Pelvic floor dysfunction

Pelvic floor dysfunction (PFD) is a condition that affects the muscles, ligaments, and connective tissues supporting the pelvic organs. When these structures weaken or become uncoordinated, it can lead to various complications, including lower urinary tract (LUT) dysfunction. This condition significantly impacts the quality of life of both patients and caregivers.

Pelvic floor dysfunction can result from muscle weakness, nerve damage, or excessive muscle tension. Common causes include aging, childbirth, pelvic surgery, trauma, and chronic conditions such as obesity or neurological disorders. The dysfunction affects bladder control, often resulting in overactive bladder (OAB) symptoms such as urinary urgency, frequency, and incontinence. In some cases, it may also lead to voiding difficulties and urinary retention due to inadequate relaxation of the pelvic muscles.

Pelvic floor dysfunction in men can be caused by chronic straining (due to constipation or heavy lifting), prostate surgery, or pelvic trauma.

Symptoms of Pelvic Floor Dysfunction

• Urinary urgency – Sudden, strong need to urinate.

• Urinary frequency – Increased need to urinate throughout the day.

• Urge incontinence – Inability to delay urination, leading to involuntary leakage.

• Pelvic pain – Discomfort in the lower abdominal or perineal area.

• Incomplete bladder emptying – Feeling like the bladder is not fully emptied after urination.

• Bowel dysfunction – Issues such as constipation or fecal incontinence.

  
  

Urinary Dysfunction in Pelvic Floor Dysfunction

Urinary disturbances are frequently observed in patients with pelvic floor dysfunction and can significantly impact daily life. Common lower urinary tract symptoms (LUTS) in PFD include:

• Nocturia – Waking up multiple times at night to urinate.

• Hesitancy – Difficulty initiating urination due to muscle dysfunction.

• Straining – Needing to push or strain to empty the bladder.

• Urinary retention – Inability to completely empty the bladder, leading to residual urine and potential infections.

Treatment of Pelvic Floor Dysfunction and Urinary Dysfunction

1. Pelvic Floor Rehabilitation

2. Pelvic floor physical therapy – Exercises such as Kegels to strengthen or relax the muscles.

3. Biofeedback therapy – Helps patients improve muscle coordination.

4. Electrical stimulation – Stimulates weak muscles to improve bladder control.

Symptom Management for Urinary Dysfunction

1. Anticholinergic medications – Reduce detrusor overactivity but may cause side effects.

2. Beta-3 adrenergic agonists – Improve bladder storage capacity with minimal side effects.

3. Urethral bulking agents – Used for stress incontinence to support the urethra.

4. Absorbent products – Provide protection against leakage and ease daily activities.

   
   

Conclusion

Urinary dysfunction is a common and often debilitating symptom in pelvic floor dysfunction. Proper assessment, including urodynamic studies, is essential for accurate diagnosis and differentiation from neurological conditions. A multidisciplinary approach involving urologists, physiotherapists, and pelvic health specialists can optimize treatment and improve the quality of life for patients experiencing bladder dysfunction.