Common Women's Pelvic Health Conditions
Top Contributors - Jess Bell, Kim Jackson and Olajumoke Ogunleye
Introduction[edit | edit source]
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[edit | edit source]
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.[1] 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.[1]
There are two extremes of pelvic floor states:[1]
- 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.”[2]
- The pelvic floor muscles:[1]
- 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.”[2]
- Symptoms associated with this type of pelvic floor are:[1]
- 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.[1]
Signs associated with underactive and overactive pelvic floors are summarised in Table 1.
| 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 |
Because there is some crossover in symptoms, it is essential to perform a careful initial assessment and ongoing evaluation to select the correct treatment paths. LINK TO LATER COURSE
Common Pelvic Health Conditions[edit | edit source]
Pelvic floor conditions can be:[1]
- Pressure conditions
- Pelvic support conditions
- Neuromuscular or myofascial conditions
- Pain conditions
- Mixed conditions
Common conditions are discussed below.
Incontinence[edit | edit source]
Incontinence is the uncontrolled loss of urine, gas, or stool of any amount.[1]
Urinary Incontinence[edit | edit source]
Urinary incontinence (UI) can be categorised as:
- Stress UI:[3]
- An involuntary loss of urine that occurs during movements / activities (such as coughing, sneezing, laughing, running, heavy lifting) that increase abdominal pressure (i.e. stress) on the bladder
- Urge UI:[3]
- An unintentional loss of urine which can occur when the bladder muscle contracts
- There is often a sense of urgency
- Mixed UI:[4]
- An individual has both stress and urgency urinary incontinence
- Overflow incontinence:[5]
- Urinary incontinence occurs when the bladder is excessively full (with no cause identified)
- Functional incontinence:[6]
- It occurs when there are cognitive, functional, or mobility issues that affect an individual’s ability to use the toilet
- No bladder / neurological causes
- Also referred to as “toileting difficulty”
References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 Afolabi I. Common Women's Pelvic Health Conditions Course. Physioplus, 2022.
- ↑ 2.0 2.1 Siracusa C, Gray A. Pelvic floor considerations in COVID-19. J Womens Health Phys Therap. 2020;44(4):144-51.
- ↑ 3.0 3.1 Sountoulidis P. Stress urinary incontinence [Internet]. ICS Committees. 2018 [cited 2 January 2022]. Available from: https://www.ics.org/committees/standardisation/terminologydiscussions/sui
- ↑ Sung VW, Borello-France D, Newman DK, Richter HE, Lukacz ES, Moalli P et al. Effect of behavioral and pelvic floor muscle therapy combined with surgery vs surgery alone on incontinence symptoms among women with mixed urinary incontinence: The ESTEEM randomized clinical trial. JAMA. 2019;322(11):1066-76.
- ↑ Mangir N, Chapple C. Management of urinary incontinence in men. Trends in Urology and Men's Health. 2020;11(2):18-22.
- ↑ Khandelwal C, Kistler C. Diagnosis of urinary incontinence. Am Fam Physician. 2013;87(8):543-50.
