Pelvic Floor Dysfunction

Pelvic Floor Dysfunction

What Is Pelvic Floor Dysfunction?

Pelvic floor dysfunction refers to a range of disorders that occur when the muscles and ligaments in the pelvic floor are impaired. While this condition primarily affects women, a small percentage of men can also experience it.

Pelvic floor disorders may develop due to injury or weakening of the pelvic area muscles or connective tissues. This dysfunction can interfere with the ability to relax and coordinate the pelvic floor muscles effectively during bowel movements.

There are several treatment options for pelvic floor disorders, which vary based on individual symptoms. Your doctor may recommend lifestyle changes, physical therapy, medication, or, in some cases, surgery.

What are pelvic floor muscles?

The pelvic floor consists of a group of muscles that form a hammock-like structure at the base of the pelvis, extending from the pubic bone in the front to the tailbone in the back. These muscles support the bladder and bowel, helping to control urination and bowel movements. Maintaining strong pelvic floor muscles can also enhance your sex life. Just like any other muscles in the body, it’s important to keep your pelvic floor muscles strong.

When you cough, sneeze, or laugh, your pelvic floor muscles should contract to prevent urine leakage. These muscles should relax during urination or bowel movements and then tighten again afterward. This process helps control the release of urine, bowel movements, and gas.

For proper function, the pelvic floor muscles should be capable of tightening and lifting, maintaining a hold, and fully relaxing to release. Just like any other weak muscle, the pelvic floor muscles can be strengthened. Regular exercise is essential for them to function effectively.

The pelvic floor is an essential part of the body that plays a critical role in several bodily functions. Maintaining its health is crucial to prevent or alleviate issues such as incontinence, pelvic organ prolapse, and sexual dysfunction. By prioritising pelvic floor health, you can improve your quality of life and maintain overall well-being.

What Causes Pelvic Floor Dysfunction?

Pelvic floor dysfunction can arise from a variety of factors. Some of the most common causes include childbirth, menopause, and obesity. Additionally, some women may have a genetic predisposition to develop this condition due to naturally weaker connective tissue and fascia. Recent surgery can also contribute to pelvic floor dysfunction.

Some of the reasons for pelvic floor disorders (PFD) are preventable, while others are not. One significant improvement can be achieved by losing weight and exercising, as obesity is a major contributing factor to prolapse.

PFD is common during and after pregnancy. While experiencing symptoms is not unusual, they should resolve quickly and not persist for an extended period.

If your symptoms last longer than six weeks after giving birth or are severe, we recommend seeking help. Treatment for PFD is typically straightforward and painless.

There is also some evidence suggesting that a hysterectomy may lead to pelvic floor dysfunction. While this procedure has been linked to an increased risk of pelvic floor disorders (PFD) due to causing the pelvic floor to be more susceptible to weakness, the findings on this relationship have been inconsistent and are more specifically associated with pelvic organ prolapse. Pelvic floor dysfunction though, can often lead to pelvic organ prolapse. To read more about this condition click HERE.

What can be mistaken for pelvic floor dysfunction?

“Pelvic floor disorders are frequently misdiagnosed as chronic infections or gastrointestinal issues, such as irritable bowel syndrome (IBS). One specific condition, called rectocele, is a type of prolapse that can lead to constipation. This occurs when the rectum bulges into the back wall of the vagina or affects more anterior organs.”

Symptoms of Pelvic Floor Dysfunction

When pelvic organ prolapse occurs, there may be a visible protrusion of organs or a lump felt in the vagina or anus. Symptoms can significantly impact a woman’s daily life. However, many individuals find it challenging to discuss this issue and seek care due to feelings of embarrassment and stigma.

Common types of pelvic floor disorders (PFD) include pelvic organ prolapse, urinary incontinence, and fecal incontinence. These disorders are prevalent among older women. Symptoms can vary from person to person but typically include:

• Constipation
• Bowel incontinence – Leakage of poo or passing wind from either the anus or vagina when bending over or lifting.
• incomplete emptying of faeces
• Pain in your lower back
• Pelvis muscle spasms
• Pelvic pain – rectal, abdominal or vaginal pain, heaviness in the pelvic region
• Dyspareunia – Pain or discomfort with sex
• Reduced sensation in the vagina
• Painful urination
• Urinary incontinence – Leaking urine when coughing, sneezing, laughing or running.
• Overactivity of the bladder – Needing to go to the toilet a lot and often urgently
• myofascial pelvic pain and pelvic organ prolapse
• Discomfort or pressure in the rectum or pelvic area
• Passing wind from either the anus or vagina when bending over or lifting.
• Prolapse of the pelvic organs – descent of the bladder, bowel or womb into the vagina

There are several effective ways to strengthen the pelvic floor, helping to prevent issues or alleviate their symptoms. One of the best methods is to perform pelvic floor exercises, commonly known as Kegel exercises. These involve the contraction and relaxation of the pelvic floor muscles.

