Types of pelvic floor dysfunction

Most people associate pelvic floor dysfunction with urinary incontinence or peeing a little, but the truth is that this is only one of the three main problems women most often face. The differences are key because the appropriate treatments will also vary. If you haven’t already, it’s a great idea to brush up with Get to know your pelvis. Now, let’s delve into the most common types of pelvic floor dysfunction.

1. Urinary incontinence

Leaking when you laugh, aka stress urinary incontinence, is a very common issue but that does not mean it’s normal. It’s actually a problem with external sphincter of the urethra which is made of pelvic floor.  Urine will leak if this sphincter is damage or “unfit”,  so simple steps to improve pelvic floor fitness is needed.

The key to correcting this issue will vary,  but we always look to begin with conservative care options first, meaning no medications or surgeries.  These may include pelvic floor muscle training (PFMT), muscle stimulation treatments such as the Elvie “kegel” trainer, lifestyle modifications, mechanical devices such as an incontinence pessary, or the Libby chair. Barring success with these methods, you might need to consider surgery.

2. Pelvic organ prolapse

The pelvic floor supports three pelvic organs: the bladder, the uterus, and the rectum. Over time and with a lack of pelvic floor fitness, these organs may not be as supported. One, two, or all three of them might begin to “drop” or “descend” down towards the vagina.  If the pelvic floor is left untreated, the suspending organ tissues can give out and a prolapse is the result.

Lifestyle modification, PFMT, a prolapse passary, or the Libby chair all help correct this issue.  Options such as surgery should only be considered after these conservative options have been tried as conservative options are safer and very effective.

3. Sexual dysfunction

A lack of pelvic fitness can result in all sorts of sexual problems ranging from painful intercourse to a lack of lubrication to the inability to achieve orgasm. In men, it can cause erectile dysfunction and other problems. An overactive or tight pelvic floor is typically the problem here so the pelvis tissues must be retrained to respond properly.  Doing lots of “kegels” is not the answer here.  Contrary to popular belief, the goal is not a tight pelvic floor but a fit one.

Treatment options for this type of problem include PFMT with an emphasis on down training (teaching the muscles to relax), cognitive behavioural therapy strategies, and of course the Libby chair (she takes care of everything!!). There are also some medications designed to help with these issues, but these should not be attempted before conservative care strategies.