# Pelvic Floor Dysfunction - I thought it was only something Mom's got.



## Maegwin (Nov 11, 2012)

I discounted having PFD for a long time because I've never had kids but now I'm finding out that there's more to it. Sorry for the long post, I'm copying info from a couple of sites. I want it all in one place for my own reference but hopefully it will help some of you as well. Copied text is in blue.

Other factors that can increase the risk of PFD aside from pregnancy or radiology treatment include repeated heavy lifting or even genes. I had no idea it could be genetic.

*Symptoms of PFD:*


Urinary problems, such as an urgent need to urinate, painful urination or incomplete emptying of their bladder
Constipation, straining or pain during bowel movements
Pain or pressure in the vagina or rectum
A heavy feeling in the pelvis or a bulge in the vagina or rectum
Muscle spasms in the pelvis

It would explain why I had bowel incontinence as a child which switched to severe constipation as a teenager. I continue to have urinary incontinence when I'm really excited or stressed. When I have to go pee it's not a little urge but a sudden painful, immediacy that's really hard to hold back. I often get "pee headaches" especially at night when I sleep through urges and my body gets tenser and tenser as it tries to hold it back. Even when I do really have to go it can be hard to release, or it will release very slowly, or not completely.

*PFD and IBS:*

The pelvic floor muscles play an important role in the process of having a bowel movement. The muscles of the pelvis must relax and contract in a coordinated way to eliminate stool. However, some people cannot control these muscle movements and need to strain or assume different positions to achieve a bowel movement.

I never feel like I have control over my bowels, even when I take laxatives. My bowels work when they work. I take laxatives before bed or eight hours before I get up in the morning, but even then I allow myself three hours every morning for my body to work. I've woken up at midnight to be at work by 4:30am at times. During those three hours I am doing nothing but trying to get my muscles to relax enough to allow my body to work. I use warm drinks, a semi-reclined position with my feet elevated, and a heating pad. To pass the time, I'll read a book, listen to music, watch a movie, play a game, or anything that isn't physically active or stressful.

*Other Symptoms of PFD:*


Constipation, straining and pain with bowel movements
Unexplained pain in the lower back, pelvis, genitals or rectum
Pelvic muscle spasms
A frequent need to urinate
Painful intercourse for women

My hips are always in pain. The muscles feel really tight. Sometimes I feel like my pelvic bones get locked up or misaligned. I'll get my boyfriend to sit on my hips while I lie on a hard surface or push down on my tail bone while I lie face down on the bed. Either method usually produces a loud crack and instant relief from some of the pain I was feeling.

Sex is frequently painful for me. I either have to abstain from it completely or restrict it to certain positions that don't press against painful areas. Even still I never have sex when I'm constipated and frequently have to fast for a few days before the pain diminishes enough for sex to be enjoyable.

*Treatments:*

People who have pelvic floor dysfunction tend to contract their pelvic floor muscles rather than relax the muscles, which would allow the bowel to empty.


Behavior changes, such as avoiding pushing or straining when urinating and having a bowel movement. This also might include learning how to relax the muscles in the pelvic floor area. For example, warm baths and yoga can help relax these muscles.
Medicines, such as low doses of muscle relaxants like diazepam
Physical therapy and biofeedback, which can help you learn how to relax and coordinate the movement of your pelvic floor muscles

I am definitely going to look into some muscle relaxants. I tried robaxacet once but it's effects wore off quickly after repeated use. I know pain killers can cause constipation but sometimes I find taking a T3 relieves the pain enough for my muscles to relax and actually allow my body to work.

Yoga REALLY feels good but I can't always do it if I'm really constipated. Also, the relaxation it provides doesn't last for more than an hour. Still it feels good, and any relief is worth it.

I'm going to physio next week but I think I'll also call the Women's hospital and ask about being seen by someone there for PFD.


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## annie7 (Aug 16, 2002)

yes --as i said in your other post, good luck with all this, Maegwin!







i was dx'd with pfd as well as a rectocele and a vaginal prolapse (all dx'd with the defecatory proctogram test--then had an anal manometry as well.) and i've never been pregnant or had kids. men can develop pfd too. i know men who've been dx'd with it.

i'm glad you are going to try some physio for pelvic floor dysfunction.

many people with pelvic floor pain/problems have found the book "a headache in the pelvis" very helpful. i think you can get it on amazon.


