What Is Pelvic Floor Dysfunction? Risk, Symptoms, Diagnose And Solution

A pelvic floor is a group of muscles and other tissues that support the bladder and bowel and assist in their movement.

They also contribute to sexual function, including orgasm. The pelvic floor plays a role in preventing organ prolapse (when organs sag) and urinary or fecal incontinence (passing urine or stool without intending to do so).

What is pelvic floor dysfunction?

Pelvic floor dysfunction is a common condition characterized by an incomplete or failed relaxation of the pelvic floor muscles. When this happens, you may leak urine when you cough, sneeze, laugh, lift something heavy or exercise and can also include other symptoms such as:

• Incomplete emptying of the bladder
• Urgency, a sudden and uncontrollable need to urinate
• Stress incontinence, the leakage of urine when you exert pressure, such as from exercise or heavy lifting
• Fecal incontinence or difficulty controlling bowel movements.

if you have symptoms of pelvic floor dysfunction, you should see your health care provider.

If you are over age 50, certain conditions increase the chance that pelvic floor dysfunction is present. These include:     

• Vaginal childbirth      
• Many births       
• Nonsurgical delivery (such as forceps or vacuum-assisted delivery)    
• Long labor (generally more than 14 hours)       
• Anesthesia used during labor and birth─particularly spinal anesthesia may affect the way your pelvic floor operates after you give birth.

How does pelvic floor dysfunction happen?

Women can develop pelvic floor dysfunction because of:

Childbirth: Pregnancy may weaken the pelvic floor muscles and surrounding support tissues, causing them to stretch or tear during childbirth. As a result, organs such as the bladder drop into the vaginal opening (cystocele) or bulge into the vagina (rectocele).      

Constipation: Chronic (long-term) straining to move bowels can weaken the pelvic floor. A sudden increase in physical activity─such as exercise─can cause the muscles to strain and become fatigued, producing a similar result.      

Weak abdominal wall muscles: Some people have weaker abdominal wall muscles than others. These muscles help support the pelvic floor and act as a sling to hold up the organs in the abdomen. Weak abdominal wall muscles can lead to organ prolapse─the falling off one or more of these organs into or out of their normal positions─and also increase your risk of developing fecal incontinence.          

Menopause: If you are menopausal, levels of estrogen─a female hormone─fall. This may cause the pelvic floor to weaken and can cause symptoms of urinary incontinence. Accompanying changes in your body due to menopause─such as less fat under the abdominal wall─may also play a role. Menopause-related pelvic floor dysfunction is common in women who have never had any children.     

Age: As you get older, the tissues and muscles around the bladder and vagina ─as well as other organs─become weaker. Incontinence may be caused by a weakening of these structures or their supporting structures.        

Injury: In some cases, pelvic floor dysfunction is an injury related to surgery ─such as a hysterectomy─injury from childbirth or severe constipation. An ill-fitting or poorly designed internal device made specifically for treating incontinence may also lead to pelvic floor dysfunction.      

What are the risks of pelvic floor dysfunction?

If you have pelvic floor dysfunction, you may be at risk for other conditions, including:

Urinary tract infections (UTIs), which can occur when urine stays in your bladder too long because your muscles don’t close tightly enough to prevent leakage; UTIs only occur because living with pelvic floor dysfunction is not good for you.

Infertility, which may be a sign of more serious conditions such as endometriosis (when uterine tissue grows outside the uterus); if you have severe fecal incontinence, it may lead to infertility because you are unable to control your bowel movements during intercourse.

Pelvic organ prolapse, when one or more organs drop out of their normal positions.

Abdominal hernias (when organs protrude through an opening in the muscles of your abdomen).

Chronic pain.  (pain that persists for more than 6 months; you may also have other symptoms such as changes in bowel or bladder function).

How is pelvic floor dysfunction diagnosed?

To diagnose pelvic floor dysfunction, your doctor will review your medical history and do a physical exam. They may also recommend certain tests to help confirm the diagnosis. Some of these include:

Bladder diary or charting, which records when you have incontinence, how much urine you pass, whether it’s involuntary, and the circumstances surrounding the leakage.

