PFD is a common problem. In females it can include:
- Pelvic Organ prolapse
- Urinary incontinence
- Anal Incontinence
- Sexual dysfunction
- Combination of the above
Issues with the pelvic floor are more common:
- During and after pregnancy (more info)
- If you are very overweight
- During and after menopause
- After a period of constipation or if constipation is persistent.
See below for more information:
- Pelvic Organ Prolapse (POP)
- Urinary Incontinence (UI)
- Anal Incontinence (AI)
- Pelvic Floor Muscle Training (PFMT)
- Useful links for PFD
- Devices that may help
- Myth busting!
- How to be referred to a specialist physio
Pelvic Organ Prolapse (POP)
There are 4 main types of POP; you can have more than one…
- Cystocele (Bladder Prolapse) – this is when the front vaginal wall bulges down or out of the vaginal entrance bladder prolapse
- Rectocele (Rectal prolapse) – this is when the back vaginal wall bulges down or out of the vaginal entrance. This is not to be confused with a rectal mucosal prolapse where the rectum itself comes out of the anus
- Uterine (cervical prolapse) – this is when the uterus moves down or out of the vaginal entrance
- Urethrocele (Urethral prolapse) – This is when the front vaginal wall remains well supported but the tube from the bladder bulges down
It may be is possible that you have more than one. Please read our NHS Forth Valley Prolapse information leaflet here.
Urinary Incontinence (UI)
There are 2 types of Urinary incontinence; it is common to get a mix of both problems and both may respond well to pelvic floor muscle training…
- Stress Incontinence (SUI) – this is when your abdominal pressure increases and urine is forced out of the bladder. Abdominal pressure is constantly changing during movement and it is particularly high during coughing, sneezing, laughing and exercise. If you are overweight your abdominal pressure will also be very high during simple movements like getting off a chair.
- Urge incontinence (OAB- wet) – an over active bladder will make you feel like you need the toilet all of the time (urgency) and you may go regularly and pass only small amounts of urine (frequency). You may also wake several times overnight to empty your bladder (Nocturia). This is caused by the over activity of the muscle in the bladder wall which squeezes urine out of your bladder. In addition to pelvic floor muscle training (PFMT), this problem can respond well to fluid changes and bladder drill.
Anal Incontinence (AI)
Anal incontinence can be loss of control of stools (faecal) but also of wind (flatal), both problems can respond well to PFMT. Consistency of the stool is also something to take into consideration, aim for a type 3 or 4 stool on the Bristol stool chart. If the stool is difficult to pass it causes difficultly emptying the rectum fully and if the stool is too loose it is very difficult to maintain control. Both can lead to anal incontinence. A pharmacist or your GP may be able to suggest something that can help improve stool consistency. See here for more information.
Pelvic Floor Muscle Training (PFMT)
Technique
- Find a comfortable position; sitting, lying, standing and kneeling (all fours!) are good options; try to vary your positions
- Relax and breathe normally throughout
- Imagine you are trying to stop yourself from passing wind and urine at the same time
- You should feel a lift as you contract your muscles and a drop as you relax them
- Do not clench your buttocks or your abdominal muscles
- Include both long holds and short squeezes (see below)
Long Holds
- Contract your pelvic floor muscles using the technique above
- Hold for as long as you can up to 10 seconds
- Release and let them fully relax
- Rest for 5-10 seconds
- Repeat as many times as you can until the muscles fatigue
- Repeat 3 times per day
Short Squeezes
- Contract your pelvic floor muscles using the technique above
- Release and let them fully relax
- Rest for 1-2 seconds
- Repeat as many times as you can until the muscles fatigue
- Repeat 3 times per day
The Knack
Contract the pelvic floor muscles just before you know you might be about to leak such as when coughing, sneezing, laughing or doing particular movements during exercise e.g. squat.
Useful Links for Pelvic Floor Dysfunction
- Pelvic Floor Exercises
- NHS Squeezy App
- NHS Forth Valley Choose to lose
- Bladder and Bowel Community
- British Dietetic Association
- NHS BMI Calculator
- The Menopause and the effects on the bladder
- Constipation
- Pelvic Obstetric and Gynaecological Physiotherapy
Devices that may help with PFMT
There are many devices available on the internet and in shops that may help with pelvic floor muscle training.
- Weighted devices- also known as vaginal weights, Kegal weights or vaginal cones. These weighted devices will add resistance to your pelvic floor exercises and assist with strengthening. Most come with a variety of weights and sizes. To begin with you would start with the lightest/ largest weight and progress as your strength develops to a smaller/ heavier weight.
- Stimulator- Pelvic floor stimulation can help women with a weak contraction to strengthen their pelvic floor. Small amounts of electrical stimulation are delivered to the nerves and muscles of the pelvic floor by a small internal probe. This can help with pelvic floor muscle rehabilitation.
- Biofeedback- Pelvic floor biofeedback device can monitor your pelvic floor contraction accurately and will show you are doing your exercises correctly. This allows you to monitor your progress and assists with improving your pelvic floor contraction and intensity by helping you ‘see’ the contraction.
Myth busting!
‘The pelvic Floor is one big muscle’……….. FALSE- the pelvic floor is a group of muscles with 2 distinct layers; the muscles and fascia in the deep layer work together to suspend and lift the pelvic organs up and forwards closing the urethra, vagina and anus to keep you continent. The more superficial layer assists with this and is also involved with sexual function. Interestingly the pelvic floor is the only horizontal group of muscle in the human body which is one of the reasons it is so vulnerable in people who are overweight.
‘I can work the front and the back of my pelvic floor separately’…….. FALSE- Although there are many muscles in the pelvic floor they are switched on by the same nerves at the front and back so it is impossible to do one without the other, however, your sensation may differ at the front and back and you may get a better contraction by concentrating your efforts on one or the other.
‘It’s all about the strength’….. FALSE- the pelvic floor has a lot to do; it has to be strong but also needs to be able to coordinate an intricate pattern of movement, timing and reflexes to maintain your continence.
‘If I’m having incontinence my muscles must be weak and loose’…… FALSE- As mentioned above movement of the pelvic floor is extremely important, in some cases the muscles are weak because they are tight and cannot move enough. This is often the case in women who also have sexual dysfunction such as pain during intercourse, during a smear test or while using tampons. In this instance, pelvic floor muscle exercises done incorrectly can make the problem worse.
‘Pelvic Floor muscle training (PFMT) doesn’t work’…….. FALSE- When done regularly and correctly PFMT can be very effective. Sticking to a program of exercises can be the biggest difficulty so consider using a diary or the NHS Squeezy App to help remind you and record your progress.
How to be referred to a specialist physio
- It is important that your GP has the opportunity to discuss your symptoms, examine you and do some provisional checks prior to referral.
- You can discuss referral to a specialist Pelvic Health Physiotherapist with your GP and if appropriate they will refer you.
- If you are having problems with vaginal bleeding, rectal bleeding, blood in the urine, menopause or recurrent urinary infections, your GP may suggest that you are referred to a different service.