Pelvic Floor Dysfunction: What You Need To Know

The topic of pelvic floor dysfunction is one many women prefer to brush under the carpet as they may find its symptoms frustrating and embarrassing. In reality, pelvic floor disorders are common, affecting 1 in 4 women between the ages of 30 and 70 globally.

What are Pelvic Muscles?

The pelvic floor consists of muscles and connective tissues that support the bladder, bowel, and reproductive organs. These muscles form a “hammock” at the base of the pelvis and play a crucial role in bodily functions such as urination, bowel movements, and sexual activity.

Functions of the Pelvic Muscles

• Support pelvic organs:

  Keeping the bladder, bowel, and reproductive organs in place.

• Assist with continence:

  Controlling urine and stool release.

• Absorb external pressure:

  Helping protect the spine and organs during activities like lifting or coughing.

A healthy pelvic floor is essential for overall physical health, and strengthening these muscles can prevent issues like incontinence and pain.

What Exactly is Pelvic Floor Dysfunction?

Pelvic floor dysfunction is the inability to correctly relax and coordinate the pelvic muscles. This group of muscles supports the pelvic organs and controls bladder and bowel movements. When these muscles don’t function properly, it can lead to issues such as incontinence, constipation, or pain. Pelvic floor dysfunction can occur due to various factors, including injury, childbirth, or surgery, and affects both women and men.

Symptoms of Pelvic Floor Dysfunction

• Frequent trips to the bathroom

• Urinary Incontinence or loss of bladder control when coughing, sneezing or lifting heavy items.

• Bowel Incontinence or difficulty having regular bowel movements

• Pain during sex

• Experiencing organs bulging from the vagina or a heavy feeling in the pelvic area

• Unexplained lower back pain

• Persistent pain in the pelvic area, genitals, or rectum – with or without bowel movements.

What Causes Pelvic Floor Dysfunction?

There are several factors that play a role, including:

• Traumatic injuries: Accidents such as car crashes or falls from heights can harm the pelvic muscles.

• Childbirth: Damage to the pelvic muscles during vaginal delivery.

• Chronic Constipation: Repeated straining can weaken the pelvic muscles.

• Surgery: Operations like hysterectomies can lead to muscle damage.

• Obesity: Excessive weight puts pressure on the pelvic floor.

• Ageing: Muscles naturally weaken with age.

• Stress and anxiety

• Connective tissue disorders

How is Pelvic Floor Dysfunction Diagnosed?

Physical Examination

The journey to understanding pelvic floor dysfunction begins with a comprehensive physical examination. Your gynae will discuss your medical history and perform a pelvic exam to evaluate the strength and function of your pelvic muscles, checking for tenderness, muscle tone issues, or signs of prolapse.

Symptom Assessment

During your appointment, your gynae will ask about the symptoms you’ve been experiencing. It’s important to share details about any discomfort, incontinence, or issues with bowel movements. This conversation allows your gynae to understand your unique situation better and tailor a treatment plan just for you.

Specialised Tests

• Urodynamics:

  This test helps assess how well your bladder is functioning. By filling your bladder with water through a catheter while measuring pressure and flow, it gives insight into any bladder-related issues contributing to your pelvic floor dysfunction.

• Defecography:

  This imaging test can be invaluable if you’re experiencing bowel issues. It shows how well your rectum and anus work together during bowel movements, highlighting any challenges within your pelvic floor.

• Electromyography (EMG):

  EMG measures the electrical activity in your pelvic floor muscles, helping to identify any weakness, overactivity, or coordination problems contributing to your symptoms.

Imaging Tests

• Ultrasound:

  This non-invasive test uses sound waves to create images of your pelvic organs and muscles, allowing for a better understanding of their structure and function.

• MRI (Magnetic Resonance Imaging):

  MRI offers detailed images of the pelvic area, helping to identify any anatomical concerns that may need attention. It’s particularly useful for planning any potential surgical interventions if necessary.

How is Pelvic Floor Dysfunction treated?

Treatment and management of pelvic floor dysfunction depend on the severity of the condition.

• Pelvic Floor Exercises

  Physical therapy is helpful for milder cases or after childbirth. Symptoms such as incontinence and sexual difficulty can be managed by doing specific exercises regularly that help strengthen the core muscles. Your gynae or a physiotherapist will be able to advise you on this.

• Pessaries

  This is a non-surgical treatment for pelvic floor disorders. A pessary is a removable device which is placed in the vagina to support the prolapsed tissue and hold the uterus in place.

• Surgery

  If the prolapse is substantial or severe, your gynaecologist may suggest surgery to reconstruct the pelvic anatomy. This may be done via open or laparoscopic methods. In some cases, a hysterectomy (removal of the uterus) may be required.

Pelvic Floor Prolapse vs. Pelvic Floor Dysfunction:

Understanding the Difference Although pelvic floor dysfunction and pelvic floor prolapse are related, they are two distinct conditions with different causes and symptoms. Recognising the differences can help you better understand your situation and seek the appropriate treatment.

Pelvic Floor Dysfunction

Pelvic floor dysfunction occurs when the pelvic muscles aren’t working as they should. This can make it difficult to relax or coordinate the muscles, leading to issues with bladder and bowel control and sexual health. Symptoms may include incontinence, constipation, pain, or trouble with everyday activities due to muscle weakness or imbalance. Causes can include childbirth, constant constipation, surgery, or age-related changes.

Pelvic Floor Prolapse

Pelvic floor prolapse happens when the pelvic organs, like the bladder, uterus, or rectum, drop or bulge into the vaginal canal due to weakened pelvic muscles and ligaments. This condition is often a result of pelvic floor dysfunction, where the muscles can no longer support the organs properly. Symptoms of prolapse can include a heavy feeling in the pelvic area, vaginal bulging, or discomfort during physical activity or sex. In more severe cases, the prolapsed organs may even descend outside the vaginal opening.

For more information on the diagnosis and treatment of pelvic floor disorders, make an appointment with our gynaecologists at any of our women’s clinics in Singapore.