COVID-19 and the Pelvic Floor

Did you know there is an observed Increase in pelvic floor problems during and after a COVID-19 infection?  Yep. There's an increase in pee problems of urgency & leaks...there's an increase in poop problems (too loose AND too constipated) and there's an increase in prolapse pressure complaints and even pelvic pain!!

Is this surprising? Or Not? Let's Learn Together!

Hey there! 👋 It’s me, Dr. Kelly Sadauckas, one of a handful of Doctor’s of Physical Therapy in the world who are double board certified in pelvic health orthopedics.  That means I'm a huge geek, AND your go to expert for all things pelvic floor.  Today, I’m here to demystify why things might feel a bit different down there after dealing with COVID-19. Let’s dive into it together!

The Science:

While more literature is being added every day, in 2020, there was a study from the Journal of Women's Health Physical Therapy that talked about how and why COVID-19 can mess with our pelvic floor. 

(Here's the official citation if you're into that: Siracusa C, Gray A. Pelvic Floor Considerations in COVID-19. J Womens Health Phys Therap. 2020;44(4):144-151. doi:10.1097/JWH.0000000000000180.) Sounds fancy, right? Or you can just click here to open the study summary in a new window.

Now, having some pelvic floor issues post-COVID doesn’t mean you did something wrong or that you’re less awesome. It just means your body fought off a tricky virus and has a few side effects that need some attention. No worries, we're here to help!

People had MORE leaks, MORE prolapse pressure complaints, MORE constipation and MORE seggsy-time problems after COVID 🙁

Let me say it AGAIN for those in the back:

Folks who've had COVID noticed more urinary incontinence, pelvic pressure, constipation, and even sexual issues when compared to their age-matched counterparts AND when compared to themselves pre-COVID!

This means that Pelvic side effects of COVID are as real as the respiratory ones!!

So, if you know someone who's been through the COVID adventure, make sure to ask them about these things.  Even if you're not an expert in treating pee, poop or seggsy-time issues, just listening and letting them know there is a connection, and there is help available (even if you’re not the one providing it) can mean a lot, and change a lot of lives.

Now, you might be wondering, "Why and how does COVID-19 mess with the pelvic floor?" Great question! Let's break it down:

Why & How Does COVID-19 Mess With The Pelvic Floor?

Our pelvic floor muscles usually chill out during normal breathing, but when we have shortness of breath (thanks, COVID), the pelvic muscles are recruited to help out with breathing. The problem is, these muscles aren’t used to working all the time, and they get tired. And tired pelvic floor muscles can lead to leaks and pelvic pressure. Not fun!

Oh, AND…if you're also dealing with frequent coughing or sneezing, that's like adding fuel to the fire. 

Those frequent, repeated, POWERFUL, downward movements can irritate our already tired pelvic floor, leading to more complaints like urgency, leakage, and pressure. It's a whole party down there!

I have a penis.  Pelvic Complications Don’t Apply to Me. 

Think again, batman. COVID-19 does ALL of the above to all ages, sexes and genders…and furthermore can affect cells in the testicles specifically, causing inflammation that might lead to erectile dysfunction. 

Don't panic, though! If this sounds familiar, talk to your doctor or a pelvic floor PT. They've got your back!  The key is that when its an underlying muscular disorder, be sure that the treatment involves the MUSCLES and not just popping a pill.  The pill tries to improve blood flow…by taking a pill.  Pelvic PTs (and trusted online wellness programs) will teach you to improve blood flow naturally, and for the long-term, so you don’t always need that pill to get jiggy. 

If I was on a ventilator during COVID, am I at risk for pelvic complications?

Yes, if you were on a ventilator during your COVID battle, adds yet ANOTHER layer of complexity to the pelvic situation.  

First off, kudos for making it through!  We’re glad you’re still here with us.  

Being on a ventilator increases your chances of constipation, which, believe it or not, is a big deal. 

Constipation messes with pelvic floor muscles and can lead to incontinence and pain.  Plus, the extra ‘straining’ to force the poop out also further damages the pelvic muscles, contributing to more leaks and pain and pressure!!!   So, hydration, fiber, and some diaphragmatic breathing might just be your new best friends. Trust me, your pelvic floor will thank you later!

In a nutshell, COVID-19 affects more than just our lungs. 

It can mess with our whole system, and understanding these effects is a work in progress for the medical community.  YOU might need to be the primary advocate for yourself, or someone you love, to stand up and say “No. These leaks are not a normal consequence of aging, but they are related to my past COVID-infection and I would like to try Pelvic PT to get to the bottom of them.”  

Find a Pelvic PT near you here, or peruse Pelvic Floored’s Online Course Catalogue for Streamable Pelvic Wellness.  It’s never too late to invest in your pelvic health, and there’s no better time than right now to start. Vag Lab is a 2-hour course in vulvar pelvic muscle assessments, and the Signature Series is a full 12-week progression of lifestyle modifications and exercises, to bring you the pelvis of your dreams. If you have a penis, you're not left out--a penis-facing course will be added soon :). Join the Mailing List to be notified when new courses drop :) 

Thanks for hanging in there with me! And if you want more awesome tips for your pelvic health, follow me on Instagram, and join my mailing list. Subscribers get exclusive discounts and access to cool events. Don't miss out—sign up today!

Thanks a bunch for reading!

xoxo, Dr. Kelly 😊

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From the Oct-Dec 2020 issue of Journal of Women's Health Physical Therapy, by Syracusa and Gray. Official Citation and link:

Siracusa C, Gray A. Pelvic Floor Considerations in COVID-19. J Womens Health Phys Therap. 2020;44(4):144-151. doi:10.1097/JWH.0000000000000180