Pelvic Floor Muscles
The pelvic floor muscles are a group of muscles that run from the pubic bone and the front to the tailbone at the back. There are three openings in the female pelvic floor, the urine tube, the vaginal opening in the middle and the anus at the rear. These muscles support the pelvic organs, help control continence (bladder and bowel) and play an important role in sexual function.
For more information visit the continence foundation of Australia website.
https://www.continence.org.au/pages/pelvic-floor-women.html
Males have pelvic floor muscles too, they are located fairly similarly and have the two openings being the urine tube and the anus. The male pelvic floor supports the bladder and the bowel and contributes to sexual function.
For more information visit the continence foundation of Australia website.
Urinary Incontinence
There are two main types of urinary incontinence, they are Stress Urinary Incontinence (SUI) and Urge Urinary Incontinence (UUI). They can occur in isolation or together and have a variety of causes.
Stress incontinence can occur when there is movement such as laugh, cough, jump or play sport and leakage can range from a few drops to a lot more. Women can experience this as young athletes, during pregnancy, post-natal or with menopause changes. Men can also experience SUI post prostate surgery and may take some time for it to resolve or reduce with physiotherapy. Urge incontinence on the other hand is associated with a sudden desire to void, an inability to hold off going to the toilet, and frequent visits to the toilet during the day or night.
For further information about detailed treatment options, please see the Australian Commission for Safety and Quality in Health Care.
Prolapse
Pelvic Organ Prolapse (POP) is a general term and can be classified further depending on what pelvic tissues or organs are involved.
Generally, it is defined as a decent of bladder, uterus (womb), and/or bowel into the vagina or downwards into the anus. It can be felt as heaviness or pressure or a bulge in the vagina and the sensation may be constant or come and go from time to time. It can contribute to painful intercourse, reduce the control of your bladder or bowel, cause retention or incontinence of urine, and may cause trouble with UTI’s or kidney function. It may affect your quality of life however depending on the extent, some people are not bothered by it at all.
Having an assessment and gaining knowledge of your condition is important, however it is only diagnosed when you are bothered by the symptoms.
There are many factors that can contribute to a prolapse, and some of these may include or be a combination of;
- Constipation & straining
- Pregnancy & delivery
- Straining when heavy lifting
- Pelvic floor muscle weakness
- Genetic predisposition
Your Pelvic Floor muscles provide an important role in the support of the pelvic organs. They provide muscle bulk, muscle strength and an ability to switch on or off when they are needed. If you have pelvic organ prolapse symptoms you can consult your pelvic health physiotherapist so you have a good understanding of how to optimise your pelvic floor muscle function. Other structures such as the tissues in the pelvis which support the muscles and organs can also play a large role, which is why it is not only the muscles that support, but also the tissues and ligaments.
For further detailed information on treatment options, please see the Australian Commission for Safety and Quality in Health Care.
Bowel Dysfunction
The pelvic floor plays a large part in healthy bowel function. Whilst the contents of the stool is important, we rely on the pelvic floor to hold faecal matter without involuntary passage of wind or stool. Constipation, soiling, straining and a sense of incomplete emptying are signs that your bowels may not be functioning at an optimal level. Healthy bowels aim to pass a nice soft sausage type stool with ease every 1 -3 days. Pelvic health physiotherapy can assist in helping you learn how to use your pelvic floor muscles when passing, how to position yourself, how to eat, drink and exercise well to ensure your bowels are at their best.
Fecal incontinence is more common than you may think, and there are many risk factors for developing poor control of your bowels. Some of the risk factors for developing poor bowel control include; aging and post menopause changes, tearing or episiotomy in childbirth can damage some of the muscles or nerves surrounding your anal sphincter, chronic constipation, chronic diarrhea, some types of prolapse, surgery or some medications. Many of these issues can be treated and improved with correct diagnosis, treatment, understanding and giving back confidence and control to individuals.
Pelvic and Sexual Pain
Dyspareunia
This is a term used to describe painful intercourse and can be either deep or at the entrance. It can cause much discomfort and this may last after the event or into the next day. The causes are mixed and may be from a physical issue, psychological issue or a combination.
Vulvodynia
Vulvodynia can be classified into more specific terminology once assessment has been made. But generally speaking it is discomfort either with touch or constant and it affects the area just inside the vulva.
Vaginismus
More related to the muscles and their ability to spasm with insertion and this may cause discomfort, pain and possibly prevent penetration.
Endometriosis
Endometriosis affects 1 in 10 Australian women, and many of those suffer for years before being diagnosed. Some common symptoms of the condition are cyclic pain with menstruation or hormonal shifts, lower pelvic pain and cramps, low back pain, difficulty with bowels and heavy bleeding. Period pain that extends beyond 1 -2 days of discomfort is never normal, it is important to let your general practitioner know about this.
Pelvic health physiotherapy can help provide solutions to managing the discomfort, electrotherapy for pain relief, improving optimal musculoskeletal health, addressing any pelvic floor issues, providing relief strategies, bowel management, exercise tolerance and empowering the patient to flourish and achieve their goals. Pelvic health physiotherapists are excellent at managing the cyclic nature of the condition and what exercise or management strategies are best for different times of the month.
Pudendal Neuralgia
The Pudendal nerve supplies specific areas of the pelvis including the buttocks, vulval regions, clitoris, scrotum, penis and anus. This nerve can become irritated and may cause pain, numbness or discomfort to these areas. This condition is known as pudendal neuralgia and can be caused by a variety of reasons. This nerve can be damaged from prolonged sitting, cycling, childbirth, tightness in the pelvic floor muscles, surgery or traumatic causes. Physiotherapy can help alleviate the symptoms, and promote healing through muscle release, posture advice, exercise modifications to assist your journey to recovery.
For more information please visit https://ranzcog.edu.au/womens-health/patient-information-resources/pudendal-neuralgia-(1)