Do You Leak When You Cough or Sneeze? Afraid to Be Far From a Bathroom? Constantly Going to the Bath

If you answered yes to any of the above questions, you may need to talk with your doctor about getting a script for pelvic floor physical therapy. Medication or surgery aren’t the only options for treatment. Today, we’ll discuss with you the anatomy and background on the pelvic floor. Friday, we’ll go into different treatment options.

First, let’s talk about the different issues surrounding the pelvic floor. The major dysfunctions are urinary leakage, fecal leakage, painful intercourse, impotence in males, and constipation. Both men and women can suffer from these issues.

It is common to hear women say “I pee myself when I cough or sneeze, but it is normal because I had children.” WRONG!! It is not normal to pee yourself, no matter the circumstances and there are treatment options available to fix the issue or at least improve it. Please, don’t be ashamed or embarrassed by this topic. It can become debilitating and life altering. It does not matter if it started two days ago or 20 years ago, there are plenty of treatment options available.

Painful intercourse can be related to a tight pelvic floor. There are many women who suffer from painful intercourse and just assume that is how their body is and it won’t get any better. FALSE! Sex should not be painful and you do not have to live with that. As you age and your hormones change, specifically after menopause, you experience vaginal dryness. Discuss with your OBGYN about this issue. There are creams that can be applied to increase lubrication.

Don’t think the pelvic floor is just a women’s issue, men also suffer from pelvic floor issues as well. Men can also seek physical therapy for any dysfunctions related to the pelvic floor. Please don’t be ashamed and seek medical help. There is help out there, you don’t have to live with these issues.

Anatomy of the Pelvic Floor

The pelvic floor is a dome-shaped musculature that separates the pelvic cavity from the perineal region below. The pelvic cavity encloses the bladder, intestines, and uterus. The pelvic floor acts like a hammock to hold everything in place.

• Main functions

  • To support the abdominal and pelvic viscera

  • To maintain the continence of urine and feces

  • Allows voiding, defecation, sexual activity, and childbirth

• Muscles of Pelvic Floor

  • Levator ani muscles (largest component)

    • Pubococcygeus – makes up the floor of the abdominopelvic cavity, primary function to control urinary flow

    • Puborectalis – function is to maintain fecal continence, during defecation this muscle relaxes

    • Iliococcygeus – function is to elevate the pelvic floor and the anorectal canal

• Coccygeus muscle

  • Main function is to support the pelvic viscera, flexes the coccyx (tailbone)

Dysfunctions of the Pelvic Floor

• Urinary incontinence

  • 4 types: stress, urge, overflow, and neurogenic

  • Involuntary leakage of urine

  • Urinates when you do not want to
    

• Fecal incontinence

  • Inability to control bowel movements

  • Stool can leak unexpectedly from the rectum

• Constipation

  • Infrequent bowel movements or difficult passage of stools

  • Can be caused by painful experience

  • Learned habit

Painful intercourse

• Dyspareunia – female sexual pain

• Pelvic and/or vaginal pain during intercourse

• Pain can be limited to duration of intercourse or may last 24 hours after

• Could be related to traumatic experience

• Impotence

  • Trigger points and subsequent weakness in the pelvic floor can play a role in erectile problems

  • Bulbocavernosus muscle of the pelvic floor tightness can lead to decreased blood flow to enlarged penis

As you can see, there are many dysfunctions that can occur within the pelvic floor. These dysfunctions can cause minimal or major life altering issues. No matter the degree of dysfunction, it is important that you talk to your health care professional about them. If your health care professional does not suggest physical therapy, PLEASE BRING IT UP! If you are covered for physical therapy on your insurance plan, you are covered for pelvic floor therapy. Know your options and educate yourself about the issues you are facing.

Stay tuned for Friday’s post regarding the different treatment options relating to the pelvic floor.

Disclaimer: I am in no way diagnosing anyone, if you have persistent pain you need to call your local physical therapist and schedule an appointment.