The pelvic floor is a group of muscles below the pelvis which in women support the bladder, vagina, womb and rectum (the lowest part of the bowel just above the anus) and in men the bladder, bowel and prostate area.
The female pelvic floor
A well functioning pelvic floor assists both bladder and bowel continence and has an impact on intercourse in both men and women. In men the muscles of the pelvic floor can be weakened through constipation and straining to pass bowel motions, lack of exercise and being overweight, chronic coughing (e.g. due to smoking or asthma), diabetes, Parkinson’s Disease and other neurological conditions, and prostate surgery. The indications are similar in women though an additional major factor in pelvic floor problems relating to women is pregnancy and childbirth.
General symptoms of pelvic floor dysfunction are associated with going to the toilet (having a bowel movement or going for a pee). In the bowel, these can include constipation or losing the feeling of needing to go. Feeling that the bowel hasn’t been properly emptied and having to make several visits to the loo in quick succession are also associated. Sometimes residual stool that is not passed can leak (faecal incontinence).
Diagnosis is usually made through a defacating proctogram. During this painless procedure the patient is given a special liquid enema designed to show up on x-ray. A video x-ray is then taken while the rectum is functioning. The x-ray will show up signs of dysfunction with the pelvic floor and will also be able to pinpoint other internal problems which may be causing the symptoms, such as a rectal prolapse or rectocele.
Treatment options can be very effective for pelvic floor dysfunction. To help prevent it in the first place, special pelvic floor exercises can be practised regularly and are now recommended for pregnant women, both before and after birth. For individuals suffering obstructive defacation constipation (straining and discomfort or pain when passing a motion), biofeedback can be effective. This is done with the support of a therapist who will help to identify the particular muscles causing the problem and recommend specific therapies to counteract the poor working of the pelvic floor muscles.
Outcomes and further sources of support
Practising of pelvic floor exercises when pregnant and following birth can help in maintaining muscle tone and strength, helping with labour as well as bowel and urinary problems post childbirth. Biofeedback has been shown to be effective in cases of obstructive defacation in up to ¾ of people who use this method with a trained therapist.
Further information on exercises relating to childbirth can be found on The National Childbirth Trust’s web site.