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Pelvic Floor Dysfunctions: Symptoms, Diagnosis & Treatment

Thousands of people are diagnosed with pelvic floor disorder every year.

They experience digestive, urinary, and sexual complications that impair normal functions. The impact of these complications on quality of life remains a significant healthcare concern, especially for older people.

A substantial proportion of those diagnosed with this condition will make a full recovery following non-surgical treatments, especially physical therapy, biofeedback, and medications.

However, some severe cases may require surgery for effective treatment.

Despite the apparent improvements in our understanding of factors associated with dysfunction of the female and male pelvic floor muscles, many questions remain.

Here, we discuss pelvic floor dysfunction and the associated and known causes. The article also offers some insight into the treatment of this condition.

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About the pelvic floor

The female and male pelvic floor is the muscles and ligaments between the trunk and the lower extremities. They span the bottom of the pelvis and provide essential support functions for pelvic organs.

The pelvis houses organs like the bladder, uterus, prostate, and rectum, which the pelvic floor muscles support by wrapping around the pelvic bone. Critically, the proper operation of these muscles is necessary for normal urinary, sexual and digestive functions in both males and females. 

Contracting and relaxing these muscles (including voluntary and involuntary activities) allows one to control urination, sexual sensation, and bowel movements.

Therefore, conditions that weaken these muscles can lead to several complications, including bowel and bladder control problems. These secondary conditions have a massive negative impact on quality of life.

Pelvic floor dysfunction

Pelvic floor dysfunction is an umbrella term used to describe symptoms and conditions causing impairment of the female or male pelvic floor muscles. It is the inability to relax and coordinate the pelvic floor muscles correctly. 

The symptoms can range from mild to severe depending on the underlying causes and your overall health.

The exact incidence in the general population is unknown, but it is common in males and females.

Recent estimates suggest that the disorder affects more than 20% of the general population, which increases with age.

If left untreated, it can lead to discomfort, long-term damage, and an increase in the risk of infections. Below, we will discuss the common symptoms and causes.

Symptoms and Causes

Pelvic floor muscles support the organs in your pelvis, including the bladder, rectum, uterus, and prostate. Usually, you can urinate and pass feces because your body tightens and relaxes the pelvic floor muscles.

This muscle movement is similar to the action of other muscles, such as the tightening required to lift objects.

However, in pelvic floor dysfunction, your body keeps tightening these muscles instead of relaxing them. This abnormal tension leads to:

  • Stress urinary incontinence – leaking of urine due to sudden pressure on the bladder and urethra. This issue often occurs from sudden forceful activities such as coughing and exercise.

  • Overactive bladder – symptoms that cause frequent, urgent, or leakage.

  • Pelvic organs prolapse – pelvic organs moving out of place and causing pressure.

  • Fecal incontinence – reduced control of bowel movements and unexpected leaking of feces.

  • Lower back pain.

  • General pelvic pain, affecting the genitals and rectum.

Further, some symptoms are sex-specific, including pain during sex in females or problems with getting and keeping an erection in men.

What causes pelvic floor dysfunction?

To date, the causes of pelvic floor dysfunction are not fully known.

However, numerous conditions and factors link to the disease, including:

Obesity

One study found pelvic floor dysfunction is significantly more prevalent in obese individuals than in the control group (Pomian et al., 2016).

Traumatic injuries to the pelvic area

Accidents and medical treatment affecting the pelvic region can increase the risk of the disorder. For example, prostate cancer treatments, including surgery and radiotherapy, can cause pelvic floor dysfunction (Matta et al., 2019).

Old age

Muscle strength and function often decrease with age, which can independently or in conjunction with other comorbidities cause pelvic floor dysfunction.

Pregnancy

Females often experience weakened pelvic floor muscles after childbirth.

How is pelvic floor dysfunction diagnosed?

