Pelvic floor dysfunction may include any of a group of clinical conditions that includes urinary incontinence, fecal incontinence, pelvic organ prolapse, sensory and emptying abnormalities of the lower urinary tract, defecatory dysfunction, sexual dysfunction and several chronic pain syndromes, including vulvodynia in women and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) in men. The three most common and definable conditions encountered clinically are urinary incontinence, anal incontinence and pelvic organ prolapse.
By definition, postpartum pelvic floor dysfunction only affects women who have given birth, though pregnancy rather than birth or birth method is thought to be the cause. A study of 184 first-time mothers who delivered by Caesarean section and 100 who delivered vaginally found that there was no significant difference in the prevalence of symptoms 10 months following delivery, suggesting that pregnancy is the cause of incontinence for many women irrespective of their mode of delivery. The study also suggested that the changes which occur to the properties of collagen and other connective tissues during pregnancy may affect pelvic floor function.
The pelvic floor is a combination of multiple muscles with ligamentous attachments creating a dome-shaped diaphragm across the boney pelvic outlet. This complex of muscles spans from the pubis (anterior) to the sacrum/coccyx (posterior) and bilateral to the ischial tuberosities. The bulk of the pelvic musculature is the levator ani, composed of the puborectalis, pubococcygeus, and iliococcygeus. The puborectalis wraps as a sling around the anorectal junction accentuating the anorectal angle during contraction and is a primary contributor to fecal continence. Elevation and support of the pelvic organs are associated with the pubococcygeus and the iliococcygeus. The pubococcygeus is the most medial component which separates, fashioning the levator hiatus with openings for the urethra, vagina (females), and anus. The bulbospongiosus and ischiocavernosus muscles are the primary contributors to the superficial portion of the anterior pelvic floor. The more superficial musculature of the posterior pelvic floor constitutes the external anal sphincter. The transverse perineal muscles cross the mid-portion of the superficial aspect of the pelvic floor and coalesce with the bulbospongiosus muscles and external anal sphincter as the perineal body.
Pelvic floor dysfunction (PFD) refers to a broad constellation of symptoms and anatomic changes related to abnormal function of the pelvic floor musculature. The disordered function corresponds to either increase activity (hypertonicity) or diminished activity (hypotonicity) or inappropriate coordination of the pelvic floor muscles. Alterations regarding the support of pelvic organs are included in the discussion of PFD and are known as Pelvic Organ Prolapse (POP). The clinical aspects of PFD can be urologic, gynecologic, or colorectal and are often interrelated. Another way to compartmentalize the concerns are anterior- urethra/bladder, middle- vagina/uterus and posterior- anus/rectum.
Pelvic floor exercises are specific movements that engage and strengthen your pelvic floor muscles, which can weaken due to factors such as childbirth, aging, menopause, obesity, chronic coughing, or heavy lifting. Most pelvic floor exercises don’t require specific equipment. These exercises typically rely on your body’s weight to initiate the stretch and engage the muscles. Pelvic floor exercises can increase bladder control, reduce the probability of pelvic organ prolapse, and increase sexual pleasure.