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Pelvic Floor Dysfunction

Pelvic Floor

The pelvic floor is made up of several muscles, ligaments and tissues that surround the pelvic bone and support that rectum like a sling. The muscles attach to the front, back, and sides of the bone, as well as to the lowest part of the spine, called the sacrum.

Both men and women have a pelvic floor. In women, the pelvic floor is the muscles, ligaments, connective tissues and nerves that support the bladder, uterus, vagina and rectum and help these pelvic organs function. In men, the pelvic floor includes the muscles, tissues and nerves that support the bladder, rectum and other pelvic organs.

palvic

Pelvic Floor Dysfunction

Pelvic floor disorders occur when the “trampoline” or “hammock” that supports the pelvic organs becomes weak or damaged and unable to correctly relax and coordinate the muscles in your pelvic floor in  urinary incontinence, constipation, pain during intercourse or pain in the lower back, pelvic region, genitals or rectum.

Types of Pelvic Floor Dysfunction

The three main types of pelvic floor disorders are:

  1. Fecal incontinence or lack of bowel control.
  2. Pelvic organ prolapse, such as rectal prolapse, a condition in which the bowel can bulge through the anus.
  3. Obstructive defecation, or the inability to pass stool through the digestive tract out the anus.

Risk Factors:

Particularly women face this problem more than men. Almost one-quarter of women face pelvic floor disorders.

  • Pelvic floor disorders affect about 10% of women ages 20 to 39,
  • 27% of women ages 40 to 59,
  • 37% of women ages 60 to 79
  •  And nearly 50% of women age 80 or older.

Causes:

Exact causes are still unknown. But doctors can link pelvic floor dysfunction to conditions or events that weaken the pelvic muscles or tear connective tissue:

  • Pregnancy.
  • Childbirth
  • Overusing the pelvic muscles (like going to the bathroom too often or pushing too hard), eventually leading to poor muscle coordination.
  • Pelvic surgery.
  • Advancing age.
  • Traumatic injury to the pelvic region (like a car accident).
  • Obesity
  • Nerve damage
  • Systemic diseases
  • Multiple deliveries
  • Large babies
  • Operative delivery

Symptoms 

  • urinary issues, such as the urge to urinate or painful urination constipation or bowel strains
  • pain in the pelvic region, genitals, or rectum
  • discomfort during sexual intercourse for women
  • pressure in the pelvic region or rectum
  • muscle spasms in the pelvis
  • Feeling like your bowel movements are not complete
  • Leakage of urine or feces
  • Frequently feeling the need to use the bathroom
  • Feeling like you need to force out urine or feces
  • Stopping and starting in the middle of urinating
  • Long-term constipation
  • Needing to change positions to get out a bowel movement
  • Unexplained lower back pain
  • Unexplained pain in your genitals, anus, or lower abdomen (pelvic region)

Diagnosis:

  • Doctor will review your medical history and observe your symptoms.
  •  After the initial consultation, your doctor will perform a physical evaluation to check for muscle spasms or knots. They will also check for muscle weakness.
  • To check for pelvic muscle control and pelvic muscle contractions, your doctor may perform an internal exam by placing a perineometer — a small, sensing device — into your rectum or vagina.
  • A less invasive option involves placing electrodes on your perineum, the area between the scrotum and anus or vagina and anus, to determine if you can contract and relax pelvic muscles.
  • Investigation: In diagnosing, X-ray can help detecting an enema of thick liquid.

Treatment

Self-care or life style modification:

To reduce strain on your pelvic floor muscles, avoid pushing or straining when using the bathroom. Relaxation techniques such as yoga and stretching can also help to relax your pelvic floor muscles. Taking warm baths is another useful technique. Warm water improves blood circulation and relaxes the muscles.

Dietary changes: 

For example, eating more fiber, drinking more fluids, and taking certain medications can make bowel movements easier.

Physical therapy

  • Trigger point massage, myofascial release (Massage, both externally and internally, can help stabilize your pelvis before using other kinds of treatment.)
  • Strain-counterstain, joint mobilization.
  • Strengthening of pelvic floor muscles and core muscle
  • Down-training / muscle relaxation
  • Management of dyspareunia related to pelvic floor hypertonicity.
  • Expert training of pelvic floor exercises.

Electrotherapy:

Electrical Stimulation:

Small probes are placed externally or inserted into the vagina or rectum to stimulate your pelvic floor muscles, helping desensitize nerves and causing muscles to contract and relax. Different varieties of electrical stimulation devices are available for home use, both for internal stimulation with a probe or for external stimulation.

Ultrasound:

In addition to being an important diagnostic tool, ultrasound can be used therapeutically to produce deep warmth in the pelvic muscles that can reduce muscle spasms and increase blood flow.

Manual Therapy

You can activate the pelvic floor anytime, anywhere. But it’s also beneficial to incorporate specific exercises that strengthen and target the pelvic floor muscles.

One way to design a program is to categorize the exercises for those who have hypotonic pelvic floor muscles versus those who have hypertonic pelvic floor muscles.

According to Crouch, hypotonic means you have low tone pelvic floor issues and need to strengthen and improve endurance and power.

Exercises for hypotonic pelvic floor muscles:

To target hypotonic pelvic floor issues, Crouch recommends these 3 exercises:

1. Quick flick Kegels

Crouch says the quick flick Kegel requires quick contractions of your pelvic floor to help activate the muscles faster and stronger to stop leaks upon sneezing or coughing.

