Pelvic Floor Dysfunction

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Original Editors - Sarah Barnes, Chris Van Wyk, Amy McCarthy, Gina Mclaughlin, John Lavin, Claire Ramsden and Carolinne Cieslak.

Top Contributors - Sarah Barnes, Carolinne Cieslak, Gina McLoughlin, Kim Jackson, Claire Ramsden, Chris Van Wyk, Amy McCarthy, John Lavin, Vidya Acharya, Nicole Hills and Rachael Lowe  

Learning Outcomes

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Overview

Ted Ex Talk [1]

What is the Pelvic Floor?

The pelvic floor is made up of a layer of muscles spanning the bottom of the pelvis that support our internal pelvic organs (bladder and bowel in males and bladder, bowel and uterus/womb in women). These muscles run like a hammock front to back from the pubic bone to the tailbone and side-to-side from one sitting bone to the other .

These muscles are similar to a trampoline, as they have the ability to move up and down. This occurs during breathing as when we inhale theme shaped diaphragm pulls down to open our lungs. This pushes down of our internal organs. To avoid squashing these organs our pelvic floor and abdominal muscle relax and create more space for the organs to move down. When we exhale the diaphragm springs back to its normal position and as it does so the abdominals and pelvic floor muscles return to their resting position. A common problem experienced by people is holding their breath during lifting activities or bowel movements, which can lead to pelvic floor dysfunctions by adding excess stress on these muscles.

Our pelvic organs sit on top of this layer of muscle. The muscles also have holes through which the urethra and anus pass through in males and urethra, anus and vagina pass through in females. The muscles are snug against these structures in order to hold the passages closed. Both the anus and urethra have extra circular muscles (called sphincters) that help to keep the passages closed and prevent leakage.

Pelvic floor muscles may be hidden but we do have voluntary control of them and therefore they can be trained like muscles in our arms or legs.

Functions of the pelvic floor muscles:

• Support internal pelvic organs in the correct positions (Bladder, bowel and vagina)
• Allow conscious control of bladder and bowel habits using the sphincter muscles. This allows us to control the release of urine, faeces and gas and to delay emptying until a convenient time. This works as the pelvic floor muscles contract the organs are lifted up and the sphincter tighten around the openings of the urethra and anus.
• Allow the passage of urine and faeces out of the body due to the pelvic floor muscles relaxing and allowing the passages to open.
• Sexual function
  • In males the pelvic floor muscles are important in erectile function by increasing rigidity and ejaculation by improving control and coordination between circulation, pelvic floor muscles.
  • In females voluntary contraction of the pelvic floor muscles can contribute to sexual sensation
• Additionally in pregnant women the pelvic floor offers support to the foetus during pregnancy and also assists in the childbirth process.

Strong pelvic floor muscles are important when we cough, laugh, sneeze or during lifting activities as there is extra force added to the abdomen and therefore additional pressure down onto the pelvic floor. If these muscles are weak, stretched or not working as they should, pressure may be felt in the pelvic region or some urinary or faecal leaking may occur during these activities.

 Signs and Symptoms

Men:

• Constipation or bowel strains
• Ongoing pain in your pelvic region, genitals or rectum.
• A prolapse – may feel as though there is a bulge/ pressure in the rectum or a feeling of needing to use your bowels without actually needing to go. - Accidentally leaking urine when you exercise, laugh, cough or sneeze.
• Feelings of urgency in needing to the bathroom, or not making it there in time.
• Frequent need to urinate.
• Difficultly emptying your bladder (discontinuous urination – stop and start multiple times) and bowels.
• The feeling of needing to have several bowel movements during a short period of time.
• Accidentally passing wind.
• Pain in your lower back that cannot be explained by other causes.
• Pain in the testicles, penis (referred pain from the pelvic floor) or pelvis during intercourse.
• Erectile dysfunction.
• Painful ejaculation.

For further information on the male pelvic floor go to: [2]

Women:

• Pain or numbness during intercourse.
• Ongoing pain in your pelvic region, genitals or rectum.
• A prolapse – may be felt as a bulge in the vagina (feeling or seeing a bulge or lump in or coming out of your vagina) or a feeling of heaviness, discomfort, pulling, dragging or dropping sensation.
• Accidentally leaking urine when you exercise, laugh, cough or sneeze (stress incontinence).
• Feelings of urgency in needing to the bathroom, or not making it there in time.
• Frequent need to urinate.
• Difficultly emptying your bladder (discontinuous urination – stop and start multiple times) and bowels.
• The feeling of needing to have several bowel movements during a short period of time.
• Constipation or bowel strains.
• Accidentally passing wind.
• Pain in your lower back that cannot be explained by other causes.

Helpful websites for further information: [3] [4]

  Risk Factors  

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   Treatment  

Pelvic floor exercises for beginners:[5]

Pelvic floor exercises for men: [6]

Progressive pelvic floor exercises: Episode 1: [7] Episode 2:[8] Episode 3: [9] Episode 4: [10] Episode 5: [11]

References

see adding references tutorial.