Pelvic Floor Dysfunction

The pelvic floor is the group of muscles and ligaments in the pelvic region. The pelvic floor is a support sling for the organs located there, including the rectum. Up to one-half of those suffering from chronic constipation have pelvic floor dysfunction (PFD) which is impaired relaxation and coordination of pelvic floor and abdominal muscles during evacuation. 

Causes

PFD can be linked to situations that weaken the pelvic muscles or tear connective tissue. These include:

• Constipation
• Childbirth
• Injury
• Obesity
• Pelvic surgery
• Pelvic organ prolapse, such as rectum or small bowel prolapse
• Nerve damage

Symptoms

Straining, hard, or thin stools and a feeling of incomplete elimination are common symptoms. Constipation can overlap with PFD so other symptoms may occur, e.g., long intervals between bowel movements, abdominal pain. Fecal incontinence is also a common issue. When function is impaired in the pelvic floor, loss of control over gas or stool can occur. Other symptoms are:

• Lower back pain
• Pain or pressure in the pelvic region or rectum

Diagnosis 

We review a patient’s medical history and symptoms. A digital exam will be done to check for muscle weakness or spasms. To determine pelvic muscle control, we may perform an internal exam by placing a small sensing device (perineometer) into the rectum. Diagnosis can be confirmed by:

• Anorectal manometry – Measures the tightness of the sphincter and sensitivity and functioning of the rectum.
• Proctography – X-ray images are made during a bowel movement on a specially designed toilet.
• MRI – Determines if the sphincter muscles are intact and to provide images during defecation. (Defecography)

Treatment

Our goal during treatment is to relax the pelvic floor muscles for easier bowel movements and more control. Biofeedback is used to monitor relaxation and contraction of the pelvic muscle via sensors to determine how to improve coordination. Intensive pelvic floor retraining exercises are taught to the patient. Other treatments are:

• Medication – Muscle relaxers can prevent muscles from contracting.
• Relaxation – Yoga, stretching, and warm baths improve blood circulation and relax muscles.
• Surgery – If PFD results from rectal prolapse (rectal tissue falling into the anal opening), surgery will loosen the affected pelvic organs so they can relax.