Understanding pelvic floor dysfunction and urinary incontinence
Do you know someone who struggles to answer nature’s call, frequent bathroom trouble, leakage accidents, or poor control over bowel and bladder function? They may be experiencing pelvic floor dysfunction and urinary incontinence. Pelvic floor dysfunction is the inability to correctly tighten and relax the pelvic floor muscles to have a bowel movement, while urinary incontinence is defined as the complaint of any involuntary leakage of urine.
The pelvic floor is a group of muscles in the pelvic area that support the pelvic organs, including the bladder, uterus, prostate, and rectum, with some muscles forming a sling around the rectum and vagina. Contracting and relaxing these muscles is what allows normal bowel and bladder movements. People with pelvic floor dysfunction contract these muscles rather than relax them, which leads to incomplete bowel movements, difficulty evacuating, or leakage of urine or stool.
Prevalence and risk
Urinary incontinence is common among women, with prevalence rates ranging from 10 to 55 percent among women ages 15 to 65. Rates rise gradually through young adulthood, plateau in middle age, and increase again after age 65. As the elderly population grows over the coming decades, the number of women affected by urinary incontinence will grow significantly as well.
The three types of urinary incontinence
Stress urinary incontinence (SUI) is the involuntary loss of urine on effort or physical exertion, such as during sports, or on sneezing or coughing.
Overactive bladder (OAB) and urgency urinary incontinence (UUI) involve involuntary loss of urine associated with urgency, often occurring alongside OAB, a syndrome of urinary urgency, usually with frequency and nighttime urination, in the absence of infection or another obvious cause.
Mixed urinary incontinence is the presence of both SUI and OAB/UUI together; stress and urgency symptoms often appear at the same time, and 10 to 30 percent of women with stress symptoms are later found to have an overactive bladder as well.
What pelvic floor dysfunction can feel like
Pelvic floor dysfunction can be genuinely challenging to live with. Concerns can include leakage of stool or urine with or without awareness, feeling the need for several bowel movements in a short time, constipation or straining pain during bowel movements, painful urination, and lower back pain that can’t be explained by other causes. Treatment depends on the type of incontinence, its severity, and the underlying cause, and sometimes a combination of treatments is needed, including biofeedback, medication, surgery, or pelvic physical therapy.
Techniques your pelvic floor physical therapist may use
Pelvic floor physical therapy addresses the pelvic floor muscle group, which supports the pelvic organs, assists with bowel and bladder control, and contributes to sexual arousal and orgasm. It can help not just with pain but with reducing symptoms of other conditions caused by pelvic floor problems, relaxing contracted, shortened muscles the same way stretching relaxes any other tight muscle in the body.
Techniques may include: education about pelvic anatomy and how habits or hygiene affect symptoms; pelvic floor exercises that teach you to contract and relax the right muscles, along with breathing and timing techniques, to stretch tight muscles, strengthen weak ones, and improve flexibility; manual therapy, using hands-on massage or stretching to improve posture, circulation, and mobility; pelvic floor biofeedback, where a probe and monitor let you see how your pelvic floor muscles are working in real time; electrical stimulation, using a low-voltage current to help you learn to coordinate muscle contractions; and vaginal dilators, tube-shaped devices that help women learn to relax pelvic muscles for easier penetration, which can also support vaginal rehabilitation after treatment for gynecological cancer.
When to talk to someone
Pelvic floor physical therapy may be part of a broader treatment plan involving primary care physicians, sex therapists, and mental health professionals. These issues aren’t always cause for alarm, but they are the body sending a message, a sudden change in your normal habits could indicate a temporary medical problem worth looking into. If you’re noticing symptoms, your doctor may suggest working with a physical therapist to help identify and strengthen the right muscles.