What causes pelvic floor dysfunction ?

Avoid routinely holding in stool or urine for prolonged periods (a common habit amongst office workers). Go when the urge initially hits you.. PHOTO | FILE | NATION MEDIA GROUP 

In Summary

Signs of PSD

• Difficulty emptying the bladder completely (most people also report repeat attacks of urinary tract infections – popularly known as UTI)
• Urinary incontinence
• Faecal incontinence (inability to control bowel movements)
• Constipation
• Prolapse: This presents as a feeling of heaviness or fullness like something falling out of the vagina or rectum. Some people also report a ‘bulge’ in the lower abdomen or pelvis. This occurs when either the uterus drops down into the vagina or parts of the intestines/rectum/bladder bulge into the vagina or when the rectum pops out of the anus.
• Sexual discomfort
• Unexplained pain in the low back, pelvic region, genital area, or rectum

By DR MUKUHI NG’ANG’A
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The pelvis is an area of the body which most people are still not comfortable to discuss (even with their doctors). Most people with pelvic problems only turn to their doctor when they cannot bear their discomfort any more.

Usually they have undergone years of unnecessary anguish and distress.

What is the pelvic floor?

The pelvic floor includes the muscles that surround the rectal area and genital area. The pelvic floor helps to support the internal organs (uterus, bladder, rectum and vagina). It helps with the control of urination, defecation and sexual function. It is also crucial in child birth.

What causes PSD?

PSD occurs mainly in women, but it can also occur in men.

Factors associated with developing PSD include:
Childbirth: Having a vaginal delivery (especially a traumatic or complicated one)

Menopause: This is due to the low levels of oestrogen associated with aging

Obesity is thought to be a risk factor in developing PSD.

Pelvic trauma: Previous accidents or sports injuries involving the pelvis and lower back may develop PSD.

Persistent (chronic) coughing: Usually associated with lung problems and smoking

Poor toilet habits: Frequent straining during bowel movements

Heavy workload: Lifting heavy loads using inappropriate techniques is unhealthy for both the back and the pelvis.

Medical conditions that impact the health of nerves to the pelvis such as diabetes, Parkinson’s disease, stroke and spinal disorders

Surgery: Surgery or radiation for cancer of the uterus, cervix or rectum may result in PSD. Back (spinal cord) surgery can also have the same effect.

In some cases, the cause is not found.

How is it diagnosed?

Most people take months (even years) before the correct diagnosis is made. Partly it is because many people assume that these symptoms are normal after events such as child birth or they think they are a normal part of aging.

Ideally, the best doctor to visit is either a gynaecologist or a urologist (urinary system specialist). If constipation or stool incontinence is a problem, it may be better to start off with a gastroenterologist (digestive system specialist).

Usually the diagnosis starts from your history. The doctor then needs to do a thorough examination (both externally and internally). This will help them determine the best form of treatment for you.

How do you deal with PSD?

Lifestyle changes: Eat a healthy diet which has lots of fibre (fruits, vegetables and cereal) to prevent constipation. In addition, eating healthy and exercising will help you maintain a healthy weight.

Toilet habits: Avoid routinely holding in stool or urine for prolonged periods (a common habit amongst office workers). Go when the urge initially hits you. Alternatively, simply go after a specified period of time even if you do not have the urge (this is can be helpful in people with recurrent urinary infections).

For people with incontinence, you may find yourself going to the toilet every 30 minutes instead of every 4 or so hours like most people. In these cases, the scenario changes a little since you need to train your bladder to hold in urine.

Medication: Sometimes, you may need medication to help relax or tighten the pelvic floor muscles. You may also need some pain relief. Constipation which is not responding to diet changes alone may require the use of laxatives. Special injections are sometimes used in the treatment of incontinence.

Treat chronic health conditions: If you have long term health problems, get them under control. Conditions such as diabetes and nerve diseases can be particularly challenging to deal with and need an entire team of health workers (and family) to help optimise your health.

Physiotherapy: There is special pelvic physiotherapy which can improve the function of the pelvic floor muscles.

Pelvic exercises: The most famous of these are the Kegel exercises in which you voluntarily tighten and relax the pelvic muscles.

Electrical stimulation and biofeedback: This is use of special equipment known as electrodes put on different parts of the pelvis to help improve the co-ordination of the concerned muscles.

Internal pelvic massage: This is a relatively popular method abroad in which the doctor (or specially trained physiotherapist) puts their finger into the rectum or vagina and massages the different parts of the pelvis. If you are not comfortable with this, similar things can be done externally instead.

Surgery: This is reserved for people with prolapse and people in whom incontinence cannot be controlled by non-surgical methods