Pelvic Floor Dysfunction

Pelvic Floor Dysfunction (PFD) refers to a variety of conditions where the muscles of the pelvic floor (the group of muscles and tissues that support the bladder, bowel, and reproductive organs) do not function properly. This can lead to a variety of symptoms, including problems with urination, bowel movements, sexual function, and pelvic organ prolapse.

Childbirth and Pregnancy

The pelvic floor muscles can be stretched or torn during childbirth, especially if the baby is large or if there are complications like a prolonged labor or the use of forceps or a vacuum.

 Aging

Estrogen helps maintain the strength and elasticity of pelvic floor muscles and tissues. After menopause, reduced estrogen levels can lead to muscle weakening and decreased support for the pelvic organs.

 Obesity

 Excess body weight, especially abdominal fat, places additional pressure on the pelvic floor muscles, leading to weakening over time.

Chronic Straining

Lifting heavy objects improperly (especially without using the core muscles) can put significant pressure on the pelvic floor.

 Trauma or Injury

Surgery in the pelvic area, such as a hysterectomy (removal of the uterus) or prostate surgery, can damage the pelvic floor muscles, nerves, and tissues, leading to dysfunction.

 A sedentary lifestyle can contribute to the weakening of the pelvic floor muscles. Regular physical activity, particularly exercises that target core strength, can help maintain pelvic floor health.

Symptoms

• Urinary problems: Including incontinence, frequent urination, or difficulty urinating.
• Bowel issues: Constipation, fecal incontinence, or incomplete evacuation.
• Pelvic pain: A constant feeling of pressure, pain, or aching in the pelvic region.
• Sexual problems: Painful intercourse or reduced sensation during sex.
• Lower back pain: Sometimes related to pelvic floor dysfunction, especially if muscle imbalances are present.

Physiotherapy Management

Pelvic Floor Physiotherapy Rehabilitation is a specialized form of physical therapy aimed at improving the function and strength of the pelvic floor muscles, which support the bladder, bowel, and reproductive organs. It is a highly effective treatment for pelvic floor dysfunction (PFD) and is often considered the first line of care for many pelvic health issues. A trained pelvic floor physical therapist (PFPT) uses a combination of manual techniques, exercises, and educational strategies to help patients recover, manage, or prevent pelvic floor dysfunction.

Pelvic Floor Muscle Training

• Kegel Exercises: These are exercises designed to strengthen the pelvic floor muscles. Kegels involve contracting and relaxing the pelvic floor muscles in a controlled manner, typically in sets of 10-15 repetitions.
  • Coordination of Muscle Activation: The therapist may teach patients to use the pelvic floor muscles in conjunction with other core muscles (like the diaphragm, abdominals, and back muscles) for optimal support.

Biofeedback

• Biofeedback is a technique used to help patients gain awareness of their pelvic floor muscles and improve control. A sensor is placed (either externally or internally) to measure the pelvic floor muscle activity, providing real-time feedback on muscle contractions or relaxation.
• This feedback helps patients learn how to properly engage or relax the pelvic floor muscles, even if they cannot feel or control them on their own.

Manual Therapy

• Soft Tissue Mobilization: The therapist may use their hands to apply pressure to the pelvic muscles, fascia, or surrounding tissues to release tension, improve mobility, and reduce pain.
• Myofascial Release: This technique focuses on releasing tightness in the muscles and fascia (connective tissue) around the pelvis, which can contribute to pain, tension, or dysfunction.

Pelvic Floor Stretching and Relaxation Techniques

• For patients with overactive pelvic floor muscles, physiotherapists teach stretching techniques and relaxation exercises to help reduce tightness and spasms in the pelvic muscles. This may include diaphragmatic breathing, progressive muscle relaxation, and pelvic floor stretching exercises.

Postural and Core Strengthening Exercises

• Poor posture and imbalances in core muscle strength can contribute to pelvic floor dysfunction. Physiotherapists may prescribe exercises to improve posture and strengthen the core muscles, which work together with the pelvic floor muscles for stability and support.

Bladder and Bowel Training

• For patients experiencing urinary incontinence or constipation, pelvic floor physiotherapists may provide strategies to help train the bladder and bowel. This can involve scheduled voiding, techniques to improve emptying, and advice on reducing bladder irritants (such as caffeine or alcohol).
• Pelvic floor retraining also includes education on how to “listen” to your body’s cues and avoid straining during urination or defecation, which can exacerbate pelvic floor dysfunction.

Lifestyle Education and Advice

Physiotherapists often provide advice on healthy lifestyle changes to improve pelvic health, such as:

• Proper hydration and nutrition to support bladder and bowel function.
  • Recommendations for weight management, as excess weight can put additional pressure on the pelvic floor.
  • Techniques to avoid constipation, such as a high-fiber diet and correct positioning during bowel movements.
  • Avoiding heavy lifting or correcting improper lifting techniques that strain the pelvic floor.