Causes - Childbirth

Childbirth when difficult 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 just because of laxity, a tear or loss of attachment of the muscle or fascia. A muscle can also be weak because it is tense.

It is common that the pelvic floor is weaker after childbirth and women can develop symptoms of incontinence or prolapse. As a result women may start to subconsciously hold the pelvic floor, fearing the symptoms. It can happen that gradually the abdomen sets up a negative holding pattern, further feeding into the negative pelvic floor holding.

The pelvic floor responds well to "facilitation" to get the right muscles going again. Further squeezing the ones already working frequently doesn’t do the job. The rehabilitation needs to be specifically targeted at the inhibited and damaged muscles in order to maximize any training effect.

Symptoms

• Stress incontinence can follow when the pelvic floor muscles just don't have the range of movement to reach the neck of the bladder in the event of increases of intra-abdominal pressure. They are unable to stabilize the neck of the bladder sufficiently to prevent a leak when there is an existing imbalance.
• Urge incontinence can happen when the muscle of the bladder becomes overactive and often this leads to even more negative holding of the pelvic floor.
• Fecal incontinence occurs when the muscles of the back passage have weakened or fecal urgency is when there is an acute sensitivity to descending stool which can often be associated with tension and trigger points in the pelvic floor.
• Pelvic organ prolapse can happen post-natally or as a consequence of childbirth but only become symptomatic later in life. When any organs come down the pelvic floor has to work harder to support the organs. Clinically it can be noticed that the muscles become very tense and then of course the prolapse worsens as the lift of the pelvic floor is decreased. The pelvic floor has a "shelf" that the organs sit on, this shelf is the upper vaginal axis and it should be horizontal, often when the organs have descended the upper axis has become more vertical and the support is lost. The approach is to first facilitate and release the pelvic floor muscles and then strengthen the lift. Not all prolapses respond to a level that is manageable to the patient but most will improve and some do resolve. It is always a good idea to try to mobilize and strengthen the pelvic floor even if surgery is ultimately indicated.