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Pelvic floor muscles are layers of muscle and tissue that stretch across the bottom of the pelvis, supporting the bladder, bowel, and uterus. They are essential for maintaining bladder and bowel control and supporting sexual functions. Pelvic floor dysfunction can manifest as either hypertonicity (increased muscle activity) or hypotonicity (decreased muscle activity) and can result from various factors, including traumatic injuries, overuse, pregnancy, and childbirth. While pelvic floor exercises can help strengthen these muscles, involuntary contractions and spasms can occur, leading to pain and inflammation.
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What You'll Learn
- Pelvic floor dysfunction (PFD) can be caused by hypertonicity or involuntary contractions
- Weak pelvic floor muscles can lead to incontinence and pelvic organ prolapse
- Pelvic floor exercises, or Kegels, can help strengthen muscles
- Physical therapy and medication can help treat pelvic floor dysfunction
- Pregnancy, childbirth, and trauma are risk factors for pelvic floor damage
Pelvic floor dysfunction (PFD) can be caused by hypertonicity or involuntary contractions
Pelvic floor dysfunction (PFD) refers to a wide range of symptoms and anatomical changes related to abnormal function of the pelvic floor musculature. PFD can be caused by either increased activity (hypertonicity), diminished activity (hypotonicity), or inappropriate coordination of the pelvic floor muscles. Pelvic floor muscles support the bladder, bowel, and uterus, and help control the release of urine, faeces, and flatus. When these muscles are weakened, it can lead to conditions like incontinence or pelvic organ prolapse.
Hypertonicity of the pelvic floor muscles, also known as having pelvic muscles that are too tight, can lead to various symptoms, including pelvic pain, constipation or difficulty moving bowels, painful intercourse, and difficulty urinating. This condition is less understood than hypotonicity, and can be associated with sexual trauma, childbirth, stress, and other gynaecological conditions. Treatments for hypertonicity include physical therapy, breathing and relaxation techniques, injections, medications, and cognitive behavioural therapy. Pelvic floor exercises, or Kegels, can also help strengthen the muscles and improve control.
Involuntary contractions of the pelvic floor muscles can result in urinary incontinence, which is the involuntary leakage of urine. This can occur during activities that increase intra-abdominal pressure, such as coughing, laughing, sneezing, or physical exertion. It can also be sudden and accompanied by a strong urge to void. Involuntary contractions can also lead to faecal incontinence, which is the involuntary leakage of stool. This can be related to dyssynergic defecation, or inadequate relaxation of the pelvic floor muscles during attempted defecation.
Pelvic floor dysfunction can be assessed through digital palpation of the muscles for contraction, relaxation, and pain. Examinations may include a bimanual exam of the pelvic organs, a rectal digital exam, and an evaluation on the toilet for prolapse. While there are various treatments for PFD, there is currently no cure. Management of PFD often involves a multidisciplinary approach, including the involvement of a physical therapist specialising in pelvic floor disorders, as well as a sex therapist for certain cases.
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Weak pelvic floor muscles can lead to incontinence and pelvic organ prolapse
The pelvic floor muscles are a combination of multiple muscles with ligamentous attachments that create a dome-shaped diaphragm across the boney pelvic outlet. They support the pelvic organs, including the bladder, urethra, prostate (males), vagina, uterus (females), anus, and rectum. Pelvic floor muscles also contribute to continence of urine and feces and sexual functions of arousal and orgasm.
Pelvic floor dysfunction (PFD) refers to a broad range of symptoms and anatomical changes related to abnormal pelvic floor muscle function. PFD corresponds to either increased activity (hypertonicity), diminished activity (hypotonicity), or inappropriate coordination of the pelvic floor muscles. Weak pelvic floor muscles, or hypotonicity, can lead to incontinence and pelvic organ prolapse. Incontinence is a common symptom of weakened pelvic floor muscles, manifesting as difficulty controlling urination, defecation, or passing gas.
Pelvic organ prolapse (POP) occurs when the muscles, ligaments, and tissues supporting the pelvic organs become weakened, overstretched, or underused. This can cause the pelvic organs, such as the uterus, bladder, and rectum, to loosen and sag or even bulge into the vagina. In more severe cases of POP, an organ may bulge onto another organ or outside the body. Vaginal childbirth is the most common cause of POP, and other risk factors include multiple births, assisted births, perineal tearing, large babies, chronic constipation, chronic coughing, and frequent heavy lifting.
The symptoms of POP depend on its location and can vary from leaking urine when coughing or exercising (stress incontinence) to constipation or difficulty controlling defecation. In some cases, POP can lead to urinary tract infections (UTIs) or kidney infections if urine backs up into the urinary tract or kidneys. Treatment options for POP include pelvic floor exercises, maintaining a healthy weight, preventing constipation, and avoiding smoking. In severe cases, reconstructive surgery may be necessary to strengthen the pelvic walls and secure the pelvic organs into place.
