Pelvic Floor Dysfunction

Pelvic floor dysfunction is the inability to correctly relax and coordinate your pelvic floor muscles to poop. Symptoms include constipation, straining to poop, having urine (pee) or stool leakage and experiencing a frequent need to pee. Treatments include biofeedback, pelvic floor physical therapy and medications.

Pelvic floor dysfunction is a common condition where you can’t correctly relax and coordinate the muscles in your pelvic floor to urinate (pee) or have a bowel movement (poop). Think of your pelvis as being home to organs like your bladder, uterus, prostate and rectum. Your pelvic floor muscles are the home’s foundation. They’re the support structure keeping everything in place.

Normally, you’re able to go to the bathroom without issue because your body tightens and relaxes your pelvic floor muscles. This is just like any other muscular action, like tightening your biceps when you lift a heavy box or clenching your fist.

But if you have pelvic floor dysfunction, your body keeps tightening these muscles instead of relaxing them. This tension means you may have:

• Trouble evacuating (releasing) a bowel movement.
• An incomplete bowel movement.
• Pee or poop leakage.

The symptoms of pelvic floor dysfunction

The following signs and symptoms can let you know you might have a pelvic floor issue:

• Frequent bathroom visits.
• Having to frequently start and stop when you’re trying to pee.
• Straining or pushing to pass a bowel movement.
• Having to change positions on the toilet or use your hand to eliminate stool.
• Constipation (Experts estimate that up to half of the people with long-term constipation also have pelvic floor dysfunction).
• Leaking stool (fecal incontinence).
• Leaking urine (urinary incontinence).
• Painful urination.
• Unexplained low back pain.
• Ongoing pain in your pelvic region, genitals or rectum — with or without a bowel movement.

Causes of pelvic floor dysfunction

Experts don’t know the exact cause of pelvic floor dysfunction. But, a few known factors may play a role. These include:

• Traumatic injuries to your pelvic area (like a car accident or a fall from a high place).
• Overusing your pelvic muscles (straining to go).
• Prior pelvic surgery (like a hysterectomy or prostatectomy).
• Pregnancy and childbirth (especially difficult deliveries).
• Aging (muscles naturally weaken somewhat over time).
• Stress and anxiety.
• Connective tissue disorders.

Conditions can be mistaken for pelvic floor dysfunction

Pelvic floor dysfunction can exist alongside (and be mistaken for) many other conditions, including:

• Interstitial cystitis: This condition causes pain in your pelvis or bladder. The pain can lead to loss of muscle relaxation in your pelvic floor muscles. So, having one of these conditions increases your risk of having the other.
• Irritable bowel syndrome (IBS): IBS is a group of symptoms that affect your digestive tract. While researchers haven’t identified a link between IBS and pelvic floor dysfunction, they share certain symptoms. These symptoms include constipation and trouble emptying your bowels completely.
• Pelvic organ prolapse (POP): POP happens when the muscles holding your pelvic organs (uterus, bladder and rectum) in place loosen and become too stretched out. The weaker muscles can cause your organs to stick out of your vagina.
• Erectile dysfunction (ED): ED is when you can’t get or maintain an erection during sex. Sometimes, pelvic muscle tension or pain is the cause, but ED is a complex condition, so this may not be the case.
• Prostatitis: Pelvic floor dysfunction symptoms closely resemble prostatitis. This is an infection or inflammation of your prostate. Prostatitis can have many causes, including bacteria, sexually transmitted infections (STIs) or trauma to your nervous system.
• Constipation: Constipation can mimic pelvic floor dysfunction or vice versa. Constipation and straining can also lead to pelvic floor dysfunction.
• Anorectal conditions: Conditions that affect your anus (butthole) and rectum, like fissures or fistulas, can share features of pelvic floor dysfunction.

Diagnosis

Gynaecologist at Shreya Hospital in Ghaziabad will usually start by asking about your symptoms and taking a medical history. Doctor may ask:

• Do you strain to poop?
• Are you able to empty your bladder?
• Do you feel empty after a bowel movement?
• How often do you poop or pee?

If you’re AFAB, they may ask about prior pregnancies and if you’re experiencing pain during sex.

Gynaecologist may do a physical exam to test how well you can control your pelvic floor muscles. Using their hands, your provider will check for spasms, knots or weakness in these muscles. Your provider will also perform a rectal exam and (if you’re AFAB) a pelvic exam.

You may also need other tests, including:

• Anorectal manometry. This test measures how well your anal sphincters are working. It measures the pressure in your muscle contractions that help you poop. Providers often perform an electromyography (EMG) at the same time to test the coordination of your pelvic floor muscles.
• Defecating proctogram. Your provider may order this test to see how well you can start a bowel movement and empty your bowels. It can show how different organs are working when you poop. Providers also use it to check for prolapse and other anatomic abnormalities of your pelvic floor organs.
• Urodynamics. Your provider may order urodynamic testing if you have problems peeing. This test can show how well you can empty your bladder. A weak pee flow and having to start and stop to pee can be signs of pelvic floor dysfunction.

Management and Treatment

Gynaecology Doctor can treat pelvic floor dysfunction without surgery. Treatments include:

• Pelvic floor physical therapy: A physical therapist can help you identify which pelvic floor muscles are too tense. They can teach you exercises to stretch these muscles and improve their coordination.
• Biofeedback: This is the most common treatment for pelvic floor dysfunction. It usually occurs alongside physical therapy. During your appointment, your physical therapist may use sensors and video to monitor your pelvic floor muscles as you relax or clench them. They’ll give you guidance to improve your muscle coordination.
• Medications: You may need daily medications to keep your bowel movements soft and regular. Some of these medications are available over the counter (OTC) and include stool softeners such as generic stool softeners.
• Relaxation techniques: Your provider or physical therapist might recommend relaxation techniques such as meditation, warm baths, yoga and exercises, or acupuncture to relieve tension in your pelvic floor muscles.
• Trigger point injections: If physical therapy and biofeedback don’t help, your provider may recommend you see a pain injection specialist. These doctors can pinpoint the specific muscles that are overly tense. They’ll use a small needle to inject numbing medications to relax them.