What is the pelvis, pelvic girdle and pelvic floor muscles?

Pelvis is the lower part of trunk of human body with the skeleton embedded in it. The lower part of the trunk is made up of a bony structure that is in the shape of a ring and is known as the pelvic girdle. Some important functions of the pelvic girdle are:

• To connect the upper part of the skeleton with the lower limbs
• To act as a point of attachment for muscles and ligaments to aid in movements
• To hold and protect the soft organs located in the pelvic region such as uterus, bladder and

A group of muscles together form a structure in the form of a sling or hammock across the pelvis and are known as the “pelvic floor”. The pelvic floor in women, comprises of muscles, ligaments, connective tissues, and supports the pelvic organs such as bladder, uterus, vagina and rectum.

What are pelvic floor disorders?

The pelvis and pelvic floor diseases can be broadly categorized as:

Abnormalities of skeletal or the pelvic organs such as:

• Pelvic girdle pain
• Ankylosing spondylitis with sacroiliac involvement
• Infections – pelvic inflammatory disease (PID), interstitial cystitis (IC)
• Chronic pelvic pain due to infections

Disorders of pelvic floor muscles such as:

• Lack of bladder control or urinary incontinence
• Lack of bowel control or fecal incontinence
• Prolapse, i.e bulging of the uterus, bladder and bowel onto the vagina
• Sexual dysfunction

Pelvic pain:

• It is a feeling of discomfort or abdominal pain below the belly button, usually associated with uterus pain, female ovary pain etc.

What are the symptoms and long-term complications of pelvic disorders?

The symptoms of pelvic disorders vary from person to person, but some of the common ones include:

• Constipation, pain or strain in bowel movements
• Feeling of a bulge or heaviness in the pelvis, vagina or rectum
• Feeling of pressure or pain in the vagina or rectum
• Pelvic pain during pregnancy
• Problems of urination: urgency to urinate, incomplete bladder emptying, pain while urinating, leakage while coughing, laughing or exercising
• Spasms in the pelvicmuscles

Complications of pelvic disorders may include:

• Recurrent urinary tract infections
• Gynaecological fistulas
• Prolapse of uterus
• Rectoceles (posterior vaginal prolapse)
• Enteroceles (small bowel prolapse)
• Cystoceles (anterior bladder prolapse)
• Cystourethroceles (prolapse of bladder and urethra into the vagina)

What are the causes of pelvic floor disorders?

Some of the common causes of pelvic floor disorders include:

• Weakening of muscles due to advancing age
• Increased pressure on the pelvic floor due to obesity, chronic constipation and straining to pass stools, and chronic coughing induced byfactors like smoking
• Inherent weakness of tissues due to some underlying medical issues
• Pregnancy and childbirth
• Previous history of surgeries like hysterectomy
• Radiation treatment for certain cancers

Pelvic pain may be caused by:

• Chronic pelvic inflammatory disease
• Digestive diseases like colitis, diverticulosis (formation of diverticula, benign pouches along the walls of intestine) and diverticulitis (inflammation of diverticula)
• Endometriosis
• Fibroids
• Interstitial cystitis i.e an inflammation of the bladder

How are pelvic floor disorders diagnosed?

Your gynaecologists or urologists may be able to diagnose pelvic floor disorder by:

• Medical history
• A physical examination using a speculum. Sometimes,this may be the only means to examine the pelvic floor
• Tests: Depending on the anticipated cause, other tests may be required like
• Anal manometry
• Cystoscopy/ Laparoscopy or Hysteroscopy
• Dynamic defecography
• Endoanal ultrasound
• Urodynamics
• Imaging or radiological tests like MRI for identifying causes like endometriosis, fibroids, pelvic congestion, pelvic inflammatory diseases
• Blood tests

What are the treatments for pelvic disorders?

Treatment modalities vary depending on the underlying cause and medical condition of the patient:

• Medications
• Physical therapy and biofeedback
• Pessary: A device known as pessary is inserted in the vagina to support the organs
• Surgery:In case other conservative modes like medications, lifestyle changes fail to control the symptoms, surgery may be advised depending on factors like age, medical condition, underlying cause etc

Conservative approaches include:

• Lifestyle changes
  • – Diet management- consume high fibre diet, avoid drinks and foods containing agents such as caffeine that stimulate the bladder
  • – Weight control
  • – Cessation of smoking
  • – Engagingin physical activity
  • – Engaging inrestorative activities such as meditation, yoga etc
• Pelvic floor exercises: Popularly known as Kegel exercises can help in muscle control of symptoms like incontinence

How soon is recovery after surgery to treat pelvic floor disorders?

The recovery time after surgery varies from person to person and the type of surgery. However in general, you may be advised to avoid the following for a few weeks:

• Strenuous exercise
• Lifting heavy objects
• Straining
• Sexual intercourse

What are the risks vs benefits of pelvic floor surgery?

The benefits of pelvic floor surgery include freedom from symptoms that can be socially embarrassing and may have an effect on the psychology of the patient. However it being a major surgery, is not devoid of risks that may include but are not limited to:

• Infection
• Damage to nearby structures
• Complications of anaesthesia
• Life threatening complications are rare

What affects the cost of surgery for pelvic floor disorders and pelvic fractures?

Pelvic floor disorders and pelvic fracture surgery can be a complex treatment and the cost of surgery varies based on:

The call for a multidisciplinary team consisting of specialists like urologists, gynaecologists, colorectal surgeons, reconstructive surgeons, orthopaedicians, physical therapists, radiologists and trained support staff like nurses.

• Underlying cause, and general health of the patient
• The type of surgery
• The infrastructure support requirements like OT
• Hospitalstay
• Tests and medications

To know more about pelvis disorders and pelvic floor disorders, you can request a callback and our pelvic floor disorders specialist will call you and answer all your queries.

Related blogs you may like to read:

• Pelvic Inflammatory Disease (PID)

References

• American College of Obstetricians and Gynecologists. Pelvic support problems. http://www.acog.org/~/media/For%20Patients/faq012.pdf?dmc=1&ts=20120516T1511454386. Accessed on March 11, 2018
• US Department of Health and Human Services. How are pelvic floor disorders diagnosed. Available at:https://www.nichd.nih.gov/health/topics/pelvicfloor/conditioninfo/diagnosed Accessed on March 11, 2018
• American College of Obstetricians and Gynecologists. Surgery for Pelvic Organ Prolapse. Available at: https://www.acog.org/Patients/FAQs/Surgery-for-Pelvic-Organ-Prolapse Accessed on March 11, 2018

Disclaimer:

“The content of this publication has been developed by a third party content providerwho are clinicians and/or medical writers and/or experts. The information contained herein is for educational purpose only and we request you to please consult a Registered Medical Practitioner or Doctor before deciding the appropriate diagnosis and treatment plan.”