Tips for identifying and dealing with pelvic floor problems

The pelvic floor can sometimes become too weak, stretched or even too tight. In many cases this can be debilitating and have a significant impact on quality of life.

Pelvic floor problems are very common in Ireland, affecting about one in 10 women and some men. Pelvic floor health is important in maintaining several body functions and ensuring good quality of life.

In many cases, patients can be embarrassed to talk about their symptoms with their family and GP. And some GPs are not really aware of these conditions and the treatment options available.

One of the primary underlying disorders in these group of patients is pelvic floor dysfunction (PFD), which is the inability to control the muscles of the pelvic floor. Contracting and relaxing these muscles allows people to control bowel movement, urination and sexual function in women.

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Here is some advice for people who may be suffering from problems with their pelvic floor.

What causes pelvic floor issues to occur?

These problems are common among women after difficult childbirth and delivery. In particular, women who have had multiple pregnancies with difficult and long labour should be on the lookout for symptoms. The ageing process can also cause these issues to develop as pelvic floor muscles get weaker over time. Additionally, chronic or repeated straining on the toilet, associated with constipation, can cause problems.

What symptoms should I look out for?

The common signs to look out for include accidentally leaking faeces or urine at rest or when you exercise, laugh, cough or sneeze, needing to get to the toilet in a hurry or constantly needing to go. There can also be sensation of incomplete and difficult bowel evacuation. Over time and without treatment, pelvic floor problems can cause chronic constipation, difficult or incomplete evacuation of faeces, faecal incontinence, urinary incontinence, bladder dysfunction, pelvic pain and pelvic organ prolapse.

How can I avoid pelvic floor problems from developing?

A balanced healthy diet with plenty of fibre and fluids can help, as this may prevent constipation. Additionally, straining during defecation should be avoided. If you suffer from constipation, laxatives should be considered to help manage symptoms.

Pelvic floor physiotherapy and exercises can also help. Although they’re hidden from view, your pelvic floor muscles can be consciously controlled and therefore trained, much like your arm, leg or tummy muscles. Pelvic floor physiotherapists can train patients in exercises to tighten and contract muscles and improve pelvic floor health. This is particularly important in patients who have had multiple pregnancies or a difficult labour.

Don’t be embarrassed to get treated

With pelvic floor issues, early detection and presentation is crucial. Anyone who thinks they might be experiencing symptoms should go to their GP, who may refer them to a specialist centre. A multidisciplinary specialist team (MDT) management approach is recommended and the best way to deal with these issues.

At Beacon Hospital's pelvic floor centre our multidisciplinary team includes consultants in colorectal surgery, urology, gynaecology, gastroenterology, pain specialists and radiology. There are also specialist pelvic floor physiotherapists, a clinical psychologist and nurse specialists.

It’s important that non-surgical treatment options, such as exercises and the use of laxatives, are exhausted. Surgery should only be considered following careful assessment, investigation and consultation. Furthermore, patients should be heavily involved in the decision-making process.

Most importantly, everyone should know treatment options are available and people experiencing these very common issues should not suffer in silence.

– Mr Reza Kalbassi is consultant colorectal surgeon at Beacon Hospital