Insights into pelvic floor disorders

Pelvic floor disorders encompass conditions that impact the muscles, ligaments, and connective tissues within the pelvic region. These disorders can lead to a variety of uncomfortable symptoms, and affect both men and women.

Here, Professor Charles Knowles, renowned consultant colorectal surgeon in London, offers an expert insight into pelvic floor disorders. He explains potential causes, diagnostic approaches, as well as available treatments.

What are pelvic floor disorders?

Pelvic floor disorders refer to a range of conditions affecting the muscles, ligaments, and connective tissues that support the pelvic organs, including the bladder, uterus, vagina, and rectum.

These disorders can lead to symptoms, such as:

• Urinary incontinence: Refers to leakage of urine, which can occur with coughing, sneezing, or physical activity (stress incontinence), or a sudden urge to urinate (urge incontinence).
• Faecal incontinence: Refers to the inability to control bowel movements, resulting in leakage of stool.
• Pelvic organ prolapse: Refers to a feeling of pressure or bulge in the pelvic area, often due to the descent of pelvic organs (such as the bladder, uterus, or rectum) into the vagina or through the anus.
• Pelvic pain: Refers to chronic discomfort or pain in the pelvic region, which may be associated with sexual activity, urination, or bowel movements.

Can men experience pelvic floor disorders?

Yes, pelvic floor disorders aren’t exclusive to women; men can also experience them. While they are less common in men, conditions such as urinary incontinence, faecal incontinence, pelvic pain, and rectal prolapse can occur.

What causes pelvic floor disorders?

In women:

• Childbirth: The stress and trauma of vaginal childbirth can weaken pelvic floor muscles and lead to pelvic organ prolapse or urinary incontinence.
• The menopause: Hormonal changes during the menopause can contribute to pelvic floor weakness and urinary incontinence.
• Chronic conditions: Obesity, chronic coughing, and constipation can exert pressure on the pelvic floor muscles and contribute to the development of pelvic floor disorders.

In men:

• Prostate conditions: Enlarged prostate (benign prostatic hyperplasia) or prostate cancer treatment (such as radical prostatectomy) can impact pelvic floor function and lead to urinary incontinence or pelvic pain.
• Pelvic surgery: Procedures involving the prostate, bladder, or rectum can disrupt pelvic floor function and contribute to pelvic floor disorders.
• Chronic conditions: Obesity, chronic constipation, and neurological disorders can also increase the risk of pelvic floor disorders in men.

How are pelvic floor disorders diagnosed?

Diagnosis of pelvic floor disorders typically involves a complete medical evaluation by a specialist, including a medical history review and rectal examination (vaginal examination also in women). Thereafter, additional tests may be recommended such as pelvic ultrasound, urodynamic testing, anorectal physiology testing and/or MRI scan to assess pelvic organ anatomy and function.

What treatment options are available for pelvic floor disorders?

Treatment options for pelvic floor disorders may include:

• Pelvic floor exercises: Strengthening exercises (also known as ‘Kegels’) to improve pelvic floor muscle function and control.
• Lifestyle modifications: Dietary changes, weight management, and smoking cessation to reduce pressure on the pelvic floor.
• Medications: Medications to manage symptoms such as constipation, incontinence, or pelvic pain.
• Physical therapy: A supervised programme of pelvic floor muscle training to address muscle weakness or incoordination (biofeedback therapy). Modified programmes are also employed for pain.
• Trans-anal irrigation (for rectal problems).
• Surgery: All surgical procedures are first discussed at a multidisciplinary meeting to ensure that surgery is warranted and that the right operation is offered. In addition, we provide joint operating (urogynaecology and bowel surgeons together) as routine to avoid treating one problem but missing another. We offer all contemporary surgical procedures for:

◦ incontinence, including neuromodulation

◦ chronic constipation, including colectomy, stoma and ACE

◦ pelvic organ prolapse, including mesh-free minimally invasive (laparoscopic and robotic) abdominal and perineal (transanal and transvaginal) approaches

In terms of prevention, seeking prompt medical attention for conditions such as urinary tract infections, chronic coughing, or bowel disorders can help prevent complications that may contribute to pelvic floor dysfunction.

If you require expert diagnosis and treatment for pelvic floor disorders, schedule a consultation with Professor Charles Knowles via his Top Doctors profile today.