Pelvic floor dyssynergia: causes, symptoms, and exercises for relief

Struggling to go #2? You’re not alone. Constipation can happen for many reasons — from dehydration to fiber intake. One common (and often overlooked) cause is a coordination issue in your pelvic floor muscles called pelvic floor dyssynergia (also known as anismus).

Straining during bowel movements or feeling like you can’t fully empty your bowels can be physically and emotionally exhausting. But these symptoms — and your overall quality of life — can improve with the right approach, including pelvic floor physical therapy, biofeedback, and targeted exercises.

In this article, learn how to manage pelvic floor dyssynergia at home, with guidance from Hinge Health pelvic health physical therapists.

What is pelvic floor dyssynergia? 

For a bowel movement to happen smoothly, your pelvic floor muscles need to relax and lengthen. Pelvic floor dyssynergia occurs when these muscles become tense during bowel movements.

“Instead of relaxing the muscles, someone may tighten them by straining or holding their breath during a bowel movement,” says Morgan Dunn, PT, DPT, a Hinge Health physical therapist.

This condition is a coordination issue — not a structural problem, and often not a sign of a bigger issue. With the right guidance, your body can relearn how to relax and coordinate these muscles more effectively.

Causes of pelvic floor dyssynergia

Typically, pelvic floor dyssynergia develops from learned movement patterns rather than a single cause. Over time, habits like straining during bowel movements or holding stool can affect how the pelvic floor muscles coordinate. Other factors — such as chronic constipation or past injury to the pelvic area — can also play a role. Common causes include: 

• Chronic constipation and learned patterns. Repeated straining can train your pelvic floor to tighten instead of relax during bowel movements. Over time, this becomes a habit, reinforcing unhelpful coordination patterns.

• Childhood bowel habit patterns. Pelvic floor dyssynergia can start early with habits like holding in stool. “This pattern can condition the pelvic floor muscles to tighten instead of relax during bowel movements, contributing to ongoing coordination difficulties,” says Dr. Dunn.

• Previous pelvic trauma or surgery. Injury, surgery, or trauma in the pelvic area can affect how these muscles function, leading them to tense when they should relax or making it harder to sense and control them.

• Pregnancy and childbirth. Changes in load and potential muscle strain during pregnancy and delivery can affect coordination over time. “When the muscles stay chronically tense, they may struggle to relax properly, like an elevator already stuck at the top floor,” says Dr. Dunn.

• Stress and anxiety. The mind-body connection is real — your pelvic floor responds to your nervous system. When stress or anxiety is high, these muscles may stay more tense, affecting their ability to relax and coordinate.

• Uncertainty about how and when to properly relax the pelvic floor muscles. Many people unintentionally tighten their pelvic floor when they should be relaxing. “Gaining a better understanding of when and how to relax your pelvic floor muscles can resolve tension and improve overall coordination,” says Dr. Dunn.

Symptoms of pelvic floor dyssynergia

Pelvic floor dyssynergia can lead to discomfort in activities involving the pelvic floor, such as having a bowel movement, urinating, or having sex, for example. Some of the most common symptoms of pelvic floor dyssynergia include:

• Chronic constipation (fewer than three bowel movements per week)

• Excessive straining

• Feeling of incomplete emptying

• Need for digital assistance (using fingers to help pass stool)

• Hard, dry, or lumpy stools despite hydration and fiber

• Spending a long time on the toilet

• A sensation of blockage in the rectum

• Bloating or lower abdominal discomfort

• Pain during or after bowel movements (in some cases)

• Urinary symptoms like urgency or difficulty starting

• Pelvic pain or discomfort during sex

How movement can help pelvic floor dyssynergia

Movement — especially relaxation-focused movement — plays a key role in improving pelvic floor coordination.

“Focusing on breathing mechanics can help relax the pelvic floor, along with incorporating movement and gentle stretches to reduce tension,” says Dr. Dunn.

Learning how to relax these muscles is just as important as strengthening them. Techniques like diaphragmatic breathing can help your pelvic floor lengthen, while gentle movement improves flexibility and awareness.

Strengthening nearby muscles — like your core, hips, and back — can also reduce the workload on your pelvic floor, helping it function more efficiently.

In some cases, a physical therapist may also guide you in using tools like a pelvic wand or rectal dilator to help release muscle tension.

A combination of breathing, stretching, and strengthening exercises can help reduce tension and improve coordination over time. Diaphragmatic breathing and reverse Kegels help retrain your pelvic floor to lengthen and relax — rather than tighten — during bowel movements, while also improving coordination with your diaphragm. Movements like deep squats and child’s pose gently stretch the pelvic floor and surrounding muscles, helping release built-up tension. Meanwhile, abdominal bracing strengthens the connection between your core and pelvic floor so they can work together more effectively.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Treatments for pelvic floor dyssynergia

Pelvic floor physical therapy with biofeedback is the primary treatment for pelvic floor dyssynergia. But there are also many simple at-home strategies you can try in addition to that, including: 

• Practice proper toilet positioning. Keep your knees higher than your hips during bowel movements (using a footstool can help). “This opens up the pelvic floor and allows stool to pass more easily,” says Dr. Dunn.

• Coordinate breathing with bowel movements. Breathing directly impacts your pelvic floor, so try to coordinate it with your bowel movements. Start by inhaling and expanding your belly, then gently exhale while keeping your abdomen relaxed. “You can try making a ‘shh’ sound as you exhale to help keep your pelvic floor relaxed,” says Dr. Dunn.

