Treatment of Pelvic Floor Dysfunction
Background and Definition
The pelvis consists of three paired bones: the ilium, ischium, and pubis that interconnect and form the innominate bones, meeting in the midline at the pubic symphysis anteriorly and the sacrum posteriorly. The midline joint anteriorly is called the pubic symphysis joint and posteriorly the sacroiliac joint. These are the two joints of the pelvis.
The pelvic floor is composed of muscles and fascia that form a sling from the pubic bone to the tailbone and functions to support the pelvic organs, contraction, and relaxation. The organs include the bladder, the intestines, and the uterus. Their function is critical for urinary and fecal continence and sexual intercourse. The pelvic floor stabilizes the connecting joints of the pelvis.
The pelvic floor muscles attach to the pubis and coccyx. The pubic bones are held together by ligaments and the pubic symphysis. The pubic symphysis is a disc. This disc and the supporting ligaments can be torn or sprained, resulting in pelvic instability. If the pelvic floor muscles are trying to contract and the pelvis is unstable, muscle spasms will occur. The sacrotuberous, sacrococcygeal and sacroiliac ligaments are vital to providing stability in the “back portion” of the pelvic rim upon which the muscles attach.
Pelvic floor dysfunction can be defined as spasm or a lack of coordination of the pelvic floor musculature. In pelvic floor dysfunction, the musculature is sometimes weak and sometimes tight. There also may be an impairment of the sacroiliac joint, the low back, the coccyx, and/or the hip joints. The pelvic organs respond with increased or decreased sensitivity, which results in a wide range of symptoms. Pelvic floor dysfunction is a very disabling condition.
Pelvic floor dysfunction is most common, but not exclusively limited to women of reproductive age, as other women, men and children can suffer from the condition as well.
Spasms of the muscles of the pelvic floor commonly result in urological issues such as poor urine stream, urinary frequency and urgency, and urge incontinence. Pelvic pain or pressure is frequent and is generally severe. Other common symptoms include chronic constipation, lower back pain, genital pain, rectal pain, vulvodynia, erectile dysfunction, pain with sitting, painful intercourse, discomfort with bowel movement, and sleep disturbance.
When an individual experiences muscle spasms, the pain is excruciating, and any activity that puts pressure on the pelvis, the involved organs, and the pelvic floor ligaments is going to make the symptoms worse.
Treatment for Pelvic Floor Dysfunction in Modern Medicine
Treatment will vary depending on the cause of the condition. Many times, the underlying cause is not determined. Physical therapy is frequently recommended.
Kegel exercises may be encouraged to strengthen the pelvic floor. Other treatments include external and internal soft tissue mobilization, myofascial and trigger point release, visceral manipulation, connective tissue manipulation, deep tissue massage, biofeedback, transcutaneous electrical nerve stimulation (TENS), heat and cold therapy, muscle strengthening, relaxation and reeducation, exercises, stretching, postural education, nerve blocks, and epidurals.
These treatments may offer some relief to the sufferers of pelvic floor dysfunction, but when the underlying problem is an unstable pelvis, they do not mend the actual source of the problem, and therefore do not bring permanent relief. Sufferers continue to live with PFD trying to “control” the symptoms, but the symptoms still decrease their enjoyment of life.
What causes Pelvic Floor Dysfunction?
Pelvic floor dysfunction may occur after pregnancy or childbirth. Other causes may be an undiagnosed infection, poor posture from chronic low back or sacroiliac problems, trauma from a fall or other injury, or a post-surgical issue. There may be referral or trigger points from other areas, such as internal organs which cause tenderness in the pelvic floor. Conditions such as endometriosis can also lead to pelvic floor pain.
If pelvic floor pain lingers and no known source is found, injured, loose or weak ligaments and instability of the pelvis should be considered. In pelvic floor dysfunction, the musculature is in spasm and muscles that are constantly contracting or in spasm will generate pain. But why are the muscles in spasm? One basic principle people forget about muscle spasms is that muscle spasms will occur when a muscle contracts against an unstable base. When the muscle contracts against a stable base, it is possible to get maximum force from that muscle, and the likelihood of muscle injury is minimal. When the muscle contracts against bone that is moving and unstable, minimal muscle force can be achieved and the likelihood of injury is great. How does this apply to PFD? Good question!
Numerous ligaments surround the pelvis and help to keep it stabilized. When these ligaments become weak, they are unable to maintain pelvic stability and can cause pain. Injury to the pubic symphysis, pubic ligaments or any of the ligaments that stabilize the lower back (especially sacroiliac joint) would cause the pelvic floor muscles to be contracting continually against an unstable base. This would mean every time we urinated, defecated, held our breath or had sex, the muscles would try to generate force attached to structures that are moving. The pelvic floor would be unable to function correctly.
Injury to the pelvic floor ligaments would result in the pelvic bones moving excessively. In such a scenario, pelvic floor muscle spasm has to occur. Treatments such as massage therapy, exercises and re-education would only have temporary benefit. They would address the muscle spasm part of the problem but not the cause of the muscle spasms.
Prolotherapy for Pelvic Floor Dysfunction
Prolotherapy to the injured ligaments induces a mild “healing” inflammatory reaction, which stimulates the repair of the injured or lax ligaments. Prolotherapy injections to the weakened pelvic floor ligaments will cause an increase of blood supply and regenerative cells to the area. A natural healing cascade is put in motion resulting in the deposition of new collagen at the weakened areas. This new collagen strengthens the ligaments. Once the ligaments are of normal strength, the pelvic floor musculature can contract with maximum force against a stable base. Thus, the muscle spasms stop. The chronic pelvic floor pain, low back pain, genital pain and bowel/bladder symptoms stop because the muscle tone in the pelvic floor gets back to normal. Then the person can exercise and be active to their hearts delight. Prolotherapy is a great treatment for Pelvic Floor Dysfunction!