What is pelvic floor dysfunction?
people, having a bowel movement is a seemingly automatic
function. For some individuals, the process of evacuating stool
may be difficult. Symptoms of pelvic floor dysfunction include
constipation and the sensation of incomplete emptying of the
rectum when having a bowel movement. Incomplete emptying may
result in the individual feeling the need to attempt a bowel
movement several times within a short period of time. Residual
stool left in the rectum may slowly seep out of the rectum
leading to reports of bowel incontinence.
The process of defecation (having a bowel movement) requires
the coordinated effort of different muscles. The pelvic floor is
made up of several muscles that support the rectum like a
hammock. When an individual wants to have a bowel movement the
pelvic floor muscles are supposed to relax allowing the rectum
to empty. While the pelvic floor muscles are relaxing, muscles
of the abdomen contract to help push the stool out of the
rectum. Individuals with pelvic floor dysfunction have a
tendency to contract instead of relax the pelvic floor muscles.
When this happens during an attempted bowel movement, these
individuals are effectively pushing against an unyielding
How is pelvic floor dysfunction diagnosed?
The diagnosis of pelvic floor disorder starts with a careful
history regarding an individualís symptoms, medical problems and
a history of physical or emotional trauma that may be
contributing to their problem. Next the physician examines the
patient to identify any physical abnormality. A defecating
proctogram is a study commonly used to demonstrate the
functional problem in a person with pelvic floor dysfunction.
During this study, the patient is given an enema of a thick
liquid that can be detected with x-ray. A special x-ray video
records the movement of the pelvic floor muscles and the rectum
while the individual attempts to empty the liquid from the
rectum. Normally the pelvic floor relaxes allowing the rectum to
straighten and the liquid to pass out of the rectum. This study
will demonstrate if the pelvic floor muscles are not relaxing
appropriately and preventing passage of the liquid.
The defecating proctogram is also useful to show if the
rectum is folding in on itself (rectal prolapse). Many women
have outpouching of the rectum known as a rectocele. Usually a
rectocele does not affect the passage of stool. In some
instances, however, stool may become trapped in a rectocele
causing symptoms of incomplete evacuation. The defecating
proctogram helps to identify if liquid is getting trapped in a
rectocele when the individual is trying to empty the rectum.
How is pelvic floor dysfunction treated?
Pelvic floor dysfunction due to non-relaxation of the pelvic
floor muscles may be treated with specialized physical therapy
known as biofeedback. With biofeedback, a therapist helps to
improve a personís rectal sensation and pelvic floor muscle
coordination. There are various effective techniques used in
biofeedback. Some therapists train patients by teaching them to
expel a small balloon placed in the rectum. Another technique
uses a small probe placed in the rectum or vagina or electrodes
placed on the surface of the skin around the opening to the
rectum (anus) and on the abdominal wall. These instruments
detect when a muscle is contracting or relaxing and provide
visual feedback of the muscle action. This visual feedback helps
the individual to understand the muscle movement and aids in
improving muscle coordination. Approximately 75% of individuals
with pelvic floor dysfunction experience significant improvement
Abnormalities identified with a defecating proctogram such as
rectal prolapse and rectocele may be treated with a surgical