What Is Pelvic Floor Dysfunction?

Pelvic floor dysfunction can be a distressing and uncomfortable condition, but with the right information and support, it is possible to manage and treat it effectively. Read on to learn more about the causes, signs, and management of pelvic floor dysfunction, as well as important information on risk factors and potential complications.

Overview

The condition known as pelvic floor dysfunction (PFD) describes a weakening or impairment of the muscles, ligaments, and connective tissues that support the pelvic organs. The pelvic floor is made up of a collection of muscles that runs from the pubic bone to the base of the spine and resembles a hammock. It is essential to maintain support for the rectum, bladder, uterus, and other pelvic organs as well as manage bowel and bladder function.

When the pelvic floor muscles become dysfunctional, it can lead to various problems such as urinary incontinence, faecal incontinence, pelvic organ prolapse, chronic pelvic pain, and sexual dysfunction. These issues can significantly impact a person's quality of life, causing discomfort, embarrassment, and limiting daily activities.

Causes of pelvic floor dysfunction

Pelvic floor dysfunction can arise from a variety of factors, including:

• Pregnancy and childbirth: The process of pregnancy and vaginal delivery can weaken the pelvic floor muscles and stretch the connective tissues. Researchers have found that the more children a person gives birth to, the higher the risk. If a suction device or forceps are utilised during delivery, the risk may increase
• Ageing: As we age, the pelvic floor muscles naturally weaken, making them more prone to dysfunction
• Chronic constipation: Straining during bowel movements over a prolonged period can put stress on the pelvic floor muscles
• Chronic coughing: Conditions such as chronic bronchitis or asthma that involve persistent coughing can strain the pelvic floor muscles
• Obesity: Excess weight can place additional pressure on the pelvic floor, leading to muscle weakness
• Pelvic surgery: Surgical procedures involving the pelvic area, such as hysterectomy or prostate surgery, can disrupt the integrity of the pelvic floor¹ 
• Other Factors: Incontinence may be worsened by medications that reduce muscle tone, such as benzodiazepines, opiates, alpha-blockers, calcium channel blockers, and methyldopa. There may be a synergistic interaction of antihistamines and anticholinergics (acetylcholine blocker) that causes urinary hesitation and retention²

Signs and symptoms of pelvic floor dysfunction

Pelvic floor dysfunction can manifest in various ways, and the symptoms may differ from person to person. Common signs and symptoms include:²

• Urinary problems: Frequent urination, urgent need to urinate, urinary leakage, or difficulty initiating or stopping urination
• Bowel problems: Constipation, straining during bowel movements, faecal incontinence, or a sensation of incomplete bowel emptying
• Pelvic pain: Chronic pain in the pelvic region, lower back pain, discomfort during intercourse, or pain during bowel movements
• Pelvic organ prolapse: A sensation of heaviness or pressure in the pelvis, or the protrusion of pelvic organs into the vaginal or rectal area 

Management and treatment for pelvic floor dysfunction

The symptoms and causes of pelvic floor dysfunction dictate how it is managed and treated. Some common approaches are as follows:²

• Kegel exercises, or exercises for the pelvic floor: The tone and support of the pelvic floor can be improved with regular exercise. Core exercises can be incorporated, too 
• Behavioural therapies: Methods like biofeedback, in which patients learn to regulate and fortify the pelvic muscles themselves, can be helpful
• Lifestyle changes: Symptoms can be reduced by making adjustments to one's lifestyle, such as eating healthier, weight loss, getting more sleep, limiting smoking, and exercising regularly.
• Medication: Medications such as topical oestrogen (applying oestrogen-containing creams, gels, patches etc directly to the skin or mucous membranes), anticholinergics etc are sometimes provided to help with symptoms like chronic pain or problems with bladder control
• Surgery: Repairing or reinforcing the pelvic floor by surgery may be advised for severe cases or when non-invasive treatments have failed
• Self-splinting: Supporting the patient's posterior vagina, anterior vagina, or perineum with a digital splint can help them urinate or defecate more easily
• Pessary: Vaginal pessary for stress incontinence and pelvic organ prolapse
• Physical Therapy: Massage of trigger points, myofascial release, strain-counter strain, and joint mobilisation are all techniques used in physical therapy.Treatment for dyspareunia caused by overactivity of the pelvic floor muscles. Professional instruction in pelvic floor exercises
• Invasive procedures: Botulinum toxin (Botox) injections, electrical stimulation of sacral nerve, acupuncture and trigger point injections 