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Pelvic floor exercises, or Kegels, can help strengthen muscles
Pelvic floor muscles support the bladder, bowel, and uterus. They also assist with essential bodily functions like urination, defecation, and sexual intercourse. Over time, these muscles can weaken due to various factors such as injury, ageing, pregnancy, childbirth, and even surgery. Weak pelvic floor muscles can lead to conditions like incontinence or pelvic organ prolapse.
Pelvic floor exercises, also known as Kegels, are an effective way to strengthen these muscles. By performing Kegels, you can improve your control over bladder and bowel functions and prevent leakage issues. The exercises involve tightening and then releasing the pelvic floor muscles, similar to the motion of a claw vending machine game. To locate the correct muscles, try stopping the flow of urine while sitting on the toilet or inserting a finger into your vagina and squeezing the muscles around it.
When performing Kegel exercises, it's important to focus on the right muscles. Avoid tightening your abdomen, buttocks, or thighs. Start by contracting the pelvic floor muscles for about 5 seconds, then release and relax for another 5 seconds. Repeat this process 10-15 times, aiming for three sets per session. Gradually increase the duration and number of Kegels as you progress.
In addition to Kegel exercises, there are other physical activities that can strengthen the pelvic floor muscles. These include bridge pose, squats, pelvic tilts, and bird-dog exercises. Bridge pose, for example, involves lying on your back with bent knees and engaging your pelvic floor muscles as you lift your hips towards the ceiling. Pelvic tilts help strengthen the lower back and abdominal muscles, contributing to pelvic floor stability.
It's important to note that Kegel exercises may not be suitable for everyone. Consult with a trained physical therapist specialising in pelvic floor muscles to determine the best course of treatment for your specific needs. They can help you coordinate and strengthen the key muscle groups in your core, ensuring a holistic approach to maintaining or improving your pelvic health.
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Physical therapy and medication can help treat pelvic floor dysfunction
Pelvic floor muscles support the bladder, bowel, and uterus. They can weaken over time due to injury, childbirth, or the ageing process, leading to conditions like incontinence or pelvic organ prolapse. Pelvic floor muscles that are too tight may be associated with sexual trauma, other types of trauma, stress, or gynaecological conditions.
Most patients with pelvic floor conditions will need to get an internal exam of their pelvic floor muscles. The exam can help identify any muscle, strength, or coordination problems causing pain, discomfort, or functional impairments. As part of an internal exam of your pelvic floor muscles, your pelvic floor physical therapist will need to place their finger into either your rectum or vagina to assess your pelvic floor muscles. Pelvic floor physical therapy can also be helpful before and after surgery.
In addition to physical therapy, medication can be used to treat pelvic floor dysfunction. Medication can help treat symptoms of urinary or bowel incontinence. For example, beta-3 agonist oral medications, such as mirabegron, can be taken once a day to relax the bladder muscle and decrease unwanted contractions that cause urine leakage. Local vaginal estrogen, in the form of a low-dose cream or tablet, can also improve symptoms of urinary frequency and urgency.
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Pregnancy, childbirth, and trauma are risk factors for pelvic floor damage
The pelvic floor is composed of a sheet of muscle fibres and connective tissues that stretch like a hammock from the pubic bone at the front to the tailbone at the back. These muscles support the pelvic organs, including the bladder, urethra, prostate (in males), vagina, uterus (in females), anus, and rectum. Pelvic floor muscles also contribute to continence of urine and feces and sexual functions of arousal and orgasm.
Women who have had multiple births, assisted births (with forceps or ventouse), third and fourth-degree perineal tearing, or large babies (birth weight over 4kg) are at greater risk of pelvic floor muscle damage. The risk of pelvic floor damage during childbirth is also increased by modifiable factors such as the use of forceps, the duration of active pushing in the second stage of labour, and the vigilance for anal sphincter injuries.
Trauma to the pelvic floor can also be caused by sexual trauma, accidents, stress, and other gynecological conditions. Pelvic floor dysfunction (PFD) refers to a range of symptoms and anatomical changes related to abnormal function of the pelvic floor muscles, including hypertonicity (increased muscle tension), hypotonicity (decreased muscle tension), and inappropriate coordination of the muscles. Treatment options for maternal pelvic floor trauma include conservative and surgical approaches, with a focus on addressing specific problems and symptoms.
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Frequently asked questions
Pelvic floor muscles are thin layers of muscle and other tissue that form a basket to support pelvic organs such as the bladder, bowel, and uterus.
Pelvic floor dysfunction (PFD) refers to a range of symptoms and anatomical changes related to abnormal function of the pelvic floor muscles. This includes hypertonicity (increased muscle activity), hypotonicity (diminished muscle activity), or inappropriate coordination of the pelvic floor muscles.
The exact cause of pelvic floor dysfunction is unknown, but several factors may contribute to it. These include traumatic injuries to the pelvic area, overuse of pelvic muscles, prior pelvic surgery, pregnancy and childbirth, aging, stress and anxiety, and connective tissue disorders.
