Pelvic Floor Dysfunction

According to a study by the National Institutes of Health, close to 25% of women suffer from pelvic floor dysfunction. The number increases to 37% of women who are between 69 and 79 years, and nearly 50% of women who are over 80 years old. Even though this study indicates only women, and the condition is most common in women, pelvic floor dysfunction also affects men. While this condition becomes quite common with age, it should not be classified as untreatable and acceptable discomfort a person has to live with. With the correct information as well as an effective treatment plan, it is possible not to suffer the pain of this condition in silence anymore.

At Gyn LA, we are committed to providing quality health care to women of all ages in Los Angeles, CA, and its surroundings. Our doctors, surgeons, and physical therapists are highly trained to handle advanced, high-risk, and low-risk gynecological surgeries and treatments. Thus, if you are suffering from pelvic floor dysfunction, feel free to call us, and we will do all we can to help you.

Understanding Pelvic Floor Dysfunction (PFD)

Pelvic floor dysfunction (PFD) is the lack of ability to contract or relax the muscles of the pelvic floor correctly to enable a controlled bowel movement. The Pelvic floor refers to a group of ligaments and muscles in your pelvic region. These muscles provide support to the organs in your pelvis. They also act as a sling around your vagina and rectum. These organs include the uterus (women), bladder, rectum, and prostate (men).

The contraction and relaxation of the muscles of the pelvic floor enable the control of bladder and bowel movements. It also helps to control sexual intercourse in women.  People who suffer from PFD contract these muscles instead of relaxing them, thus finding it difficult to defecate. Also, in other cases, these people may feel like the defecation process is incomplete, or they leak stool or urine.

If it is not treated, PFD can result in discomfort, infection, or long-term damage to the colon.

Causes of PFD

Most PFD causes are not known. However, traumatic injuries that occur to and around the pelvic region after involvement in an accident may contribute to pelvic floor dysfunction. Also, complications that occur during vaginal childbirth may lead to PFD. Other PFD causes arise from learning events of repeated straining actions. These events then develop into a repeated practice of incorrect muscle coordination. Other causes of PFD include:

  • Pelvic surgery
  • Obesity
  • Nerve damage

Symptoms of Pelvic Floor Dysfunction

Several signs may suggest that you have PFD. In case you start experiencing any of the signs below, you have to see your doctor and discuss it with him/her. Some symptoms might also indicate that you have other conditions. However, a complete doctor’s examination should tell the actual cause of your symptoms. Symptoms of PFD may include:

  • Leakage of urine/stool with/without your knowledge
  • A burning/pain when urinating
  • Vaginal burning
  • Pain during sexual intercourse (in women)
  • A frequent or intense need to urinate
  • A straining pain when defecating or constipation
  • Painful menstruation
  • Chronic pain in the pelvic region, rectum, genitals, groin, back, and abdomen with/without defecation
  • Muscle spasms in the pelvis
  • Pressure around the pelvis region and rectum
  • Pain in the lower back
  • Feeling like you cannot complete defecating
  • Feeling like you need to defecate after every short period

Types of PFD

There are three main types of pelvic floor disorders. They are:

  • Pelvic organ prolapse
  • Fecal incontinence
  • Urinary incontinence

Pelvic Organ Prolapse

The uterus, rectum, and bladder (pelvic organs) are located around the vaginal canal. Due to how they are arranged, the organs can drop from their usual place in the lower belly and push against the vaginal walls. This happens when the supportive tissues around the pelvic area become stretched or weak due to surgery or childbirth. The drops are what we call prolapse. Prolapse can also be caused by:

  • Chronic coughing, heavy lifting, or chronic constipation. These three can lead to the straining of abdominal muscles
  • Menopause, which leads to a decrease in estrogen levels. A reduction in estrogen levels results in the weakening of the pelvic tissues
  • Normal aging
  • Obesity

Even though pelvic organ prolapse is not usually associated with severe health risks, it can lead to significant discomfort. Its symptoms include:

  • Heaviness in your vagina
  • Feeling like something is falling out of your vagina
  • Difficulties when using the toilet
  • A pressure or pulling in the pelvis or lower abdomen
  • Unwanted urine leakage
  • Pain during sexual intercourse
  • Frequent urinary tract infections because of a reduced capability of releasing urine from the urethra
  • If the prolapse is significant, you may even see tissues hanging outside your vagina

Types of pelvic organ prolapse include the following:

  • Cystocele- This happens when the front vaginal wall sags and leads to the dropping of the bladder.
  • Uterine prolapse- It happens when the uterus prolapses into the vaginal canal
  • Rectocele- This occurs when the back vaginal wall pouches forward, making the intestines or rectum to bulge towards the vagina
  • Vaginal vault prolapse- This when the walls of the vagina sag after undergoing a hysterectomy

Fecal Incontinence

Fecal incontinence is also called anal or bowel incontinence. It is the inability to have control over defecation.  This, in turn, leads to the unexpected leakage of stool from the rectum.  Fecal incontinence is the second most common type of pelvic floor dysfunction. It ranges from occasional stool leakage when passing gas to completely losing bowel control. People with this condition may feel like they need to defecate but might not hold the stool until they reach the toilet.

Common fecal incontinence causes include constipation, diarrhea, and nerve or muscle damage. The nerve or muscle damage can be linked to giving birth or aging.

