The pelvic floor is made up of several muscles that support the rectum like a sling. Coordinated contracting and relaxing of the pelvic floor muscles control bowel and bladder functions - the pelvic floor must relax to allow for urination, bowel movements, and, in women, sexual intercourse. Pelvic floor dysfunction occurs when there is either too much tension on the pelvic floor muscles (high tone) or not enough (low tone) contributing to urinary incontinence, constipation, pain during intercourse or pain in the lower back, pelvic region, genitals or rectum.
Who is at risk of Pelvic Floor Dysfunction?
It's estimated that one-third of adult women experience some form of pelvic floor dysfunction, with 30 percent of those requiring surgery to correct the problem. The primary causes of pelvic floor dysfunction include pregnancy, obesity and menopause. Some women are genetically predisposed to developing pelvic floor dysfunction, born with naturally weaker connective tissue and fascia.
Postpartum pelvic floor dysfunction only affects women who have given birth. Pregnancy and the changes pregnancy makes to the pelvic floor cause postpartum pelvic floor dysfunction, not the method of delivery, so you may develop postpartum pelvic floor dysfunction whether you deliver by caesarian or vaginally.
Diagnosing Pelvic Floor Disorders
Each pelvic floor diagnosis begins with your full medical history. This includes a catalogue of symptoms, medical problems and any history of physical or emotional trauma that may be contributing to your problem. Using this information to guide the diagnosis, your doctor will perform a physical exam to identify any physical abnormalities.
Your doctor may use external and internal manual techniques to evaluate the function of the pelvic floor muscles and assess your ability to contract and relax these muscles. Your doctor will be looking for signs of muscle spasms, muscle knots and weakness or misalignment where your hipbones meet. Your doctor may also use externally placed electrodes to measure whether you're able to effectively contract and relax your pelvic floor muscles. Pelvic floor contractions can also be measured internally with a perineometer, which is a tampon-like sensor that can be placed into the vagina or rectum.
A defecating proctogram can also be used to diagnose pelvic floor dysfunction. In this procedure, you receive an enema of thick liquid that can be detected by X-ray. The X-ray video records the movement of the pelvic floor muscles and the rectum while you attempt to void the liquid from your rectum. Normally, the pelvic floor relaxes, allowing the rectum to straighten and the liquid to pass. A defecating proctogram can help determine if the pelvic floor muscles are not relaxing appropriately and preventing passage of the liquid.
Non-invasive Treatment of Pelvic Floor Disorders
The goal of any treatment for pelvic floor dysfunction is to relax the muscles of the pelvic floor and avoid overtaxing them. Treatment usually combines different methods of solving your problem. Popular non-invasive treatments for pelvic floor dysfunction include:
Self-Care
Training yourself to avoid pushing or straining when urinating and defecating will take some of the stress off your pelvic floor muscles and alleviate symptoms. Maintaining good posture to alleviate stress on the bladder and pelvic organs and regular warm baths have also shown results in treating pelvic floor disorders. A regular regimen of stretching and yoga can also help.
Massage
Massage, both externally and internally, can help stabilize your pelvis before using other kinds of treatment. Manual therapy takes patience and may require one to three sessions per week depending on the technique used and your response to treatment. Internal massage involves the therapist inserting a finger into the vagina or rectum to massage the connective tissue directly. A technique known as Thiele Stripping involves your therapist locating an internal trigger point in the pelvic muscles and massaging it directly. External techniques include deep tissue massage, skin rolling, joint mobilization and therapies used specifically to relax your pelvic floor.
Biofeedback
Using electrodes placed on the body or probes inserted into the vagina or rectum, biofeedback can sense the degree of tenseness in your pelvic floor muscles. Results displayed on a computer provide cues to help you learn to relax those muscles. Patients can undergo biofeedback treatment at their doctor's office or rent or purchase machines of their own.
Electrical stimulation
Small probes are placed externally or inserted into the vagina or rectum to stimulate your pelvic floor muscles, helping desensitize nerves and causing muscles to contract and relax. Different varieties of electrical stimulation devices are available for home use, both for internal stimulation with a probe or for external stimulation.
Ultrasound
In addition to being an important diagnostic tool, ultrasound can be used therapeutically to produce deep warmth in the pelvic muscles that can reduce muscle spasms and increase blood flow.
Minimally invasive procedures for Pelvic Floor Disorders
Transvaginal trigger-point injections
In the office, an anesthetic and steroid (anti inflammatory) can be injected directly into the spastic pelvic floor. This can provide significant relief of symptoms. In refractory conditions, botulinum toxin can be injected into the muscle to force relaxation of the spastic muscle groups
Pudendal Nerve Blocks
The pudendal nerve innervates the pelvic floor. Under some light sedation, our anesthesia pain specialists can inject an anesthetic and steroid at the nerve, decreasing nerve irritation and improving pain
Pudendal neuromodulation
At Beaumont, a method to place a "pacemaker" type device at the pudendal nerve has been developed. We have found significant improvement in pelvic pain in many patients treated with this device.