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## tummyrumbles (Aug 14, 2005)

I have pelvic floor dysfunction but because evacuation is a lot easier depending on diet I'm sure mine is IBS related. Your symptoms sound quite severe and maybe there's medical issues there as well as IBS. I'm wondering whether constipation itself can also be irritating to the colon, and I'm trying to get my head around how that works. I just don't eat constipating food at all anymore, no no white flour, pasta etc. I'm finding a modified low FODMAP diet is very good - I exclude all breads, but I can get a bit hungry. Considering you can eat all you want, I'm wondering if this is partly psychological from bread withdrawal. This is a typical diet if this helps: rice pops/corn flakes with milk (lactose free if you like), salads and cheese for lunch (lettuce, tomato, carrot, cucumber) and dinner is any non-fatty meat/fish/eggs with potato, pumpkin, sweet potato and maybe some moderate FODMAPS like peas and broccoli. If I get hungry I have another few bowls of rice/corn cereal. I've found evacuation is quickest with this diet. I would never take laxatives as after a while your colon gets dependent on them and won't work. Constipating foods as well as high FODMAP or just insoluble high fibre foods are out for me. This diet seems to be soothing for my colon, hardly any digestion gas at all. The hardest thing is the edgy feeling of hunger I get but this could be a lack of dopamine from wheat withdrawal. It's the starches that make us full, and the most satisfying starches (breads) cause the most gas. Another reason why IBS is so hard to cure.


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## IndianRopeTrick (Jul 25, 2013)

annie7 said:


> yes --as i said in your other post, good luck with all this, Maegwin!
> 
> 
> 
> ...


Can men have pfd too ? I did a quick scan and it seemed that its something only women can have.

and meg has got so much to deal with. Waking up at midnight just to be able to work at 4-30. Damn...

Now, I think I am a weakling. I really wish I could meet such people and talk to them about how they live.

Meg, do you feel sleepy/tired at work ?


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## annie7 (Aug 16, 2002)

indianropetrick

pfd is more common in women but oh yes--men can have it too. i've read posts both on this board and another one from men who've been diagnosed with it.

http://physical-therapy.advanceweb.com/Features/Article-1/A-Male-Malady.aspx

http://www.uchospitals.edu/specialties/pelvic/faq/pelvic-floor-disorders.html

oh no you're not a weaklling!







you work with computers--tech work--something like that, right?? (brain fog here, sorry) i totally admire that! takes so much intelligence, brilliance and creativity!

i've done the shift work too. worked 29 years as a postal clerk--had all sorts of bizarre shifts--midnight start --2 am start--4 am start, 5 and 6 am start, afternoon shift et al. 10-12 hour days. so i'd get up three or four hours earlier to give myself time to eat breakfast, try to go to the bathroom and have a bm and allow time for the commute. you just do what you have to do...

but yes shift work does play havoc on your bowels (at least it did on mine) as well as your sleep. definitely made my insomnia worse. and yes i was tired all the time until i finally got on the day shift. but then all the stress of working with the customers was exhausting.


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## IndianRopeTrick (Jul 25, 2013)

annie7 said:


> oh no you're not a weaklling!
> 
> 
> 
> ...


Thanks. But now, it is killing the intelligence and creativity, the very basis for my employment. I am waiting for this storm to pass and return to a normal life. Just hoping that the rough patch does not last long enough to become a

serious concern to the employer. They already know I am "a bit" unwell, but not exactly what. Keeping my fingers crossed :|


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## annie7 (Aug 16, 2002)

oh yes--intelligence and creativity sure does require sleep! and rest. and yes i do hope your rough patch passes soon. you have a very difficult job to do on no sleep.

have you ever tried meditation. meditation is not a substitute for sleep of course but one of it's benefits is that it provides deep rest for the brain. 20 minutes to a half hour once or twice a day is good but even just meditating for just 5 or 10 minutes--relaxing, clearing your mind of thoughts and then just gently letting go of the thoughts when they come up--helps to rest and restore the mind--and helps to relieve stress. i've been meditating since the early 70's and it's been a lifesaver for me.


