The female pelvic floor

Sue Croft1

1Physiotherapist Highgate Hill, Brisbane

 

You can never do too many pelvic floor exercises…….or can you?

Having an overactive pelvic floor can impact on voiding and defaecation throughout your lifespan, with implications from when parents first begin toilet training with a child through to adulthood. The implications for the child in their future years with ineffective toilet training can be enormous. Bladder/bowel dysfunction (BBD) in paediatrics can include several conditions related to urinary voiding and defaecation such as dysfunctional voiding, dysfunctional elimination syndrome and lead to dysfunctional lower urinary tract symptoms including urinary incontinence, recurrent UTI’s, dysuria, voiding postponement and potentially vesicoureteral reflux. (1)

Young girls can be prone to recurrent urinary tract infections because of poor voiding patterns where there is a dyssynergic pattern of voiding. There can be a failure of relaxation of the external urethral sphincter and /or the pelvic floor muscles leading to high voiding pressures and incomplete emptying of the bladder. This can also lead to girls developing urinary leakage due to their voiding position and technique. There is evidence that suffering with LUTS in childhood increases the risk of subsequent problems as an adult. (2)

Having damage to the pelvic floor muscles from vaginal deliveries where the pelvic floor muscles avulse from the pubic bone (levator avulsion) causes weakness of the pelvic floor which has a high correlation to prolapse due to an enlarged genital hiatus and subsequent ballooning.  A levator avulsion can triple the risk of significant anterior and central compartment vaginal prolapse. (3) Having weakened pelvic floor muscles post vaginal delivery also affects continence with stress urinary incontinence (SUI) occurring in up to 35% of women post-delivery developing stress incontinence. (4)

Developing a habit of straining at stool can cause constipation, rectal prolapse and anal fissures, which can lead to pain and subsequent withholding of the stool. Bloating, faecal impaction followed by faecal incontinence, feeling unwell and causing subsequent behavioural issues in young children (5), are just some of the consequences of poor defaecation training. These defaecation issues can lead to significant constipation in their adult life with a long, redundant bowel potentially leading to surgery and resultant colostomy or ileostomy.

This session will cover the physiotherapy management of urinary incontinence including the consequences of an overactive pelvic floor and will briefly touch on the management of persistent pelvic pain causing dyspareunia from a non-relaxing pelvic floor.

A practical revision of the correct positions and dynamics of bladder and bowel emptying will be covered for those in the audience who are new to continence and pelvic floor dysfunction.

References

  1. American Urological Society (2010) Management of children with vesicouretal reflux and bladder/bowel dysfunction.
  2. Salvatore S et al (2012) Is overactive bladder in children and adults the same condition? ICI-RS 2011. Neurourol Urodyn 31(3):349-51. doi: 10.1002/nau.22223. Epub 2012 Mar 15
  3. Dietz HP and Simpson J, (2008) Levator trauma is associated with pelvic organ prolapse. Br J Obstets Gynaeocol 115:979-984.
  4. Hunskaar S, Lose G, Sykes D, Voss S. The prevalence of urinary incontinence in women in four European countries.BJU International. 2004; 93:324–330.
  5. Van Dijk M et al (2010) Prevalence and Associated Clinical Characteristics of Behaviour Problems in Constipated Children. Pediatrics 125 No. 2 February 1, 2010 pp. e309 -e317
    (doi: 10.1542/peds.2008-3055) first published online January 18, 2010

 


Biography

Sue Croft is a Brisbane based Physiotherapist with a special interest in pelvic floor dysfunction including urinary incontinence, prolapse conditions, bowel management and pelvic pain for women, men and children.

Sue has written two books (2011, 2012) on pelvic floor dysfunction which have since gone into three reprints. Pelvic Floor Recovery: Physiotherapy for Gynaecological Repair Surgery, specifically for women to prepare for or recover successfully from hysterectomy and/or gynaecological repair surgery and Pelvic Floor Essentials which covers the essential information about the bladder, bowel and pelvic floor including treatment of urinary incontinence, urgency, frequency, prolapse management, bowel dysfunction and pelvic pain.