The Pelvic Floor
The Basics
This is not a substitute for direct care by YOUR doctor. Confirm with your doctor before doing any of the following.
- The pelvis is at the bottom of your abdomen and holds up your bowels, urinary system, and reproductive organs. The complex muscles at the bottom of your pelvis both hold things in place but also allow your body to release urine and stool when you want it to. Sometimes the muscles can be hyperactive, meaning they do not relax when they should. This can cause pain or inability to release urine or stool. Things like aging, connective tissue disorders, pregnancy (and childbirth), chronic constipation, and chronic cough amongst other things can lead to weakness in this area. For some people, this leads to an inability to hold in urine, stool, or gas as desired. Organs can also "prolapse" or drop down from where they are supposed to be within the pelvis.
- Many of these problems can be improved and sometimes fixed. For most patients with colon and rectum related issues, the first step is documenting your symptoms in a diary to keep tract of what may be causing them and what makes them better. Many patients benefit from pelvic floor physical therapy with biofeedback. This is a special kind of physical therapy that trains your body to do what you want it to do, when you want to do it. Avoiding both constipation and diarrhea as possible are very important. Having enough fiber and water daily is key. Good bathroom habits are also very important. Do not sit on the toilet for more than about 5 minutes if possible. If nothing comes out, or you feel like something is left, then try standing up and walking around. Return to the toilet when you feel very ready to have a bowel movement. IF YOU READ ON THE TOILET THEN SET A TIMER!
- If these non-surgical options do not work, some patients are good candidates for surgical repairs. If you are a candidate for a surgery, what kind of surgery, what the expected outcome is, how likely the repair is to last, and when the surgery should be done are all discussions that should be had with your doctor.
Betschart C, Singer A, Scheiner D. Beckenboden der Frau: Anatomie und normale Funktion [Female pelvic floor: anatomy and normal function]. Ther Umsch. 2019;73(9):529-534. German. doi: 10.1024/0040-5930/a001035. PMID: 31113318.
Eickmeyer SM. Anatomy and Physiology of the Pelvic Floor. Phys Med Rehabil Clin N Am. 2017 Aug;28(3):455-460. doi: 10.1016/j.pmr.2017.03.003. Epub 2017 May 27. PMID: 28676358.
https://www.continence.org.au/about-continence/continence-health/pelvic-floor
https://fascrs.org/patients/diseases-and-conditions/a-z/pelvic-floor-dysfunction
