Millions of Americans quietly struggle with pelvic floor dysfunction – something Tracy Gallagher is working to change, one patient at a time. Seven years ago, Gallagher started focusing on this lesser-known condition affecting people who suffer in silence. Her reason was deeply personal.

“I became interested in it because I had family members that were living with incontinence,” says Gallagher, who works at OSF HealthCare Saint Anthony Medical Center in Rockford, Illinois. “I think people sometimes feel that it’s normal, especially after pregnancy, and they're not aware that help is out there. As I looked into pelvic floor therapy I knew I wanted to help that population and bring more awareness to it.”

More than 11 million men, women and children suffer from some form of pelvic floor dysfunction, including postpartum changes such as posture, muscle length and strength, which can lead to pain and discomfort. The same goes for athletes, including runners and gymnasts.

“Pelvic floor dysfunction is the inability to control and contract and relax the pelvic floor muscles,” says Gallagher. “That can create different issues, such as chronic constipation, urinary or fecal incontinence or pain.”

The pelvic floor consists of three layers of muscle, connective tissue and ligaments that form a supportive “hammock” at the base of the pelvis. It supports the pelvic organs, manages pressure and maintains stability. These muscles can become overactive or underactive with aging, trauma and hormonal shifts.  Besides bowel and urinary issues, pelvic floor dysfunction can also cause abdominal, back, hip and pelvic pain.

For women, pelvic floor issues happen when the muscles or tissues of the pelvic area become weak or injured – usually a result from childbirth, obesity, age or genetics. Pelvic floor dysfunction can affect one in four women at some point in their lives.

Childbirth increases the risk of developing pelvic floor disorders, strongly associated with incontinence and pelvic floor relapse. And changes to the nerves and muscles during pregnancy can lead to weakness or dysfunction, especially with each additional baby. Gallagher says pelvic floor therapy can help pregnant women who are experiencing back and pelvic pain with safe and effective exercises. That goes for post-delivery as well.

“Post-partum patients might have some pelvic pain, or they might have pain around their incision site. If they had a C-section, we could address that with manual therapy,” she says. “We can teach them exercises that might help if they're having urinary incontinence or any issues in that area as well.”

Treatment options 

Pelvic floor therapy offers many options for treatment. That includes exercises for the pelvic floor muscles, breathing exercises, diet and lifestyle changes. For example, eating a high fiber diet and increasing water intake can help with constipation, and losing weight can relieve pressure on pelvic organs.

“We utilize various manual techniques, breathing activities, exercises, there's pelvic floor relaxation positions that people can get into to kind of help relax those muscles and decrease the pain,” says Gallagher. “Sometimes pelvic floor therapy might help lower back pain or pelvic pain that somebody's been having for an amount of time and tried other traditional orthopedic therapies.” 

Pelvic floor therapy treatment can last from a couple of weeks to months. Doing therapist-recommended exercises at home also helps patients recover quicker.

And while it might be uncomfortable to discuss these types of issues with your medical provider or therapist, it’s an important step to feeling good again.

“They're embarrassed because they might have symptoms that may include incontinence or pain,” says Gallagher. “Our goal is to give them that comfort level to attend therapy and return to that quality of life.”

Learn more about pelvic floor therapy here.

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It can be an embarrassing ailment, but experts say it’s time to talk about it.

Urinary incontinence is when a person leaks urine by accident.

Uwais Zaid, MD, a urologist at OSF HealthCare in Alton, Illinois, says urinary incontinence can wreak havoc on a person’s social life and intimacy with partners. In other words, you can’t go out and have a good time with friends if you don’t know when you’re going to suddenly “go.”

“It can be associated with medications. It can be associated with aging,” Dr. Zaid says. “It can be associated with certain surgeries. A lot of our cancer survivors, whether they're from prostate cancer, cervical cancer, uterine cancer…they can have effects to their urinary control.

“Things as normal as having children,” Dr. Zaid adds as a cause.  “Over time [childbirths] can wreak havoc on the pelvic floor and on the urinary sphincter, and you can have urinary accidents as a result.”

While incontinence is often associated with older people, Dr. Zaid says all those precursors apply to any age.

Dr. Zaid says urinary incontinence breaks down into four groups.

• Stress: This is when the bladder sphincter does not work as well. Simple things like coughing, sneezing, laughing or bending over could provoke a release of urine.
• Urge: “When the bladder has a mind of its own,” Dr. Zaid remarks. This is when you have to go and you just can’t make it to the bathroom in time. Dr. Zaid adds that hearing or seeing certain triggers like running water or jingling of keys as you rush to enter your home might provoke urge incontinence.
• Overflow: This occurs when your bladder is full. This is the opposite of urge incontinence, Dr. Zaid says, and is associated with infections and kidney issues.
•  Functional: This applies to someone who may have normal bladder control but can’t get to the toilet in time due to physical limitations like arthritis.

A health care provider will ask you about your symptoms and health history to see which type of urinary incontinence is ailing you. Testing would typically follow. Each type of incontinence, generally, has its own treatment plan.

• Stress: A provider may recommend pelvic floor physical therapy as treatment. For women, a small device can be inserted to stop leaks. Surgery is also an option.
• Urge: You may be told to cut back on caffeinated food and drink, spicy food and alcohol. Medicine and surgery are also options.
• Overflow: “That's where we need to make sure we're not missing anything like a blockage - for women, a prolapse and for men, an enlarged prostate.” Dr. Zaid says.  “A stone in the bladder. A tumor in the bladder. And we also need to make sure the kidneys are functioning okay.”
• Functional: Since people with this type of incontinence may have a normal bladder, external solutions are necessary. For example, keeping your route to the bathroom clear of obstacles like chairs and doors. For older adults with physical limitations, have a walker handy for when the need to go arises.

Other tactics include urgency suppression, when you distract yourself from thinking about urinating. You could take long, relaxing breaths or sit completely still.

Timed voiding is when you schedule times to urinate. Dr. Zaid says this can work in both directions. If you are urinating too frequently, set a timer on your phone to go every hour. Then when you get comfortable, you can increase the time. If you are holding on to your urine too long, set a plan, get comfortable then decrease the time.

The bottom line: if something seems off about your bathroom visits or if friends or family remark “You’re sure in there a lot,” see a doctor.

“If you’re chronically wet down below, it increases your risk of fungal infections and skin breakdowns,” among other serious health issues, Dr. Zaid says.

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