What is pelvic floor dysfunction?
Pelvic floor dysfunction refers to the abnormal function of the pelvic floor muscles. This can affect bowel, urinary and in women, sexual organ function. With regards to bowel function, the pelvic floor muscles are important to maintain control over the bowel and to efficiently achieve a bowel movement. If the pelvic floor muscles relax too much, fecal incontinence (stool leakage) or rectal prolapse (sagging of the rectum) can result. If these muscles fail to relax, it can lead to difficulty achieving a bowel movement. These are common disorders among women but can affect men as well.
What causes pelvic floor dysfunction?
Several things can lead to pelvic floor dysfunction, including pregnancy, vaginal delivery, pelvic floor trauma, obesity, pelvic floor surgery and/or radiation and longstanding difficulty with bowel irregularity including constipation and/or diarrhea.
What are the gastrointestinal signs and symptoms of pelvic floor dysfunction?
Pelvic floor dysfunction can cause a variety of gastrointestinal symptoms including fecal incontinence, rectal prolapse, constipation, bloating, abdominal cramping or pain, a sensation of incomplete bowel emptying, the urge to have a bowel movement but unable to achieve a bowel movement, changing one’s position to achieve a bowel movement and needing to place your finger in the rectum or vagina to assist with having a bowel movement.
How is pelvic floor dysfunction diagnosed?
Pelvic floor dysfunction is diagnosed after a rectal and/or pelvic exam in addition to specialized testing at a pelvic floor center. This testing typically includes anorectal manometry, electromyography and defecography. Anorectal manometry is used to evaluate the strength of the pelvic floor muscles. It involves placing a small tube with pressure sensors into the rectum. Electromyography is used to evaluate the nerve coordination of the pelvic floor muscles. It involves placing a small sponge in the anus or using a small electrode to stimulate the nerves of the pelvic floor muscles. Defecography is used to evaluate the movement of the pelvic floor muscles during a bowel movement. It involves placing a small amount of barium into the rectum and watching the pelvic floor muscles move as the barium is passed out of the rectum.
How is pelvic floor dysfunction treated?
Once your pelvic floor dysfunction is defined, it allows your gastroenterologist to design a treatment plan for you. Depending on what is required, a variety of treatments may be used to include agents that alter your stool consistency such as laxatives or antidiarrheals, agents that relax your muscles such as antispasmodics and agents that improve your nerve function, such as tricyclic antidepressants or serotonin reuptake inhibitors. Biofeedback therapy to retrain your pelvic floor muscles so they coordinate optimally may also be considered. Other possible interventions include Botox injections, spinal cord stimulation through a device called Interstim or a referral to a colorectal surgeon if surgery is indicated.
When to seek medical advice?
See your gastroenterologist if you have rectal bleeding, weight loss, need to insert your finger into your rectum or vagina to achieve a bowel movement or have persistent bowel irregularity.
International Foundation for Functional Gastrointestinal disorders website: www.aboutgimotility.org