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Pelvic Floor Dysfunction — Accurate Diagnosis, Targeted Treatment

Difficulty emptying the bowel, chronic pelvic pressure, painful defecation, or leakage — these symptoms may all stem from the same root cause: pelvic floor dysfunction. Dr. Karmina Choi provides specialist evaluation and builds individualized treatment plans that address the underlying mechanism.

ANORECTAL CONDITION

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Common questions

Expert Colorectal Care | Fort Lee, NJ

Common

yet frequently undiagnosed — symptoms overlap with IBS, hemorrhoids, and constipation

High

success rate with pelvic floor physical therapy when the right diagnosis is made

Women

disproportionately affected — childbirth, hormonal change, and anatomy all play a role

What is pelvic floor dysfunction?

The pelvic floor is a group of muscles, ligaments, and connective tissue forming a hammock-like structure at the base of the pelvis — supporting the rectum, bladder, uterus, and vagina, and controlling defecation and urination. When these structures are weak, overactive, or discoordinated, the result is pelvic floor dysfunction.

In colorectal medicine, pelvic floor dysfunction most commonly presents as difficulty evacuating the bowel (outlet constipation), pelvic organ prolapse, fecal incontinence, or chronic anorectal pain. The same underlying structural weakness can produce any combination of these symptoms, which is why a comprehensive pelvic floor evaluation — rather than treating each symptom in isolation — is the most effective approach.

Types of pelvic floor dysfunction

Overactive / tight pelvic floor

Muscles that are too tight or fail to relax — causing difficulty with defecation, painful bowel movements, and chronic pelvic or anorectal pain. Often underlying dyssynergic defecation (anismus).

Weak / lax pelvic floor

Muscles that cannot generate sufficient support — leading to prolapse, fecal incontinence, urgency, and difficulty controlling bowel movements. Worsened by aging, childbirth, and hormonal change.

Dyssynergic defecation

Paradoxical contraction of the puborectalis muscle during straining — creating an obstruction that makes passing stool difficult despite normal colonic transit. Diagnosed with anorectal manometry and balloon expulsion testing.

Prolapse and anatomical defects

Rectocele, rectal or uterine prolapse — structural failures of pelvic floor support causing a bulge, pressure, incomplete evacuation, or the need to manually assist defecation.

Hypertonic

Hypotonic

Dyssynergia

Structural

Symptoms that may indicate pelvic floor dysfunction

Difficulty emptying the bowel

Straining, prolonged time on the toilet, incomplete emptying, or needing to use fingers to assist — hallmarks of outlet dysfunction.

Chronic pelvic pressure or heaviness

A sensation of fullness, dragging, or pressure in the pelvis — worse with standing, walking, or physical activity.

Bowel urgency or leakage

Sudden urgent need to defecate with little warning, or accidental leakage of stool or gas — from weakness or poor coordination.

Painful defecation

Pain during or after bowel movements — may reflect an overactive pelvic floor rather than a structural anorectal problem.

Chronic constipation unresponsive to laxatives

Constipation that doesn't improve with fiber and laxatives — a strong signal that outlet dysfunction rather than slow transit may be the driver.

Visible tissue bulging

A bulge at the anal opening or in the vaginal area — suggesting rectocele, rectal prolapse, or pelvic organ prolapse.

How Dr. Choi evaluates pelvic floor dysfunction?

Clinical history and functional review. Bowel habits, defecation pattern, symptoms with straining and lifting, obstetric history, prior surgeries, and quality of life — reviewed in detail to identify which type of dysfunction is most likely present.

Anorectal examination. Assessment of resting tone, squeeze strength, pelvic floor descent, puborectalis coordination during straining, and any structural abnormalities including rectocele or prolapse.

Anorectal manometry and balloon expulsion testing. Objectively measures sphincter pressures, rectal compliance, and the ability to expel a balloon — the diagnostic standard for dyssynergic defecation and the essential test before initiating biofeedback therapy.

Defecography or MRI when indicated. Dynamic imaging that captures how the pelvic floor behaves during straining and defecation — identifying rectocele, intussusception, excessive perineal descent, and enterocele that may not be apparent on examination alone.

Pelvic organ prolapse assessment. Dr. Choi evaluates for coexisting bladder, uterine, or vaginal vault prolapse — conditions that share the same anatomical substrate and frequently require coordinated multidisciplinary management.

Treatment — matched to your dysfunction type

Bowel habit optimization

Dietary fiber, hydration, meal timing, footstool positioning during defecation, and avoiding prolonged straining — foundational changes that reduce the mechanical load on an already-stressed pelvic floor and support recovery alongside other treatments.

