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Pelvic floor dysfunction

by | Lower body

Learn with us at Lamberti Physiotherapy

Pelvic floor dysfunction affects both men and women. The pelvic floor is a group of muscles and ligaments supporting the bladder, uterus (womb) and bowel. The openings from these organs, the urethra from the bladder, the vagina from the uterus and the anus from the bowel, pass through the pelvic floor.

The pelvic floor muscles attach to your pubic bone at the front and the tailbone at the back and form the base of your pelvis. These muscles function to provide pelvic and spinal stability, help maintain optimal intra-abdominal pressure, provide support and closure of the urethra and anus, prevent urinary and faecal incontinence, sexual function, and support breathing. The current statistics are showing that 1 in 3 women and 1 in 10 men suffer from urinary incontinence.

 

pelvic floor muscles
pelvic floor dysfunction statistics

What can cause dysfunction of the pelvic floor?

  • Activities (cough, sneeze, laugh, run, jump, push, pull, carry, lift)
  • Childbirth/post-natal
  • Being overweight
  • Trauma to nerves, muscles, or joints
  • Post-surgery
  • Peri- and menopause (change in estrogen)
  • Stress
  • Being disabled

The green in the below pictures show the pelvic floor supporting and surrounding the urethra and anus.

Pelvic floor female bladderPelvic floor male bladder

 

 

 

 

 

 

 

 

Symptoms you may recognise that affect specific organs

1. Bladder
  • Leak with cough, sneeze, exercise (stress incontinence)?
  • Can’t make it to the toilet on time (urgency)?
  • Strain to empty your bladder (hyper- or hypotonic pelvic floor)?
  • Urine stream slow / hesitant?
  • Bladder pain?

 

2. Bowel:constipation is a symptom of pelvic floor dysfunction
  • Constipation?
  • Laxative use?
  • Frequency of bowel movement?
  • Hard stools?
  • Straining?
  • Emptying (obstructive defecation)?
  • Pain with bowel movement?
  • Leaking stool?
  • Leaking wind?
3. Prolapse:
  • Bulging / heaviness in vagina (prolapse)?
  • Something coming out of the vagina / anus?

 

4. Sexual Function:
  • Pain with intercourse (dyspareunia)?
  • Difficulty with tampon insertion (vaginismus)?
  • Lubrication (vaginal dryness) / erectile dysfunction?
5. Pelvic Pain:
  • Pain with bladder and/or bowel?
  • Function / surgery / cancer?
  • History of endometriosis / painful periods / fibroids / polycystic ovarian syndrome?
  • Pelvic girdle pain, lower back pain and hip pain?

How do you treat pelvic floor dysfunction?

  • Normalise movement patterns
  • Recruit deep low load muscle
  • Normalise breathing pressures
  • Strengthen for sport/work back to function and participation
  • Restore normal sensori-motor integration/proprioception for control
  • Increase mindful awareness to:
    • change behaviours
    • change relationships with the toilet
    • retrain ‘as normal as possible’ posture and movement patterns

Some information to help the process

  1. Your fluid intake should be = 1500 ml – 2400 ml per day.
  2. Try to stop smoking – nicotine can aggravate the bladder.
  3. Chronic coughing from COPD, COVID, etc. may cause urinary incontinence.
  4. Diet modification (eating fruits and vegetables and adding fibre to your diet).
  5. Weight loss.
  6. Avoid bladder stimulants including coffee, tea, alcohol, and chocolate to change urge behaviours.
  7. Exercises.
  8. Mindfulness.
  9. Bowel regularity.
  10. Avoid constipation – can increase bladder sensitivity.
  11. Defecation position (squat) to allow easier passage of stools.

How can physiotherapy help?

Physiotherapy can help to assess your symptoms and create a treatment plan specifically for your condition. Our physiotherapists at Lamberti Physiotherapy are trained to assess, diagnose, and treat some of the symptoms of pelvic floor dysfunction conditions. If you think that you may have some measure of pelvic floor dysfunction, complete a form here and select your nearest Practice for a confidential discussion and assessment.

References and credits

Image credits:
https://www.kenhub.com/en/study/pelvic-floor-muscles
http://cioffredi.com/projects/pelvic-health-rehabilitation
https://www.kenhub.com/en/study/female-urinary-bladder
https://www.kenhub.com/en/study/male-urinary-bladder

References:
• The Most Common Functional Disorders and Factors Affecting Female Pelvic Floor, Sabina Tim and Agnieszka I. Mazur-Bialy 2021
• A simplified fascial model of pelvic anatomical surgery: going beyond parametrium centered surgical anatomy, Stefano Cosma1 · Domenico Ferraioli2 · Marco Mitidieri3 · Marcello Ceccaroni4 · Paolo Zola5 · Leonardo Micheletti1 · Chiara Benedetto 2020
• An International Continence Society (ICS) report on the terminology for pelvic floor muscle assessment Helena Frawley1 | Beth Shelly2,3 | Melanie Morin4 |Stéphanie Bernard5 | Kari Bø6,7 | Giuseppe Alessandro Digesu8 |Tamara Dickinson9 | Sanchia Goonewardene10 | Doreen McClurg11 |Mohammad S. Rahnama’i12,13 | Alexis Schizas14 |Marijke Slieker‐ten Hove15,16 | Satoru Takahashi17 | Jenniffer Voelkl Guevara 2021
• Physical Therapy in the Treatment of Central Pain Mechanisms for Female Sexual Pain Carolyn Vandyken 1, Sandra Hilton 2 2011
• Zelano C, Jiang H, Zhou G, Arora N, Schuele S, RosenowJ, GottfriedJA. Nasal respiration entrains human limbic oscillations and modulates cognitive function. Journal of Neuroscience. 2016 Dec 7;36(49):12448-67.
• Standardization of terminology of pelvic floor muscle function and dysfunction: report from the pelvic floor clinical assessment group of the International Continence Society
• Bert Messelink 1, Thomas Benson, Bary Berghmans, Kari Bø, Jacques Corcos, Clare Fowler, Jo Laycock, Peter Huat-Chye Lim, Rik van Lunsen, Guus Lycklama á Nijeholt, John Pemberton, Alex Wang, Alain Watier, Philip Van Kerrebroeck 2005
• Wyndaele M, Hashim H, Pathophysiology of urinary incontinence, Surgery (2017), http://dx.doi.org/10.1016/j.mpsur.2017.03.002
• Chesnel C, Charlanes A, Tan E, Turmel N, Breton FL, Ismael SS, Hentzen C, Amarenco G. Influence of the urine stream interruption exercise on micturition. International Journal of Urology. 2019 Nov;26(11):1059-63.
• Andrews, M .The pathophysiology of chronic constipation. Can J gastroenterol 2011;25(suppl B):16B-21B.
• Costilla, V.C. and A.E. Foxx-Orenstein, Constipation: understanding mechanisms and management. Clin Geriatr Med, 2014. 30(1): p. 107-15.
• George, S.E. and D.F. Borello-France, Perspective on Physical Therapist Management of Functional Constipation. Phys Ther, 2017. 97(4): p. 478-493.
• http://cioffredi.com/projects/pelvic-health-rehabilitation/
• Evaluating pelvic floor disruption following vaginal delivery using three-dimensional transperineal ultrasound Lina Salman, Dan Valsky, Yuval Lavy, Simcha Yagel, Drorith Hochner-Celnikier 2017