Different types of pelvic floor disorders and how to treat them

If you’ve just given birth, your pelvic floor muscles are very important for a complete postpartum recovery. They’ve been there for you through a rough ride- they have supported your baby while you were pregnant and helped you birth it…

It’s pelvic floor payback time now! 

Getting your pelvic floor back healthy and strong is vital if you want go back to leading a normal life- like  being able to have good sex, walk, run and go out with friends without the fear of urine leaking or your pooch sticking out.

Most women I know take a little way of leakage in their stride after childbirth- as something that happens and has to be endured patiently. Similarly, they also take a bit of pain, heaviness and backaches as almost normal after childbirth.

This is really scary. But, much scarier than this is the fact that you may only be identifying incontinence or an overactive bladder as the only pelvic floor (PF) disorders possible.

These two biggies, however, are only the tip of the iceberg! A compromised pelvic floor causes many other issues most women are not aware are happening due to a PF issue, like a prolapsed pelvic organ - bladder, rectum, uterus or the upper vagina.

Other common syndromes associated with a poor pelvic floor are pain during passing stools and n the pelvic area, diastatis recti or abdominal separation and difficulty emptying your bladder or bowel completely.

If you are one of those patient souls waiting for your pelvic floor to heal naturally, I have to break it to you that a compromised pelvic floor gets worse as you grow older. Sometimes alarming symptoms present post-menopause only. 

Bad PF symptoms get worse and sometimes a surgery is the only option… and in many cases, surgery also may not help much.

Here is a short picture of the other very common types of pelvic dysfunction disorders that you may not even be aware of, and so fail to seek treatment for them. Remember, knowledge is power!

Pelvic floor dysfunction disorders that you should be aware of 

1.    Rectocele or prolapse of the rectum into your vagina

The vagina and the rectum can be thought of as two muscular tubes running parallel to each other and sharing a common muscular wall between them which is called the “rectovaginal septum”.  A rectocele occurs when this septum becomes weak and the rectum bulges forwards into your vagina especially after a vaginal birth.

A small rectocele is very common after childbirth and usually has no symptoms. But, trouble starts if it becomes large. Stool can become trapped within it, making it difficult to poo. You also go around with a constant sensation of incomplete evacuation. 

2.    Cystocele or prolapse of the bladder 

This develops when the bladder drops into the vagina due to a weakening of the connective tissue supporting it. 

This leads to leakage and overflow of urine when the bladder becomes full, even in the night, as well as urinary retention as the bladder is not able to empty completely. 

3.    Prolapse of the uterus

In this, the uterus drops down into the vagina and bulges out due to a weakening of the connective tissue and ligaments supporting it. 

In extreme cases, the entire uterus may bulge out through the vaginal opening. 

A uterus prolapse can cause pain in the lower back,  difficulty pooing, and pain during sexual intercourse, feeling of pressure- all extremely common in most new moms. 

4.    Prolapse of the vagina

Here, the upper part of the vagina drops down into the lower part, so that the vagina turns inside out. It can also protrude out of the vaginal opening making it extremely painful. You may experience pain while just sitting and walking, bleeding and discharge, as well as infections and urinary incontinence.

5.    Pain while passing stools 

This happens due to a problem in a specific muscle in the pelvic floor- its name is the puborectalis muscle and it wraps around the lower rectum as it passes in the pelvic floor. 

It actually relaxes normally while passing stools. Due to the dysfunction this muscle contracts instead of relaxing during a bowel movement causing a lot of pain.

6.    Pelvic pain

This is a very common type of pelvic floor disorder that happens in about 12 % of women after childbirth. The pain is usually felt in the rectum, sacrum or lowest part of the spine, or the tailbone all the time or sometimes.

How to look after your pelvic floor after a delivery?

Unless we have a specific reason to, most of us probably go about our lives without giving our pelvic floor much thought—and when we do, we focus a bit too much on Kegel exercises.

But Kegel is not the way to go if you have what’s called ‘non-relaxing pelvic floor dysfunction’ in which the pelvic muscles are too tight. This type of problem causes pain and problems with defecation, urination, and sexual function and requires relaxation and coordination of pelvic floor muscles and urinary and anal sphincters.

These disorders affect the quality of your life and are more often also associated with postpartum depression.

Non-relaxing pelvic floor dysfunction can’t be helped by Kegel exercises and may only make the symptoms worse. 

For non-relaxing pelvic disorders, you have to seek a trained physical therapist who will chalk out a physical exercise programme to relax your pelvic floor muscles. You can also ask your doctor about other options like surgery to treat this type of dysfunction. But, an early referral for targeted physical therapy is your best bet.

The pelvic floor disorders that can be helped by doing Kegel or pelvic floor strengthening exercises are the ones caused by relaxed pelvic muscles like pelvic organ prolapse, (uterus, rectum, vagina)  or urinary incontinence.

Kegels can help with leakage but do not affect an extreme prolapse. Though, they tend to be most helpful if the prolapse is mild.

How these exercises help is by strengthening the pelvic floor muscles and making the pelvic floor long, supple, and taut, to generate long-term forces that hold up your pelvic organs and close your bladder. 

This is how you can do Kegels

Squeeze the muscles around your vagina, urethra, and rectum or the muscles used to stop a stream of urine and hold for about 1 or 2 seconds, then relax for about 10 seconds. 

Gradually, increase the ‘hold’ to about 10 seconds each. 

Repeat about 10 times in a row and do a set several times a day while sitting, standing, or lying down.  

If you don’t know which muscles to squeeze, ask your doctor to use biofeedback devices and electrical stimulation to make the correct muscle contract. 

If your pelvic floor is way gone, she may also insert a device called a pessary into your vagina to support the pelvic organs. 

Finally, this is what every mom - new or not- needs to do for her pelvic floor

Most pelvic floor issues are created by pregnancy and childbirth- but your pelvic floor health is determined by habits that accumulate over time like sitting in a chair the bulk of every day, not using a squat, being stressed out all the time, being overweight and then, of course, doing extreme exercises like Kegels to compensate, leading to more tension in the abdomen and pelvic floor.

The thing to do, therefore, is to check your pelvic floor health before you become pregnant. This should be made mandatory like taking iron pills before a pregnancy if you ask me. 

Another benefit of identifying and correcting PF dysfunction early on is that you have lesser problems post-childbirth and your pelvic floor is able to  heal naturally and effortlessly.

About the Author

Shikha Gandhi