Pelvic floor dysfuntion

What is pelvic floor dysfunction?

Pelvic floor dysfunction is a common condition where you're unable to properly relax and coordinate the muscles of your pelvic floor, the muscles that support organs including your bladder, womb, prostate and rectum. This can affect how you pass urine, empty your bowels, and in some cases, your sex life.

What are the symptoms of pelvic floor dysfunction?

Symptoms vary depending on which part of your pelvic floor is affected, but can include:

• needing to pee frequently, or having to stop and start while you pee
• leaking urine when you cough, sneeze, laugh or exercise, or a sudden, urgent need to pee
• straining, or needing to change position or use your hand to help empty your bowels
• constipation, or a feeling that you haven't fully emptied your bowels
• leaking wind or stool
• pain or discomfort in your pelvis, lower back, rectum or during sex
• a feeling of heaviness, pressure, or a bulge in your vagina or back passage.

What are the causes of pelvic floor dysfunction and who is at risk?

Experts don't fully understand the exact cause of pelvic floor dysfunction, but a number of factors are known to increase your risk, including:

• pregnancy and childbirth, especially difficult vaginal deliveries or birth injuries
• ageing, as muscles naturally lose some tone and strength over time
• menopause, due to hormonal changes
• long-term or chronic constipation, and straining on the toilet
• being very overweight or obese
• previous pelvic surgery, such as a hysterectomy or prostate removal
• traumatic injury to your pelvic area
• a close relative with the condition
• certain bowel or neurological conditions, such as IBS, stroke or multiple sclerosis

Are there different types of pelvic floor dysfunction?

Pelvic floor dysfunction can happen because your muscles are too tight, too weak, or poorly coordinated. It covers a range of related conditions, including:

• Stress urinary incontinence: Leaking urine when you cough, sneeze, laugh or exercise
• Urge incontinence (an overactive bladder): A sudden, strong need to pee, sometimes with leaking before you reach the toilet
• Pelvic organ prolapse: When your bladder, bowel or womb bulges down into your vagina, due to weakened support
• Anal or bowel incontinence: Difficulty controlling wind or stool
• Sexual dysfunction: Including pain during sex, or in men, erectile dysfunction.

How is pelvic floor dysfunction diagnosed?

Your doctor will ask about your symptoms and medical history, including your bladder and bowel habits and, if relevant, any pregnancies. They'll usually examine you, which may include an internal vaginal or rectal examination to check how well you can contract and relax your pelvic floor muscles. You can ask for this to be explained, paused, or stopped at any time. You may also need:

• anorectal manometry, which measures the pressure and coordination of your anal muscles
• a defecating proctogram, an imaging test that shows how well you empty your bowels
• urodynamic testing, if you have problems peeing, to see how well you can empty your bladder.

How is pelvic floor dysfunction treated?

Non-surgical treatment

Most people are treated without surgery. Options include:

• Pelvic floor physiotherapy: A physiotherapist can identify which muscles need stretching or strengthening and teach you exercises to improve their coordination
• Pelvic floor muscle training (Kegel exercises): Regularly contracting and relaxing your pelvic floor muscles, usually for a minimum of 3 to 6 months, to build strength and control
• Biofeedback: Sensors monitor your pelvic floor muscles as you contract and relax them, helping you learn to control them correctly
• Devices: Such as vaginal pessaries, to support pelvic organs if you have a prolapse, or weighted vaginal cones and electrical stimulators, to help with muscle training
• Medication: To help with bladder control or bowel movements
• Lifestyle changes: Such as reaching a healthy weight, treating constipation, and cutting down on caffeine, fizzy drinks and alcohol if these irritate your bladder.

Surgical treatment

If non-surgical treatment doesn't relieve your symptoms, surgery may be an option, particularly for prolapse or urinary incontinence. This might involve a procedure to support and repair a prolapse, such as a hysterectomy for uterine prolapse; a mid-urethral sling to support the urethra and prevent leaks; or, for bowel control problems, repair of the anal sphincter muscles.

When should I see a doctor?

See your GP if you have ongoing symptoms of pelvic floor dysfunction, such as leaking urine or stool, or a feeling of pressure or bulging in your vagina or back passage. Seek immediate medical attention if you have:

• severe abdominal pain
• blood in your urine, or bleeding from your back passage
• vaginal bleeding after menopause
• a sudden or significant change in your bladder or bowel control
• stool or urine coming out of your vagina
• a significant injury to your spine or pelvis.