Blog Guest Author: Laura Price. BSc Hons. PG Cert. HCPC. MCSP. MPOGP
Women’s Health Physiotherapist
What is Pelvic Floor Dysfunction (PFD)?
Pelvic floor dysfunction (PFD) is a condition in which the pelvic floor muscles around the bladder, anal canal, and vagina do not work properly.
Symptoms include:
- Urinary Incontinence.
- Difficulty emptying the bladder.
- Faecal incontinence.
- Difficulty emptying the bowels.
- Pelvic organ prolapse.
- Sexual dysfunction (pain/ lack of sensation/ inability to climax)
- Chronic pelvic pain.
What increases your risk of developing PFD?
Risks can be divided into things that can be changed (modifiable) and things that cannot be changed (non- modifiable) and risks related to the birth of your baby (obstetric risk):
| Modifiable | Non-Modifiable | Obstetric |
| A body mass index (BMI) above 25 | Age | Being over 30 years of age when having a baby |
| Smoking | Family history of urinary incontinence, overactive bladder, faecal incontinence or prolapse | Having had one or more babies prior to current pregnancy |
| Lack of exercise | Gynaecological cancers and treatments related to this | Having an assisted birth (Forceps or ventouse) |
| Constipation | Gynaecological surgery e.g. hysterectomy | Having a birth where the baby is lying face up – back to back birth. (occipito-posterior) |
| Diabetes | Fibromyalgia | An active second stage of labour that lasts longer than 1 hour |
| Chronic respiratory disease. | Injury to the anal sphincter during birth (OASI) |
Identifying if you have an increased risk can help to prevent symptoms from developing or manage them early.
Below are some useful resources to help manage some of these risk factors:
https://www.nhs.uk/health-assessment-tools/calculate-your-body-mass-index
https://www.gov.uk/government/publications/physical-activity-guidelines-adults-and-older-adults
https://www.asthmaandlung.org.uk
https://www.nhs.uk/conditions/constipation
What are the pelvic floor muscles?
The pelvic floor muscles are a collection of muscles that form the “floor” of the pelvis. The main role of these muscles is to support the pelvic organs and the fascia and to maintain continence.
Pelvic floor muscles can become weak due to the risk factors above and are unable to provide support or manage pressure in the abdomen which may result in symptoms of incontinence and prolapse.
These muscles can also cause symptoms of pain and difficulty emptying if they do not lengthen and relax fully.
All women and girls aged 12 and above should complete regular pelvic floor exercises to prevent PFD. This is particularly important in pregnancy and after childbirth.
What is supervised pelvic floor exercise?
Those who have been identified at risk of developing pelvic floor dysfunction or have developed symptoms can benefit from supervised pelvic floor muscle training.
This is considered the first line treatment for urinary incontinence and prolapse.
Following a full assessment of your symptoms, a pelvic health physiotherapist will undertake an assessment of the function of the pelvic floor, including strength, endurance, co-ordination, and technique. This can also include assessment of the abdomen, ribs, hips, lower back and supporting muscle function.
An individualised training programme can then be advised with support for progressing strength training for the individual women’s needs and goals.
Training should be undertaken for at least 3 months and should include 3 sets per day.
Where someone is unable to undertake this kind of training, symptoms and strengthening can be supported with intravaginal supports, biofeedback and neuromuscular electrical stimulation.
For more information on pelvic health physiotherapy:
Email: wwpelvicphysio@gmail.com
Instagram: @wwpelvicphysio
Facebook: http://www.facebook.com/share/1LXFdym3CL/
References:
NICE (2021) Pelvic floor dysfunction: prevention and non surgical management. NG210. https://www.nice.org.uk/guidance/ng210
NICE (2019) Urinary incontinence and pelvic organ prolapse in women: management. NG123. https://www.nice.org.uk/guidance/ng123
The POGP Why choose a POGP registered physiotherapist. https://thepogp.co.uk/patient_information/why_choose_a_pogp_registered_physiotherapist.aspx
