Pelvic Floor Dysfunction

The pelvic floor is a network of muscles that connects the pubic bone, tailbone, and hip joints, somewhat approximating a hammock. The pelvic muscles work in coordination to allow for urination, defecation, and sexual function – all of which involve relaxation of these muscles.

Pelvic floor laxity is the decrease in tone or strength of the pelvic floor muscles. This frequently leads to conditions like urinary incontinence or pelvic organ prolapse. Conversely, pelvic floor hypertonicity, or an increase in tone of the pelvic floor, can also lead to pelvic dysfunction. This typically manifests as an inability for these muscles to relax.

Symptoms and Diagnosis

It can be difficult to diagnose a patient with pelvic floor hypertonicity, as patients can present with a variety of symptoms including pelvic pain, frequent urgent need to urinate, urinary incontinence and even painful intercourse. It can cause difficulty urinating – even complete urinary retention. It can also cause urinary incontinence because muscles lack the ability to contract any further. It can lead to constipation and painful intercourse.

Just a 10% contraction of the pelvic floor muscles causes a 50% reduction in blood and oxygen flow.

This can be diagnosed with a good history and physical exam.

Causes of Pelvic Floor Problems

There are several mechanisms that can be responsible for pelvic floor dysfunction and pelvic floor hypertonicity. The primary mechanism is what we call deferred voiding – where you see a bathroom, but you don’t want to go. It can be something that you’ve always had or it’s something that you’ve developed because of social norms. You don’t want to use public bathrooms – you only want to use your own bathroom. Through those mechanisms or behaviors, you give your brain an improper signal. You’ve increased the muscle tone, and this causes a sustained tone that is not normal.

Another mechanism in the development of pelvic floor hypertonicity is secondary to pain. Women with recurrent painful UTIs have a normal response where muscles contract secondary to pain. Think “if it hurts, you don’t want to do it.” Conditions like fibromyalgia and interstitial cystitis are also associated with a high incidence of pelvic floor hypertonicity.

Trauma surgery and even delivery during pregnancy can lead to pelvic floor hypertonicity. Scarring causes a response in the pelvic muscles to contract. This contraction essentially leads to increase in tone.

Stress and anxiety can also cause an increase in pelvic floor tone. There is not a direct mechanism, neurologically speaking, that associates the two, but in the caveman era, the stress response was to protect vital organs. The primitive self causes a tilt of the tailbone or a contraction – a shortening of those muscles. So, with a subconscious stress response, it would be appropriate to have a contraction as a protection mechanism. However, today, that protection mechanism is not necessary, but one still experiences this associated contraction

Treatment

Therapies for pelvic floor hypotonicity include behavioral changes, physical therapy with a specialized pelvic floor physical therapist, muscle relaxers, vaginal suppositories, trigger point injections and Botox. If you feel you have signs and symptoms of pelvic floor hypotonicity it’s important to seek the care of a specialized urologist.