The muscles of the pelvic floor normally relax during urination while the bladder contracts. In some patients these muscles may become “irritated,” often contracting abnormally. The general term given to this problem is “pelvic floor dysfunction” (PFD).”
The cause of PFD is unknown; however, approximately 30 percent of patient’s identify a urinary tract infection as the cause of their symptoms. In these patients, urinary frequency and urgency persist long after their urinary tract infection has been treated successfully.
Pelvic Floor Dysfunction Symptoms
Female symptoms may include:
- Urinary frequency
- Pelvic pain
- Pain associated with sexual intercourse
- Sensation of incomplete urination
- Lower back pain
- Pain behind the vagina
- Decreased urinary flow
- Constipation
Male symptoms may include:
- Urinary frequency and urgency
- Sensation of incomplete urination
- Lower back pain
- Pain in the testicles and/or penis
- Pain associated with ejaculation
- Decreased urinary flow
- Constipation
Diagnosis of Pelvic Floor Dysfunction
The diagnosis of PFD is often difficult to make since no specific test exists to identify this problem. The final diagnosis is made on the basis of:
- Typical symptoms
- Objective findings on physical examination such as point tenderness on rectal/pelvic examination and abnormalities in the urine flow
- Absence of other abnormalities such as prostatitis, endometriosis, urinary tract infection, bladder cancer, neurologic disease
What is the cause of the decrease in urinary flow?
The normal process of urination involves coordination between the bladder and pelvic floor muscles; the pelvic floor muscles relax while the bladder muscles contract. In most patients, the bladder contracts normally but the urine flow is poor due to the continued tightening of the pelvic floor.
What accounts for different symptoms in different patients?
This is unknown at the present time; however, the differences in symptoms most likely represent abnormal function in different regions of the pelvic floor muscles.
What is the cause of urinary frequency and urgency?
The sensation of urinary frequency and urgency appears, in many cases, to be linked to PFD. The natural tendency for many patients is to strain and push the last drop of urine out so that they can prolong the intervals between bathroom sessions. Unfortunately, pushing and straining appear to further aggravate the pelvic floor muscles and worsen the symptoms. Hence, a vicious cycle develops.
Pelvic Floor Dysfunction Treatment
Treatment for PFD is rather non-specific and is primarily aimed at relaxation of the muscles which are affected. General treatment measures include:
- Pelvic floor relaxation techniques
- Warm sitz baths two to three times a day
- Avoidance of constipation with stool softener
- Anti-inflammatory agents
- Stress reduction: stressful situation at home or at work, although not the cause of PFD, appear to worsen the symptoms of many patients
- Avoidance of sitting for long periods of time; patients should sit on chairs with very firm, supportive seat cushions.
Approximately 80 percent of patients who undergo conservative management of PFD will achieve relief of their symptoms. Unfortunately, symptoms may take up to three months to improve. Patients who undergo conservative therapy are expected to have “good” and “bad” days but should have an overall trend of improvement. The final outcome of treatment is extremely dependent upon the individual patient’s motivation. Patients who achieve the best results are those who make these treatment measures a part of their daily lives.
If conservative therapy fails, other forms of therapy which address specific symptoms may be employed such as:
- Analgesics
- Muscles relaxants
- TENS (transcutaneous electrical nerve stimulation)
- Acupuncture
- Biofeedback
Technique of Pelvic Floor Relaxation
Identification of the pelvic floor muscles is central to the technique. To identify the muscles of the pelvic floor, begin to urinate. When your stream is at its maximum flow rate, attempt to stop the flow suddenly.
Make a mental note of the group of muscles which you have tightened. Dysfunction of these muscles is usually responsible for your symptoms. This maneuver is meant only for identification of your “problem” muscles. It should be performed once or twice. Repeated tightening of these muscles may aggravate your symptoms.
Once your pelvic floor muscles have been identified, it is extremely important to monitor them carefully throughout the day, particularly during urination.
When urinating, these muscles must be in a relaxed state. There should be no straining, even if your bladder doesn’t feel completely empty. It is better to come back five minutes later than to strain.
Make sure that you do not become constipated since straining of the bowels may also aggravate your symptoms. Use a stool softener, in necessary.
Pelvic floor relaxation is a fairly easy technique to learn. However, it requires a great deal of practice, patience, and motivation to achieve maximal effect.
Kegel Exercises
These pelvic floor muscle exercises can strengthen the muscles that hold urine inside the bladder. Here’s how you do them:
- Imagine that you are trying to control passing gas
- Pull in or tighten your pelvic muscles and hold for a count of 3 (you should feel a lifting sensation in the area around your vagina or pulling in of your rectum).
- Then completely relax the muscle for a count of 3 (it is important to control both the tightening and relaxing of the muscle).
- Repeat 10 to 15 times, at least 3 times a day.
- Each time you do these exercises, alternate your position between lying, sitting, and standing.
Talk to your health care professional to make sure you are doing the exercises the right way.