Causes of Pelvic Floor Dysfunction
Pelvic floor dysfunction can be caused by various factors, including:
Muscular Tension: Chronically increased muscle tension or spasms of the pelvic floor muscles are thought to be the main cause of pelvic floor muscles. This can be due to actions that strain the pelvic floor muscles such as chronic constipation.
Trauma or Injury: Trauma to the pelvic floor muscles can occur due to childbirth, surgery, or prolonged sitting, leading to damage to the muscles supporting the pelvic floor.
Psychological Stressors: Stress, anxiety, and other psychological factors can contribute to pelvic pain syndromes like pelvic floor muscles. These factors can lead to muscle tension and exacerbate pain symptoms.
Symptoms of Pelvic Floor Dysfunction
You may not have any symptoms. However, if you do, the symptoms may gradually develop and worsen over time. The common symptoms of pelvic floor dysfunction are chronic rectal or pelvic pain that is associated with increased muscle tenderness or spasm. Other symptoms include:
- Pain or discomfort when sitting for prolonged periods of time placing increased pressure on the pelvic area
Pain associated with bowel movements, sexual intercourse, and/or urination
Chronic urinary or fecal incontinence
Impact of Pelvic Floor Dysfunction
Pelvic floor dysfunction can lead to several conditions:
- Chronic Pelvic Pain: Persistent or recurring pain in the pelvic region is the hallmark symptom of levator ani syndrome. This pain is typically dull, aching, or cramping in nature and may worsen with certain activities or positions.
- Levator Ani Syndrome: Persistent tension or dysfunction of the pelvic floor muscles can contribute to generalized pelvic floor dysfunction. This can affect bowel and bladder function, sexual function, and overall pelvic stability.
- Urinary Symptoms: The increased tension in the pelvic musculature can lead to a range of urinary symptoms including increased frequency, urgency, hesitancy, incontinence, or incomplete bladder emptying.
Diagnosis of Pelvic Floor Dysfunction
Diagnosing pelvic floor dysfunction typically involves:
Medical History: Discussion of symptoms, past medical conditions, and any history of injury to the pelvic muscles.
Physical Examination: Assessment focusing on the pelvic area including palpation of the pelvic muscles to assess for tenderness or muscle spasms. A digital rectal exam (DRE) may be utilized to evaluate causes of levator ani syndrome.
Diagnostic Imaging: Imaging such as pelvic ultrasound, CT scans, or MRI scans to visualize pelvic structures and detect structural causes of pelvic pain.
Prognosis of Pelvic Floor Dysfunction
Pelvic floor dysfunction can often be effectively managed with a combination of physical therapy, lifestyle changes, and sometimes medication or surgery, depending on the severity and underlying cause. With appropriate treatment, many individuals experience significant improvement in symptoms and quality of life.
Treatment of Pelvic Floor Dysfunction
Treatment options include:
Conservative Treatments: Non-surgical approaches include:
Medications: Such as nonsteroidal anti-inflammatory drugs (NSAIDs) or muscle relaxants for pain management.
Physical Therapy: Exercises to strengthen pelvic floor muscles under the guidance of a specialized pelvic floor physical therapist that will teach exercises to relax and strengthen the muscles of the pelvic floor.
Dietary Modifications: For individuals with bowel symptoms associated with levator ani syndrome, dietary changes such as increasing fiber intake, staying hydrated, and avoiding triggering foods may help improve bowel function and reduce symptoms.
Acupuncture or Chiropractic Care: Some patients find relief through alternative therapies.
Surgical Intervention: When conservative measures are ineffective or symptoms worsen, surgery may be considered:
Surgical Options: Surgery is rarely considered for levator ani syndrome and is usually reserved for cases where conservative treatments have failed and there is a clear structural problem contributing to symptoms. Possible surgical options include myomectomy or sphincterotomy.
Procedure Videos
References
- Corton M. M. (2009). Anatomy of pelvic floor dysfunction. Obstetrics and gynecology clinics of North America, 36(3), 401–419. https://doi.org/10.1016/j.ogc.2009.09.002
- Kotarinos R, Brubaker B. Myofascial pelvic pain syndrome in females:Pelvic Floor Physical Therapy for Management. In: UpToDate, Connor RF (Ed), Wolters Kluwer. (Accessed on July 26, 2024.)