How can I check my pelvic floor at home?

Lie down and insert a finger into your vagina. Try to squeeze around your finger with your vaginal muscles. You should be able to feel the sensation in your vagina, and you may also be able to feel the pressure on your finger. If you can feel this, you are using the right muscles.

How are pelvic floor disorders (PFDs) treated?

When it comes to enhancing a woman’s quality of life, effective treatment can be a game changer. It has the power to ease troubling symptoms and remove barriers that may hold her back from fully enjoying her daily activities. Some types of treatments include the following.

• Nonsurgical treatments (Kegel / pelvic floor exercises, medications, vaginal pessary)
• Lifestyle modifications
• Surgery

Nonsurgical Treatment

• Pelvic floor muscle training (PFMT) otherwise known as Kegel exercises – This involves the practice of contracting and relaxing the pelvic floor muscles. When performed correctly and consistently, PFMT may help improve symptoms of urinary incontinence and pelvic organ prolapse. However, it’s important to note that PFMT cannot correct prolapse. Women can do these exercises independently or seek assistance from a pelvic floor physical therapist.
• Lifestyle Changes – To prevent PFD, it is advised to modify lifestyle factors such as diet, physical activity, quitting smoking, and losing weight.
• Medicine – Medication is sometimes prescribed to address bladder control issues or to prevent loose stools and frequent bowel movements.
• Vaginal pessary – A pessary is a plastic device used to treat pelvic organ prolapse and can also help improve bladder control. It is inserted into the vagina by a woman or her healthcare provider to support the pelvic organs. A doctor will fit the pessary to ensure it is the right shape and size for comfort and will provide instructions on how to use and care for it.

Kegel / Pelvic Floor Exercises

Pelvic floor exercises are designed to strengthen the muscles that support your bladder, rectum, and sexual organs. These muscles play a crucial role in controlling bladder and bowel function. Commonly referred to as Kegel exercises, these workouts are particularly beneficial for individuals with weak or damaged pelvic floor muscles, as such conditions can lead to urinary incontinence.

You can perform pelvic floor exercises in various positions: standing, sitting, or lying down. To begin, it’s easiest to start while lying down with your knees bent. As you become more comfortable with the exercises, you can move on to doing them while sitting or standing. When done correctly, these exercises can be performed discreetly, so no one will know you are doing them.

How do I do pelvic floor exercises?

To begin, find a quiet and comfortable space where you can sit or lie down with your feet flat on the floor. To identify your pelvic floor muscles, imagine that you are trying to stop the flow of urine or trying to prevent yourself from passing gas.

To identify your pelvic floor whilst sitting Please watch the video below.

Pelvic Floor Exercises – Identify Your Pelvic Floor Sitting

You can gradually increase the number of pelvic floor squeezes up to a maximum of 10 slow contractions and 10 fast contractions. Be careful not to overexert the muscles.

The slow squeezes help build endurance in the pelvic floor, which supports the organs in the pelvis and enables you to hold on for longer periods. The quick squeezes improve your pelvic floor’s ability to react swiftly when you cough or sneeze.

If you notice a bulge in the vaginal area while exercising, stop immediately and consult your doctor or physiotherapist.

Strengthening these muscles takes a minimum of three months. It’s important to perform the exercises regularly and to maintain this routine. Aim to complete sets of slow and quick squeezes three times a day. To establish a consistent habit, try to do them at the same times each day. Setting reminders on your mobile phone or using a pelvic floor exercise app can be beneficial.

You may not notice immediate improvements, so it’s essential to stay committed. Continue this routine for at least 4 to 6 months. As your muscles become stronger, you’ll be able to increase your hold time, the number of repetitions during each session, and eventually progress to doing the exercises while standing.

Don’t try to stop and start your flow of urine whilst on the toilet – this can interfere with normal bladder function.

To help ensure you exercise daily, try linking it to an everyday activity, such as brushing your teeth or waiting at traffic lights. Make it a habit to tighten your pelvic floor muscles before you cough, sneeze, or lift anything. You can also download the NHS approved “Squeezy” App. It will send you reminders to do the exercises and you can personalise the programme to suit you. You can find the App HERE.

Many people find it challenging to identify which muscles to engage. If you’re unsure or if your symptoms aren’t improving, consider asking your doctor for a referral to a specialist. They can evaluate your technique to ensure you’re performing the exercises correctly and provide tailored advice.

The specialist will assess your ability to contract your pelvic floor muscles and determine the strength of those contractions. If you can effectively contract these muscles, you will receive a personalized exercise program based on your assessment.

Lifestyle Changes

In addition to pelvic floor exercises, making certain lifestyle changes can also support pelvic floor health. Maintaining a healthy weight, eating a balanced diet rich in fiber, staying hydrated, and avoiding constipation can all help reduce strain on the pelvic floor. Additionally, quitting smoking and minimizing prolonged sitting or standing can further benefit pelvic floor health.

