First things first...
Pelvic Floor Dysfunction is a condition that has many symptoms and effects every individual in a personal way. Not all symptoms are linear, just like every pain journey, but I've tried to come up with the ultimate guide to Pelvic Floor Dysfunction to raise awareness around this often misunderstood condition.
So what is Pelvic Floor Dysfunction?
Pelvic floor dysfunction is a condition where you cannot control the muscles of your pelvic floor. Your pelvic floor muscles are the group of muscles in your pelvic region that act like a cosy sling to keep your bladder, uterus and rectum supported. Your pelvic floor relaxes and contracts these muscles, allowing you to go to the bathroom have sex without any issues. However, when these muscles do not work, this is where the problems begin...
What are the symptoms of Pelvic Floor Dysfunction?
Symptoms can include;
Urinary urgency and frequency.
Unable to get peeing and finding that you have stopping and starting of urine stream.
You suffer from painful or burning urination, or incomplete emptying of the bladder.
Constipation, straining, pain with bowel movements, feeling of unable to empty, experiencing a rectocele or anal fissures.
Unexplained pain in the lower back, pelvic region, tailbone area, genital area, or rectum.
Pain during or after sexual intercourse, orgasm, or sexual stimulation.
Inability and pain regarding any insertion into the vagina, an example would be painful to use tampons.
Uncoordinated muscle contractions causing the pelvic floor muscles to spasm.
Leakage of stool/urine with or without your awareness.
Okay, so if I think I have PFD how do I get diagnosed?
Diagnosis will of course vary depending on your location. However, standard practise is to first go chat with your G.P. and request to be referred to a pelvic floor physio therapist.
Pelvic Floor PT's are specially trained to diagnose and treat PFD. To diagnose you they will first check you externally and internally for issues such as muscle spams, muscle knots, weakness or misalignment. They will be able to evaluate how your pelvic floor muscles function and if you have the ability to contract and relax your muscles. This is how they will be able to diagnose the condition and know what best PT treatment to recommend, as there are many variations of PFD.
If an internal examination is too painful please voice this concern, the PT is there to work with you and go at your pace.
How is Pelvic Floor Dysfunction treated?
This all depends on the type of Pelvic Floor Dysfunction you may have.
Your muscles could be;
High tone/hypertonic/non-relaxing - This means that your muscles cannot relax or release so this is what you will need to work on with your therapist. STAY AWAY from kegals, they are exercises that tighten the pelvic floor and are your kryptonite. They can make the condition worse.
Low tone - This is when the muscles cannot contract and can cause incontinence issues. It's often associated due to trauma in childbirth, but you DO NOT have to have, had a baby to suffer from PFD. You may have also suffered a prolapse.
A mixture of the two/global PFD - This is when you have a mixture of low tone and high tone muscles. Your physio will be able to asses this and know the best route of treatment.
This is only a few the types of PFD. The condition covers many spectrums which often is why it is misdiagnosed and often unrecognised.
I suffer from high tone PFD so treatment for this variation is as follows;
Self-Care — Avoid pushing or straining when urinating and ask your healthcare provider about how to treat constipation. Relaxing the muscles in the pelvic floor area overall is your goal. Heat is helpful to do this.
Medicines — Low doses of muscle relaxants such as diazepam (Valium), 2 mg three times a day, may be helpful. Maintaining good posture to keep pressure off your bladder and pelvic organs and using stretching or other techniques such as yoga to avoid tightening and spasms in the other pelvic muscles, also help PFD therapy to succeed. Just remember to choose yoga that DOESN'T tighten your pelvic floor.
Physical therapy — A physical therapist specially trained in pelvic floor dysfunction will complete an external and internal evaluation of your pelvis. You will receive external and internal trigger point release physio therapy. You will be given home exercises and relaxation techniques. PRACTISE THESE!
If internal therapy is too painful your PT can carry out external therapies such as: skin rolling, deep tissue massage also known as “myofascial release,” trigger-point therapy to release tight spots and joint mobilisation.
Devices to help you — Your PT will know what devices will help you best. If you are having pain during insertion or are unable to have sex you can try working with dilators, if you suffer from internal spasms maybe an internal tens machine might offer you relief. If you are finding it hard to have a bowel movement you may be shown how to use a femmeze wand. If you are coming to the end of your PT sessions and want to continue internal therapy you PT might teach you how to use a Therawand so you can perform trigger point release yourself. There are products out there to help.
Associated Conditions
There are two conditions associated with PFD however there isn't much information available on which comes first/why these conditions are connected or correlated.
I will go into this in more detail soon.