Pelvic Floor Disorders

The rectum, bladder, uterus, and vagina are supported by muscles and connective tissue that keep them in place. A pelvic floor disorder is a mechanical condition in which the pelvic floor muscles, that support these organs doesn’t contract and relax properly. Many factors (including pregnancy, age, and previous surgery) can affect the musculature of the pelvic floor, creating weakness and ultimately leading to a pelvic floor disorder that negatively affects the mechanisms involved in urination, defecation, and sexual intercourse. A pelvic floor disorder can lead to other complications such as anismus, rectal prolapse, intussusception, and rectocele.

SYMPTOMS

• Trouble pushing out stool
• Difficulty relaxing pelvic muscles during intercourse and defecation
• Urine leakage
• Stool leakage or bowel incontinence
• Constipation
• Bloating
• Pain during intercourse

The following conditions are associated with pelvic floor disorders:

• Anismus (also called dyssenergic defecation, inappropriate puborectalis contraction, puborectalis syndrome, paradoxical puborectalis, pelvic floor disorder, spastic pelvic floor syndrome, and anal sphincter dyssenergia): the pelvic floor muscles don’t relax during a bowel movement
• Rectal prolapse: the rectum protrudes out through the anus, usually because of chronic straining and constipation
• Intussusception: the rectum folds into itself, causing a blockage
• Rectocele: the wall of the rectum bulges into the vagina

Many women with a rectocele report that to have a successful bowel movement, they must insert a finger into the vagina and press on the puborectalis muscle to straighten the angle of the rectum and facilitate emptying.

CAUSES

Pelvic floor disorders are caused by many factors that weaken the pelvic floor muscles, including:

• Pregnancy
• Straining
• Large birth weight babies
• Gynecological surgery
• Aging

Neurological conditions, such as multiple sclerosis (MS) can also cause pelvic floor disorders, because the signals to the brain that are involved in defecation can get disrupted, interfering with muscular relaxation. Spinal cord injuries, strokes, and Parkinson’s can all contribute to developing a pelvic floor disorder.

DIAGNOSIS

Diagnosing a pelvic floor disorder often involves nothing more than a thorough rectal exam (a gloved finger is inserted into the rectum to assess physiological problems with the pelvic floor musculature). Yet some individuals may need a more in-depth investigation, which may include any of the following medical test:

• Transvaginal ultrasound: an ultrasound probe is inserted vaginally, and using sound waves, the probe transmits pictures of the pelvis onto a monitor
• Anorectal manometry: checks the pressure in the rectum by inserting a thin tube, with a small balloon on its end, into the rectum
• Defecography: shows the relationship between the rectum and the vagina during bowel movements, using x-ray imaging

TREATMENT

Exercise & Biofeedback

Because weakened pelvic floor muscles cause pelvic floor disorders, strengthening these muscles, as well as establishing a strong mind-body connection to contract and relax these muscles, are the most important steps in treating the condition. Kegel exercises to strengthen the pelvic muscles, as well as exercises that strengthen the core and pelvic musculature, and biofeedback to re-establish the mind-body connection of muscular contractibility and relaxation, are the most effective treatments.

Surgery

Although some pelvic floor disorders are more serious and will require surgery, it’s always wise to consider trying strengthening exercises and biofeedback before considering surgery as an option. The progress you can make in overcoming your pelvic floor disorder with exercise and biofeedback alone can be remarkable.