Pelvic Floor Dysfunction
The outlets of the pelvic organs such as the bladder, uterus and rectum are controlled by contraction and relaxation of the pelvic floor muscles. Coordinated contraction and relaxation of these muscles is necessary for controlling the bowel movements and urination.
Pelvic floor dysfunction refers to inappropriate contraction of the muscles (contraction of the muscles when relaxation is necessary to have a bowel movement).
Symptoms
Pelvic floor dysfunction leads to difficulty in evacuating stools or constipation. It may also cause a sensation of incomplete evacuation or leakage of urine or stool.
Causes
The cause of pelvic floor dysfunction is not clear in most cases. In some cases it appears to be caused by traumatic pelvic injuries, or due to childbirth related injuries. In others it is seen as a learned behavioral abnormality due to excessive straining.
Testing
Testing may involve evaluation of the function of the pelvic floor relaxation and contraction, rectal sensation as well as rectal pressure. The test for assessing rectal muscle function is called anorectal manometry. This abnormality can also be detected by x-ray based test called sitz marker study which involves ingesting a pill containing markers that can be seen on an x-ray. MRI of the pelvis called defecating MR proctography can also be used to check muscle function. Lastly, nerve function may need to be evaluated by means of a test called electromyography (EMG).
Treatment
Treatment of the condition primarily involves a technique called biofeedback therapy with the assistance of a physical therapist. The physical therapist will use sensors and videos to monitor the pelvic floor movement and contraction, providing valuable feedback to guide you to relax the muscles at the appropriate time. Relaxation techniques such as meditation and warm baths are usually recommended as well. Occasionally, pelvic floor dysfunction is due to rectal prolapse and may need surgical intervention to improve bowel habit.
FAQs
Pelvic floor dysfunction is a condition in which the muscles of the pelvic floor are weak, tight, or have poor coordination, resulting in problems with bowel, bladder, or sexual function.
Symptoms of pelvic floor dysfunction can include constipation, painful bowel movements, difficulty initiating defecation, pelvic pain, and excessive straining to have a bowel movement.
Pelvic floor dysfunction can be caused by a variety of factors, including injury, pregnancy, childbirth, surgery, aging, chronic constipation, and obesity. It can also be the result of certain medical conditions, such as multiple sclerosis or spinal cord injury.
Pelvic floor dysfunction is usually diagnosed by a healthcare provider through a physical examination and discussion of the patient’s symptoms. Further testing, such as anorectal manometry, sitzmarker study, barium gel or MRI defecating proctogram and rectal ultrasound may be needed to confirm the diagnosis and determine the specific cause of the dysfunction.
Treatment for pelvic floor dysfunction may include physical therapy with focus on pelvic floor muscle exercises/retraining, biofeedback therapy, behavioral modification, and medication depending on the specific cause and severity of the dysfunction.
Certain measures, such as maintaining a healthy weight and avoiding constipation, may help prevent pelvic floor dysfunction. Kegel exercises, which involve contracting and relaxing the pelvic floor muscles, may also be helpful in maintaining pelvic floor muscle strength.