3 Mount Elizabeth, #14-15, Mount Elizabeth Medical Centre, Singapore 228510

Pelvic Floor Disorders

Pelvic Floor Disorders

What are pelvic floor disorders?

Pelvic floor disorders (PFDs) develop when the muscles and tissues in your pelvic area become weak or damaged. This group of muscles is located at the bottom of your pelvis and supports important organs like the bladder, rectum, and, in women, the uterus. When dysfunction of pelvic floor muscles occurs, it can lead to various problems affecting how you urinate, have bowel movements, and even your sexual health.

Issues associated with pelvic floor disorder can result in emotional distress and a reduction in quality of life. If left untreated, this condition can progress into further complications such as infections and colon damage.
Pelvic floor muscles form a supportive hammock at the base of the pelvis, securing pelvic organs, including the bladder, uterus or prostate, and rectum.

Pelvic floor disorders may affect men and women differently due to the anatomical differences of the pelvis. Common types of pelvic floor disorders include:

Urinary incontinence:

A condition characterised by loss of bladder control such as stress incontinence (urine leak during activities that put pressure on your bladder such as coughing, sneezing, or exercising) and urge incontinence (urge to urinate followed by involuntary urine leak).

Faecal incontinence:

A condition in which patients struggle with stool leakage and general difficulty in controlling their bowel movements.

Pelvic organ prolapse:

This occurs when the pelvic organs, such as the bladder or uterus, drop from their normal position and bulge into the vagina due to weakened pelvic muscles.

Sexual dysfunction:

This includes problems like pain during sex, reduced sexual satisfaction, and, in men, erectile dysfunction.

Pelvic pain:

Chronic pain in the pelvic area, which can be accompanied by symptoms like painful urination or bowel movements.

What are the symptoms of pelvic floor disorders?

PFDs can cause a range of symptoms that affect urinary, bowel, and pelvic functions in both men and women. Here are some common signs to watch for:

Urinary Issues:

  • Leaking urine when you cough, laugh, or exercise.
  • A frequent or urgent need to urinate.
  • Difficulty starting or stopping urination.
  • Painful urination.
  • Feeling like you can't empty your bladder.

    • Bowel Issues:

  • Leaking stool or having trouble controlling gas.
  • Constipation, including straining to have a bowel movement or feeling like it’s incomplete.
  • Pain or difficulty during bowel movements.
  • A sensation of heaviness or a bulge in the rectum.

    • Pain:

  • Unexplained pain in the lower back, pelvis, genitals, or rectum.
  • Pressure or pain in the rectum.
  • Pain while urinating.
  • Pain during intercourse for women or ejaculation for men.

    • Other symptoms of PDFs include:

  • Reduced sensation in the vagina.
  • Tampons that dislodge or fall out.
  • A bulge at the vaginal opening.
  • Muscle spasms in the pelvic area.
  • A feeling of "falling out" or heaviness in the pelvic region.

    • Do pelvic floor disorders affect women more than men?

    Statistics show that 32% of women will have at least one pelvic floor disorder at some point in their lives. However, a recent study suggests that although much attention is directed toward women's pelvic floor disorders, 16% of men are also affected by these issues. This indicates that while pelvic floor disorders are more common in women, they are still a significant health concern for men.

    Men can experience a range of pelvic floor symptoms and these symptoms often stem from dysfunction in two key muscles: the external anal sphincter (EAS) and the puborectal muscle (PRM).

  • Prevalence and muscle dysfunction: A study involving 199 men revealed that only 21% had normal muscle function. Interestingly, even among those who reported no symptoms, 80% had some degree of muscle dysfunction.
  • Muscle assessment: The PRM tends to show more dysfunction and more severe dysfunction compared to the EAS. This dysfunction isn't necessarily linked directly to the number of symptoms, suggesting complex underlying interactions.
    • The lack of awareness, coupled with embarrassment, often delays men in seeking help for their symptoms. While pelvic floor disorders are often associated with women, they are a significant issue for men as well. Understanding and recognising the symptoms and seeking early treatment can help manage these conditions effectively.
    Symptoms of pelvic floor disorders include involuntary leakage of urine, especially during physical activities like coughing, sneezing, or exercising.

    Are pelvic floor disorders painful?

    PFDs can cause pain, though the intensity varies from person to person. Conditions like pelvic organ prolapse and interstitial cystitis are especially known for causing discomfort and pain. For some, the pain can be severe enough to disrupt daily activities, while others might experience only mild discomfort or no pain at all but still face significant issues like incontinence or prolapse.

    Who is at risk of pelvic floor disorders in Singapore?