• Address contributing constipation factors. Dehydration and too much (or too little) fiber can contribute to constipation. Staying hydrated keeps your digestive system moving and softens stool, so it’s easier to pass. Eating plenty of fiber-rich foods, such as fruits, vegetables, beans, and whole grains, can also soften stool and prevent constipation. Ramp up your fiber intake gradually to prevent digestive distress. 

• Consider temporary medication support. If home remedies aren’t bringing enough relief, talk to your doctor about whether an over-the-counter stool softener could be an option. (Always check with your healthcare provider before starting any new medication.)

• Manage stress and anxiety. When your nervous system is stuck in a heightened state, your body can tense up — that’s why it’s common to get a headache or jaw pain when you’re stressed. “The same thing can happen in your pelvic floor,” says Dr. Dunn. Prioritize activities that help you manage stress, whether exercise, journaling, meditation, mindfulness, or talking to a therapist or supportive loved one.

Physical therapy for pelvic floor dyssynergia

Pelvic floor physical therapy is one of the most effective ways to treat pelvic floor dyssynergia because it focuses on retraining how your muscles coordinate — not just strengthening them.

A pelvic floor physical therapist will assess how your muscles are working and identify patterns of tension or poor coordination. 

One of the most common tools used is biofeedback — a technique that uses small sensors to show you, in real time, when your pelvic floor muscles are contracting or relaxing. Think of it like a guide that helps you "see" what your muscles are doing, so you can learn to control them more easily. This helps you build awareness and learn how to release tension more effectively during bowel movements.

Treatment may also include:

• Breathing exercises to improve coordination between your diaphragm and pelvic floor

• Gentle stretching and relaxation techniques to reduce muscle tension

• Training on proper toilet positioning and bowel mechanics

• Guidance on habits that support more efficient, comfortable bowel movements

In some cases, your PT may also teach you how to use tools like a pelvic wand or dilator to help release tight muscles.

With consistent practice, many people see meaningful improvements in symptoms and bowel function. The goal is to help your pelvic floor muscles relax and respond more naturally, so bowel movements feel easier and less stressful over time.

How to prevent pelvic floor dyssynergia from recurring

If you’ve had pelvic floor dyssynergia in the past — or want to prevent it — a few simple habits can help keep your pelvic floor relaxed and coordinated. Consider these strategies recommended by Hinge Health physical therapists.

• Continue practicing proper coordination. Deep, diaphragmatic breathing helps your pelvic floor relax and move more naturally over time. If you’re having trouble going #2, try using slow breathing and a gentle “shh” exhale instead of straining.

• Maintain toilet positioning habits. Keeping your knees higher than your hips (using a footstool if needed) can help your pelvic floor stay relaxed and allow stool to pass more easily.

• Respond to the urge promptly. Try not to delay bowel movements. Holding stool can lead to buildup in your digestive tract and increase tension in your pelvic floor.

• Avoid excessive straining. Aim to stay relaxed during bowel movements. “Straining can increase tension and affect the muscles and tissues that support the pelvic floor,” says Dr. Dunn.

• Stay physically active. Regular movement helps keep your digestive system moving. Find activities you enjoy — like walking, biking, swimming, or strength training — so you can stay consistent.

• Manage stress. Stress can increase muscle tension throughout your body, including your pelvic floor. “Continue stress management practices that regulate your nervous system so your pelvic floor muscles stay relaxed and coordinated,” says Dr. Dunn.

• Check in with a PT if needed. A pelvic floor physical therapist can help you stay on track. Consider occasional follow-ups if symptoms start to return.

When to see a doctor

Pelvic floor dyssynergia symptoms often improve on their own with simple management. But if your pain is severe, getting worse, or causing difficulty with daily activities, see a healthcare provider. It’s also a good idea to get care if you:

• Experience severe pain during bowel movements

• Notice blood in your stool or rectal bleeding

• Experience unexplained weight loss along with bowel changes

Living with and managing pelvic floor dyssynergia 

The timeline for improvement can vary, but many people notice changes — and improved quality of life — within about four to six weeks of starting physical therapy. Consistency matters. With regular practice, many people see meaningful progress, though some benefit from ongoing support with a pelvic floor physical therapist.

PT tip: Prioritize toilet position 

The right position can make a big difference. “Keeping your knees above your hips and using deep breathing can make bowel movements easier and improve coordination over time,” says Dr. Dunn.

How Hinge Health can help you

If you have pelvic pain, bladder, bowel, or other pelvic symptoms that are affecting your quality of life, you can get the relief you've been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

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2. Grimes, W. R., & Stratton, M. (2023, June 26). Pelvic floor dysfunction. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK559246/

3. Pelvic Floor Dyssynergia. (n.d.). Stanfordhealthcare.org. https://stanfordhealthcare.org/medical-conditions/digestion-and-metabolic-health/pelvic-floor-dyssynergia.html

4. Wallace, S. L., Miller, L. D., & Mishra, K. (2019). Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women. Current Opinion in Obstetrics and Gynecology, 31(6), 485–493. doi:10.1097/gco.0000000000000584 

5. Cui, J., Xie, F., Yue, H., Xie, C., Ma, J., Han, H., Fang, M., & Yao, F. (2024). Physical activity and constipation: A systematic review of cohort studies. Journal of Global Health, 14. doi:10.7189/jogh.14.04197