Dr. Kelli Berzuk is a physiotherapist and Director of IPPC-Incontinence & Pelvic Pain Clinic. She has focused her area of practice to pelvic floor physiotherapy and in 2011, she received an award from the Winnipeg-based Women’s Health Research Foundation of Canada to support her research in the area of pelvic floor dysfunction. She took time out to talk about the issue to Wave.

What is the pelvic floor?

The medical term “pelvic floor” encompasses the pelvic area of the body and includes anatomical structures such as the bony pelvis, the pelvic organs (bladder, bowel and, in women, the uterus), as well as nerves, blood vessels, ligaments and muscle.

What is the pelvic floor muscle?

The pelvic floor muscle is part of the pelvic floor. It is a multi-layered muscular sling that fills the interior bowl of the pelvis, forming its base, inserting into the pubic bones and the tailbone. The pelvic floor muscle wraps around the urethral and rectal openings and, additionally, the vagina in women. Because of its anatomical position, it plays a role in proper bladder, bowel and sexual function, childbirth, support to the pelvic organs, postural support and core stabilization of the trunk. The pelvic floor muscle also plays a role in assisting the diaphragm during respiration.

What is pelvic floor dysfunction?

Pelvic floor dysfunction, or PFD, refers to disorders found within the pelvic floor. Bladder and bowel dysfunction, sexual dysfunction, pelvic pain, pelvic organ prolapse (descent of the organs) and pelvic floor muscle dysfunction are all 

behaviour to compensate for dysfunction in one pelvic organ often leads to dysfunction within the pelvic floor muscle itself, potentially affecting the function of neighbouring organs. For example, straining to defecate due to constipation leads to injury of the pelvic floor muscle that may, over time, negatively affect bladder and/or sexual function. Another example is chronic pelvic pain, which may originate in one pelvic organ before other organs become painful and dysfunctional.

The International Pelvic Pain Society explains that chronic tensing of the pelvic floor muscle as a protective or support mechanism in response to prolonged pelvic pain leads to subsequent injury to the muscle. For this reason, what may begin with uterine pain, perhaps with a diagnosis of endometriosis, may eventually lead to bowel dysfunction and/ or bladder dysfunction with corresponding pain in these organs, and even referred pain in surrounding areas.

What causes PFD?

Because there are multiple forms of PFD, the causes are various and numerous. Also, issues can arise within the organs themselves as a primary source (for example, interstitial cystitis of the bladder, endometriosis of the uterus and irritable bowel disease of the bowel), or the pelvic organs can be afflicted secondarily via pelvic floor muscle dysfunction if the muscle has been injured (for example, a tear during childbirth).

Anything that irritates the bladder, bowel, or uterus, or injures the pelvic floor muscle can produce or exacerbate PFD symptoms.

What are some of the risk factors?

Some risk factors associated with PFD are:

• Diet filled with bladder- or bowel- irritating foods and beverages, smoking, dehydration
• Certain medications, radiation and chemotherapy
• Chemicals, dyes or friction from clothing that is irritating to the perineum
• Family history of PFD
• Childhood bed wetting
• Certain medical conditions such as diabetes and multiple sclerosis • Hormonal changes associated with menopause • Increased weight/increased BMI
• Chronic urinary tract or yeast infections
• Pregnancy, vaginal delivery, forceps, episiotomy, perineal tearing • Chronic straining to defecate
• Poor voiding and defecation biomechanics (such as hovering over the toilet seat) or patterns (such as voiding or defecating too often or not frequently enough)