Impacting normal defecation, bowel storage, continence, or causing perineal pain are all symptoms of pelvic floor dysfunction that shouldn’t be left untreated. However, there seems to be some misinformation about these conditions. Women often fail to seek care. So, Tanisha Saxena packs up the details for this week’s health segment.
Observed as one of the largest “unaddressed issues in women’s health,” pelvic floor dysfunction (PFD) is the inability to correctly relax and coordinate the pelvic floor muscles to have a bowel movement. Well, what do we actually mean by the dysfunction of the pelvic floor in the body?
A person suffering from pelvic floor dysfunction often feels symptoms such as constipation, straining to defecate, urine or stool leakage, and a frequent need to pee.Doctor Poornima Kinila, Consultant Obstetrics and Gynecology and Infertility at Aster RV Hospital, explains, “Pelvic floor dysfunction is an entity that encompasses many organ systems, namely the genitourinary, gastrointestinal, and musculoskeletal system.
It occurs due to certain factors that stress the pelvic muscles. The pelvic floor is made up of a group of muscles designed like a hammock, on which pelvic organs like the bladder, uterus, and anal canal sit. Weakening and dysfunction thence can cause the pelvic organs to prolapse through the vagina, causing discomfort, friction in walking, urinary incontinence, and faecal incontinence.”
The official data from the National Center for Biotechnology Information states that 21.8 percent of women in India suffer from pelvic floor dysfunction (PFD). It clearly adds that women suffer from PFD more than men. “Women are more prone to it as childbirth is the main cause of this disorder. Other conditions include obesity, menopause, straining, pelvic radiation, pelvic surgery, and trauma to the pelvic organs. Straining and various levels of perineal injury during childbirth weaken the pelvic muscles and tissues, which in turn cause pelvic floor disorders,” says Doctor Karthika Reddy Byreddy, Consultant Obstetrician and Gynaecologist, Yashoda Hospitals, Hyderabad.
Well, it is not that men don’t experience pelvic dysfunction. They suffer from pain while urinating, having sexual intercourse, and even sitting. These symptoms indicate muscle tightness. Consultant interventional gastroenterologist Dr. Shrikanth Appasani sheds light on the dysfunction of the pelvic floor in terms of its effect on the intestinal organs. He elaborates, “The pelvic floor supports the internal organs, including the intestine. Now, when the intestine has to empty out the waste, it changes shape.
To put it simply, if you are at a social gathering or travelling and do not want to use the restroom right now, the intestine must hold the waste in order for it not to pass. The pelvic floor then reshapes itself to prevent faecal matter from pushing it down. This is one of the many functions of the pelvic floor. The pelvic floor now also supports the internal organs, preventing them from protruding outside. For instance, when you stand, organs such as the urinary bladder or uterus, by their very weight or gravity, have the tendency to come down. As a result, the pelvic floor keeps the organs inside. The most common symptom is constipation, followed by other complications.”
According to a study, pelvic floor disorders (PFDs) consist of urinary incontinence (UI), faecal incontinence (FI), and pelvic organ prolapse (POP). The prevalence of PFDs is estimated to range between 12 and 42%, and while symptoms can present as early as age 20, their prevalence increases with age, and they are most often seen in late adulthood. Thus, as life expectancy continues to increase in developed nations and the elderly female population grows, PFDs are expected to become more prevalent. This upsurge has already led to increases in PFD-related healthcare costs.
Doctor Sudhindra Vooturi, a physiotherapist at KIMS hospital, joins the discourse and further adds, “There are some non-pharmacological management strategies for pelvic floor dysfunction: First, there is lifestyle management: losing weight, relaxing (to reduce anxiety), and quitting smoking. Second, pelvic floor exercises will strengthen the pelvic floor muscles and increase neuromuscular control, thus reducing symptoms of PVD. Lastly, specific exercises to activate pelvic floor muscles, including Kegel exercise, hypopressive exercise, or transverse abdominis activation.”
Wondering what these exercises look like and how effective they are? Doctor Sudhindra gives us the lowdown on two of these exercises. To begin with, hypopressive exercises lower intra-abdominal pressure while concurrently increasing the tone of the pelvic floor muscles and deep abdominal muscles. This regime includes thirty-three consecutive HEs, which each involved a posture to be performed in different body positions (standing, kneeling, quadruped, sitting, and supine), combined with a hypopressive maneuver in which the women performed an expiratory apnea (breath hold at end expiration) while drawing in their abdomen and opening their rib cage.
Activation of the transversus abdominis (TrA) has been shown to facilitate pelvic floor muscle activation and vice versa. TrA activation also leads to increased pelvic floor muscle activity without directly training the pelvic floor musculature.Transverse abdominis activation can be progressed based on body position, increasing hold times, and increasing sets. Activation can first begin in low-load body positions, including supine, quadruped, sitting, or standing. Arm and/or leg movements, as well as movements like walking or balancing on a tilt board, can be used to challenge TrA activation. The plank is a great exercise for TrA.
Doctor Sudhindra also comments on the stigmatising aspect of pelvic floor dysfunction and why women delay seeking help. “Yes, there is a stigma attached to PFD, which is why most women do not seek advice or help early (when it is easily managed). In the early stages, only urinary incontinence is observed, and women do not seek help at this time (they either manage by drinking less fluids, which again is a problem, or they stop socialising and travelling). Most of the time, women seek medical advice when there is faecal incontinence, which is leaked faeces. The dysfunction had worsened by that point.
Efforts should be made to spread awareness about seeking help early,” he concludes.
According to a study published in the journal Knowledge of Pelvic Floor Disorders in Women Seeking Primary Care: A Cross-Sectional Study, this failure to seek care is related to misconceptions about the conditions themselves, with one study demonstrating that 81% of women do not perceive UI as abnormal and believe that PFDs are a “natural part of childbirth and aging”. Additional barriers to presentation include personal embarrassment, being unaware that PFDs are medical conditions, and being unaware that treatment options exist.In a nutshell, we need to understand and address the knowledge gap among the masses, thus enabling early treatment.
