Global Health

Pelvic Floor Dysfunction

For most people, having a bowel movement is a seemingly automatic function For some individuals, the process of evacuating stool may be difficult Symptoms of pelvic floor dysfunction include constipation and the sensation of incomplete emptying of the rectum when having a bowel movement Incomplete emptying may result in the individual feeling the need to attempt a bowel movement several times within a short period of time Residual stool left in the rectum may slowly seep out of the rectum leading to reports of bowel incontinence

The process of defecation having a bowel movement requires the coordinated effort of different muscles The pelvic floor is made up of several muscles that support the rectum like a hammock When an individual wants to have a bowel movement the pelvic floor muscles are supposed to relax allowing the rectum to empty While the pelvic floor muscles are relaxing, muscles of the abdomen contract to help push the stool out of the rectum Individuals with pelvic floor dysfunction have a tendency to contract instead of relax the pelvic floor muscles When this happens during an attempted bowel movement, these individuals are effectively pushing against an unyielding muscular wall

The diagnosis of pelvic floor disorder starts with a careful history regarding an individual’s symptoms, medical problems and a history of physical or emotional trauma that may be contributing to their problem Next the physician examines the patient to identify any physical abnormality A defecating proctogram is a study commonly used to demonstrate the functional problem in a person with pelvic floor dysfunction During this study, the patient is given an enema of a thick liquid that can be detected with x-ray A special x-ray video records the movement of the pelvic floor muscles and the rectum while the individual attempts to empty the liquid from the rectum Normally the pelvic floor relaxes allowing the rectum to straighten and the liquid to pass out of the rectum This study will demonstrate if the pelvic floor muscles are not relaxing appropriately and preventing passage of the liquid

The defecating proctogram is also useful to show if the rectum is folding in on itself rectal prolapse  Many women have outpouching of the rectum known as a rectocele Usually a rectocele does not affect the passage of stool In some instances, however, stool may become trapped in a rectocele causing symptoms of incomplete evacuation The defecating proctogram helps to identify if liquid is getting trapped in a rectocele when the individual is trying to empty the rectum

The pelvic floor is a group of muscles that attach to the front, back, and sides of the pelvic bone and sacrum the large fused bone at the bottom of your spine, just above the tailbone Like a sling or hammock, these muscles support the organs in the pelvis, including the bladder, uterus or prostate, and rectum These muscles also wrap around your urethra, vagina in women, and rectum Bowel and bladder functions are controlled by contracting and relaxing these muscles These muscles must relax to allow for urination, bowel movements, and, in women, sexual intercourse

Pelvic floor dysfunction due to non-relaxation of the pelvic floor muscles may be treated with specialized physical therapy known as biofeedback With biofeedback, a therapist helps to improve a person’s rectal sensation and pelvic floor muscle coordination There are various effective techniques used in biofeedback Some therapists train patients by teaching them to expel a small balloon placed in the rectum Another technique uses a small probe placed in the rectum or vagina or electrodes placed on the surface of the skin around the opening to the rectum anus and on the abdominal wall  These instruments detect when a muscle is contracting or relaxing and provide visual feedback of the muscle action This visual feedback helps the individual to understand the muscle movement and aids in improving muscle coordination Approximately 75% of individuals with pelvic floor dysfunction experience significant improvement with biofeedback

Abnormalities identified with a defecating proctogram such as rectal prolapse and rectocele may be treated with a surgical procedure

Tags: Floor, Floor Dysfunction, Pelvic Floor, Pelvic Floor Dysfunction