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Pelvic Floor Dysfunction

Your pelvic floor is a strip of muscles through which the rectum passes. In women, the urethra also passes through the pelvic floor. When the muscles in the pelvic floor are compromised, pelvic floor dysfunction may occur, making it difficult to control bowel movements and urination may be compromised. You may also experience discomfort and pain.

Types

Pelvic pain: This may include proctalgia fugax, which is an abnormal pain in the rectum that comes and goes suddenly. Pelvic pain may also come in the form of pudendal neuralgia, which is a type of chronic pain in the pelvic floor that usually presents after giving birth and may reappear randomly after that.

Pelvic floor dysfunction is often caused by pelvic inflammatory disease, a condition that may occur when a woman develops an infection in her reproductive organs. The infection may occur as a result of a sexually transmitted disease, douching or using an intrauterine device (IUD) for contraception.

Symptoms

  • Chronic constipation
  • Excessive need to use the bathroom
  • Leakage of fecal matter or urine
  • Lower back pain
  • Pain in the genitals, pelvic area or rectum
  • Straining to pass stool
  • Trouble expelling stool and urine

If you experience any of these symptoms frequently, talk with your healthcare provider about solutions.

Prevention

  • Pelvic floor dysfunction is difficult to prevent.
  • Kegel exercises to engage the muscles you use to start and stop the flow of urine can help improve the health of your pelvic floor.

Risk Factors

  • Childbirth and pregnancy
  • Obesity
  • Straining too hard when going to the bathroom
  • Surgery in the pelvic area
  • Traumatic injury to the pelvic region
  • Diagnosis

    • Medical history and symptom review. The provider will review your symptoms and personal health history. He or she will also conduct a physical exam, which includes an exam of the rectum and vagina.
    • Colonic transit study. You will take a pill containing metal markers that may be viewed in a series of X-rays during a span of several days. The goal is to observe the way stool passes through your colon.
    • Videodefecogram. This is an X-ray that examines your muscle movement when you are passing stool. Fluoroscopy, magnetic resonance imaging (MRI) and X-rays may be part of this test.
  • Treatment

    • Conservative management. This may include increasing fiber and fluid intake.
    • Injections. Anti-inflammatory agents and local anesthetics can help.
    • Pelvic floor physical therapy. Biofeedback may include electrical stimulation of the muscles in the pelvic floor, massage therapy or ultrasound, as well as exercises you can do at home.
    • Pelvic reconstructive surgery. This is only recommended in the case of severe pelvic organ prolapse, which causes bulges in the pelvic region.
  • Follow-up Care

    Staying in contact with your doctor can help ensure you are appropriately managing your pelvic floor dysfunction.