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Pelvic Floor Dysfunction

What is Pelvic Floor Dysfunction?

Pelvic floor dysfunction is the inability to control the muscles of the pelvic floor. Pelvic floor muscles are a group of muscles and ligaments in the pelvic region that support the bladder, uterus, vagina, and rectum and help in the functioning of these pelvic organs. Coordinated contracting and relaxing of the pelvic floor muscles controls bladder and bowel functions - the pelvic floor should relax to allow for bowel movements, urination, and, particularly in women, sexual intercourse.

Causes of Pelvic Floor Dysfunction

Most causes of pelvic floor dysfunction are still unclear; however, physicians have associated this to events or conditions that has resulted in pelvic muscle weakness, such as:

  • Trauma or injury to the pelvic region
  • Pelvic surgery
  • Childbirth
  • Obesity
  • Radiation treatment
  • Heavy lifting
  • Nerve damage
  • Pelvic scarring/adhesions
  • Endometriosis

Symptoms of Pelvic Floor Dysfunction

There are several symptoms that are associated with pelvic floor dysfunction. Some of the common symptoms include:

  • Urinary issues, such as urinary urgency, frequency, hesitancy, or painful urination
  • Pain in the pelvic region
  • Constipation 
  • Muscle cramps in the pelvic region
  • Discomfort during sexual intercourse
  • A feeling of incomplete bowel movements
  • Lower back pain

Diagnosis of Pelvic Floor Dysfunction

As part of the diagnostic process, your physician will review your medical history and symptoms and perform a thorough physical examination to check for muscle weakness, muscle cramps, and other signs. Your physician may also order additional tests to determine the exact cause of the pelvic floor dysfunction. These tests include:

  • Anorectal manometry to evaluate the functionality of control muscles and rectum and strength of these muscles
  • Electromyography (EMG) to evaluate the functionality of several nerves in the anal sphincter and pelvic floor
  • Endorectal ultrasound to obtain images of the pelvic structures, such as control muscles, anus, and rectum wall
  • Videodefecogram, a special x-ray that is taken during a bowel movement to check muscle movement and is a crucial test to determine pelvic floor dysfunction
  • Colonic transit study is a series of x-rays that evaluates the passage of stool through the colon to detect potential locations and causes of constipation

Treatment of Pelvic Floor Dysfunction

The objective of pelvic floor dysfunction treatment is to relax pelvic floor muscles by destressing them. The treatment varies based on the cause of the dysfunction and severity of the symptoms and includes:

  • Biofeedback: This method is the most common treatment for pelvic floor dysfunction where the doctor uses special sensors and video to monitor the pelvic floor muscles as the patient attempts to relax or contract them. After observing the muscle activity, your therapist will provide feedback and tell you how to improve muscle coordination.
  • Medication: Your physician may prescribe a muscle relaxant to deal with pelvic floor dysfunction. The relaxant prevents the contraction of pelvic muscles and helps in destressing the muscles.
  • Relaxation techniques: Your physician will recommend relaxation techniques such as yoga and stretching to relax your pelvic floor muscles. Taking warm baths is another technique that improves blood circulation and relaxes the muscles.
  • Surgery: if your pelvic floor dysfunction is a result of rectal prolapse or rectocele, surgery may be necessary. Surgery helps in loosening the affected pelvic organs and relaxing them.

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