Pelvic floor dysfunction: Signs and symptoms

Roseanna Grace, Clinical Specialist Pelvic Floor Physiotherapist working within the NHS and Private Practice and Sanature’s Brand Ambassador, highlights the signs and symptoms that women should look out for in pelvic floor dysfunction

Unfortunately, many Women’s Health conditions are ‘dismissed’ or ‘normalised’ and this is something that Roseanna wanted to discuss in more detail, in this article. Firstly, the pelvic floor muscles have four main functions; these are:

Sexual function – A strong pelvic floor gives you stronger feedback/sensation during sex and results in (amongst with other factors) orgasm strength and endurance. Sex should be enjoyable, pleasurable and there should be no pain or dysfunction at any time. If these muscles are dysfunctional, sex may be painful or there may be an inability to have sex.

Posture – The pelvic floor attaches into the coccyx and supports your trunk and lumbar spine. If these muscles are weak, you could be prone to acute episodes of low back pain. Strengthening the core and pelvic floor are two good starting points to address in optimum self-management.

Pregnancy and Childbirth – The pelvic floor muscles stretch and thin and often weaken during a pregnancy as the baby grows and gets heavier. They then aid contraction and turning of the baby during vaginal delivery.

Continence of stool, urine and wind – Save the best for last! We take for granted how well these muscles work when we have no dysfunction or symptoms associated with any of the above. If the muscles are dysfunctional and weak, we experience unwanted symptoms of incontinence, pain and/or vaginal pelvic organ prolapse.

Conditions linked to pelvic floor dysfunction are:

• Pelvic organ prolapse (this can be anterior, posterior, cervical descent or urethral).
• Urinary urgency (with or without incontinence)
• Urinary frequency (with or without incontinence)
• Stress urinary incontinence
• Urge urinary incontinence
• Mixed urinary incontinence
• Overactive Bladder Syndrome
• Dyspareunia (painful sex)
• Inability to use a tampon or insert anything per vagina (vaginismus)
• Vulvodynia ( pain localised at the vulva)
• Urgency to open your bowels
• Urge faecal incontinence
• Painful bladder syndrome
• Repeat urinary tract infections
• Chronic constipation
• Chronic pelvic pain
• Endometriosis
• Levator Ani Syndrome
• Proctalgia Reflux

On a typical 1.5-2.0 litres intake of fluid, an average amount of times you should empty your bladder is every 3-4 hourly or 6-8 total number of voids per day. Any more than this is suggestive of a dysfunctional pelvic floor/bladder which can both be addressed by an experienced pelvic floor physiotherapist.

Getting up once per night to open your bladder is normal, anything more than this is strictly abnormal and should be addressed. This may be an indication that your pelvic floor muscles are showing signs of dysfunction!

Sex should never be painful at insertion, during or afterwards. If you have any pain or discomfort, please do mention this to your GP or Pelvic Floor Physiotherapist – there are lots that we can do to help!

85% of women with mild-moderate pelvic organ prolapse will massively improve this JUST by strengthening the pelvic floor muscles – you do not necessarily require surgery. Did you know that this is very common? Up to 78% of women following a normal vaginal delivery will have evidence of pelvic organ prolapse postnatally and later on in life, 50% of all women will have a prolapse. This does not mean it is normal, but it is common.

1 in 3 women will suffer with urinary incontinence. Please never accept this as normal – it is very common, but it is not something you have to normalise or live with. You can get this better and live without leaks!

Top tips if you are suffering with any of the following at your first step towards optimum self-management:

Trial reducing your caffeine intake to 85% decaffeinated. This includes tea and coffee, but also hot chocolate and fizzy drinks. Other drinks that can irritate bladders are carbonated drinks (fizzy) or those high in acidity such as lemon and lime, or those with blackcurrant in – do try and cut these out.

Whether you use a tampon, menstrual pad or urinary liner or pad – it is important to switch to 100% natural cotton. Products that are not natural, or 100% cotton contain harmful chemicals such as chlorine bleach which when used on your delicate skin such as the vulva/vagina – can cause an inflammatory reaction and can worsen any pain and discomfort.

If you are overweight, consider how you can start to implement a healthier lifestyle. As little as 6lb weight loss can help improve your pelvic floor symptoms!

If you are constipated, do make sure you avoid straining as constant straining can weaken your pelvic floor muscles and is a common and regular cause of weakness. Be sure you are drinking enough fluids and have a healthy, balanced diet. If despite this, you are still straining on a regular basis – consider seeking advice from your GP or from a Pelvic Health Physiotherapist.