The diagnosis usually starts with investigating the type and extent of your symptoms. Having any of the previously described symptoms and the known comorbidities is usually a good indication of the dysfunction.

You are likely to undergo a physical examination, where the doctor checks how well you can control your pelvic floor muscles.

In some cases, you may require a further test to get an accurate diagnosis, including:

  • A urine flow test to check how well you empty your bladder.
  • Defecation test to check the movement of your muscles as you empty your rectum.
  • Surface electrodes to test pelvic muscle control via electrical current.

Please, speak to your doctor about your symptoms and the potential tests. Most of the tests to diagnose pelvic floor dysfunction are non-invasive.

How do you treat pelvic floor dysfunction?

Luckily, there are several non-surgical treatment options for pelvic floor dysfunction to improve your pelvic health.

This includes physiotherapy, relaxation techniques, and medications. The use of each approach will depend on the severity of your symptoms.

Physical therapy

Pelvic floor physical therapy is the most common therapy for pelvic floor dysfunction. It involves using physical exercise to improve muscle coordination.

A pelvic floor physiotherapist will deliver these exercises and employ various techniques to monitor and support your treatment.

After determining the most affected muscles, the pelvic health physiotherapist will teach you exercises to stretch and improve your coordination.

Relaxation techniques such as meditation, yoga, and acupuncture may help with symptom relief.

Medications

Medications to help with bowel movement and urine flow help to treat pelvic floor dysfunction.

Your doctor will advise and prescribe the right prescription for your specific case. You may get pain relief or anti-inflammatory drugs to relieve your symptoms.

Dietary changes

Eating certain foods (e.g., fiber) and drinking more fluids can make bowel movements and urine flow easier, thereby reducing the severity of symptoms.

Surgery

When the condition affects daily activities, especially in pelvic organ prolapse, you may require surgery to treat and improve symptoms.

However, healthcare providers rarely treat pelvic floor dysfunction with surgical intervention.

Conclusion

Pelvic floor dysfunction is a common condition that affects both men and women, dramatically reducing their quality of life.

The inappropriate function of the pelvic floor muscle can cause a range of symptoms, including pain, urinary problems, erectile dysfunction, and pain during sex.

The cause of this condition is not fully known. Several comorbidities have been identified, including obesity, specific medical treatments, and traumatic injuries.

Physical therapy, with or without medications, can relieve symptoms and treat the condition. You rarely need surgery to fix misplaced pelvic organs.

Your doctor will help you decide on the best treatment approach depending on your medical history and overall health.

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Sources

  1. Matta, R., Chapple, C.R., Fisch, M., Heidenreich, A., Herschorn, S., Kodama, R.T., Koontz, B.F., Murphy, D.G., Nguyen, P.L., Nam, R.K., 2019. Pelvic complications after prostate cancer radiation therapy and their management: an international collaborative narrative review. Eur. Urol. 75, 464–476. Available from: https://pubmed.ncbi.nlm.nih.gov/30573316/
  2. Pomian, A., Lisik, W., Kosieradzki, M., Barcz, E., 2016. Obesity and pelvic floor disorders: a review of the literature. Med. Sci. Monit. Int. Med. J. Exp. Clin. Res. 22, 1880. Available from: https://pubmed.ncbi.nlm.nih.gov/27255341/
  3. Herschorn S. (2004) Female pelvic floor anatomy: the pelvic floor, supporting structures, and pelvic organs. Rev Urol. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1472875/
  4. Cohen D, Gonzalez J, Goldstein I. (2016) The Role of Pelvic Floor Muscles in Male Sexual Dysfunction and Pelvic Pain. Sex Med Rev. Available from: https://pubmed.ncbi.nlm.nih.gov/27872005/
  5. Myers C, Smith M. (2019) Pelvic floor muscle training improves erectile dysfunction and premature ejaculation: a systematic review. Physiotherapy. Available from: https://pubmed.ncbi.nlm.nih.gov/30979506/

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