, much like a church)

  • Pain in this area of the vagina for any reason, is called vestibulodynia

  • May be a result of hypersensitive nerve endings or an overgrowth of nerve fibers in the vestibule area of the vulva

  • May be exacerbated by chronic yeast infections

• Vulvodynia

  • The vulva is the external female genitals - often incorrectly referred to as the vagina 

  • Long term (more than 3 months) pain anywhere on the vulva is vulvodynia

There you have it. A few very quick and dirty explanations of pelvic floor issues, symptoms or conditions you could be facing. I hope it’s a helpful start in understanding your own body a little bit more… or what someone else could be going through.

As always, please reach out if you think this list or this blog would benefit from further additions. I’m always up for a chat, especially in the name of no-bullshit, accessible and helpful feminine education.

Here for you and your hive, 

-Laine

• REFERENCES

  Bø K, Anglès-Acedo S, Batra A, et al. International urogynecology consultation chapter 3 committee 2; conservative treatment of patient with pelvic organ prolapse: Pelvic floor muscle training.Int Urogynecol J. 2022 Oct;33(10):2633-2667.

  Gin GT, Rosenblum E, Wilkinson LD, Brady PH. Female Pelvic Conditions: Chronic Pelvic Pain.FP Essent. 2022 Apr;515:11-19.

  Goldstein I, Komisaruk BR, Pukall CF, et al. International Society for the Study of Women's Sexual Health (ISSWSH) Review of Epidemiology and Pathophysiology, and a Consensus Nomenclature and Process of Care for the Management of Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia (PGAD/GPD). J Sex Med. 2021 Apr;18(4):665-697.

  Padoa A, McLean L, Morin M, Vandyken C. The Overactive Pelvic Floor (OPF) and Sexual Dysfunction. Part 2: Evaluation and Treatment of Sexual Dysfunction in OPF Patients.Sex Med Rev. 2021 Jan;9(1):76-92.

  Pierce H, Perry L, Chiarelli P, Gallagher R. A systematic review of prevalence and impact of symptoms of pelvic floor dysfunction in identified workforce groups. J Adv Nurs. 2016 Aug;72(8):1718-34.

  Prendergast SA. Pelvic Floor Physical Therapy for Vulvodynia: A Clinician's Guide.Obstet Gynecol Clin North Am. 2017 Sep;44(3):509-522.

  Wallace K. Female pelvic floor functions, dysfunctions, and behavioral approaches to treatment. Clin Sports Med. 1994 Apr;13(2):459-81.

About the Author: Laine Wall

If you are looking for a pelvic physio, I would love to help you on your pelvic health journey. 

I work out of, and own, a pelvic physiotherapy clinic called The Hive Pelvic Health Co. in Millbrook, Ontario and also offer virtual appointments if you reside in Ontario, Canada. 

Have more questions?  Get in touch with me. 

The Hive Pelvic Health Co. is located in the township of Cavan-Monaghan, in Peterborough County; and is less than 20 minutes from the city of Peterborough and 30 minutes from Durham region. 

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Next on your reading list:

1. How To Relax Pelvic Floor Muscles: The what, why, when & how of pelvic floor relaxation & the FBB - from a Pelvic Physio.

2. I Pee When I Sneeze: Pregnancy: Three quick tips on how to keep your pants dry, from a pelvic physiotherapist.

3. The Best Lube For Pregnancy, Postpartum, Menopause & All Your Kinks: A guide to the slippery stuff

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