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## annie7 (Aug 16, 2002)

some more info on treating pelvic floor dysfunction off the top of my head..

this u-tube video --how to empty your bowels without straining--is one i've posted before so maybe you've already seen it but the PT in it does mention a lot of the tips and tricks etc my PT told me about:






the belly breathing is really important. i've found it helps me a lot. you breathe from the belly instead of the chest--expand the belly to breathe which in turn pushes the pelvic floor down which is supposed to help make evacuation easier.

also elevating the feet on a footstool or shoebox etc while sitting on the toilet helps.it straightens out the anorectal angle and allows for a more complete evaucation.

biofeedback/physical therapy seem to be the first line of treatment for pfd.

other treatments:

progressive anal dilation--using anal dilators (similar to vaginal dilators) and a special warming fluid that comes with them. this one can be effective especially when used in conjunction with the biofeedback. PT program. you'd definitely would want a trained professional--like a PT--to show you how to use them.

http://www.ncbi.nlm.nih.gov/pubmed/9102268

botox injections. quite a few months ago (may maybe?) someone on this board posted about success with this. here's one link and i've read others.

http://www.ncbi.nlm.nih.gov/pubmed/10733120

also see the "related citations" (links) listed to the right of the article.

5 mg valium--helps relax pelvic floor muscles.

nytroglycerin suppositories can also help relax the muscles.

sitz baths or just sitting in a bathtub with warm water (body temp or slightly higher). water level low or up to the top of the hips--whatever works best. do this for 20-30 minutes one to three times a day.

some people find a tens unit (tens machine) helps relieve pelvic pain and relax pelvic floor muscles. put the contacts on or around your bikini line. you can get a tens unit on amazon. that's where i got mine--very reasonable priced and good quality. it's made by omron. it can also help relieve pain elsewhere on the body.

if i think of more i'll post it later.


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## annie7 (Aug 16, 2002)

...you can also purchase a home biofeedback machine to work with either in between your biofeedback sessions or afterwards to help keep your muscles relaxed. you can ask your PT about buying one. i have an address and phone for a company who makes one but i don't know if they ship outside the usa.

about biofeedback and physical therapy--it does require a lot of hard work and total dedication. and of course a great physical therapist. i was lucky--my therapist was terrific and she wasn't "cookie-cutter" either--she adjusted the therapy to my needs.

some people need more home practice and biofeedback/PT sessions than others for success. others need to return to biofeedback/PT for occasional "tune-ups". it's all about training your pelvic floor muscles to relax--retraining your muscle memory. people like me who've had problems with this since childhood may need more time to retrain that muscle memory since it's been there since forever--lol..

and of course bio/PT doesn't help everybody. but it is definitely worth a try especially if your insurance covers it.

biofeedback/PT does not help with slow colonic transit per se--it just helps with getting stool out of the rectum. although i've read and also been told by my gastros and PT that when stool constantly gets backed up in the rectum due to pfd (or any outlet obstruction) and you're not able to get much out every day--then that in turn can affect your colonic transit --peristalsis--and cause it to slow down--if it's backed up at the outlet then everything tends to slow down in turn as a reaction to that.


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## Maegwin (Nov 11, 2012)

IndianRopeTrick said:


> Thanks. But now, it is killing the intelligence and creativity, the very basis for my employment. I am waiting for this storm to pass and return to a normal life. Just hoping that the rough patch does not last long enough to become a
> 
> serious concern to the employer. They already know I am "a bit" unwell, but not exactly what. Keeping my fingers crossed :|


Those early mornings were when I worked shifts as well. After a long road I am now able to work from home as a graphic designer. Still, my body wakes me up a lot throughout the night or I have a restless sleep. I know what you mean about the tiredness killing the creativity and intelligence. I've had to get government assistance with my income.


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## Maegwin (Nov 11, 2012)

So much information Annie thank you! 

