Pelvic Floor Conditions cause symptoms of pain, discomfort and embarrassment. Diagnosis is the first step to treating the cause.
Evacuatory problems mean difficulty in emptying the bowels when it is time to go to the toilet. Constipation can refer to a sluggish or slow bowel which may result in your stools becoming too hard and difficult to pass. However, it can also be caused by obstructive defecation syndrome (ODS) or the sensation of a blockage to emptying the bowel.
- Straining to empty your bowels
- Prolonged and sometimes unsuccessful attempts to pass stools
- Manual assistance or ‘digitation’ in the rectum or vagina needed to empty the bowels
- A feeling of incomplete emptying after emptying your bowels, or difficulty wiping the anus clean
- Needing to use laxatives or enemas.
There are a number of possible causes of ODS, including both co-ordination issues and structural weakness:
- Problems relaxing the anal sphincter or pelvic floor muscles when passing stools
- A weakness in the muscle wall that allows the rectum to push against the vaginal wall and form a ‘rectocele’ . You may notice a bulge inside your vagina or a dragging sensation, particularly towards the end of the day or if you have been lifting or standing. A rectocele can also result in needing to go repeatedly or the sensation of retained stool and incomplete evacuation
- Internal rectal prolapse which can obstruct the bowel
- An ‘enterocele’ or prolapse of the small bowel or sigmoid colon into the pelvis on straining.
ODS is particularly common in women often due to damage to the pelvic floor during natural childbirth or in patients that have had pelvic surgery, such as a hysterectomy.
Your doctor will want to carry out an internal examination to see if you have a prolapse or hernia. You may be referred for a diagnostic procedure called defecation proctography, which involves inserting a contrast dye into your rectum and taking X-rays as you pass stools to see what is causing the obstruction.
Ensuring adequate posture during evacuation and avoiding straining can help prevent ODS developing. Maintain a soft stool consistency is also important and not delaying evacuation when the urge is present.
Faecal incontinence (also known as bowel incontinence) means a problem controlling your bowels. The symptoms include:
- Urge incontinence – a sudden urge to pass stools, but being unable to reach the toilet in time
- Leaking stool, for example when you pass wind it is wet
- Passive incontinence – soiling yourself without realising you needed to go to the toilet
- Concerns about passing stools that are affecting your day-to-day life.
The problems may occur occasionally, or on a daily basis.
Faecal incontinence is usually a symptom of an underlying condition. There are many different causes of faecal incontinence, which can occur earlier in life leading to symptoms later on, including:
- Childbirth involving forceps, instrumentation or tears, a history of prolonged labour or delivery of twin babies
- Weakening of the sphincter muscle that controls the opening to your anus
- Certain conditions that affect the nerves in your anus, including stroke, diabetes, multiple sclerosis and dementia
- Irritable bowel syndrome causing a very loose stool
- A history of surgery in the perianal or rectal area.
It may be helpful to keep a food and symptom diary so you can identify triggers and a pattern to your symptoms.
It is believed that one in 10 people are affected by faecal incontinence at some point in their lives.
Women are more commonly affected than men due to the history of childbirth. The problem can occur at any age but it is more common in older people. However, faecal incontinence is not an inevitable consequence of ageing and you should seek medical advice as treatment and investigation can be undertaken.
Although many people can be embarrassed to visit their GP with faecal incontinence, you don’t need to suffer in silence, as there are treatments available that can help.
To prevent faecal incontinence or reduce the severity of symptoms you are advised to:
- Avoid straining when you pass stools, as this can weaken your anal sphincter muscles
- Eat high fibre foods to prevent constipation
- Discuss the risks of delivery at the time of childbirth
- Undertake pelvic floor exercises as recommended.
Pelvic pain can arise from the bowel, bladder or reproductive system. It may be:
- Acute – sudden and unexpected pain. If you have an intense pain that comes on suddenly you should see your doctor or specialist urgently
- Chronic – persistent or recurrent pain that lasts for six months or longer. This feels more intense than ordinary period pains and lasts for longer. It affects roughly one in six women and can have a number of possible causes.
Pelvic pain during pregnancy should always be investigated by a doctor as it may be a sign of ectopic pregnancy or miscarriage.
