Pelvic Floor Dysfunction (PFD) is a term applied to a wide variety of clinical conditions, including urinary incontinence, anal incontinence, pelvic organ prolapse, sensory and emptying abnormalities of the lower urinary tract, defecatory dysfunction, sexual dysfunction, and several chronic pain syndromes [1].
Causes And Symptoms of PFD
The pelvic floor is made up of muscles, ligaments, connective tissues and nerves that support the bladder, uterus, vagina and rectum. These muscles and nerves are arranged in a complex manner surrounding the pelvic bone and the sacrum. When the pelvic floor is unable to function properly, it results in PFD [2].
Typical symptoms of PFD include:
- Problems in the urethra such as an urgent need to urinate, painful urination or incomplete emptying of their bladder
- Severe constipation or painful bowel movements
- A bulge in the vagina or rectum
- Heaviness in the pelvis
- Pain or pressure in the vagina or rectum [3].
Diagnosis
For a patient who is suffering from PFD, a detailed medical history is required and the medical practitioner may conduct a physical examination of the pelvic floor. The patient also needs to give a detailed description of any prior anorectal surgeries and bowel patterns. When it comes to women, doctors also ascertain the woman’s child-bearing history such as prolonged labour, vaginal tears and forceps deliveries [4].
Treatment of PFD
Biofeedback
Biofeedback for pelvic floor dyssynergia has been recommended as one of the best alternative treatments. Studies say that more than 70% of adult patients complaining of pelvic floor dyssynergia may benefit from biofeedback training. While high dietery fibre and laxatives are encouraged, many patients do not receive complete relief from such treatments. The three main biofeedback techniques used to treat pelvic floor dyssynergia are sensory training, electromyographic feedback, and manometric feedback.
- Sensory: A water filled balloon is introduced in the rectum. Once introduced, the balloon is slowly withdrawn. Patients are requested to pay attention to the sensations evoked by the balloon and must try to ease its passage
- Electromyography: Electromyography is recording a patient’s averaged electro-myographic activity from the pelvic floor muscles for training.
- Manometry: With the help of catheters, balloons and probes, anal canal pressure is measured. Simultaneously, the contraction and relaxation of the pelvic floor muscles are studied.[5].
E-Stim Therapy
E-stim therapy is a painless treatment where a stimulator is used to send electric pulses which helps relax the pelvic muscles. This form of therapy also improves bladder and bowel incontinence and pain during intercourse [6].
Yoga
There are several Asanas (poses) and Kriyas (procedures) that strengthen pelvic floor muscles and rejuvenate the pelvic region.
1. Ashwini Mudra
2. Gomukhasana
3. Shalabasana
Other Therapies
Other therapies for individuals suffering from PFD include pelvic floor muscle training, electrogalvanic stimulation, constipation management, behavioral modification, incontinence devices and pharmacotherapy including vaginal estrogen (for women) [6].
Most of these therapies are relatively painless and it is best advised for patients suffering from PFD to take immediate treatment without delaying it.
References
- Bump, Richard C., and Peggy A. Norton. “Epidemiology and natural history of pelvic floor dysfunction.” Obstetrics and gynecology clinics of North America 25.4 (1998): 723-746.
- DeLancey, John OL. “The hidden epidemic of pelvic floor dysfunction: achievable goals for improved prevention and treatment.” American journal of obstetrics and gynecology 192.5 (2005): 1488-1495.
- Frequently Asked Questions About Pelvic Floor Disorders. The University Of Chicago Medicine.
- Kann, B. R. Pelvic Floor Dysfunction. American Society of Colon and Rectal Surgeons.
- Bassotti, G., et al. “Biofeedback for pelvic floor dysfunction in constipation.”Bmj 328.7436 (2004): 393-396.
- Starr, Julie A., et al. “Outcomes of a comprehensive nonsurgical approach to pelvic floor rehabilitation for urinary symptoms, defecatory dysfunction, and pelvic pain.” Female pelvic medicine & reconstructive surgery 19.5 (2013): 260-265
