Pelvic Floor Dysfunction (PFD) is when the muscles surrounding your anus, vagina and urethra do not contract and relax properly.
When the pelvic floor muscles (PFM) function normally, urination and bladder function can be partially controlled by the contraction and relaxation of the pelvic floor. When you urinate, the PFM relax, signaling the bladder to contract, and voiding occurs normally. Conversely, when there is an urge to urinate that you cannot immediately act on, contracting the PFM sends a message to the bladder, telling it to relax and wait.
With Pelvic Floor Dysfunction, the muscles do not relax properly, and often contract at inappropriate times (like when you are trying to void). This makes it difficult for the bladder to function properly, making you feel like you have to “bear-down” to push the urine out. This pushing activity worsens the PFD, and puts strain on the structures that support the pelvic floor. These strong, spontaneous contractions can become painful spasms, triggering painful sensations throughout the pelvic region. This tightening of the pelvic floor can also contribute to bladder spasm, or intense feelings of urgency to void.
Pelvic floor dysfunction is rarely diagnosed alone, it is usually a symptom of one or more disease or syndrome. The most common are Vulvadynia and Interstitial Cystitis.

Symptoms:

• Poor Urine Stream - if the PFM are in spasm, your urine stream will be slow, erratic and/or uneven
  
• Feeling a need to “bear-down”- if you need to push to urinate or defecate, the pelvic floor muscles may not be relaxing properly. It is very important to not push the urine out. Relax, take your time, breathe. Every time you bear-down, you worsen the condition.
  
• Unexplained pain in the pelvic region, low back or genitalia – These symptoms could indicate a lot of things, be sure to consult a physician if you suspect that you may have an infection.
  
• Painful Intercourse (Dyspareunia) – This pain may be felt during intercourse or after, sometimes not until the next day

.

What can I do?
Treating pelvic floor dysfunction requires a team approach. A gynecologist or urologist (or both) that is familiar with PFD and how it effects function is important. There are medications, diet plans and supplements that help to treat the conditions associated with PFD. It’s very important to have a medical team that you are comfortable with. Remember that everyone responds differently to treatments, and communication is important. If something doesn’t work the first time, it may just need a little time, or some modification, or maybe scrapped all together.

Physical therapy is conservative treatment that has gained a lot of recognition in the medical community over the past several years. As physical therapists, here are some of the tools and techniques that we use to help correct this problem:

• Biofeedback (surface emg) therapy – using surface electrodes near your anus, or vaginal or rectal probes, you are connected to a machine that will give you immediate feedback as to whether the muscles are relaxed or contracted. You will learn to isolate and relax the muscles of the pelvic floor. The focus for biofeedback for pelvic floor dysfunction is very different than for incontinence. Here at Slainte Physical Therapy we use “down-training” to relax the muscles. Be sure if you seek care elsewhere you ask specifically about down-training.
  
• Manual Therapy - This includes various techniques both internal (vaginal or anal) and external to help reduce the spasm of the pelvic floor, and balance the structures of the entire pelvic region and spine.
  
• Electrical modalities – Including electrical stimulation and therapeutic ultrasound to help reduce pain and spasm.