  • Begin by lying on the floor with your knees bent and feet flat on the floor. As this exercise becomes easier, try sitting or standing while performing it.
  • Find your pelvic floor muscles using the tips described above.
  • Exhale, pull your navel to your spine, and quickly contract and release your pelvic floor muscles. Aim to contract for 1 second before releasing.
  • Maintain steady breathing throughout.
  • Repeat the quick flick 10 times, then rest for 10 seconds. Do 2–3 sets.

2.Heel slides

Heel slides encourage pelvic floor contractions while targeting the deep abdominal muscles.

Heel-slides

  • Begin by lying on the floor with your knees bent and pelvis in a neutral position.
  • Inhale into the rib cage, then exhale through the mouth, letting your ribs naturally compress.
  • Draw your pelvic floor up, lock in your core, and slide your right heel away from you. Only go as far as you can without losing your connection to your deep core.
  • Find the bottom position, then inhale and bring your leg back to starting position.
  • Repeat.
  • Do 10 slides on each side before changing to the other leg.

3. Marches (also called toe taps)

Like heel slides, the marching exercise increases core stability and encourages pelvic floor contractions.

Marches

  • Begin by lying on the floor with your knees bent and pelvis in a neutral position.
  • Inhale into your rib cage, then exhale through your mouth, letting your ribs naturally compress.
  • Draw your pelvic floor up and lock in your core.
  • Slowly lift one leg up to a tabletop position.
  • Slowly lower this leg to the starting position.
  • Repeat the movement alternating legs. You should not feel any pain in your lower back. It’s important that your deep core stays engaged throughout the entire exercise.
  • Alternate legs for 12–20 times total.

Exercises for hypertonic pelvic floor muscles

1. Happy Baby Pose (Supine Pelvic Floor Stretch)

The Happy Baby Pose is a great addition to a pelvic floor routine when stretching and releasing are the goal.

happy-baby

  • Begin by lying on the floor with your knees bent.
  • Bring your knees toward your belly at a 90-degree angle, with the soles of your feet facing up.
  • Grab and hold the outside or inside of your feet.
  • Open your knees until they’re slightly wider than your torso. Then, bring your feet up toward your armpits. Make sure your ankles are over your knees.
  • Flex your heels and push your feet into your hands. You can stay in this position for several breaths or gently rock from side to side.

2. Diaphragmatic breathing

Diaphragmatic breathing encourages the functional relationship between the diaphragm and pelvic floor. It’s also an excellent exercise for reducing stress. (23Trusted Source)

Diaphragmatic breathing

  • Begin by lying flat on the floor on a yoga or exercise mat. You can also perform the exercise in a seated position.
  • Do a few seconds of progressive relaxation. Focus on releasing the tension in your body.
  • Once relaxed, put one hand on your stomach and the other on your chest.
  • Inhale through your nose to expand your stomach — your chest should stay relatively still. Then, breathe in for 2–3 seconds and exhale slowly.
  • Repeat several times while keeping one hand on the chest and one on the stomach.

Another Pelvic floor exercises:

Bridging :

To do this exercise:

pelvic-exercise

  • Lie on the back and bend the knees, with the feet flat on the floor about hip-width apart. Keep the arms by the sides with the palms facing down.
  • Contract the buttocks and pelvic floor muscles, and lift the buttocks several inches off the ground.
  • Hold this position for 3–8 seconds.
  • Relax the buttocks and pelvic floor muscles, and lower the buttocks to the ground.
  • Repeat this up to 10 times per set.
  • Rest, then perform up to two additional sets. Ridges

Squeeze and release

This rapid movement helps the pelvic floor muscles respond quickly.

Squeeze

To perform this exercise, a person should:

  • Sit in a comfortable position.
  • Picture the pelvic floor muscles.
  • Squeeze them as quickly as possible and release them without trying to hold the contraction.
  • Rest for 3–5 seconds.
  • Repeat this 10–20 times per set.
  • Do two sets later in the day.

Squat

To perform a squat, a person should:

  • Stand with the feet hip-width apart, keeping them flat on the floor.
  • Bend at the knees to bring the buttocks toward the floor, going only as low as is comfortable.
  • Keep the back straight and tilted slightly forward. The knees should be in line with the toes.
  • Focus on tightening the buttocks and pelvic floor while returning to a standing position.
  • Repeat this exercise, doing up to 10 repetitions per set.
  • Rest before performing any additional sets.

Lunges

  • Start in a standing position with your feet hip-width apart.
  • Step forward longer than a walking stride so one leg is ahead of your torso and the other is behind. Your foot should land flat and remain flat while it’s on the ground. Your rear heel will rise off of the ground.
  • Bend your knees to approximately 90 degrees as you lower yourself. Remember to keep your trunk upright and core engaged.
  • Then, forcefully push off from your front leg to return to the starting position.

Piriformis Stretch

  • Grab underneath one leg, pushing your elbow into the lower thigh of the opposite leg. Gently pull your leg toward your body until you feel a stretch in your buttock and hold.
  • Hold for 60 seconds and again concentrate on relaxing the pelvic floor.
  • Repeat 2 times on each side, 2 times per day.

Exercises to avoid

Until a person has done several months of pelvic floor work, they should avoid the following exercises:

  • Sit ups with the legs held straight in the air
  • lifting heavy weights for minimal repetitions
  • double leg lifts
  • running, jumping, and other high-impact activities
dr-debbekadhar
Dr. Debika Dhar

Physiotherapist , Mayfair Wellness Clinic

BPT (DU),
faculty of Medicine (NITOR),
Sports Injury Specialist,
Trained in Neuro Rehabilitation

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