I was diagnosed with pelvic floor dysfunction, PFD, shortly after being diagnosed with IC (interstitial cystitis). I had retention of urine and IBS (irritable bowel syndrome). It was easy to diagnose, I did not have to go through a lot of tests because it was obvious that I had it because it goes hand in hand with IC. I didn’t know what it was, or how to deal with it, just that it was a diagnosis. The doctor that was treating my IC at the time, moved away to Louisiana. And the doctor that took over for him tested me for PFD, but has not put me in any therapy. I’m assuming it is something I will just live with. It doesn’t give me serious issues, as of yet, I suppose if it ever does, then the doctor will proceed with therapy. It is not something I want to go through though, so I will not push for it.
The pelvic floor muscles are a group of muscles that support the organs in your pelvis like a sling. Those organs include, the bladder, uterus (women), prostate (men) and rectum, (the organ at the end of the large intestine that holds solid waste). By flexing these muscles you control your bladder and bowel movements. The “pelvic floor” refers to a group of muscles that attach to the front, back, and sides of the pelvic bone and sacrum (the large fused bone at the bottom of your spine, just above the tailbone).
Pelvic floor dysfunction is when these muscles do not work properly. The muscles contract instead of relax causing them to not have complete bowel movements or allow the bladder to empty.
The cause of pelvic floor dysfunction is unknown, though some may have it due to traumatic injuries in the pelvic area or complications of childbirth.
Many people with interstitial cystitis (IC) have problems with the group of muscles in the lower pelvic area and develop pelvic floor dysfunction (PFD). If you have IC and a poor urine stream, feel the need to push or bear down to urinate, and have painful intercourse, you may have PFD. Treating PFD may be very helpful in reducing symptoms and pain for some IC patients—most patients see improvement after several weeks of therapy.
Kegel exercises, frequently used to treat incontinence, may make both IC and PFD symptoms worsen.
Symptoms of pelvic floor dysfunction include:
- The feeling that you need to have several bowel movements during a short period of time.
- The feeling that you cannot complete a bowel movement.
- Constipation or straining pain with bowel movements.
- A frequent need to urinate. When you do go, you may stop and start many times, or have incomplete emptying
- Painful urination.
- Pain in your lower back that cannot be explained by other causes.
- Ongoing pain in your pelvic region, genitals, or rectum.
- Pain for women during intercourse, orgasm, or sexual stimulation
Your physician will begin your exam by asking about your symptoms and taking a careful history. Questions he or she may ask include:
- Do you have a history of urinary tract infections?
- Have you given birth to a child?
- Do you have interstitial cystitis (a long-term inflammation of the bladder wall) or irritable bowel syndrome (a disorder of disorder of the lower intestinal tract)?
- Do you have pain with intercourse?
Next, he or she will do a physical examination to evaluate your ability to control your pelvic floor muscles. Using his or her hands, the doctor will check for muscle spasms, muscle knots, or muscle weakness.
Your physician may also test your pelvic muscle control by placing surface electrodes (self-adhesive pads) on the perineum (the area between the vagina and rectum in women, and between the testicles and rectum in men) or sacrum (the triangular bone at the base of your spine). A small device called a perineometer may also be placed into the rectum or vagina to test your muscle control.
How is pelvic floor dysfunction treated?
Pelvic floor dysfunction can often be successfully treated without surgery. Treatments for pelvic floor dysfunction include:
- Biofeedback. The most common treatment for pelvic floor dysfunction is biofeedback, done with the help of a physical therapist. This non-painful, non-surgical technique provides improvement in more than 75% of people with pelvic floor dysfunction.
- External and internal evaluation of your pelvis
- External and internal manual therapy
- Application of various devices to help relax your pelvic floor
- Training in home exercise and therapy
- Medication. In some cases, your physician may prescribe a low-dose muscle relaxant to deal with pelvic floor dysfunction. Low doses such as diazepam (Valium), 2 mg three times a day, may be helpful. 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 help PFD therapy to succeed.
- Relaxation techniques. Your physician or physical therapist may recommend relaxation techniques such as warm baths, yoga, and exercises.
- Surgery. If your physician determines your pelvic floor dysfunction is the result of a rectal prolapse or rectocele, surgery may be necessary. A rectal prolapse is when the tissue that lines the rectum falls down into the anal opening. A rectocele occurs in women when the end of the rectum pushes through the wall of the vagina. By using the defecating proctogram test (a video proctogram is an x ray test which is frequently recommended to investigate patients who have problems emptying their bowel and have symptoms of obstructed defecation, the test shows how well the bowel empties), your physician should be able to determine if these conditions are causing your pelvic floor dysfunction.
- Self-Care. Avoid pushing or straining when urinating and ask your healthcare provider about how to treat constipation. Relaxing the muscles in the pelvic floor area overall is important. Using methods such as warm baths at least twice a day is helpful.
Pelvic floor dysfunction is a very treatable condition, usually though the use of biofeedback and physical therapy. Seeing your physician if you have any symptoms of pelvic floor dysfunction can provide treatment for this often debilitating condition and improve your quality of life.