What is Pelvic Floor Dysfunction?

Pelvic floor dysfunction (PFD) is the inability to control the pelvic floor muscles. The pelvic floor consists of muscles and ligaments that support the bladder, rectum, uterus (female) and prostate (male). Pelvic floor dysfunction involves the inability to properly contract and relax the pelvic floor muscles. This lack of muscle control can cause difficulty with bowel movements and urination. It can also cause painful intercourse, especially for women.

What are the symptoms of pelvic floor dysfunction?

The symptoms of PFD include, but are not limited to, the following:

• Urinary incontinence or fecal incontinence
• Painful urination
• Frequent urination that may intermittently stop and start midstream
• Constipation or straining with bowel movements
• Heavy feeling in the bowel (feeling the need to empty the bowel several times in a short amount of time or feeling that the bowel is not empty).
• Lower back pain
• Chronic pelvic, genital or rectal pain
• Painful intercourse, especially for women

What are the causes of pelvic floor dysfunction?

• Childbirth complications
• Trauma to the pelvic area
• Obesity
• Repeated straining of the pelvic floor muscles
• Nerve damage
• Pelvic surgery

How is pelvic floor dysfunction diagnosed?

• Medical history — A health care provider will review an individual’s medical history and description of symptoms.
• Physical exam — A physician will perform a physical exam, checking for muscle weakness, knots or spasms.
• Internal exam — A perinometer (a small, sensing instrument) may be inserted into the vagina or rectum to check pelvic muscle control.
• Electrode placement — Electrodes may be placed on the perineum — the area between the vagina and rectum (female) or testicles and rectum (male) — to test the ability to contract and relax the pelvic muscles.
• Uroflow test — A uroflow test involves an individual drinking water to fill the bladder. When the individual feels the urge to urinate, they empty the bladder into a special toilet to determine if the flow of urine is weak and intermittent rather than strong and steady.
• Defecating proctogram — An individual is given a thick liquid enema in order to defecate. Video X-rays are taken as the individual attempts to eliminate the substance from the rectum. This test helps a physician determine how the muscles are contracting and relaxing during defecation.

What treatments are available for pelvic floor dysfunction?

A variety of treatment options for pelvic floor dysfunction are available:

• Pelvic floor muscle training
• Biofeedback
• Botulinum toxin injections into the bladder muscle
• Injections of bulking agents into the urethra
• Medication, such as muscle relaxants
• Nerve stimulation
• Self-care techniques, such as yoga and stretching exercises
• Vaginal pessary (a supportive ring placed in the vagina to support the bladder)
• Surgery

Surgery is rarely needed for pelvic floor dysfunction, but it may be required if the condition is severe or other treatments are unsuccessful. The type of surgery depends on the symptoms of pelvic floor dysfunction. If urine leakage is an issue, a bladder sling may be recommended. If the uterus or vagina has prolapsed outside the body, a sacral colpopexy, sacrospinous ligament suspension or uterosacral suspension may be recommended. Each of these surgeries aims to provide support for the pelvic floor by either using a mesh sling (bladder sling or sacral colpopexy) or attaching prolapsed organs to the body’s own ligaments (sacrospinous ligament suspension or uterosacral suspension).