Treatment Options for Pelvic Floor Dysfunction
Pelvic floor physiotherapy should be offered as first-line treatment for patients experiencing symptoms of pelvic floor dysfunction, including persistent pain, urinary and/or fecal leakage. 1
Conservative Treatment Approaches
Initial Management
- Begin with education about bladder/bowel dysfunction, timed voiding, adequate fluid intake, and aggressive management of constipation 1
- Implement lifestyle modifications including proper toilet posture with buttock support, foot support, and comfortable hip abduction to avoid activating abdominal muscles 1
- Pelvic floor (Kegel) exercises and cognitive behavioral therapy can decrease anxiety, discomfort, and lower urinary tract symptoms 1
- Conservative measures alone may benefit approximately 25% of patients with fecal incontinence 1
Biofeedback and Physiotherapy
- Pelvic floor physiotherapy is beneficial for patients with pain or other pelvic floor issues 1
- Biofeedback therapy can be implemented through:
- Biofeedback therapy is recommended for patients with fecal incontinence who don't respond to conservative measures 1
- Success rates with comprehensive treatment approaches can reach 90-100% 1
Medication Options
For Urinary Symptoms
- Antimuscarinic medications (e.g., oxybutynin) may be used for patients with mixed disorders such as pelvic floor dysfunction and overactive bladder 1, 2
- Low-dose vaginal estrogen can be used for women with more severe symptoms or those who don't respond to conservative measures 1
For Pain Management
- Lidocaine can be offered for persistent introital pain and dyspareunia 1
- Pain relievers should be offered to women on aromatase inhibitors experiencing arthralgia that interferes with intimacy 1
Advanced Interventions
For Fecal Incontinence
- Perianal bulking agents (e.g., intraanal injection of dextranomer) may be considered when conservative measures and biofeedback therapy fail 1
- Sacral nerve stimulation should be considered for patients with moderate or severe fecal incontinence who haven't responded to conservative measures and biofeedback therapy 1
- Barrier devices should be offered to patients who have failed conservative or surgical therapy 1
For Vaginal Symptoms
- Vaginal dilators may benefit patients with vaginismus and/or vaginal stenosis, particularly important for women treated with pelvic radiation therapy 1
- Vaginal moisturizers and lubricants can improve vulvovaginal tissue quality 1
- For women with current or history of breast cancer on aromatase inhibitors who haven't responded to previous treatment, vaginal dehydroepiandrosterone may be offered 1
Surgical Options
- Anal sphincter repair (sphincteroplasty) should be considered in postpartum women with fecal incontinence and in patients with recent sphincter injuries 1
- Referral to specialists may be necessary:
Factors Affecting Treatment Success
- Adherence to home exercises depends on program efficacy, personal experiences, self-awareness, and professional feedback 3
- Treatment success is measured by improvement in voiding and bowel diary, flow rate, post-void residual urine measurement, frequency and severity of incontinence episodes, and urinary tract infection recurrence 1
- Evidence suggests that six months of supervised pelvic floor muscle training has benefits in terms of anatomical and symptom improvement 4
- Pelvic floor physical therapy has robust evidence-based support as a first-line treatment for most pelvic floor disorders 5
Common Pitfalls and Caveats
- Constipation management is crucial and often discontinued too early; treatment may need to be maintained for many months before the child regains bowel motility and rectal perception 1
- Pelvic floor abnormalities often involve multiple compartments, requiring comprehensive assessment 1
- Behavioral or psychiatric comorbidities should be addressed concurrently 1
- Patients with refractory disease may require further evaluation with full urodynamic studies or magnetic resonance imaging 1