Diagnosis of pelvic floor dysfunction

It's crucial to speak with a healthcare provider if you're concerned that you may have pelvic floor problems. The diagnosis could include:³

• Review of medical history: Your symptoms, medical and gynaecological history, and any other elements that can affect pelvic floor dysfunction will all be discussed by your doctor. The doctor should enquire about any other bodily discomfort conditions, as well as any concerns with bowel motions, urination, or pain during sexual activity 
• Physical Examination: The strength, tone, and coordination of the pelvic floor muscles will be evaluated during a full physical examination, which will also include a pelvic examination. Additional tests may be needed to diagnose nerve involvement
• Diagnostic tests: To assess the pelvic floor's performance and determine any underlying problems, additional tests may be carried out. Defecography to examine bowel function, urodynamic testing to measure bladder function, and imaging tests like ultrasound or MRI are a few examples 
• Referrals to experts: Your doctor may occasionally recommend that you see a pelvic floor problems expert such as a urologist, gynaecologist, colorectal surgeon, or physical therapist 

Risk factors

Several factors can increase the risk of developing pelvic floor dysfunction. These include:⁴

• Pregnancy and childbirth: Giving birth vaginally using forceps or vacuum, especially multiple times, put an individual at a higher risk due to the strain placed on the pelvic floor muscles during pregnancy and delivery 
• Ageing: As mentioned earlier, the natural ageing process can weaken the pelvic floor muscles, making older individuals more susceptible to dysfunction
• Chronic conditions: Certain chronic conditions such as obesity, chronic constipation, chronic cough, or connective tissue disorders can contribute to pelvic floor dysfunction
• Lifestyle factors: Factors like smoking, heavy lifting, high-impact exercises, and a sedentary lifestyle can increase the risk of pelvic floor dysfunction
• Family history: People with a positive family history are at risk. 
• Body weight: Obesity and high BMI increase the risk of Pelvic floor dysfunction 
• Pelvic floor surgery: People who undergo hysterectomy or other pelvic organ surgeries are more at risk 

Complications

Pelvic floor dysfunction can result in a number of issues, including:

• Faecal and urinary incontinence: Weakened pelvic floor muscles can make it difficult to control bowel and bladder movements, which can result in leakage that is unintentional
• Pelvic organ prolapse: In extreme situations, the pelvic floor muscles may be too weak to appropriately hold the pelvic organs, causing them to descend or protrude into the vagina or rectum
• Pelvic floor dysfunction can affect sexual function by causing pain during sexual contact, lowering sexual satisfaction, or making it more difficult to experience orgasm

FAQs

Can pelvic floor dysfunction be prevented?

While some risk factors like pregnancy and ageing are not preventable, certain measures can help reduce the risk of pelvic floor dysfunction. These include maintaining a healthy weight, practising pelvic floor exercises, managing chronic conditions, and adopting proper lifting techniques.

How common is pelvic floor dysfunction?

About 11% of individuals assigned female at birth (AFAB) will undergo one or more surgical procedures by the age of 80 for pelvic organ prolapse or urine incontinence. Up to 40% of them in their reproductive age are thought to experience sexual dysfunction regularly. Up to 50% of pregnant individuals may have PFD.² 

When should I see a doctor?

If you experience symptoms such as urinary or faecal incontinence, chronic pelvic pain, or pelvic organ prolapse or are at a risk, it is recommended to see a healthcare professional specialising in pelvic floor disorders. 

Summary

Pelvic floor dysfunction is a condition characterized by weakened or impaired muscles, ligaments, and connective tissues in the pelvic region. Numerous symptoms, including pelvic pain, prolapsed pelvic organs, and urinary and gastrointestinal issues, may result from it. People can find relief and enhance their quality of life by visiting the doctor, getting a proper diagnosis, and putting appropriate management techniques in place, such as pelvic floor exercises, lifestyle changes, and, if required, surgical interventions. Keep in mind that the best way to deal with pelvic floor dysfunction is through early intervention and proactive management.