Underactive Pelvic Floor

What is an Underactive Pelvic Floor?

The pelvic floor muscles span from the pubic bone at the front of the pelvis to the tail bone at the back of the pelvis. This group of muscles assists with stabilising the pelvis during movement supports the pelvic organs (rectum, bladder and uterus) and opens and closes the anus, vagina and urethra to assist with emptying the bowel and bladder as well as sexual function.

If the pelvic floor is underactive, this usually means that there is difficulty activating the pelvic floor musculature or weakness of the pelvic floor musculature.

What Causes an Underactive Pelvic Floor?

There are many factors that can lead to an underactive pelvic floor, including:

• Pregnancy
• Childbirth esp. Involving prolonged labour or the use of forceps
• History of chronic respiratory conditions
• History of chronic constipation or straining when making a bowel movement
• Regular heavy lifting
• Elite / high-level athletes involving high impact and high load sports. E.g. running, gymnastics and weight lifting.
• Obesity
• Age
• Hormonal changes. E.g. menopause
• Pelvic Surgery

What are the Symptoms of an Underactive Pelvic Floor?

The symptoms of the underactive pelvic floor may include:

• Leakage of urine during coughing, sneezing, lifting, running or other forms of physical activity
• Losing control of the bowel or bladder before making it to a toilet
• Inability to control ‘wind.’
• Low back pain
• Dislodging of tampons
• Pelvic and vaginal discomfort
• Prolapse – slipping of the pelvic organs
• Neural damage

How is an Underactive Pelvic Floor Diagnosed?

Usually, a clinical diagnosis can be made using the information you have given and a physical examination. During this examination, your physiotherapist may need to perform an internal exam to assess the ability of the pelvic floor muscles to activate, as well as testing the coordination and strength of the pelvic floor musculature. If further information is required, we can perform other tests and investigations, including ultrasound, EMG biofeedback or manometry devices, bladder testing, and/or urine testing. However, these tests will only be required based on your presentation.

What Treatments are available for an Underactive Pelvic Floor?

Often, physiotherapy is considered the first line of treatment for the underactive pelvic floor and can include:

• Education
• Lifestyle Recommendations
• A pelvic floor exercise program
• Ultrasound to assist with pelvic floor activation
• Electrical Stimulation to help with pelvic floor activation
• Adjustment of usual toileting habits
• Advice to modify or manage lifting and exercise habits
• Controlled coughing

What Results Can You Expect?

A large proportion of people with an underactive pelvic floor will have their symptoms improved or resolved with physiotherapy treatment. However, if left untreated, often the problem continues to worsen gradually.

Will You Need Surgery?

A percentage of people may not experience enough improvement with physiotherapy alone and may need to go on to have surgery to resolve their symptoms.

For more information please consult your physiotherapist with a special interest in pelvic floor conditions.