Pelvic Floor Muscle Dysfunction

Abstract

Pelvic floor muscle dysfunction is a problem that affects women of all ages. The disorder can present as chronic pelvic pain, dyspareunia, rectal pain, chronic constipation, lower back pain, and a wide array of other complaints. As a result of the various presenting symptoms, patients with pelvic floor muscle dysfunction are seen by a variety of health care workers, including obstetrician-gynecologists, urogynecologists, urologists, colorectal surgeons, orthopedic surgeons, physical therapists, chiropractors, pain management specialists, psychotherapists, and others. The purpose of this review is to discuss the etiology, symptomatology, associated conditions, diagnostic tools, and treatment options for this condition.The supportive function of the female pelvic floor is generally achieved by a combination of multiple components working together in a highly coordinated, specialized fashion. This intricate unit is made up of bones, ligaments, muscles, connective tissue, visceral organs, nerves, and vessels. These components are involved in a wide variety of functions that range from simple acts, such as sitting, standing, and walking to more complicated ones, such as child birth, micturition, and defecation. The dynamic capacity of the pelvic floor can be traumatized by a number of events and this can lead to pelvic floor dysfunction. It is important to review the anatomy and function of the pelvic floor, and recognize potential causes for damage and options for treatment when there is dysfunction. ANATOMY BonesThe bony pelvis provides the scaffolding to which the supportive tissues attach. The bones of the pelvis include the pubic bone, the ilium, and the ischium. Ligaments, muscles, fascia, and tendons attach to various parts of the pelvic bones including the ischial spines, rami and tuberosities, the iliac spines, the pubic rami, the sacrum, and the coccyx. The femur is attached to the pelvis via the obturator internus and the piriformis muscles. MusclesThe deep striated muscles of the pelvic floor are made up of the levator ani group that includes the puborectalis, pubococcygeus, and ileococcygeus. The coccygeus, piriformis, and obturator internus muscles also contribute to the pelvic floor. There are smooth muscles that are part of the sphincter mechanism for the urethra and rectum that also contribute to the pelvic floor. 1 Finally, there are superficial muscles such as the bulbospongiosus, ischiocavernosus, and the deep and superficial transverse perinei muscles. 2 These superficial muscles unite at the perineal body, an important component of the pelvic floor.

Results of Sacral Neuromodulation Therapy for Urinary Voiding Dysfunction: Five-Year Experience of a Retrospective, Multicenter Study in China

“…Through these mechanisms, SNM could achieve clinical therapeutic goals for IC/BPS . According to the literature, hypertonic pelvic floor muscle dysfunction is present in approximately 85% of IC /BPS patients . The data in this study showed that the effectiveness rate of SNM for the treatment of IC /BPS was 72.4%.…”

Exercise‐induced hypoalgesia in young adult females with long‐standing patellofemoral pain – A randomized crossover study

“…The magnitude of the EIH effect has recently been shown to be diminished when evaluated after a CPM paradigm (Gajsar et al, 2018) which may have influenced the possibility to detect EIH in the current study. Furthermore, it is unknown if patients have a similar EIH response, as the majority of research has been on healthy individuals (Koltyn.F, 2000). Chronic pain patients demonstrate increased pain sensitivity which has also been associated with an inefficient EIH (Vaegter, Handberg, & Graven-Nielsen, 2016).…”

Prospective Outcomes of a Pelvic Floor Rehabilitation Program Including Vaginal Electrogalvanic Stimulation for Urinary, Defecatory, and Pelvic Pain Symptoms

“…PFD is common, affecting 24% to 33% of women (1,2). Pregnancy, menopause, trauma, pelvic surgery, obesity, and systemic diseases have been suggested as inciting events or conditions that contribute to PFD (3). …”