Pelvic Floor Dysfunction
The pelvic floor is the group of muscles lining the pelvis. Organs associated with the pelvic floor include the bladder, urethra, vagina, anus, and rectum. Any diseases or disorders that affect the pelvic floor muscles can lead to pelvic floor dysfunction.
Some of the pelvic floor dysfunctions are explained below
Urinary incontinence: Refers to loss of bladder control resulting in involuntary leakage of urine. It commonly occurs in women due to pregnancy and childbirth, menopause and the structure of the female urinary tract. There are two types of urinary incontinence; stress incontinence and urge incontinence.
Stress incontinence ‐ Refers to leakage of small amounts of urine during physical activities such as coughing, laughing, sneezing, or exercising that suddenly increases the pressure within the abdomen.
Urge incontinence ‐ This condition refers to urine leakage with the sudden urge to urinate or unable to hold the urine.
Diagnosis of Pelvic Floor Dysfunction
Your physician diagnoses your condition through physical, pelvic and neurologic examination and suggests appropriate treatments.
Treatment of Pelvic Floor Dysfunction
The treatment options include pelvic floor exercises, bladder control techniques, diet and lifestyle changes, urethral inserts, sacral nerve stimulators, and minimally invasive surgeries, and biofeedback treatments.
Pelvic organ prolapse: This condition most commonly occurs in women when the pelvic floor organ shifts from the normal position and bulges out against the walls of the vagina. When this condition occurs, you may feel a bulge coming out of the vaginal opening. The condition occurs due to weak or stretched pelvic muscles resulting from childbirth or surgery. There are different types of pelvis organ prolapse, such as rectocele, cystocele, enterocele, and uterine prolapse.
Your doctor will diagnose the condition by performing a physical examination, including pelvic examination, with reference to medical and family history, and may perform other tests such as cystoscopy, ultrasound scan, and magnetic resonance imaging (MRI).
Treatment options include physical therapy, biofeedback, and medicines which will weaken the vaginal muscles and ease the pelvic muscles. Pessary, a removable device fitted in the vagina to reduce pain and pressure of pelvic organ prolapse. If the non-surgical treatment does not reduce the symptoms of pelvic organ prolapse, then surgery treatment is considered. There are several types of surgeries to correct different types of pelvic floor prolapse which include:
- Repair of the vaginal wall
- Repair of prolapsed pelvic organ
- Closure of the vaginal opening
- Removal of uterus
Faecal incontinence: It is the inability to control bowel movements which leads to passing of stool accidentally. It occurs when pelvic muscles are damaged during child birth, constipation, anal or nerve injury, and rectal prolapse. Your physician will perform a physical examination and may order other tests such as anal manometry, Magnetic resonance imaging (MRI), Anorectal ultrasonography, Proctography, Proctosigmoidoscopy and Anal electromyography to diagnose faecal incontinence.
To restore the bowel control, diet and lifestyle changes, medicines and physical exercises are suggested as a part of the treatment. If the non-surgical techniques do not work, then surgery would be considered as a last treatment option. Sphincteroplasty, the most common faecal incontinence surgery indicated, involves reconnecting the separated ends of a sphincter muscle injured by childbirth or other injuries.
Defecatory dysfunction: Refers to difficulty in emptying the bowels. Symptoms may include frequent and uncomfortable sensation to have bowel movements, constipation and leakage of gas, diarrhoea, or solid stool.
Voiding dysfunction: This condition refers to inability to completely empty the bladder. It most commonly affects children. In normal cases, when an individual wants to have a bowel movement, the pelvic muscles relax and the abdominal muscles contract allowing to empty the bowel. But in the voiding dysfunction, the pelvic muscles contract instead of relaxing, resulting in incomplete emptying of urine.
Treatment options for voiding dysfunction include managing constipation, treating urinary tract infections, physical exercises, and medicines to decrease the bladder hyperactivity. Diet changes are suggested. Surgery is rarely considered and involves correction of anatomical abnormality that is causing the voiding dysfunction.