Would You Benefit from Pelvic Floor Therapy?
The pelvic floor consists of all neurovascular, visceral (organs) and myofascial (muscle and connective tissue) structures that are arranged between the pubic bone to the coccyx bone and laterally between the walls of the ischium.
Typically, healthy pelvic floor muscles help maintain normal bladder and bowel function, as well as enhance sexual response. When these muscles become weak or are in spasm, a person may experience urinary or bowel incontinence, as well as pelvic pain. If the ligament structures that hold the pelvic organs up are over-stretched, such as what occurs with intense pushing during childbirth or in chronic constipation, then a prolapse (dropping of the organs through the vaginal wall) can occur.
According to research, the following risk factors can contribute to pelvic floor dysfunction, leading to bladder or bowel incontinence, or even pelvic pain:
- Menopause – due to decreased estrogen
- Smoking – chronically increased intra-abdominal pressure (IAP)
- Constipation – chronic pushing and increased IAP
- Medications (side effects of some medications can cause constipation)
- Lung disease (including asthma) – chronically increased IAP
- Obesity – IAP
- Occupation – heavy lifting
Fortunately, these promoting risk factors can be prevented and/or modified by changing behavior patterns (smoke cessation) and by learning new physical habits in physical therapy (proper body mechanics to avoid increasing intra-abdominal pressure with lifting, voiding bowels without straining, massage to pelvic floor muscles to increase blood flow in menopausal patients).
Additionally, an inciting (unavoidable) risk factor that contributes to pelvic floor dysfunction is childbirth. However, research has found with pregnancy and delivery that a decreased risk of developing pelvic floor dysfunction and prolapse occurs with decreasing second stage labor, having no episiotomy, and reducing delivery that requires operative assistance.
24 studies examined from 1995-2005 revealed that pelvic floor therapy cure rate was 73%. Furthermore, prolapses did not worsen when pelvic floor exercises were performed in 83% of 754 women studied, revealing a preventative effect. Consequently, 72% of the women with prolapses, who did not do pelvic floor exercises, developed worse prolapses.
If you identify with any of the risks or symptoms above, then it would be recommended to seek treatment from your physician, who can determine if you would benefit from pelvic floor therapy.
Herschorn S. Female Pelvic Floor Anatomy: The Pelvic Floor, Supporting Structures, and Pelvic Organs. Rev Urol. 2004; 6(Suppl 5): S2-10.
Bump RC, Norton PA. Epidemiology and natural history of pelvic floor dysfunction. Obstet Gynecol Clin North Am. 1998; 25: 723-746.
Bump RC, McClish DM. Cigarette smoking and pure genuine stress incontinence of urine. A comparison of risk factors and determinants between smokers and non-smokers. Am J Obstet Gynecol. 1994; 170: 579-582.
Norton C. Prevention and management in pelvic floor disorders. In: Pemberton JH, Swash M, Henry MM (eds.). The Pelvic Floor: Its Function and Disorders. London: WB Saunders; 2002.
Landefeld CS, Bowers BJ, Feld AD, et al. National Institutes of Health state-of-the-science statement: prevention of fecal and urinary incontinence in adults. Ann Intern Med. 2008; 148: 1-10.
Piya-Anant M, Therasakvichya S, et al. Integrated health research program for the Thai elderly: prevalence of genital prolapse and effectiveness of pelvic floor exercise to prevent worsening of genital prolapse in elderly women. J Med Assoc Thai: 2003; 86: 509-515.