Pelvic Floor Dysfunction

Written by Tele Demetrious

Updated:

What is pelvic floor dysfunction

Pelvic floor dysfunction is a condition characterised by a range of potential symptoms and issues which may occur in association with excessive stretching, weakness or tightness of the pelvic floor muscles. Symptoms may include:

The pelvic floor muscles sit deeply at the base of the abdomen, forming a sling between the coccyx (tail bone) at the back and the pubic bone at the front. They are primarily responsible for supporting the bowel, bladder (and uterus, in women) and controlling bowel and bladder function (such as allowing you to ‘hold on’ until an appropriate time and place). They also act to stabilise the pelvis (therefore impacting lower back stability) and are an important component of optimal sexual health.

There are many factors which may act in isolation or combination to cause impairment of these muscles and subsequent pelvic floor dysfunction. Some of the more common factors may include:

Pelvic floor dysfunction is very common, typically affecting females more commonly than males with approximately 50% of women affected at some stage in their lives. In Australia, approximately 4.8 million people (both males and females) of all ages and backgrounds are affected by pelvic floor dysfunction with subsequent incontinence.


Cause of pelvic floor dysfunction

Pelvic floor dysfunction typically occurs when the pelvic floor muscles are weakened, stretched excessively or too tight (i.e overactive). The following factors may work in isolation or combination to cause pelvic floor dysfunction:



Signs and symptoms of pelvic floor dysfunction

The signs and symptoms of pelvic floor dysfunction can vary significantly between individuals based on the type and severity of the dysfunction. Symptoms of a weak or excessively stretched pelvic floor may include:

Symptoms of an overactive pelvic floor may include:


Diagnosis of pelvic floor dysfunction

A thorough subjective and objective examination from a physiotherapist with postgraduate training in women’s and men’s health is usually sufficient to diagnose pelvic floor dysfunction. This will often entail real time ultrasound investigation and sometimes digital assessment. In some cases, referral to a specialist may be required for further evaluation and testing. This may include EMG or nerve conduction studies, X-ray or MRI investigation, manometry (a test involving the insertion of a small catheter with a balloon on one end into the rectum), balloon expulsion tests or a variety of other examination procedures.


Treatment of pelvic floor dysfunction

Underactive or weak pelvic floor

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Overactive pelvic floor

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Physiotherapy for pelvic floor dysfunction

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Other intervention for pelvic floor dysfunction

Despite appropriate physiotherapy management, some patients with pelvic floor dysfunction do not improve adequately or, in some cases, continue to deteriorate. When this occurs, other intervention may be required. This may include:



Exercises for pelvic floor dysfunction

The following pelvic floor exercises are frequently prescribed in physiotherapy clinical practice to improve strength and control of the pelvic floor muscles and to prevent or treat pelvic floor dysfunction. You should discuss the suitability of these pelvic floor exercises with your physiotherapist prior to beginning them. Generally they should be performed 3 times daily provided they do not cause or increase symptoms.


Pelvic Floor Exercises – Neutral Spine

Begin your pelvic floor exercises by setting yourself up in a comfortable position that allows relaxation of your global muscles, isolated pelvic floor activation and maintenance of your spine in a neutral position.

For those who are new to pelvic floor exercises, it is generally most appropriate to begin either lying on your back or whilst sitting, in neutral spine. Other alternative starting positions may include four-point kneeling or lying on your side.

Once you are confident with activating your pelvic floor in these positions, you can progress to other more functional positions such as standing or whilst walking etc.


Achieving neutral spine

Neutral Spine refers to the position whereby your spine is in optimal postural alignment (figures 1 – 4). Generally, neutral spine can be obtained by ensuring the following:

Pelvic Floor Exercises - Neutral Spine Supine
Figure 1 – Neutral Spine in Lying

Pelvic Floor Exercises - Neutral Spine in Sitting
Figure 2 – Neutral Spine in Sitting

Pelvic Floor Exercises - Neutral Spine in Standing
Figure 3 – Neutral Spine in Standing

Pelvic Floor Exercises - Neutral Spine in Four Point Kneeling
Figure 4 – Neutral Spine in Four Point Kneeling


How to contract your pelvic floor muscles

Once you have positioned yourself in neutral spine and in an ideal starting position for you (i.e. generally lying on your back or sitting), identify the 2 or 3 parts of your pelvic floor as follows:

  1. The muscles that control the flow of urine – to identify how to contract these muscles for training, try to stop the flow of urine mid-stream next time you are urinating. Hold these muscles for a few seconds and then relax. This should not be used as an exercise and should only be used for muscle identification.
  2. The muscles that control your anal sphincter – these muscles can be activated by tightening the muscles around your anus as though you are trying to stop the passing of wind. Squeeze and lift these muscles inwards and upwards. Hold these muscles for a few seconds and then relax.
  3. For women – the muscles that surround your vagina – the easiest way to tighten these muscles correctly is by inserting your fingers into the vagina and then try to squeeze them. Slowly pull your fingers out and use your pelvic floor muscles to resist. If this is not comfortable for you, try to tighten these muscles by squeezing and lifting the muscles in and around this opening. Hold for a few seconds and then relax.

When performing pelvic floor exercises, it is generally most beneficial to activate all parts of your pelvic floor simultaneously. This can be achieved by gently tightening the muscles around your back passage and at the same time squeezing and lifting the muscles around your bladder outlet (and vagina – in women) as though you are trying to stop the flow of urine.


Poor recruitment patterns – what to avoid

When learning how to contract your pelvic floor muscles, it is common for patients to perform trick movements or poor recruitment patterns (contracting muscles other than the pelvic floor). Some common errors / poor recruitment patterns that should be avoided include:


Initial Pelvic Floor Exercise

You should discuss the suitability of this initial pelvic floor exercise with your physiotherapist prior to commencing. Generally it should be performed 3 times daily provided it does not cause or increase symptoms.

Beginner pelvic floor activation

Begin lying or sitting in neutral spine (figures 1 or 2) with minimal muscular effort. Relax your global muscles and ensure you are breathing normally. Tighten the muscles around your back passage as if you are trying to stop the passing of wind. Slowly and gently squeeze and lift the muscles upwards and inwards and then relax (ensuring you feel a definite letting go). Repeat 5 – 10 times, 3 times daily.


Intermediate Pelvic Floor Exercise

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Advanced Pelvic Floor Exercise

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Functional Progressions

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Rehabilitation Protocol for pelvic floor dysfunction

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Physiotherapy Products for Pelvic Floor DysfunctionPhysiotherapy products for pelvic floor exercises

To purchase physiotherapy products to assist with pelvic floor dysfunction click on the relevant link or visit the PhysioAdvisor Shop.


More Physiotherapy Pelvic Floor Exercises More Exercises


Find a Physio to assist with pelvic floor dysfunctionFind a Physio to assist with pelvic floor dysfunction

Find a physiotherapist in your local area who can assist with pelvic floor dysfunction treatment. Your physiotherapist can also assist with pelvic floor exercises and ensure you are activating your muscles correctly. Ideally you should see a physiotherapist specialising in continence and pelvic floor retraining.


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