Pelvic Floor Dysfunction

What is it? 

Within the pelvic floor are many muscles, ligaments, tissue and pelvic organs, such as the bladder, bowel and the womb (if you’re female). The pelvic floor runs much like a taut ‘hammock’, from the tailbone (coccyx) to the front of the pelvis – the pelvic organs sit on top of and are supported by these hammock-like pelvic muscles.

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The pelvic floor is also similar to a trampoline – the muscles can move up and down, especially while breathing. This is to accommodate downward pressure on the abdominal organs from the diaphragm on inhalation – the pelvic floor relaxes, and comes back up when the diaphragm contracts and pressure decreases during exhalation.

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In total, there are six main functions of the pelvic floor muscles:

1. Pelvic organ support

2. Bladder/bowel control

3. Passing of urine/faeces

4. Sexual function

5. Breathing

6. Pregnancy and childbirth

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If these muscles become weak, overstretched, torn or overactive, signs and symptoms of issues affecting the above pelvic functions may develop. Common problems include urinary incontinence, difficult or minimal bowel control, Levator syndrome (spasming muscles after bowel movement), Pudendal neuralgia (pudendal nerve damage), erectile dysfunction, etc.

What is the cause? 

Typically, weak, overstretched or malfunctioning pelvic muscles are the main contributors to conditions and symptoms of pelvic floor dysfunction. This can be caused by:

• Age

• Systemic diseases or chronic health issues – e.g. pressure in abdomen from a persistent cough, obesity, history of low back pain, etc.

• Genetics

• Surgeries – including hysterectomies or prostate surgery

• Pregnancy

  • Trauma during delivery

  • Multiple pregnancies

  • Large babies

  • Operative delivery

• Prolapsed organs – pelvic organs (uterus, cervix, vagina [F]/prostate [M],urethra, rectum, bladder, etc.) can drop down or onto other structures due to a lack of support from the pelvic floor – increased pressure from these prolapsed organs can further weaken pelvic muscles and cause other complications

• Trauma – injuries to the tailbone

• Physical exertion/constipation – including heavy lifting

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More women than men are usually diagnosed with pelvic floor dysfunction.

Signs & Symptoms

• Pelvic pain

• Increased pressure in abdominal/pelvic region

• Bulge in the pelvic region

• Urinary incontinence

• Difficulty controlling bladder movements

• Involuntary passing of urine because of a cough, sneeze, etc.

• Difficult/discontinuous urination

• Feeling the need to frequently urinate

• Difficulty, or frequently, passing stools

• Pain during sexual activity

• Women: pain/numbness during intercourse

• Men: erectile dysfunction, painful ejaculation

What can we do about it? 

If you think you might have symptoms or conditions related to pelvic floor dysfunction, it is important to see a medical professional for diagnosis and treatment/management options. You will likely be referred for imaging tests to determine the origin and extent of the injury or to rule out a differential diagnosis.

Physiotherapy is aimed at educating patients about the function of pelvic floor muscles, the importance of lifestyle factors and management through an exercise program. Physical therapy is aimed at strengthening muscle and reducing future risk. At Vitalis Physiotherapy, we can tailor a unique treatment plan for simple pelvic issues to aid in your recovery through:

• Stretching, strengthening and/or conditioning exercises

• Restoring range of movement

• Postural improvement

• Soft tissue mobilisations (massage)

• Trigger point therapy

• Dry needling (link to dry needling services)

• Taping (link to taping services page)

• A unique home exercise program – pelvic floor exercises and more

• Graded Exposure to load program

• Additional lifestyle recommendations

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If the pain is severe, strenuous activity should be avoided. Your physiotherapist may also advise you to use lumbar or pelvic support.