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Pelvic Floor Dysfunction

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Pelvic Floor Dysfunction, Pelvic Floor Muscle Dysfunction, Pelvic Floor Disorder, Pelvic Floor Muscle Weakness, Pelvic Floor Insufficiency, Pelvic Floor Dyssynergia

  • Definitions
  1. Pelvic Floor Disorder
    1. Injury, weakness or prolapse of the pelvic Muscles and surrounding ligaments and connective tissue
  2. Pelvic Floor Dyssynergia
    1. Pelvic Muscles paradoxically contract and rectal sphincter tightens during Defecation (instead of normal relaxation)
    2. Results in pain and Constipation
  • Complications
  1. Dyspareunia
  2. Chronic Pelvic Pain
  3. Urinary Incontinence
  4. Defecatory Dysfunction (Constipation)
  • Exam
  1. See Chronic Pelvic Pain Exam
  2. Patient contracts pelvic floor Muscles which should raise the perineum
  3. Assess for tenderness while palpating pelvic floor Muscles via the vaginal introitus
  • Management
  1. See Pelvic Floor Exercise
  2. Consider physical therapy (Pelvic Floor specific programs)
  3. Other interventions
    1. Gabapentin (Neurontin)
    2. Trigger Point Injection (Local Anesthetic or Botulinum Toxin A)
    3. Neuromodulation with nerve stimulator (posterior tibial, pudendal, sacral nerve)
  • References
  1. Hill (2021) Am Fam Physician 103(10):597-604 [PubMed]