A pelvic floor disorder (PFD) occurs when the muscles or connective tissues of the pelvic area weaken or are injured. The most common pelvic floor disorders are urinary incontinence, fecal incontinence and pelvic organ prolapse. PFDs are more common among older women.
The "pelvic floor" refers to a group of muscles that attach to the front, back and sides of the pelvic bone and sacrum. Like a sling or hammock, these muscles support the organs in the pelvis, including the bladder, uterus or prostate, and rectum. They also wrap around your urethra, rectum, and vagina (in women). Coordinated contracting and relaxing of these muscles controls bowel and bladder functions—the pelvic floor must relax to allow for urination, bowel movements, and, in women, sexual intercourse.
Symptoms of PFD include:
The diagnosis of pelvic floor disorder starts with a careful history regarding an individual's symptoms, medical problems and a history of physical or emotional trauma that may be contributing to their problem.
Next the physician examines the patient to identify any physical abnormality. During this study, the patient is given an enema of a thick liquid that can be detected with x-ray. A special x-ray video records the movement of the pelvic floor muscles and the rectum while the individual attempts to empty the liquid from the rectum.
Normally the pelvic floor relaxes allowing the rectum to straighten and the liquid to pass out of the rectum. The defecating proctogram is also useful to show if the rectum is folding in on itself (rectal prolapse). Many women have out-pouching of the rectum known as a rectocele. Usually a rectocele does not affect the passage of stool. In some instances, however, stool may become trapped in a rectocele causing symptoms of incomplete evacuation. The defecating proctogram thus helps to identify if liquid is getting trapped in a rectocele when the individual is trying to empty the rectum.
Pelvic floor dysfunction due to non-relaxation of the pelvic floor muscles may be treated with specialized physical therapy known as biofeedback. With biofeedback, a therapist helps to improve a person's rectal sensation and pelvic floor muscle coordination. There are various effective techniques used in biofeedback. Some therapists train patients by teaching them to expel a small balloon placed in the rectum. Another technique uses a small probe placed in the rectum or vagina or electrodes placed on the surface of the skin around the opening to the rectum (anus) and on the abdominal wall. These instruments detect when a muscle is contracting or relaxing and provide visual feedback of the muscle action. This visual feedback helps the individual to understand the muscle movement and aids in improving muscle coordination. Approximately 75% of individuals with pelvic floor dysfunction experience significant improvement with biofeedback.
Abnormalities identified with a defecating proctogram such as rectal prolapse and rectocele may be treated with a surgical procedure. There are many techniques used to get biofeedback. You should get in touch with your physiotherapist and have a discussion as to what might work best for your situation.