Common Women's Pelvic Health Conditions

Original Editor - Jess Bell based on the course by Ibukun Afolabi
Top Contributors - Jess Bell, Kim Jackson and Olajumoke Ogunleye

This article or area is currently under construction and may only be partially complete. Please come back soon to see the finished work! (2/01/2022)

Introduction

Women may seek help from pelvic health physiotherapists for several reasons. This page will explore some common conditions that pelvic health physiotherapists might encounter in clinical practice. Management strategies are discussed in detail here. LINK

Pelvic Floor

The pelvic floor muscles work synergistically with the diaphragm by contracting and lengthening with every breath. The amount of movement depends on the size of the breath. However, like any skeletal muscle, the pelvic floor muscles can become tight. Reduced range of motion in the pelvic floor can affect bowel and bladder function, sexual pleasure, core support, and athletic performance.

There are two extremes of pelvic floor states:

• Underactive pelvic floor (i.e. “low in position, lax, unsupportive, hypotonic, long or lengthened, disconnected”)
  • Characterised “by an inability to meet the demands of maintaining continence or pelvic organ support due to deficits in power, endurance, or correctly timed coordination of contraction.”
  • The pelvic floor muscles:
    • May be sluggish
    • May or may not have tender areas
    • Will have difficulty lifting and contracting
    • Will likely be weak

• Overactive pelvic floors (i.e. “high, tight, stiff/rigid, short, hypertonic, non-relaxing”)
  • Characterised “by an inability to fully relax and lengthen. Most frequently, the overactive pelvic floor is associated with symptoms of pelvic pain, urinary frequency/urgency, and defecatory dysfunction.”
  • Symptoms associated with this type of pelvic floor are:
    • Tenderness to the touch
    • Possibly painful or sensitive
    • Difficulty lifting and contracting
    • Often considered weak

In reality, these states exist along a continuum. Some women may experience elements of both overactivity and underactivity and, thus, have a mixed pelvic floor.

Signs associated with underactive and overactive pelvic floors are summarised in Table 1.

Table 1. Signs associated with underactive or overactive pelvic floor muscles

Underactive pelvic floor	Overactive pelvic floor
Leaking with running, jumping, coughing, sneezing, laughing (i.e. anything that places pressure on the bladder)	Leaking with running, jumping, coughing, sneezing, laughing (i.e. anything that places pressure on the bladder)
Sudden urgency of bladder or bowels	Sudden urgency of bladder or bowels
Difficulty lifting the pelvic floor	Difficulty lifting the pelvic floor
Pelvic floor contractions feel weak	Pelvic floor contractions feeling weak or low endurance
Tampons or menstrual cups may fall out	Difficulty starting to void or fully emptying the bladder
Sex might be described as "not feeling like it used to before kids"	Pain with penetration
Feeling of heaviness or pressure or dragging	Pain during or after intercourse
Feeling of sitting on an egg or a golf ball between legs	Persistent pain in pelvic, abdominal, groin, or genital region
Noticing a protrusion at the entrance to the vagina	Ongoing low back, hip, or groin pain
Inability to make it to the bathroom in time	Trauma, tearing, or assisted delivery during childbirth
Inability to entirely empty bowels or bladder	Doing Kegels or holding Kegels makes symptoms worse
Sacroiliac joint pain, hip pain	Diagnosis of endometriosis, interstitial cystitis, vaginismus, dyspareunia
Chronic constipation	Chronic constipation