Overview of pelvic floor dysfunction
Pelvic floor dysfunction is the incapability to control the pelvic floor muscles.
Your pelvic floor is the collection of muscles and ligaments in your pelvic region. The pelvic floor acts as a sling to support the organs of the pelvis, including the bladder, rectum, and uterus or prostate. Contracting and relaxing these muscles allows you to control your bowel movements, urination, and, in the case of women, in particular, sexual intercourse.
Pelvic floor dysfunction forces you to contract your muscles instead of relaxing them. As a result, you may experience difficult defecation. If left unprocessed, pelvic floor dysfunction can lead to discomfort, long-term colon damage, or infection.
Types of pelvic floor complications
There can be more than one complication, and whether you’re a new mom or an expectant mom, managing these issues can sometimes feel overwhelming.
The most common postpartum pelvic floor difficulties:
- Urinary incontinence
- Fecal incontinence
- Repair of pelvic organ prolapse
- Pain with sexual activity
- Pain in the vaginal opening after delivery
- Low back pain
- Pelvic pain
- Separation of the abdominal muscles
Complications of the pelvic floor before delivery (before delivery) such as:
- Pain in the pelvic girdle
- Urinary incontinence
- Fecal incontinence and
- Pain in the pubic bone
Symptoms of pelvic floor dysfunction
There are several symptoms related to pelvic floor dysfunction. If you are diagnosed with pelvic floor dysfunction, you may experience symptoms that include:
- Urinary problems, such as the urge to urinate or pain when urinating
- Constipation or bloating
- Low back pain
- Pain in the pelvic area, genitals, or rectum
- Discomfort during sexual intercourse for women
- Pressure in the pelvic region or rectum
- Muscle spasms in the pelvis
Causes of pelvic floor dysfunction
Many problems can cause the structures of the pelvic floor to weaken, including:
- Systemic diseases
- Long-lasting health problems that cause increased pressure in the abdomen and pelvis, such as a chronic cough
- Trauma during childbirth
- Multiple deliveries
- Large babies
- Operative delivery
Research specifies that stress urinary incontinence, pelvic organ prolapse, or both occur in about half of all women who have given birth. These problems are closely associated with birth-related injuries to the pelvic floor muscles.
- The pelvic floor muscles can also naturally stretch with age. Stress urinary incontinence and pelvic organ prolapse become more common with age in women.
- Collagen disorders can also affect the ability of the muscles to support the pelvic organs.
- Meanwhile, coccydynia is usually due to trauma to the tailbone, such as a fall. That said, in about a third of people with the condition, the cause of coccydynia is unknown. Pain can make it difficult to have a bowel movement.
Risk factors of pelvic floor dysfunction
While women are much more likely to be affected by pelvic floor dysfunction than men, both genders can be affected. Risk factors include:
Pregnancy and childbirth
- Age, with older women at higher risk.
- Conditions such as obesity, chronic constipation or coughing, pelvic tissue atrophy during menopause, lung problems that increase pelvic pressure, nerve and muscle diseases, and kidney or bladder stones.
- Radiation or pelvic surgery, which can damage the muscles and tissues of the pelvic floor.
- Behaviors such as smoking, repeatedly lifting heavy objects, and excessive caffeine consumption
- Enlarged prostate in men.
Diagnosis of pelvic floor dysfunction
Your healthcare provider will typically start by asking about your symptoms and taking a careful medical history. Your provider may ask you the following questions:
- Do you have a past urinary tract infection?
- If you are a woman, do you have a safe birth?
- If you are a woman, do you have pain when you have sex?
- Do you have interstitial cystitis (a prolonged inflammation of the bladder wall) or irritable bowel syndrome (a disorder of the lower intestinal tract)?
- Do you strain to defecate?
Your provider may also perform a physical exam to assess how well you can control your pelvic floor muscles. Using their hands, your provider will be checked for spasms, knots, or weakness in these muscles. Your provider may also need to do an intrarectal (into the rectum) exam or a vaginal exam.
You may also have other tests that include:
- Surface electrodes (self-adhesive pads that are placed on the skin) can assess pelvic muscle control. This could be an option if you don’t want an internal exam. The electrodes are located on the perineum (the area between the vagina and rectum in females and between the testicles and rectum in males) or the sacrum (the triangular bone at the base of the spine). This test is not painful.
- Anorectal manometry (a test that measures how well the anal sphincters are working) can assess pressure, muscle strength, and coordination. This test is not painful.
- A defecating proctogram is a check where you’re given an enema of a thick liquid that can be seen with an X-ray. Your provider will use a special video X-ray to record the undertaking of your muscles as you attempt to push the liquid out of the rectum. This will help to show how well you can pass a bowel movement or any other causes for pelvic floor dysfunction. This test is not painful.
The unfollow test can show how well your bladder can empty. If your urine flow is weak or you have to stop and start urinating, it may indicate pelvic floor dysfunction. Your provider may order this test if you have trouble urinating. This test is not painful.
Treatment for pelvic floor dysfunction
Fortunately, pelvic floor dysfunction can be treated relatively easily in many cases. If you need physical therapy, you will probably feel better, but it may take a few months of sessions. Pelvic floor dysfunction is treated without surgery. Non-surgical treatments include:
- Biofeedback: This is the most common treatment, performed with the help of a physical therapist. Biofeedback is painless and helps more than 75% of people with pelvic floor dysfunction. Your physical therapist can use biofeedback in different ways to retrain your muscles. For example, they can use special sensors and video to monitor your pelvic floor muscles as you try to relax or tighten them. Then your therapist gives you input and works with you to improve your muscle coordination.
- Pelvic floor physical therapy: Physical therapy is commonly performed at the same time as biofeedback therapy. Your therapist will determine which muscles in your lower back, pelvis, and pelvic floor are really tight and will teach you exercises to stretch these muscles and improve your coordination.
- Medications: Daily medications that help keep your bowel movements smooth and regular are a very important part of treating pelvic floor dysfunction. Some of these medications are available over the counter at the pharmacy and include Senna stool softeners or generic stool softeners. Your primary care physician or a gastroenterologist can help advise which medications are most helpful in keeping your stools soft.
- Relaxation techniques: Your provider or physical therapist may also recommend that you try relaxation techniques such as meditation, hot baths, yoga, and exercises or acupuncture.
Complications of pelvic floor dysfunction
Pelvic floor disorders affect the quality of life of millions of women around the world. There are many options for the treatment of pelvic organ prolapse and urinary incontinence, with surgery being one of the main strategies in the management of these conditions. Although rare, all surgery has complications that can cause morbidity and rarely mortality. These complications can affect long-term quality of life and represent a financial burden for both the patient and the health care system.
Reconstructive pelvic floor surgery includes perioperative complications such as injury to neighboring organs, bleeding, and infection. Recently, the International Association of Urogynecology and the International Continence Society have proposed terminology and classification of complications related to surgery of the female pelvic floor, using both native tissue and synthetic implants to improve surgical audit and facilitate comparison between studies on pelvic floor procedures.
Long-term complications, such as pelvic pain and dyspareunia, can reach 25%. Mesh-associated prolapse surgery may produce better anatomical results, but this is offset by the high complication rate, particularly from mesh exposure, which has been reported to be between 3% and 15%. Minimally invasive anti-incontinence procedures are associated with lower morbidity than their abdominal predecessors but are not without complications.
Complications of mid-urethral slings include mesh exposure (0.3%), voiding dysfunction (7%), and de novo urgency (25%). The risk and severity of complications vary according to the procedure performed and the characteristics of the patient and, therefore, patients should be informed of these risks.