To diagnose you with fecal incontinence, your doctor will ask you questions related to your medical record. Then, he/she will carry out a physical examination and tests. Doctors have many tools they use, which will help them understand what causes fecal incontinence.  They include:

  • Anorectal manometry- this checks the sphincter muscles of the anus which hold stool inside. It also checks if the rectum is working effectively.
  • Magnetic resonance imaging- this can be used in examining the sphincter
  • Defecography- this equipment shows the size of the stool your rectum can hold. It also checks how well the rectum can hold the stool as well as how effective it will empty itself.

Urinary Incontinence

Millions of men and women in America have urinary incontinence. It is one of the most common health concerns that can interfere significantly with an individual’s ability to take part in several activities. Luckily, there are several treatment options that can help patients experiencing this condition.

Urinary incontinence is a lack of control over your bladder, which, in turn, results in urine leakage. While the risk of getting urinary incontinence increases as a person continues to age, it’s not a guarantee that you will get it when you age. Symptoms may range from slight leakage to uncontainable wetting.  Women experience this condition two times more often compared to men.

Urinary incontinence can be a result of several conditions. The conditions include the weakening of those tissues that regulate the valve of the bladder. A significant sign to show you have urinary incontinence is experiencing a frequent need to urinate. Additional signs include bladder pressure and the feeling that you have not completely emptied the bladder. The severity of this condition varies from one person to another.

Urinary incontinence can be categorized into several types. You should see your doctor for necessary testing so that you can confirm what type you have as well as an effective treatment plan. The types include:

  1. Stress incontinence

Stress incontinence is most common in women, particularly after giving birth, pelvic surgery, or when they reach menopause. However, it can also affect men who have gone through radical prostatectomy. This urinary leakage disorder happens when you cough, sneeze, or participate in activities or exercises that heighten abdominal pressure.

In women, stress incontinence happens when urethral muscles and pelvic floor muscles weaken. In men, it occurs when sphincter muscles of the urinary mechanism are disrupted.

  1. Urge incontinence

The urge incontinence condition occurs when a person has a strong urge to pass urine but cannot make it to the toilet on time.

  1. Mixed incontinence

Mixed incontinence disorder combines various problems to do with a lack of bladder control. Usually, it is a combination of urge and stress incontinence.

PFD Diagnosis and Treatment

You must not diagnose yourself if you experience any symptoms. This is because certain symptoms may indicate severe conditions. A physical therapist or doctor who is specially trained to treat PFD should diagnose you. To diagnose, the doctor or therapist reviews your medical records and observes the signs. After the first consultation, the doctor performs a physical examination to see if there are any knots or muscle spasms. He/she also checks for muscle weakness.

Also, your physician may do an internal examination to assess pelvic muscle contractions, relaxation, and control. He/she does this by placing a perineometer into your vagina or rectum. Using electrodes is less invasive compared to a perineometer. Here, the doctor puts the electrodes on the perineum. That is, the region between your anus and scrotum or anus and vagina to check whether you can relax and contract pelvic muscles.

Treatment

Treatment of pelvic floor dysfunction depends on the cause and how severe the symptoms are. Surgery is rarely necessary unless it is a case of large, symptomatic rectoceles or other forms of pelvic prolapse. If there is a prolapse, surgery can help restore the usual pelvic organ’s location. Surgery can be done through the bottom, or abdomen based on the precise problem.

If it is a pelvic pain disorder, the treatment is done to reduce or relieve symptoms. In certain cases, combining several treatment techniques helps to reduce pain. General treatment procedures for PFD are as follows:

Medication

In certain cases, your doctor can prescribe muscle relaxants at low doses to help relieve PFD symptoms. Muscle relaxants may prevent muscle contraction.

Biofeedback

Biofeedback is the most common form of treatment for PFD. This treatment is administered with a physical therapist’s help. Biofeedback is a non-surgical and non-painful treatment technique. It provides relief to over 75% of the patients with PFD. A physical therapist may take different biofeedback approaches in an attempt to retrain the patient’s muscles. The approaches include using unique video and sensors to observe the muscles of the pelvic floor as a patient tries to contract or relax them. Then, the therapist gives feedback and continues to help the patient to improve the coordination of his/her muscles.

Relaxation techniques

In certain cases, your physical therapist or doctor may recommend that you take part in relaxation activities like warm baths, meditation, exercises, stretching, and yoga. These activities can help relax the muscles of the pelvic floor.

Surgery

As we said earlier, surgery may not be necessary. However, if your doctor has determined that your PFD is as a result of rectal prolapse or rectocele, surgery could be mandatory. Your doctor uses a Defecating Proctogram Test to determine whether or not it’s these conditions that resulted in your PFD. Sometimes, your surgeon may inject you with Botox, which helps in the relaxation of pelvic floor muscles.

Self-care

Self-care involves taking care of you and avoiding activities that may lead to PFD. For instance, to prevent or lower strain on the muscles of the pelvic floor, avoid straining or pushing when using the bathroom.

Consult a Gynecologist Near Me

Many patients may not be comfortable discussing the symptoms they are experiencing with their physicians. However, any patient should understand that PFD is a common medical condition that can successfully be treated if you share it with your doctor. If you have this condition, do not hesitate to know more about the treatment options you have. At Gyn LA, we help patients restore their quality of life by improving their health. Call us at 310-375-8446 to schedule an appointment with our gynecologists. We help patients in Los Angeles get through a wide range of diseases and live a healthy life.