Pelvic Floor Dysfunction | Confusing diagnosis can lead to confusing and improper treatment

Danielle.Steilen.ProlotherapistDanielle R. Steilen-Matias, MMS, PA-C

In this article we will discuss new research and what doctors are recommending moving forward in the treatment of Pelvic Floor Dysfunction in women. We will also look at how Prolotherapy treatments may provide an answer to the problems of bowel movement dysfunction, urinary incontinence, unexplained back and pelvic pain and other symptoms attributed to Pelvic Floor Dysfunction.

A study of women office workers – knowledge is power

Recent research in the International urogynecology journal has appeared that can help women understand Pelvic Floor Dysfunction symptoms, like those listed below, and help guide treatment and healing courses. Doctors found that in treating patients with Pelvic Floor Dysfunction, giving the patients knowledge of what Pelvic Floor Dysfunction is, helped the patient’s symptoms and quality of life.

Here is what those doctors did to help the patients: They conducted a “blind” study (not telling the patients what type of education or treatment they were getting). The purpose was to evaluate pelvic floor knowledge  on the awareness of the presence of Pelvic Floor Dysfunction in women office workers. The effects of receiving pelvic floor muscle health education on pelvic floor knowledge and Pelvic Floor Dysfunction were also evaluated.

The doctors concluded that an increase in knowledge/awareness following education was significantly associated with an increase in quality of life and a decrease in Pelvic Floor Dysfunction symptoms.(1)

A study of 13 radiologists – knowledge is power

In May 2017, 13 radiologists from 8 institutions representing five different nations wrote in the medical journal European Radiology, that there is a need to develop recommendations that can be used as guidance for a standardized approach regarding the diagnosis and grading of pelvic floor dysfunction. The researchers presented those guidelines.(2It can be thought that once MRI guidelines are in place, the problem takes on a new significance in mainstream medicine and Pelvic Floor Dysfunction can be better recognized.

What is Pelvic Floor Dysfunction?

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.

pelvic floor dysfunction

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.

What are Pelvic Floor Dysfunction symptoms?

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.

Pelvic Floor Dysfunction following childbirth

The connection between Pelvic Floor Dysfunction and childbirth is seemingly beyond debate. The majority of new studies centers on reducing the risk of Pelvic Floor Dysfunction after vaginal delivery. This followed a wave of studies that examined the long-term effects of a single vaginal and cesarean delivery. Many studies suggesting the use of forceps and other childbirth procedures may cause significant damage to the mother resulting in long-term problems.

In fact, the American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Obstetrics, released Practice Bulletin No. 165 Summary: Prevention and Management of Obstetric Lacerations at Vaginal Delivery

In this bulletin, more obvious reason for Pelvic Floor Dysfunction after childbirth are addressed:

“Severe perineal lacerations, extending into or through the anal sphincter complex, although less frequent, are more commonly associated with increased risk of pelvic floor injury, fecal and urinary incontinence, pain, and sexual dysfunction with symptoms that may persist or be present many years after giving birth.”

But is it only lacerations and more easily recognizable injury during childbirth that is causing the problem? What if the cause of the problem is seemingly invisible?

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. Muscles spasm because they are trying to provide stability in an unstable region.

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.

Injury to the ligaments in childbirth or as we will see in sports injury, and their successful treatment can be the turning point in Pelvic Floor Dysfunction.

Pelvic Floor Dysfunction is a real sports injury

Recently, researchers writing in the Scandinavian journal of medicine & science in sports, pushed to acknowledge that pelvic floor must be considered as an entity

This is what researchers had to say:

The pelvic floor provides support to all pelvic organs, as well as appropriately closure/opening mechanism of the urethra, vagina, and anus. Therefore, it is likely that female athletes involved in high-impact and in strong-effort activities are at risk for the occurrence of urinary incontinence.

In their study the doctors investigated the occurrence of urinary incontinence and other Pelvic Floor Dysfunction [anal incontinence, symptoms of constipation, dyspareunia (difficult or painful intercourse), vaginal laxity, and pelvic organ prolapse] in 67 amateur athletes compared with a group 96 of nonathletes. The conclusions?

Pelvic Floor Dysfunction and Obesity

As with many problems of chronic pain, obesity plays a major role. In a recent study appearing in the medical journal Best practice & research. Clinical obstetrics & gynaecology, doctors acknowledged that obesity is associated with a high prevalence of pelvic floor disorders.

Weight loss plays a major role in the improvement of these symptoms in such patients. The treatment of symptoms leads to an improvement in their quality of life.(4)


Pelvic Floor Dysfunction – Sexual Dysfunction in postmenopausal women

Doctors from the University of São Paulo investigated the high prevalence of sexual dysfunction in postmenopausal women. Reporting in the International urogynecology journal, the doctors specifically focused on pelvic floor muscle strength to see if that could influence sexual function. In the study, the doctors looked at women, average age 53 years old. The women without sexual dysfunction showed significantly higher pelvic floor muscle strength strength than women with sexual dysfunction.(5)

Treatment of Pelvic Floor Dysfunction

Treatment will vary depending on the cause of the condition. Many times, the underlying cause is not determined. Physical therapy is frequently recommended. In the Journal of sex medicine doctors have shown that physical therapy can assist with symptoms including urinary incontinence and sexual function.(6)

Kegel exercises may be encouraged to strengthen the pelvic floor. Other treatments include:

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.

Prolotherapy for Pelvic Floor Dysfunction

Clinical observations over the course of decades have shown Prolotherapy treatment to the injured ligaments induces a mild “healing” inflammatory reaction, which stimulates the repair of the injured or lax ligaments.

Prolotherapy injections can strengthen the ligaments, increasing stability and relieving muscle spasm and other symptoms.

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.

Do you have a question? You can get help and information from our Caring Medical staff

1. Berzuk K, Shay B. Effect of increasing awareness of pelvic floor muscle function on pelvic floor dysfunction: a randomized controlled trial. Int Urogynecol J. 2015 Jan 9. [Google Scholar]
2. El Sayed RF, Alt CD, Maccioni F, Meissnitzer M, Masselli G, Manganaro L, Vinci V, Weishaupt D, ESUR and ESGAR Pelvic Floor Working Group. Magnetic resonance imaging of pelvic floor dysfunction-joint recommendations of the ESUR and ESGAR Pelvic Floor Working Group. European radiology. 2017 May 1;27(5):2067-85. [Google Scholar]
3. Almeida MB, Barra AA, Saltiel F, Silva-Filho AL, Fonseca AM, Figueiredo EM. Urinary incontinence and other pelvic floor dysfunctions in female athletes in Brazil: A cross-sectional study. Scand J Med Sci Sports. 2015 Sep 15. [Google Scholar]
4. Ramalingam K, Monga A. Obesity and pelvic floor dysfunction. Best Pract Res Clin Obstet Gynaecol. 2015 Feb 19. pii: S1521-6934(15)00021-8. doi: 10.1016/j.bpobgyn.2015.02.002. [Google Scholar]
5. de Menezes Franco M, Driusso P, Bø K, Carvalho de Abreu DC, da Silva Lara LA, de Sá Rosa E Silva ACJ, Ferreira CHJ. Relationship between pelvic floor muscle strength and sexual dysfunction in postmenopausal women: a cross-sectional study. Int Urogynecol J. 2017 Jun;28(6):931-936. [Google Scholar]
6. Sacomori C, Cardoso FL. Predictors of Improvement in Sexual Function of Women with Urinary Incontinence After Treatment with Pelvic Floor Exercises: A Secondary Analysis. J Sex Med. 2015 Jan 13. [Google Scholar]

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