    In Singapore, PFDs can affect anyone, but certain factors increase the risk. Here are the main risk factors that can increase your chances of developing PFDs:
  • Childbirth: particularly vaginal births, can stretch and damage your pelvic floor muscles and tissues. The more complicated the birth, the higher the risk.
  • Ageing: as you get older, your muscles, including those in your pelvic floor, naturally lose strength and flexibility– consequently developing PFD.
  • Hormonal changes: changes in hormones, especially around menopause, can make the tissues in your pelvic area thinner and weaker, increasing the risk of pelvic floor issues.
  • Obesity: carrying extra weight puts additional pressure on your pelvic floor, weakening the muscles and leading to pelvic problems.
  • Underlying health issues: such as diabetes or chronic respiratory conditions that cause frequent coughing can repeatedly strain your pelvic floor muscles.
  • Lifestyle Factors: regularly lifting heavy objects or doing high-impact exercises can also put a lot of strain on your pelvic floor, increasing the risk of disorders.
    • These risk factors increase the pressure and strain on the anus, which can cause tears in the lining, resulting in an anal fissure.
    Procedures such as robotic-assisted surgery can repair and support weakened pelvic tissues.

    How are pelvic floor disorders diagnosed?

    Diagnosing PFDs involves a few steps, including a physical exam, taking a medical history, and doing some specialised tests. Here’s how it usually works:

    Physical exam:

    Your doctor will check for any signs of a prolapse, such as a bulge. They might also do a rectal or pelvic exam to look for other issues.

    Medical history:

    Evaluating symptoms and any relevant medical history, including past pregnancies, surgeries, and medications you’re taking.

    Specialised Testing:

  • Cystoscopy: this test involves inserting a small camera through the urethra to look inside the bladder, which can help detect inflammation, stones, or tumours.
  • Urinalysis: a urine test that can identify bladder infections, kidney problems, or diabetes.
  • Urodynamics: this test checks how well the bladder and urethra are functioning, which helps in planning treatment for bladder control problems.

    • Colonoscopy:

    This procedure examines the inside of the colon to look for disease or inflammation.

    Defecating Proctogram:

    This involves taking an X-ray video while you pass a thick liquid enema, which helps determine if your pelvic floor muscles are working properly.

    What are the treatment options for pelvic floor disorders in Singapore?

    There are various treatments and diagnostic procedures to help manage and treat PFDs in Singapore. Here are the options that are conveniently available for you at CRCS Clinic :

    Injections:

    Such as botulinum toxin can aid in addressing issues such as urinary incontinence by increasing the urine storage capacity in the bladder.

    Medications:

    Such as antimuscarinic oral medications are prescribed to manage symptoms affiliated with PFDs.

    Physical therapy:

    Such as pelvic floor muscle physiotherapy will be arranged to strengthen pelvic floor muscles.
    Where surgical interventions are necessary (such as when pelvic floor dysfunction is the result of rectal prolapse or rectocele) your surgical options include;
    Where surgical interventions are necessary (such as when pelvic floor dysfunction is the result of rectal prolapse or rectocele) your surgical options include;
    These treatments focus on fixing underlying problems, reducing strain on your pelvic muscles, and improving overall pelvic health to make you feel better.

    At CRCS Clinic, we're committed to providing comprehensive care for pelvic floor disorders with a range of effective diagnostic and treatment options. Reach out to us today and take the first step towards effective management and better well-being. We're ready to support you every step of the way.

    Robotic colorectal surgery:

    Surgery where a surgeon uses a robotic system to perform targeted operations on the colon and rectum. It’s less invasive, meaning faster recovery and less impact on your pelvic floor.

    Laparoscopic colorectal surgery:

    Similar to robotic surgery, this involves small incisions and special instruments to operate on your colon and rectum. It’s minimally invasive, leading to quicker recovery and less strain on your pelvic muscles compared to traditional surgery.

    Frequently Asked Questions

    While not all PFDs can be prevented, you can significantly reduce the risk by maintaining a healthy weight, practising regular pelvic floor exercises, and avoiding heavy lifting.

    Pelvic floor exercises, such as Kegels, are effective for many individuals, especially when done regularly and with the correct technique. They can help improve symptoms of incontinence and prevent the worsening of prolapse.

    You should seek medical attention if you experience persistent symptoms like incontinence, pelvic pain, or a noticeable bulge in the pelvic area. Early diagnosis and treatment can prevent the condition from worsening.

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    Colorectal Care Specialists (CRCS)

    3 Mount Elizabeth, #14-15, Mount Elizabeth Medical Centre, Singapore 228510

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