The pelvic floor is a muscular and ligamentous structure that supports key organs in the pelvis, such as the bladder, uterus and rectum. When this system loses its functionality, it can lead to various pathologies that affect the quality of life of patients, both men and women. Below, we will explore the main pelvic floor pathologies, their causes, symptoms and available treatments.
What is the Pelvic Floor and Why is it Important?
The pelvic floor is a set of muscles, tissues and ligaments that forms a kind of "hammock" to support the pelvic organs. Its correct functioning is essential for:
● Control urinary and faecal continence.
Maintain the pelvic organs in their proper position.
● Facilitating childbirth for women.
● Contribute to sexual well-being.
When the pelvic floor is weakened or damaged, various pathologies can develop.
Main Pelvic Floor Pathologies
- Pelvic Organ Prolapse:
○ Occurs when one or more pelvic organs (bladder, uterus or rectum) descend into the vagina due to muscle weakness.
○ Symptoms: Feeling of weight or pressure in the pelvis, difficulty urinating or defecating, discomfort when walking or having sex. - Urinary incontinence:
Involuntary loss of urine, especially with coughing, laughing, or physical activity. May be exertional, urgent or mixed.
○ Risk factors: Vaginal childbirth, menopause, ageing and obesity. - Faecal incontinence:
○ Difficulty controlling bowel movements, causing faecal leakage.
○ Causes: Muscle or nerve injuries, complicated childbirth, or previous surgeries. - Chronic pelvic pain:
Persistent pain in the pelvic region that is not directly related to the menstrual cycle or an active infection.
○ Causes: Muscle tension, nerve damage or diseases such as endometriosis. - Sexual Difficulties:
○ Pain during sexual intercourse (dyspareunia) or lack of sensation due to a weakened or hypertonic pelvic floor. - Male Pelvic Floor Dysfunction:
Prostate-related problems or muscle weakness that may affect continence and sexual function.
Causes of Pelvic Floor Pathologies
The main causes include:
Vaginal delivery: Can weaken pelvic floor muscles and tissues, especially after prolonged or multiple births.
● Ageing: The natural loss of muscle elasticity and strength with age.
Obesity: Increases pressure on the pelvic floor.
● Previous surgeries: Procedures such as hysterectomies can weaken pelvic support.
Chronic strain: Lifting heavy objects or prolonged constipation.
Neurological disorders: Damage to the nerves that control the pelvic floor.
Diagnosis of Pelvic Floor Pathologies
The diagnosis is made through:
Clinical history: Assessment of symptoms, medical history and risk factors.
Physical examination: Examination of the pelvic floor to assess muscle strength and possible prolapse.
Imaging studies: Ultrasound, MRI or cystogram to identify the degree of involvement.
Functional tests: such as anal manometry or urodynamics to assess sphincter function.
Available Treatments
Treatment will depend on the type and severity of the pathology, and may include:
- Pelvic Floor Rehabilitation:
○ Kegel exercises to strengthen muscles.
Pelvic physiotherapy, including techniques such as biofeedback and electrostimulation. - Lifestyle changes:
Weight loss, treatment of constipation and avoidance of heavy lifting. - Medical Devices:
○ Pessaries for organ prolapse, which help keep organs in place. - Pharmacological treatment:
○ Use of medication to control urinary incontinence or pelvic pain. - Surgical interventions:
○ Prolapse repair by laparoscopic or vaginal techniques.
○ Sphincteroplasty for faecal incontinence.
○ Surgical meshes in cases of severe prolapse. - Complementary Treatments:
○ Hormonal therapies in postmenopausal women.
○ Neuromodulation for pelvic floor nerve control.
Prevention of Pelvic Floor Pathologies
● Perform strengthening exercises from an early age.
● Avoid constipation by eating a diet rich in fibre.
● Controlling body weight.
● Maintain adequate physical activity and avoid excess pressure on the pelvis.