Recognition and Management of Nonrelaxing Pelvic Floor Dysfunction

Abstract

Nonrelaxing pelvic floor dysfunction is not widely recognized. Unlike in pelvic floor disorders caused by relaxed muscles (eg, pelvic organ prolapse or urinary incontinence, both of which often are identified readily), women affected by nonrelaxing pelvic floor dysfunction may present with a broad range of nonspecific symptoms. These may include pain and problems with defecation, urination, and sexual function, which require relaxation and coordination of pelvic floor muscles and urinary and anal sphincters. These symptoms may adversely affect quality of life. Focus on the global symptom complex, rather than the individual symptoms, may help the clinician identify the condition. The primary care provider is in a position to intervene early, efficiently, and effectively by (1) recognizing the range of symptoms that might suggest nonrelaxing pelvic floor dysfunction, (2) educating patients, (3) performing selective tests when needed to confirm the diagnosis, and (4) providing early referral for physical therapy.

MicroRNA-214 Affects Fibroblast Differentiation of Adipose-Derived Mesenchymal Stem Cells by Targeting Mitofusin-2 during Pelvic Floor Dysfunction in SD Rats with Birth Trauma

“…It has been shown that vaginal delivery may cause pelvic floor dysfunction (PFD) by damaging pelvic support tissues such as muscles, connective tissues and nervous structures [2]. Patients with PFD present a variety of clinical scenarios, including lower urinary tract excretory and defecation dysfunction and prolapse of the female reproductive organs and pain [3, 4]. More than 30% of women suffer from PFD, depending on the different definitions of the disorder [1].…”

American Gastroenterological Association Technical Review on Constipation

“…This procedure has greatest value in (1) excluding Hirschsprung's disease by the presence of a normal rectoanal inhibitory reflex and (2) supporting a clinical impression of defecatory disorders as evidenced by high anal resting pressures, typically ≥90 mm Hg (anismus), with relatively little voluntary augmentation, suggestive of a nonrelaxing pelvic floor/sphincter dysfunction 92 or an abnormal (ie, lower) rectoanal pressure gradient during simulated evacuation. The precise utility of a low rectoanal pressure gradient to diagnose defecatory disorders is unclear because there is considerable overlap in values for this parameter between asymptomatic subjects and patients with defecatory disorders.…”

Accurate Differentiation of Dyssynergic Defecation Patients from Normal Subjects Based on Abnormal Anorectal Angle in MR Defecography

“…In many authors' opinions, this learned misresponse (paradoxical contraction) may be due to sexual, physical or emotional abuse, or resulting from a history of painful defecation during childhood [4,5].The pathophysiology of chronic constipation is heterogeneous; so, different physiological tests, such as "balloon expulsion test", "conventional defecography", electromyography (EMG) of the muscles of anal and pelvic floor can be used to identify the DD patients [6]. Each of these tests has its own limitations, thus, none can be used separately.…”