Acute pelvic pain in women who are not pregnant may be caused by:
- Appendicitis – you will experience pain in the lower right-hand side of your tummy
- Appendicitis is swelling of the appendix, which is connected to your large intestine
- Peritonitis – the symptoms are abdominal pain that becomes steadily worse. It is caused by inflammation of the peritoneum, which is the tissue lining the abdomen. It requires immediate medical treatment and admission to hospital
- Acute pelvic inflammatory disease – a bacterial infection of the womb, ovaries or fallopian tubes. It may develop as a result of chlamydia or gonorrhoea. It requires prompt treatment with antibiotics
- Ovarian cyst – cysts can develop on the ovary. They are generally painless unless they burst or become twisted
- Urinary tract infection – this can cause pelvic pain, along with a frequent urge to wee and burning sensation ‘cystitis’
- Bowel spasm or colic – this may be caused by IBS, diverticular disease, constipation or an obstruction in the bowel
- Abscess – a pelvic abscess is a build up of pus between your vagina and your womb. It requires immediate hospital treatment
- Endometriosis – a long-term condition, which leads to heavy, painful periods. It is caused by small pieces of the womb lining being found outside the womb, in the ovaries and fallopian tubes.
Chronic pelvic pain may be caused by:
- Irritable bowel syndrome – a long-term condition of the digestive system that can cause diarrhoea, constipation, stomach cramps and bloating
- Chronic pelvic inflammatory disease or cystitis
- Recurrent urinary tract infection or ovarian cysts
- Adenomyosis – Endometriosis that affects the muscles of the womb, causing heavy painful periods
- Fibroids – benign (non-cancerous) tumours that grow in or around the womb
- Prolapsed womb – caused by the womb slipping out of position. This causes a dragging pain in the pelvis
- Inflammatory bowel disease – chronic inflammation of the bowel caused by Crohn’s disease or ulcerative colitis
- Hernia or trapped nerve.
Pelvic pain normally affects women. Men are rarely affected, with the exception of conditions like appendicitis, peritonitis, hernia and inflammatory bowel disease.
Treatment will depend on whether the pain is chronic or acute and what is causing it. You may be offered a range of possible diagnostic tests including a pelvic examination, ultrasound scans, blood test to check for infection, CT or an MRI scan.
A laparoscopic test allows your doctor to check for signs of infection including pelvic inflammatory disease and endometriosis. It involves making a small incision in your tummy and inserting a tube attached to a small camera.
You should seek urgent medical treatment if you experience sudden or acute pelvic pain to prevent potentially dangerous complications.
A pelvic organ prolapse occurs when organs in the pelvis, including he womb, bladder, bowel or top of the vagina, slip out of position and bulge externally.
You may or may not experience symptoms. If there are no symptoms, the condition might only be discovered if you have an internal examination for another reason. If you do have symptoms, they might include:
- A dragging feeling inside your vagina
- A lump or bulge coming out of your vagina or rectum
- A heavy feeling in your pelvis
- Feeling like you are sitting on a small ball
- Needing to wee more often, having problems going for a wee or leaking wee when you cough, sneeze or exert yourself
- Discomfort during sex.
Prolapse is caused by weakening of the muscles (the pelvic floor) that hold the pelvic organs in place.
There are four common types of prolapse:
- Anterior prolapse – where the bladder bulges into the front wall of the vagina
- Uterine prolapse – where the womb bulges down into the vagina
- Vault prolapse – where the top of the vagina sags down
- Posterior wall prolapse – where the bowel bulges forwards into the back wall of the vagina
- Rectal prolapse – when the bowel hangs out of the anus.
Prolapses are graded on a scale of 1 to 4 with 4 being the most severe.
You are most at risk of pelvic floor weakness if:
- You have been pregnant or had multiple births or given birth to a large baby
- You are overweight
- You have long-term constipation or another condition that causes straining
- You do a lot of heavy lifting
- You are getting older
- You have had a hysterectomy
- You have Ehlers-Danlos syndrome, Marfan syndrome or joint hypermobility syndrome.
The treatment you are offered will depend on the type and severity of your prolapse, your age and general state of health, whether you are planning to have children in the future.
Certain lifestyle changes may help you to avoid a pelvic organ prolapse or may help to ease your symptoms if you already have a prolapse. These include:
- Eating a high-fibre diet to avoid constipation
- Giving up smoking as a cough can cause or exacerbate a prolapse
- Losing weight if you are overweight
- Avoiding heavy lifting
- Exercises to strengthen your pelvic floor muscles.
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