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.
- If you are not always in control of when or where you urinate, have a bowel movement, or pass gas then you MAY have a problem with your PELVIC FLOOR. Many of these problems can be significantly improved and sometimes completely fixed.
- 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, gas, 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. Sometimes the muscles are too weak or do not respond to your nerves like they are supposed to do. 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.
- For most patients with colon and rectum related issues, the first step is documenting your symptoms in a diary to keep track 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. This kind of physical therapy requires a specialty trained physical therapist such as those here: Pelvic Health - Pelvic Floor Physical Therapy | Duly Health and Care .
- 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!
- There are different types of incontinence. Some types have to do with increased pressure in your abdomen (as in from laughing or jumping). Some types are from your body’s inability to maintain a good seal at rest. These issues are related but caused by slightly different issues and treated in slightly different ways. Some people have problems with only urine or only gas or only stool. Each of these has treatment options. You DO NOT HAVE TO SUFFER. It can be very embarrassing to discuss these issues, but almost nothing is worse than suffering in silence.
- If non-surgical options do not work, some patients are good candidates for surgical treatment. Many of these procedures are minimally invasive and involve minimal time off of work or school. If you are a candidate for a surgery, what kind of surgery, what the expected outcome is, and when the surgery should be done are all discussions that should be had with your doctor. Like almost all surgeries and medications, pelvic floor surgeries have better outcomes for patients if non-surgical treatments are optimized as well.
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