I have tried the elevated feet trick while on the toilet. Unfortunately I need to head out to get a seat with a smaller hole. I nearly fell in when I tried it. Haha. 

The belly breathing does help. It's hard to get my brain into it sometimes as I feel like I'm expanding my belly while it's full of pointy rocks.

Haven't heard of some of the others. I did try suppositories but it only relaxed my rectum. My issues are further up. I wish I could inject muscle relaxant straight into my hips. I wonder what it would take to get a valium prescription here. Is it something your PT would prescribe?

I'm not clear on this biofeedback thing. What is it? How does it "tune you up"? Can it effect higher points in the colon?


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## IndianRopeTrick (Jul 25, 2013)

annie7 said:


> oh yes--intelligence and creativity sure does require sleep! and rest. and yes i do hope your rough patch passes soon. you have a very difficult job to do on no sleep.
> 
> have you ever tried meditation. meditation is not a substitute for sleep of course but one of it's benefits is that it provides deep rest for the brain. 20 minutes to a half hour once or twice a day is good but even just meditating for just 5 or 10 minutes--relaxing, clearing your mind of thoughts and then just gently letting go of the thoughts when they come up--helps to rest and restore the mind--and helps to relieve stress. i've been meditating since the early 70's and it's been a lifesaver for me.


I had tried it before, but maybe I did it wrong. I am going to try it again. Which technique do you use ?

Thanks.


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## annie7 (Aug 16, 2002)

Maegwin--by "tune up" i just meant that people sometimes return for more biofeedback sessions later on to keep their pelvic floor muscles relaxed. and make sure they are doing the exercises properly etc.like a refresher course.

biofeedback teaches you to relax your pelvic floor muscles.here's one link--there is a lot more info out there as well...

http://www.mayoclinic.org/medicalprofs/retraining-pelvic.html

on the valium--don't know if PT's can write scripts--especially in canada--don't know what your pharmacy rules there are. but the PT could recommend to the doc to give you a script for valium if she can't write the script herself.


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## annie7 (Aug 16, 2002)

indianropetrick--i started out with using a mantra to focus on--just a word--or short phrase--something to focus the mind on and then just when thoughts come up--as they will-- and the mind wanders, just gently observe that the mind is wandering and bring your mind back to the mantra. over and over again. but gently--not judging or blaming yourself for the wandering thoughts. they are only natural--how the mind works.

after about ten years of that i attended and studied at a zen buddhist temple and learned a couple different meditation methods there--simply focusing on the breath--relaxing, breathing from the belly and focusing on that--no mantra--and at first just counting the breaths to focus the mind--count up to five and then start over again. and just bringing the mind back to the breath ever time it wanders. again, no judgement on how you're doing--no blaming yourself for wandering thoughts. later went on to hwadu meditation--koans.

and now i practice "just sitting". no mantra or breath counting--just breathing in breathing out, suspending all judgmental thinking and letting words, ideas, images, thoughts pass by without getting involved in them. and when the mind does get involved--as it inevitably will--just letting go of the thoughts..

there are many different meditation methods. visualization is another one. and there is insight meditation (vipassana-or mindfulness meditation) which i tried but didn't really click with me.

there are some good books out on it and websites.you just pick whatever works best for you.


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## tummyrumbles (Aug 14, 2005)

Some other things to try: a few heavy books placed on the floor to rest your feet on. It helps to straighten out the colon, and if you do bear down, you bear down more on your feet. Give yourself lots of time so you're not getting stressed. And take in something interesting. I do crosswords from the daily paper and this is a routine I have come to enjoy. Puzzles are good because having to think takes your mind off things (a bit like Annie7's meditation, only different). Take in a small laptop or tablet. Sometimes I talk to other IBSers while I'm (ahem) there. Once they get over the mild shock they're OK with that.

I'm wondering whether I do have pelvic floor dysfunction, as I always previously thought. If the colon works fine, say on a diet that almost totally soluable, easily digested fibre, but doesn't work so well on other days, then it's not likely to be a peristalsis dysfunction. If there was a genuine dysfunction then the colon wouldn't work well at all, regardless of your diet. Lengthy evacuation for me is always related to me eating foods I shouldn't eat.


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