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Pelvic floor disorders

Key points about pelvic floor disorders

Pelvic floor disorders include incontinence, pelvic organ prolapse, rectal and bowel prolapse and other pelvic floor disorders.
Find out what you need to know about these conditions and their treatment options.

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Pelvic floor disorders is a term that covers a range of conditions, including urinary (pee) incontinence and faecal (poo) incontinence, rectal and bowel prolapse and other pelvic floor disorders.

Below you can find information about various aspects of these conditions, including:

the symptoms
self-management tips
potential non-surgical and surgical treatment options, including procedures involving surgical mesh and alternative mesh free surgical options.

Physiotherapy with a specialist pelvic floor physiotherapist is the first treatment option, often helping with your symptoms. Then, if surgery is required, it can aid in recovery and outcome. Learn more by watching these videos about pelvic health physiotherapy.(external link)

NOTE: Surgical treatments are not always the best option and should not be sought until all non-surgical options for treatment have been exhausted.

Hopefully, the information provided on this and the linked pages will answer any questions you may have before you visit a health professional. It is intended to supplement any advice you may receive from your doctor or surgeon.

Incontinence is accidental (involuntary) loss of urine (pee) from your bladder or faeces (poo) or flatus (wind) from your bowel. It is when you pee or poo unexpectedly without meaning to. Incontinence can range in severity from a small leak to complete loss of bladder or bowel control.

Learn more about bladder control problems.

This terms refers to the bulging (herniation) of one or more pelvic organs into or out of your vagina. The pelvic organs consist of your uterus, vagina, bowel and bladder. Pelvic organ prolapse occurs when the muscles, ligaments and fascia (a network of supporting tissue) that hold these organs in their correct positions become weakened.

Learn more about pelvic organ prolapse.

The word prolapse means to slip or fall out of place. There are 3 types of rectal prolapse:

External prolapse: The entire rectum sticks out of your anus.
Mucosal prolapse: Part of the rectal lining pokes out of your anus.
Internal prolapse: The rectum has started to drop but is not yet sticking out of your anus.

Small bowel prolapse (also called enterocele) happens when the intestines drop into the pelvic space and put pressure at the top of the vagina. It can happen as a result of childbirth, aging and other processes putting pressure on your pelvic floor.

Learn more about rectal(external link) and bowel(external link) prolapse.

Hypertonic disorders are very common. A hypertonic pelvic floor occurs when the muscles in your pelvic floor become too tense and are unable to relax. Many people with a tense and non-relaxing pelvic floor experience pelvic health concerns such as constipation, painful sex, urgency, pelvic pain, elimination problems, chronic pelvic pain, bladder disorders, bladder pain syndromes, retention and incontinence.

What causes hypertonic pelvic floor?

There are many conditions or events that may contribute to having a hypertonic pelvic floor (tight pelvic floor muscles). These could include bladder or bowel dysfunction, learned behaviours in an attempt to prevent incontinence, or a painful event such as sexual trauma, infection, endometriosis or pelvic surgery.

Here are some links if you would like to learn more about the causes of pelvic floor hypertonicity:

Overactive pelvic floor muscles(external link) Sydney Pelvic Clinic, Australia
Hypertonic pelvic floor – causes, symptoms and exercises for it!(external link) Dr Amruta Inamdar, Pelvic Floor Physical Therapy, US

What are the signs and symptoms of a hypertonic pelvic floor?

The typical sign of a hypertonic or non-relaxing pelvic floor is pelvic muscle pain. However, there are a variety of signs and symptoms, including:

constipation
incomplete emptying of your bowels
straining when emptying your bowels
pelvic pain
low back pain
hip pain
coccyx (tailbone) pain
painful sex
vaginismus (an involuntary tensing of your vagina)
vulval pain (vulvodynia)
urinary incontinence (peeing without meaning to)
incomplete emptying of your bladder
slow flow of urine (pee)
hesitancy or delayed start of urine (pee) stream
urinary urgency
urinary frequency
painful urination.

If you have any of the signs or symptoms of a hypertonic pelvic floor, seeing a fully trained pelvic floor continence physiotherapist or continence nurse is essential. They will be able to identify the cause of the hypertonicity and provide tools to help overcome this.

There is no one defining cause of a hypertonic pelvic floor. However, there are several activities that can lead to the muscles tightening up.

This condition is often misdiagnosed as another disorder, so please ask your health professional about this possibility before surgical options are considered.

Learn more about hypertonic pelvic floor

The hypertonic pelvic floor(external link) Continence Foundation of Australia
The pelvic expert(external link) Founders Program, Univesrity of NSW Sydney, Australia
Easy stretches to relax the pelvis(external link) Pelvic Pain Foundation, Australia

Endometriosis (kōpū whakatupu pūtautau) is a common condition where endometrial tissue, which should only be found in your uterus (womb), also grows outside it, such as on your ovaries or bowel.

Pelvic floor dysfunction (PFD) is a common condition in women with endometriosis. Chronic inflammation of the endometrial tissue can cause severe pelvic and abdominal pain. Very often, muscles that form the pelvic floor have tightened in response to chronic pelvic pain. Often people with endometriosis may also have hypertonic floor disorder.