Author: Jessica Harnish, NP
Overview
Pelvic floor dysfunction occurs when you have abnormal coordination of your pelvic floor muscles with relaxing and contracting. These muscles control your bowel and bladder so inability to relax or having a weakness can cause problems with bowel movements, urination, and pelvic pain.
Symptoms:
- Frequent bathroom use
- Feeling incomplete bowel movement or urination, “I feel like I could go more.”
- Bowel dysfunction: constipation, leaking stool, straining or changing positions to have a bowel movement
- Bladder dysfunction: urinary frequency, urgency, leaking urine, including with laughing or sneezing
- Pain in your pelvic region
- Sexual dysfunction
Causes:
- No known cause although risk factors can contribute.
Risk factors:
- Pregnancy and deliveries (especially complicated)
- Pelvic surgery (hysterectomy, prostatectomy)
- Traumatic injuries
- Age, weight
- Behavioral such as straining to use the restroom
- Medical conditions: Connective tissue disorders
- Stress
How is it diagnosed?
In the office:
- Medical history. Will need to obtain a detailed history. Some questions that might be asked:
- Do you strain to poop? Do you feel empty after a bowel movement?
- Are you able to empty your bladder?
- Do you leak urine while laughing or sneezing?
- Physical examination
- Internal and external rectal exam to evaluate for weakness, tightness, and spasms.
Possible testing:
- Updated Colonoscopy
- Anal manometry
- A test to see if your anal and rectal muscles are coordinating together to produce a bowel movement by measuring your muscle contractions. A small tube is placed in the rectum and you will have to contract and relax your muscles.
- Defecography
- Series of x-rays taken during a replicated bowel movement to look at movement of the pelvic floor along with any structural issues.
- Alternative is done with an MRI
How is it treated?
- Pelvic floor physical therapy
- Physical therapist will use the results of above testing to make a treatment plan for you.
- Manual therapy and biofeedback may be options.
- Biofeedback is used to retrain your muscles.
- Medications
- Relaxation techniques to relax your pelvic floor (yoga, taking baths, mediation).
- Lifestyle modifications: avoid straining
- Surgery
References
American Gastroenterological Association. n.d. Constipation. https://patient.gastro.org/constipation/
American Society of Colon and Rectal Surgeons. n.d. Pelvic Floor Dysfunction. https://fascrs.org/patients/diseases-and-conditions/a-z/pelvic-floor-dysfunction-expanded-version
International Foundation for Gastrointestinal Disorders. n.d. Pelvic Floor Dysfunction. https://aboutgimotility.org/learn-about-gi-motility/disorders-of-the-pelvic-floor/pelvic-floor-dyssynergia/
National Institutes of Health-National Library of Medicine. 2023. Pelvic Floor Dysfunction. https://www.ncbi.nlm.nih.gov/books/NBK559246/
