Pelvic Floor Dysfunction
Struggling with pain in your lower back or pelvis? Have pain when urinating or during intercourse? There could be many reasons, but one often overlooked is pelvic floor dysfunction.
The “pelvic floor” is a group of muscles forming a sling across the pelvis. These muscles and surrounding tissues keep pelvic organs (bladder, uterus, and rectum) in place so that they can function properly.
Problems with one or more pelvic organs can occur when the muscles or tissues become weak or tight. Individuals with pelvic floor dysfunction have trouble contracting instead of relaxing the pelvic floor muscles. When this happens during an attempted bowel movement, you are effectively pushing against a solid muscular wall. Statistics say that one out of every five Americans suffers from some type of pelvic floor dysfunction at some time in their life. Many women report chronic pain as a symptom, with the frequency and intensity greatly affecting their quality of life.
The treatment goal is to relax and/or strengthen the pelvic muscles. Treatment usually combines self-care, medicine, physical therapy and home exercises and kegel exercises. Surgery is considered for severe cases.
- Urinary urgency, frequency, hesitancy, stopping and starting of urine stream, painful urination, or incomplete emptying
- Constipation, straining, pain with bowel movement
- Unexplained pain in the low back, pelvic region, genital area, or rectum
- Pain during or after intercourse, orgasm, or sexual stimulation
- Uncoordinated muscle contractions causing the pelvic floor muscles to spasm
- Interstitial cystitis (IC)
- Pregnancy or childbirth
- Poor posture
- Trauma such as a bad fall
- Certain surgeries
- A detailed history of your symptoms, medical problems, and any possible physical or emotional trauma that may be contributing to their problem.
- Physical examination. Using external and internal hands-on or manual techniques, we evaluate pelvic floor muscle function to determine if you can contract and relax these muscles.
- Urodynamic testing – measures pressure in your bladder when resting and filling. We insert a catheter into your urethra and bladder to fill your bladder with water. A pressure monitor measures and records the pressure within your bladder.
The goal is to relax the pelvic muscles and avoid stressing them. Treatment usually combines self-care, medicines, physical therapy, and home exercise.
- Self-Care — Avoid pushing or straining when urinating and ask your healthcare provider how to treat constipation. Relaxing pelvic floor muscles is important. Using methods such as warm baths at least twice a day helps.
- Medicines — Low doses of muscle relaxants may help.
- Good posture — Maintaining good posture to keep pressure off your bladder and pelvic organs, and using stretching or other techniques such as yoga to avoid tightening and spasms in the other pelvic muscles, also helps.
- Physical therapy — The therapist may do manual therapy or massage both externally and internally to stabilize your pelvis before using other treatment. Manual therapy takes time and patience, and may require one to three sessions per week. Many patients see improvement after six to eight weeks.
- Home exercise — Because the goal of PFD therapy is to learn to control and, especially, relax the pelvic floor, therapists will teach techniques for use at home. This usually begins with general relaxation, stretching leg and back muscles, maintaining good posture, and visualization — part of learning to sense your pelvic floor muscles and to relax them.