Pelvic Floor Dysfunction and its Role in Incontinence

One condition that affects woman and men of all ages is pelvic floor dysfunction. Your pelvic floor is a region of muscular tissue that rests in your pelvis area. This area is responsible for helping you to control bowel movements, in addition to urinary control. When these muscles are weakened, the issue can be diagnosed and it can lead to chronic pelvic pain, which is termed pelvic floor dysfunction.

Pelvic Floor Muscles and How they Function

A very unique aspect to the pelvic floor muscle system is that they play a major role in the urinary system as well as for bowel movement health. The pelvic muscles stretch across the pelvis region, act together by contracting and resting the pelvis area, which then helps you to have control of your urinary system. However, when the muscles are not functioning together, incontinence could occur as well as chronic pelvic pain.

Understanding The Classifications of Pelvic Floor Disorders

Pelvic floor dysfunction usually can be described in different types of classifications: low tone disorders as well as high tone disorders. When the muscles are classified as low tone disorder, it is typically caused by the muscles being weakened, which can prohibit maximal muscular contraction and thus causing disorder to the pelvic region. Low tone dysfunction is typically associated with conditions such as prolapse and well as incontinence.

In comparison to low tone disorders, high tone disorders can occur when the muscles are unable to function properly, which usually involves relaxation and contraction issues. When muscles are too tight or cannot fully relax, it prevents the full potential of the muscle to contract and relax, which can cause dysfunction to the muscle group. Interestingly, high tone disorders to the pelvis region are commonly caused as a secondary concern, meaning another condition creates this dysfunction.

Common Symptoms of Pelvic Floor Dysfunction

Symptoms of pelvic floor issues typically involve bowel and urinary incontinence, including the inability to have a complete bowel movement. In addition, constipation and having the urge to urinate often are signs that something is not functioning properly in the pelvic region. Women could experience painful urination as well as pain during intercourse.

Treatment Options for Pelvic Floor Disorders

There are not a wide range of treatment options for pelvic floor disorders; however, one of the most holistic approaches involves specialized physical therapy. The physical therapy techniques used for pelvic floor dysfunction should include manual relaxation techniques internally as well as externally. The optimal amount of manual therapy should include roughly 20 percent internally and 80 percent externally, so as to avoid patient dependence.
In addition to providing manual therapy, physical therapists can utilize biofeedback tools to help contract and relax the muscles in the pelvic floor. These biofeedback tools usually consist of sensors, to which the therapist can visualize how the muscles are working when the patient attempts to relax and contact. Upon visualizing the patient’s individual functionality, the therapist can provide feedback as a way to improve the effectiveness of the pelvic floor muscles. This technique is fairly new, but it is a highly specialized approach that is used in the treatment of pelvic floor disorders.

What Role Does Timing Play?

Too often patients present to specialty offices when a great deal of time has passed once symptoms have occurred. When this happens, it can be a challenge to assess the order in which the muscles have progressed in dysfunction. With that said, there is a level of importance when it comes to seeing a professional who can help with pelvic floor disorders.

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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

image

Complete tear of rectus femoris
with large hematoma (blood)

image

Separation of muscle ends due to tear elicited
on dynamic sonography examination

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