Pelvic floor dysfunction (PFD) is an all-encompassing term that relates to how well the pelvic floor muscles perform their role, including supporting the pelvic organs and maintaining bladder and bowel control.
When there is dysfunction, the muscles may be unable to contract, relax or coordinate appropriately. This can cause difficulty holding on to or passing urine, difficulty having a bowel movement, or problems supporting the pelvic organs.
There can be a muscular impairment where the pelvic floor muscles are either too weak, overactive (constantly tightened), or poorly coordinated. Pelvic floor dysfunction is common, particularly following pregnancy and childbirth, but it can affect both women and men at any age.
The most common symptoms of pelvic floor dysfunction are urinary issues, which can include:
- Urinary incontinence: Leaking urine when coughing, sneezing, exercising or with a sudden urge to go.
- Urinary frequency: Needing to urinate more often than usual.
- Urinary urgency: Experiencing a sudden, strong need to urinate.
Pelvic floor dysfunction can also involve bowel symptoms, including chronic constipation, incomplete emptying and bowel incontinence.
Other common symptoms include:
- Persistent pain or discomfort in the lower back, pelvis, hip or genital/perineal region.
- Painful intercourse (dyspareunia) or erectile dysfunction.
- Pelvic organ prolapse, which may cause a feeling of heaviness or a lump or bulge in the vagina or rectum.
Symptoms can vary depending on whether the pelvic floor muscles are weak, overactive or poorly coordinated.
One of the most common contributing factors is pregnancy and childbirth, which can cause stretching of the pelvic floor tissues and, in some cases, tearing of the muscles and connective tissues during labour and delivery.
Other contributing factors can include:
- Chronic straining: Often associated with constipation.
- Recurrent heavy lifting or chronic coughing: Both can increase pressure on the pelvic floor.
- Ageing and menopause: Changes in hormones and tissue strength can affect pelvic floor function.
- Pelvic surgery or trauma: These can alter how the pelvic floor muscles activate and function.
- Stress and tension: High levels of stress may contribute to habitual pelvic floor tightening or muscle clenching.
Pelvic floor dysfunction is not always caused by muscle weakness. In some people, the muscles are actually too tight or have difficulty relaxing.
Continence and Pelvic Floor Physiotherapists are trained to assess and identify pelvic floor dysfunction through a thorough examination.
Your physiotherapist will begin by taking a detailed history of your symptoms and asking specific questions to help identify the underlying problem.
Pelvic floor physiotherapists are also trained in internal vaginal and rectal examinations, which may be recommended to assess muscle strength, coordination, relaxation and any areas of pain or overactivity. These examinations are only performed when appropriate and with your informed consent.
In some circumstances, a transabdominal ultrasound may also be used to visualise pelvic floor muscle movement and provide further information about how the muscles are functioning.
Treatment depends on your individual diagnosis and the underlying cause of your symptoms.
Your pelvic floor physiotherapist will discuss their findings with you and outline the most appropriate treatment options following your assessment.
Treatment may include:
- Pelvic floor strengthening exercises to improve muscle strength and control.
- Pelvic floor relaxation exercises to help reduce muscle tension and improve coordination.
- Stretching and movement exercises to address associated muscle tightness or discomfort.
- Bladder and bowel education, including advice on fluid and fibre intake.
- Stress management and lifestyle modifications to reduce unnecessary pelvic floor tension.
- Biofeedback techniques to assist with muscle awareness, relaxation or strengthening.
In some circumstances, referral to a specialist may be recommended. Medication or surgical interventions may also be appropriate for certain conditions, although these are not required for everyone.
Your pelvic floor physiotherapist can help you understand your diagnosis and navigate the treatment options available.
Can pelvic floor dysfunction affect men?
Yes. Pelvic floor dysfunction can affect both men and women. Men may experience urinary or bowel symptoms, pelvic pain, or sexual dysfunction associated with pelvic floor muscle problems.
Can pelvic floor dysfunction be caused by tight muscles?
Yes. Pelvic floor dysfunction is not always related to weakness. Overactive or tight pelvic floor muscles can contribute to pelvic pain, difficulty emptying the bladder or bowel, and painful intercourse.
Should I do pelvic floor strengthening exercises if I have pelvic floor dysfunction?
Not necessarily. While strengthening exercises can help some people, others may benefit more from relaxation and coordination exercises. A pelvic floor physiotherapy assessment can help determine which approach is appropriate.
If you are experiencing symptoms of pelvic floor dysfunction, a pelvic floor physiotherapy assessment can help identify the cause and determine the most appropriate treatment.
At Hartwell Physiotherapy in Camberwell, our Continence and Pelvic Health Physiotherapist, Brooke Williams, provides individualised assessment and treatment for women and men experiencing pelvic floor concerns.
If you think you may have pelvic floor dysfunction, we recommend booking an appointment with Brooke to discuss your symptoms and treatment options.
Call Hartwell Physiotherapy on 9889 3903 OR book online.
