Pelvic Floor Disorders: What You Need to Know

Pelvic floor disorders (PFDs) are a group of conditions that affect the muscles and connective tissues of the pelvic area. They can cause problems with bladder and bowel control, sexual function, and pelvic organ support. PFDs are more common among older women, but they can affect anyone, regardless of age or gender.

Types of Pelvic Floor Disorders

There are different types of PFDs, depending on which part of the pelvic floor is affected and how. Some of the most common ones are:

• ‍Urinary incontinence: This is the involuntary leakage of urine. It can be caused by stress (such as coughing, sneezing, or laughing), an urge (such as a sudden and strong need to urinate), or a combination of both.

• ‍Faecal incontinence: This is the involuntary leakage of stool or gas. It can be caused by damage to the anal sphincter (the muscle that controls the opening of the anus), nerve injury, or constipation.

• ‍Pelvic organ prolapse: This is when one or more of the pelvic organs (such as the bladder, uterus, or rectum) drop down from their normal position and bulge into the vagina or anus. It can cause a feeling of pressure, heaviness, or fullness in the pelvic area, as well as urinary or bowel problems, sexual difficulties, or discomfort.

• ‍Obstructed defecation: This is when stool enters the rectum but cannot be pushed out easily. It can cause straining, incomplete evacuation, or a need to use fingers or other objects to help empty the bowel.

• ‍Paradoxical puborectalis contraction: This is when a pelvic floor muscle called the puborectalis contracts instead of relaxes during a bowel movement. It can cause difficulty passing stool, constipation, or a feeling of incomplete emptying.

Causes and Risk Factors of Pelvic Floor Disorders

The exact causes of PFDs are not fully understood, but some factors that may contribute to their development include:

• ‍Childbirth: Giving birth can stretch, tear, or weaken the pelvic floor muscles and tissues, especially if the delivery is prolonged, difficult, or involves forceps or vacuum extraction.
• ‍Ageing: As people get older, their muscles and tissues tend to lose strength and elasticity, which can affect their function and support.
• ‍Surgery: Some surgeries in the pelvic area, such as hysterectomy (removal of the uterus), prostatectomy (removal of the prostate), or colorectal surgery, can damage or weaken the pelvic floor muscles and nerves.
• ‍Obesity: Being overweight can put extra pressure on the pelvic floor and increase the risk of PFDs.
• ‍Chronic coughing: Having a persistent cough due to smoking, asthma, or other lung conditions can strain the pelvic floor muscles over time.
• ‍Genetics: Some people may inherit a tendency to have weaker or more elastic connective tissues, which can make them more prone to PFDs.

Diagnosis and Treatment of Pelvic Floor Disorders

If you have symptoms of PFDs, you should see your healthcare provider for a proper diagnosis and treatment plan. Your provider may ask you about your medical history, perform a physical exam, and order some tests to assess your pelvic floor function. These tests may include:

• ‍Urinalysis: This is a test that checks your urine for signs of infection, blood, or other abnormalities,
• ‍Urodynamic testing: This is a test that measures how well your bladder and urethra(the tube that carries urine out of your body) store and release urine. It may involve filling your bladder with water or air through a catheter (a thin tube)and recording the pressure and flow of urine.
• ‍Anorectal manometry: This is a test that measures how well your anal sphincter and rectum work together to hold and release stool. It may involve inserting a balloon-like device into your rectum and inflating it with air while recording the pressure and sensation.
• ‍Defecography: This is a test that uses X-rays or MRI (magnetic resonance imaging) to show how your rectum and anus change shape during a bowel movement. It may involve injecting a contrast material (a substance that makes your organs more visible on imaging) into your rectum before you defecate.
• ‍Pelvic ultrasound: This is a test that uses sound waves to create images of your pelvic organs. It may involve placing a probe on your abdomen or inside your vagina or rectum.
• ‍Pelvic exam: This is a test that involves your provider looking at and feeling your pelvic organs through your vagina or anus. It may also involve using a speculum ( a device that holds your vagina open) or a proctoscope (a device that holds your anus open) to see inside.

The treatment of PFDs depends on the type, severity, and cause of the disorder, as well as your personal preferences and goals. Some of the possible treatments include:

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• ‍Behavioral therapy: This involves changing your habits and lifestyle to improve your pelvic floor function and reduce your symptoms. It may include drinking enough fluids, eating a high-fiber diet, avoiding straining or pushing during urination or defecation, managing your weight, quitting smoking, and treating any underlying conditions that cause chronic coughing.
• ‍Pelvic floor exercises: These are exercises that strengthen and relax your pelvic floor muscles. They may involve contracting and releasing your muscles as if you are trying to stop the flow of urine or gas, holding the contraction for a few seconds, and repeating it several times a day. You may also use biofeedback (a technique that uses sensors to monitor your muscle activity and provide feedback) or electrical stimulation (a technique that uses mild electrical currents to stimulate your muscles) to help you perform the exercises correctly and effectively.
•  Medications: These are drugs that can help treat some of the symptoms or causes of PFDs. They may include antibiotics (to treat infections), anticholinergics (to relax the bladder), alpha-blockers (to relax the urethra), laxatives (to soften stool), or analgesics (to relieve pain).
• ‍Pessaries: These are devices that are inserted into the vagina or anus to support the pelvic organs and prevent them from prolapsing. They may be made of silicone, rubber, or plastic, and come in different shapes and sizes. They need to be fitted by a healthcare provider and cleaned regularly.
• ‍Surgery: This is an option for some people who have severe or persistent PFDs that do not respond to other treatments. There are different types of surgery for different types of PFDs, such as sling procedures (to support the urethra), colporrhaphy (to repair the vaginal wall), sacrocolpopexy (to attach the vagina to the sacrum), rectopexy (to attach the rectum to the sacrum),sphincteroplasty (to repair the anal sphincter), or artificial sphincter implantation (to replace the anal sphincter with a device). Surgery may have risks and complications, such as infection, bleeding, nerve damage, or recurrence of PFDs.

Pelvic floor disorders are common and can affect your quality of life. However, they are not something you have to live with. There are many effective treatments available that can help you manage your symptoms and improve your pelvic floor function. If you have any concerns or questions about PFDs, talk to your healthcare provider and find out what options are best for you. Preferably, talk to us.