Ultrasound of the pelvic floor (USP), which uses sound waves to create images of your pelvic organs. The images can show whether they are in their normal positions or if one or more may be dropped into or protruding from your vaginal opening (prolapsed).

Urodynamics, which is the use of special equipment to evaluate how well your bladder and urethra store and release urine. The doctor may pass a thin tube into your bladder through the urethra─the tube has a tiny balloon at its tip that can be inflated with air or fluid. The doctor may insert a small catheter in the urethra to measure pressure in the bladder when you are sitting, standing, or lying down. You will also be asked to do various activities that can cause urine leakage, such as laughing or coughing.

Cystoscopy (also called urethroscopy), which uses a thin, lighted tube with a camera to look directly inside the bladder and urethra. It’s used to diagnose urinary tract infections, stones, or changes in tissues lining the urethra (for example, inflammation or cancer).     

How do you know if you have pelvic floor dysfunction?

You may experience symptoms such as:

The need to urinate frequently and urgently (weak bladder).  The need to rush to the bathroom and/or take time out of your day to use the restroom.                

Leakage of an embarrassing accident.  A feeling that you can’t completely empty your bladder (incomplete bladder emptying).    

A feeling that your bladder is not as strong as it should be.  You may also have a sensation of incomplete emptying.

Backache or abdominal pain, possibly due to muscle strain.  It can feel like you’ve overused the muscles of the pelvic floor and lower abdomen (similar to how your back “aches” after a long day of shopping).  This diagnosis must be made by a qualified physiotherapist with a lot of experience in treating incontinence.  Don’t make any conclusions on your own, but do consult a professional if you have symptoms that concern you.

In post-menopausal women, pelvic pain and urinary and bowel incontinence may be caused or worsened by vaginal dryness.  Talk to your doctor about possible solutions, such as vaginal estrogen cream or tablets.

How is pelvic floor dysfunction treated?

Your treatment plan will depend on the type of pelvic floor dysfunction you have, the severity of your symptoms, and whether any serious conditions are present. The treatment plan may include:

Exercises (Kegel exercises).   You can do Kegel exercises on your own or with the help of a physical therapist who will teach you how to contract and relax your pelvic floor muscles.  The goal is to strengthen your pelvic floor muscles, which should improve bladder control.

Continence products.   You will likely need to use pads and/or adult diapers (if you do not have bowel control).  

If your symptoms are significant, an incontinence product such as a pessary or sacral nerve stimulator may be recommended.

A pessary is a device that’s placed into the vagina to help support the uterus, bladder, or rectum. A sacral nerve stimulator is a device that’s surgically implanted to stimulate the nerves that control your bowel and urinary function.

 

Medications.   You may take medications if you have an overactive bladder or if you have leakage caused by an obstruction in your bladder, prostate gland, or urethra.

Surgery.   Surgery may be an option if your symptoms are not controlled by other treatments. Surgery to repair the pelvic floor muscles is called pelvic muscle repair. In some cases, surgery on the bladder or urethra is also needed.

In many cases of urinary incontinence, exercise can help improve your condition and help you avoid surgery.  You may be referred to a pelvic physical therapist (PT), who is specially trained in treating incontinence and other pelvic floor disorders.  

A PT may also help you find the correct muscles and teach you how to contract them correctly during Kegel exercises, which can strengthen or relax your pelvic muscles if needed.  

The exercises may include:

Performing Kegel exercises correctly.   You can try it the next time you urinate or defecate, or during sex (if appropriate).  Kegels should be performed at least 10 times a day and added to your daily routine.

Contracting your pelvic floor muscles and then relaxing them.  

Holding the contraction for a count of 3 and then relaxing for a count of 3.

See Pelvic Floor Strong Program by Alex Miller>>

If you have any questions about pelvic floor dysfunction or Kegel exercises, comment below.  I’ll do my best to answer you, or find someone who can!

Why is this dangerous? As the organs drop, they may press on nearby nerves and cause pain. In addition, a full bladder can put pressure on other organs so that you have difficulty emptying your bladder completely. A rectocele may also press against the rectum and cause difficulty having a bowel movement