Pelvic Health

Quick Facts

  • woman sitting down holding her hands together on her lapPelvic floor health involves the health of pelvic floor muscles, which can affect bladder, bowel, and sexual function
  • Pelvic floor dysfunction is a condition in which the pelvic floor muscles around the bladder, anal canal, and vagina do not function properly
  • There are many causes of pelvic floor dysfunction including pregnancy and childbirth, injuries, disease, hormonal changes, age, and prior surgery (hysterectomy/prostatectomy)
  • Symptoms of pelvic floor dysfunction include urinary and faecal incontinence and problems urinating; constipation; tailbone, hip, and back pain; pain inserting a tampon; pain during or after sexual intercourse; erectile dysfunction; pressure/heaviness in lower abdomen/pelvic area/vagina/rectum; pelvic organ prolapse; sexual dysfunction; and chronic pelvic pain
  • Pelvic floor dysfunction is commonly experienced by those who have given birth, but the condition has not received a lot of medical attention
  • Pelvic organ prolapse is when one or more of the pelvic organs drops from its position
  • Treatments for pelvic floor dysfunction and pelvic floor prolapse may include physiotherapy, medication, pessaries (medical device), and surgery 
  • Preventative treatment can include pelvic floor muscle training, education, and behaviour modification 
  • On PEI, some physiotherapists have training and special authorization for pelvic floor assessment and treatment

The Longer Story

The pelvic floor includes muscles at the bottom of the pelvis, including genitals, that support the bladder, uterus, and rectum. Pelvic floor dysfunction occurs when a person loses control over the muscles in their pelvic floor, a condition that affects millions of Canadians each year.

Despite it being a common affliction, historically the condition has received little medical attention. A quarter of all women have experienced some form of pelvic floor dysfunction, according to the American Medical Association, and the main cause is pregnancy. 

However, pelvic floor dysfunction can be caused by other factors, too, including hormonal changes, injuries, and various diseases. 

Symptoms of pelvic floor dysfunction include:

  • urinary incontinence (loss of bladder control, which results in urine leaking)
  • fecal incontinence (trouble holding stool)
  • problems urinating/constipation
  • tailbone, hip, and back pain
  • pain inserting a tampon
  • pain during or after sexual intercourse
  • erectile dysfunction
  • pressure/heaviness in lower abdomen/pelvic area/vagina/rectum

Pelvic Floor Dysfunction & Daily Life

Anyone experiencing symptoms of pelvic floor dysfunction can attest that this condition can greatly affect daily life. Incontinence, for example, which affects over 3 million Canadians each year, can affect many aspects of a person’s day-to-day life. Some people with pelvic floor dysfunction experience incontinence brought on by urgency, exercise, laughing, coughing, and sneezing. Incontinence and urgency can lead to falls, causing possible additional injury.

How incontinence affects an individual varies, ranging from a minor inconvenience to something that greatly affects a person’s quality of life.

Additionally, incontinence is a symptom that can contribute to a person’s living arrangement, as some people may decide (in consultation with their medical team and family) to move into community care or long-term care facilities. Depending on a person’s overall state of health, this step may not be needed, if incontinence symptoms can be relieved and pelvic floor health increased. 

Pelvic Floor Dysfunction Treatment

Treatment options include physiotherapy, medication, a pessary, and surgery; however, most cases can be helped with pelvic floor exercises and physiotherapy. Surgery is typically a last resort and only recommended in severe cases. 

Pelvic Organ Prolapse

If left untreated, pelvic floor dysfunction can lead to organ prolapse (when one or more organs around the pelvic floor areas slips down from its position - e.g., bladder, uterus, bowel, top of vagina), a condition that can be serious and one that requires either physiotherapy, surgery or a medical device inserted to remedy.

Some studies have suggested that people who have had their uterus removed (hysterectomy) may be more at risk for pelvic floor weakness. While a hysterectomy may be performed if the uterus becomes severely prolapsed, the procedure itself - used to treat a number of medical conditions - can also increase the likelihood of pelvic organs descending into the vagina over time. 

Medical devices (such as a pessary) can be used to treat certain prolapsed organs, depending on the severity of the condition. A pessary is a device that is inserted through the vagina to support the organ that has prolapsed. There are a variety of pessaries available, depending on the structure that is prolapsing and the length and width of the vagina, as well as the severity of the prolapse. Specific pessaries include the ring, Gehrung, donut, cube, Gellhorn, inflatable pessary, and shelf pessary. A health care provider may suggest trying a pessary before opting for surgery. 

There are pros and cons to both pessaries and surgical options, so it’s important that anyone dealing with pelvic organ prolapse consult medical professionals to decide on the best course of treatment for them.

Preventative Measures

Knowing that certain situations can negatively affect a person’s pelvic floor health can help put into place preventative measures that can strengthen the pelvic floor. Note: While preventative measures can help prevent cases of pelvic floor dysfunction, there is no guarantee, and cases have occurred where a person does experience pelvic floor dysfunction despite taking preventative measures. 

The most common pelvic floor exercise to help strengthen a person’s pelvic floor is the kegel. They are simple to do and involve a repetitive motion where a person tightens their pelvic muscles. 

It's important to note that anyone experiencing any pelvic pain seek a medical assessment before starting any new exercise format/schedule. 

Local Resources

On PEI, anyone experiencing pelvic floor discomfort can receive help from:

  • A primary health care practitioner 
  • A walk-in clinic 
  • Sexual Health, Options & Reproductive Services (SHORS), especially for people without a primary care provider 
  • OBGYN (this requires a referral from a physician or nurse practitioner)  
  • A physiotherapist, with special authorization and advanced knowledge  of pelvic health  

Sources

Kuittinen, T., Tulokas, S., Rahkola-Soisalo, P., Brummer, T., Jalkanen, J., Tomas, E., Mäkinen, J., Sjöberg, J., Härkki, P., & Mentula, M. (2023). Pelvic organ prolapse after hysterectomy: A 10-year national follow-up study. Obstetrics & Gynaecology.

Published date: August 2024

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