If you’re experiencing symptoms, it’s a good idea to consult your GP about ways to reduce or alleviate them. Your healthcare provider may recommend several actions, such as the following:

• Avoid caffeinated drinks – Some beverages, such as tea, green tea, and coffee, can stimulate the bladder, making you need to use the bathroom.
• Avoid carbonated drinks and Alcohol – It is advisable to steer clear of carbonated beverages such as Coke, energy drinks, and alcoholic beverages. These drinks can aggravate the bladder, potentially leading to increased discomfort and urinary urgency. Choosing alternatives like water or caffeine free herbal teas may help maintain a healthier bladder and improve overall well-being.
• For certain bowel problems, eat a high-fibre diet – Fiber is important for digestion, helping to form stool and prevent constipation. It is found in fruits, vegetables, legumes, and whole grains, with supplements also available. Additionally, it’s best to limit citrus fruits and foods high in artificial sweeteners.
• Lose weight – Being overweight can place extra strain on your pelvic floor. For women who are overweight or obese, losing weight may help reduce symptoms of bladder control issues and pelvic organ prolapse by alleviating pressure on the pelvic organs. Consider trying low-impact exercises such as walking, swimming, or Pilates, along with making dietary changes, to aid in weight loss.

Medicine

There are a variety of medications available for the management of urinary and bowel incontinence, each designed to address specific symptoms and underlying causes. One effective treatment option is local vaginal oestrogen therapy, which may be administered as a low-dose oestrogen cream or as tablets that are inserted into the vagina. This therapy works by replenishing oestrogen levels in vaginal and urethral tissues, helping to restore their elasticity and moisture. As a result, patients often experience a reduction in symptoms such as urinary frequency, urgency, and urge incontinence, particularly in postmenopausal women whose oestrogen levels have declined.

In addition to oestrogen therapy, antimuscarinic medications are commonly prescribed for the treatment of urge urinary incontinence. These oral medications are typically taken once daily and function by blocking the action of acetylcholine, a neurotransmitter that stimulates bladder contractions. By inhibiting these contractions, antimuscarinics help to reduce the sensation of urgency and improve bladder control, ultimately leading to fewer episodes of involuntary leakage. Some examples of these medications include oxybutynin, tolterodine, and solifenacin, each varying in terms of efficacy and side effect profiles, allowing healthcare providers to tailor treatment to individual patient needs.

Overall, the choice of medication will depend on various factors, including the patient’s health status, the severity of symptoms, and potential contraindications.

It’s important to speak with your GP to learn about the options available and to determine which treatment would be best for you.

Vaginal pessary

A vaginal pessary is a device made from rubber (latex) or silicone that is inserted into the vagina to provide support for the vaginal walls and pelvic organs.

Vaginal pessaries can assist in alleviating the symptoms of moderate to severe prolapse and are a suitable option for those who cannot or prefer not to undergo surgery. Additionally, they may help you conceive in the future.

These pessaries come in various shapes and sizes to meet individual needs, with the most commonly used type being the ring pessary.

Finding the most effective pessary for you may require some experimentation with different types and sizes. Typically, a gynecologist or a specialized nurse will fit the pessary. It is important to regularly remove, clean, and reinsert the device.

Fortunately, there are effective ways to address and manage these side effects, allowing for a more comfortable experience moving forward.

Surgical Treatment

In some cases, surgery can be the best option, especially if other treatments don’t help. Many surgical procedures can be done on an outpatient basis, which means patients can go home the same day!

For women with prolapse, surgery aims to repair the condition and restore the normal structure of the body. Different techniques are available based on the type of prolapse and the individual’s situation. For uterine prolapse, doctors might suggest a hysterectomy, which removes the uterus. Women undergoing prolapse surgery may also need extra procedures to fix bladder control problems.

Some women benefit from a procedure called colpocleisis (vaginal closure), which treats prolapse by narrowing and shortening the vagina. This method is effective and has minimal risk, but it may not be suitable for those who want to keep the option for vaginal intercourse.

For bladder control issues, surgery can greatly improve quality of life, especially for those who leak urine when sneezing, coughing, laughing, or exercising (known as stress incontinence). This happens when pressure on the bladder causes leakage due to weakened support around the urethra. A common surgical option is the mid-urethral sling procedure, which places supportive material under the urethra to prevent leaks during physical activity.

Another option is to inject “bulking agents” near the bladder neck and urethra to make the tissue thicker and help seal the bladder opening. Some patients may need more injections over time for continued support.

For bowel control issues, surgery can repair damaged anal sphincter muscles, deliver medications directly into the sphincter, or even implant a stimulator to help nerve function.

Not all women are suitable candidates for surgery. Those who plan to have children in the future should think carefully about their options. While surgery can significantly improve conditions, there is a chance that prolapse may return after surgery. However, with the right information and support, women can make informed choices that improve their well-being!