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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 have multiple causes. Physicians have associated this condition to events or conditions that has resulted in pelvic muscle weakness, such as:

  • Childbirth
  • Trauma or injury to the pelvic region
  • Pelvic surgery
  • Obesity
  • Radiation treatment
  • Heavy lifting
  • Nerve damage, especially to the lower spinal region

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 pelvic examination to check for prolapse of the various pelvic organs, muscle weakness, muscle tears, and other signs.

Your physician may also order additional tests to determine the exact cause of the pelvic floor dysfunction. These tests include:

  • Multichannel urodynamics to evaluate bladder filling, emptying and identify any incontinence. This is performed in the office and an integral part of the pre-operative evaluation for most women with pelvic organ prolapse.
  • Cystoscopy to look into the bladder to identify any structural abnormalities such as stones, tumors or other lesions.
  • 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 urethral and anal sphincter muscles and pelvic floor
  • Pelvic, 3-dimensioanl and endorectal ultrasound to obtain images of the pelvic structures, such as control muscles, urethra, rectum and any previously implanted grafts/mesh.
  • Videodefecography, 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 improve symptoms of urinary, fecal or vaginal dysfunction by normalizing anatomy, support and function of the pelvic floor muscles. The treatment varies based on the cause of the dysfunction and severity of the symptoms and includes:

  • Biofeedback: This method is a very effective treatment for pelvic floor dysfunction where a specifically-trained Physical Therapist assesses the pelvic floor muscles as the patient attempts to relax or contract them. Your therapist will then provide guidance to teach you how to improve muscle function and coordination. This usually requires a few sessions.
  • Medication: Your physician may prescribe a muscle relaxant to deal with pelvic floor dysfunction. The relaxant prevents involuntary contractions of pelvic muscles and helps in relaxing the muscles if they are overly tight. Other medications may be prescribed for overactive bladder, urinary retention, prevention of urinary tract infections, and local estrogen replacement.

Surgery: if your pelvic floor dysfunction results in vaginal, uterine or rectal prolapse, surgery may be necessary. Surgery helps in normalizing support of the affected pelvic organs and allowing their normal function.