Pelvic Floor - Clinical Significance

Clinical Significance

In women, the levator muscles or their supplying nerves can be damaged in pregnancy or childbirth. There is some evidence that these muscles may also be damaged during a hysterectomy. Pelvic surgery using the "perineal approach" (between the anus and coccyx) is an established cause of damage to the pelvic floor. This surgery includes coccygectomy.

In female high-level athletes, perineal trauma is rare and is associated with certain sports (each with a distinct type of trauma): water-skiing, bicycle racing, and equestrian sports.

Damage to the pelvic floor not only contributes to urinary incontinence but can lead to pelvic organ prolapse. Pelvic organ prolapse occurs in women when pelvic organs (e.g. the vagina, bladder, rectum, or uterus) protrude into or outside of the vagina. The causes of pelvic organ prolapse are not unlike those that also contribute to urinary incontinence. These include inappropriate (asymmetrical, excessive, insufficient) muscle tone and asymmetries caused by trauma to the pelvis. Age, pregnancy, family history, and hormonal status all contribute to the development of pelvic organ prolapse. The vagina is suspended by attachments to the perineum, pelvic side wall and sacrum via attachments that include collagen, elastin, and smooth muscle. Surgery can be performed to repair pelvic floor muscles. The pelvic floor muscles can be strengthened with Kegel exercises.

Disorders of the posterior pelvic floor include rectal prolapse, rectocele, perineal hernia, and a number of functional disorders including anismus. Constipation due to any of these disorders is called "functional constipation" and is identifiable by clinical diagnostic criteria.

Pelvic floor exercise (PFE), also known as Kegel exercises, may improve the tone and function of the pelvic floor muscles, which is of particular benefit for women (and less commonly men) who experience stress urinary incontinence. However, compliance with PFE programs often is poor, PFE generally is ineffective for urinary incontinence unless performed with biofeedback and trained supervision, and in severe cases it may have no benefit. Pelvic floor muscle tone may be estimated using a perineometer, which measures the pressure within the vagina. Medication may also be used to improve continence. In severe cases, surgery may be used to repair or even to reconstruct the pelvic floor. It has been reported that patients who have overly-toned musculature may suffer from inability to relax the pelvic floor muscles - in effect, Kegel exercises would only exacerbate the problem. http://www.massagetoday.com/mpacms/mt/article.php?id=13515

Perineology or pelviperineology is a speciality dealing with the functional troubles of the three axis (urological, gynaecological and coloproctological) of the pelvic floor.