What is the function of the pelvic floor?
The pelvic floor muscles are a crucial part of our musculoskeletal system, providing support for our internal organs, support for our unborn baby when pregnant, controlling continence and playing an important part in sexual function.
Is pelvic floor dysfunction (PFD) common?
Over 25% of all women are believed to suffer from pelvic floor dysfunction, and this number is generally considered to be an under-estimation due to the sensitive nature of the symptoms causing many cases to go unreported.
What are the signs and symptoms of PFD?
Signs that your pelvic floor muscles may not be functioning correctly include constipation or IBS type symptoms (often a fluctuation between constipation and loose stools), uncontrolled flatulence with or without faecal leaking, frequency urinating or leaking of urine (can be at rest or with activity), pain during intercourse and unexplained pain in the groin, lower back, genitals and abdomen. Some or all of these symptoms may be present.
What causes PFD?
The causes of PFD are varied and often multiple, but some risk factors include: pregnancy / childbirth, multiple vaginal deliveries, obesity, repetitive urinary tract infection, pelvic surgery, sexual trauma and extreme exercise routines. Current research shows that individuals who experience chronic low back pain have an increased rate of pelvic floor dysfunction, due to the altered activity of the muscles in response. In individuals who experience back pain during pregnancy, there is a documented increase in the likelihood of PFD and continence issues in the future.
How can physiotherapy help with PFD?
Specialist pelvic floor physiotherapy can help with PFD by: examining the function of the pelvic floor muscles and identifying any discrepancies or issues, working on these through specialist release or strengthening work, providing education and strategies with which to manage symptoms and re-train muscles and pelvic behaviours, helping to reinvent quality of life through positive rehab and change.
Is it only post-natal women who suffer from pelvic floor muscle dysfunction?
Definitely not. Pelvic floor muscle dysfunction can affect women (and men!) at all stages of life, including in childhood. In fact, there is a high prevalence of dysfunction and continence issues found in young and highly functioning nulliparous (a woman who has never given birth) athletes due to overactivity and spasm of the muscles.
I have been doing pelvic floor exercises regularly. Why am I still having problems?
Pelvic floor muscles, like any other muscles, can be either weak or overactive. Overactivity can cause problems as much as weakness can, such as pain, incontinence and constipation, due to the muscles not functioning correctly. It has also been linked to pains in the groin, hips and back. Additionally, if a patient is not performing their pelvic floor exercises correctly then they may not be changing the muscular function, as desired, or may even be exacerbating the problem. A specialist physiotherapy internal assessment can determine which of these issues is the cause of the problem and begin a programme to help you improve this.
I am experiencing continence issues following pregnancy. Is this normal?
While urinary urgency and incontinence is not uncommon, it should not be considered normal. It can be caused by either weakness OR overactivity of the pelvic floor muscles, and over time the muscles and bladder can develop incorrect activity as a result. It is also important to note that this does not only happen after having children. This is a problem that can have large consequences on quality of life and happiness, and patients should be referred to a specialist for help with changing this.
I am pregnant and experiencing back pain. Is this just normal “pregnancy aches and pains” or is there anything I can do?
Again, while not uncommon, back pain early in pregnancy is not deemed normal and should be addressed. It often coincides with a muscular imbalance around the pelvis and can happen alongside other common areas of pain such as the hips, buttocks and pubic area. With the amount of change that happens in the body during pregnancy, it is hardly surprising that sometimes our muscles are slow to catch up! It is also important to note that women who experience back pain in pregnancy are more likely to experience some form of pelvic floor dysfunction, as the muscles can begin to function differently in response. Seeing your GP for a referral to a specialist physiotherapist can help to ease pain during pregnancy but also act as a preventative measure for future PFD.
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References
Pool-Goudzwaard AL, Slieker tenHoveMC, Vierhout ME, Mulder PH, Pool JJ, Snijders CJ, et al. (2005) Relations between pregnancy-related low back pain, pelvic floor activity and pelvic floor dysfunction. International Urogynecology Journal. Vol 6, Issue16, pp 468 – 474.