Pelvic floor physical therapy and biofeedback

For dyssynergic defecation, biofeedback retrains the puborectalis to relax during straining — achieving resolution or significant improvement in 70–80% of patients. For weakness-related incontinence or urgency, targeted strengthening exercises improve sphincter coordination and continence. Dr. Choi coordinates with experienced pelvic floor physiotherapists and monitors progress throughout.

Rectocele repair and prolapse surgery

When structural prolapse — rectocele, rectal mucosal prolapse, or full pelvic organ prolapse — is the primary driver, surgery addresses what physical therapy cannot. Dr. Choi performs rectocele repair and mucosal prolapse procedures. For complex pelvic organ prolapse requiring abdominal reconstruction, she coordinates with urogynecologic surgical partners ensuring all compartments are addressed together.

Coordinated care for associated pelvic conditions

Pelvic floor dysfunction rarely exists in a single compartment. Dr. Choi identifies coexisting bladder prolapse, urinary incontinence, and uterine prolapse — conditions frequently missed in isolated colorectal or gynecologic evaluations — and coordinates referral to urogynecology for comprehensive pelvic reconstruction when needed.

Foundation | All types

Core treatment | Dyssynergia and weakness

Surgical | Structual defects

Multidisciplinary

Pelvic organ prolapse — an often-missed part of the picture

Many patients presenting with outlet constipation, incomplete emptying, or rectal pressure have concurrent bladder or uterine prolapse that has not been identified. Dr. Choi evaluates all pelvic compartments at every visit and coordinates multidisciplinary care when the full picture involves more than the colorectal compartment alone — rather than leaving the patient to discover the association through another specialist visit.

Why choose Dr. Karmina Choi?

Dyssynergia expertise

Dyssynergic defecation is one of the most commonly missed causes of outlet constipation. Dr. Choi identifies and treats it with biofeedback rather than laxatives.

Surgical capability

Rectocele repair and mucosal prolapse procedures performed in-house — no referral required for the majority of structural repairs.

Natural-first philosophy

Biofeedback and conservative measures come first. Surgery is recommended only when anatomy or failed conservative treatment makes it the right next step.

Multidisciplinary coordination

Pelvic organ prolapse identified and urogynecologic care coordinated — the full pelvic floor picture addressed, not just the colorectal component.

Female physician option

Dr. Choi provides a sensitive, experienced environment — particularly important for patients with obstetric injuries or pelvic organ prolapse.

Common Questions

My colonoscopy was normal. Why am I still having bowel problems?

A normal colonoscopy rules out structural colonic disease — which is important — but tells you nothing about how the pelvic floor and anorectal junction function during defecation. Dyssynergic defecation, rectocele, and pelvic floor weakness all produce significant symptoms in patients with entirely normal colonoscopy findings. The right test is anorectal manometry and functional assessment — not colonoscopy.

How long does biofeedback therapy take?

A standard biofeedback course consists of six to eight weekly sessions with a pelvic floor physiotherapist, followed by a reassessment. Many patients notice meaningful improvement within the first few sessions. The full benefit typically consolidates over three to six months of continued home practice. Dr. Choi reviews progress at follow-up visits and adjusts the plan based on response.

Do I need surgery for a rectocele?

Not necessarily. Many rectoceles are asymptomatic or only mildly symptomatic and do not require surgery. Surgery is recommended when the rectocele is causing significant symptoms — particularly incomplete emptying, the need to manually support the perineum or vagina to defecate, or pelvic pressure — that have not responded adequately to pelvic floor therapy. Dr. Choi evaluates each patient individually and recommends surgery only when the clinical benefit clearly outweighs the risks.

Can pelvic floor dysfunction cause anal pain?

Yes — levator ani syndrome and proctalgia fugax (episodic rectal pain) are both pelvic floor pain conditions caused by spasm or hypertonia of the pelvic floor muscles. They are treated with pelvic floor physical therapy, muscle relaxation techniques, and in selected cases, injections into the levator ani. These conditions are frequently mistaken for hemorrhoids or fissures and go untreated because the source — the muscles rather than the mucosa — is not recognized.

Related conditions

Pelvic floor problems are common — and very treatable.

The right diagnosis changes everything. Dr. Choi can identify what's driving your symptoms and build a plan that addresses the actual cause.

Book a Consultation

Call (551) 321-1388

1625 Anderson Avenue, Suite 203, Fort Lee, New Jersey 07024

This page is for informational purposes only and does not constitute medical advice. Individual results vary. Please consult Dr. Choi for a personalized evaluation and treatment plan.

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Fort Lee, New Jersey 07024

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