Pelvic floor dysfunction - Overview

The pelvic floor muscles (levator ani) are attached at the front to the pubic bone, to the lateral walls of the pelvis and behind to the coccyx. They form a sling as they support the pelvic organs from back to front. They are responsible for bladder and bowel control, organ support and sexual function.

There are a number of reasons that the pelvic floor can become dysfunctional, the pelvis is the centre through which we move, we sit on it, we need it for bladder and bowel control, it houses our organs, it carries a pregnancy, a baby will pass through it and it is a strong emotional centre in our bodies meaning that we can hold it excessively without even knowing. Is it any wonder it is susceptible to injury ? Here are some of the more specific causes of damage.

Causes of pelvic floor dysfunction

Childbirth - Childbirth can be traumatic on the pelvic floor, leading to muscle and fascial tears and organ descent. The variations in presentation are immense and it should not be assumed that a muscle is weak because of a tear or loss of attachment, it is common that weakness post childbirth occurs with negative tension and muscle imbalance.

Pelvic girdle pain in pregnancy - Pelvic girdle pain in pregnancy is the potentially debilitating pain that some women experience when the pelvis loses stability and alignment. The pelvic floor will often respond by becoming overactive in its effort to restore stability and pelvic floor muscle dysfunction may follow.

Poor posture - The pelvis plays an important role in good postural alignment and in movement. If the middle back, lower back, pelvis and hips down to the feet are not aligned correctly then the pelvic floor may be put under excessive pressure leading to a build up in tension. 

Coccyx injury - The coccyx is the tail bone attached to the base of the spine. A direct blow can happen as a result of a sports or road traffic accident, a fall or childbirth. A holding pattern can set itself up secondary to pain.

Chronic constipation - Constipation over a long period of time may damage the pelvic floor weakening it and straining the organs. An imbalance can set itself up further feeding in to the pattern of constipation where the muscle dysfunction has become the main problem.

Post surgery - Pelvic floor tension and holding patterns can set themselves up after surgery where there may be pain or scar tissue.

Overactive pelvic floor disorders - Examples of overactive pelvic floor disorders are vaginismus (excessive tension of vaginal muscles), anismus (excessive tension of anal muscles) and other defecation disorders (in-coordination / tension of the muscles that need to lengthen during defecation). These are conditions where the pelvic floor muscles are held chronically tight and voluntary release is difficult. There is often no known cause. 

Chronic pelvic pain disorders - Chronic pelvic pain disorders in men and women can be debilitating. They may be classified as a urologic chronic pelvic pain disorder, a pudendal neuralgia or neuropathy or one of the vulvar pain disorders or endometriosis in women. These conditions are often associated with pelvic floor dysfunction. There are links on this site to the websites dedicated to providing information to men and women who think they may have these disorders.

Symptoms associated with pelvic floor dysfunction

Bladder - Stress incontinence, urgency, urge incontinence, frequency, urethral pain, bladder pain, pelvic floor pain, lower abdominal pain, difficulty initiating flow of urine and reduced flow. 

Bowel -  Fecal incontinence, fecal urgency, flatulence, anal pain, rectal pain, "visceral" pain, inability to defecate.

Pelvic organ descent - The urethra, bladder, uterus or rectum can prolapse through the vagina , the rectum can also prolapse through the back passage. Symptoms can be mild or distressing, balance can be restored making symptoms more tolerable where the prolapse is not too advanced.

Pain - Pain associated with pelvic floor dysfunction can be in the pelvic floor itself or can be referred with the feeling that it is in the anus or rectum or coccyx, the vagina, labia and clitoris in women and penis, scrotum or perineum in men. There is often associated lower abdominal pain and associated tension in other pelvic, lower limb and spinal muscles.