Pelvic Floor Muscle Impairment
Currently there is disagreement on the definition of pelvic floor muscle impairment(1). However, many texts include issues such as weakness, spasm, incoordination, disuse impairment, trigger points, scarring, urinary and or fecal incontinence, and organ prolapse(2). The pelvic floor muscles are considered as levator ani, striated urogenital sphincter, external anal sphincter, ishiocavernosus, and bulbospongiosus, but some texts consider some of the lower extremity muscles as well(1,3). The purpose of these muscles is to support the pelvic organs, sphincteric control, and sexual function(1).
Patient presentation can be divided into five groups:
- Lower urinary tract symptoms
- Urinary incontinence
- Urgency and frequency
- Slow or intermittent stream and straining
- Feeling of incomplete emptying
- Obstructed defecation
- Functional constipation
- Fecal incontinence
- Rectal/anal prolapsed
- Pelvic organ prolapse
- Orgasmic dysfunction
- Chronic pelvic pain
- Pelvic pain syndrome
Visual inspection of the perineum with the patient in hook lying in a clock like fashion with 12 o’clock at the pubic symphysis and 6 o’clock at the anus(1,3). Observe for perineal elevation, descent, and extra-pelvic muscle contraction(1).
- Inspect for skin pathology and anatomical abnormalities
- Observe the patient perform a pelvic floor contraction
- Observe the perineum while the patient performs a cough
- Evaluate for prolapsed by asking the patient to strain as if defecating
Digital palpation of the perineum should occur with the patient in hook lying following a clock like pattern(1,3). Palpation is used to assess the muscles during rest, contraction, and relaxation, as well as testing for pain(1,3).
- Patients should be asked to perform a voluntary contraction and a muscle grade given
- Notes should be taken on asymmetry in muscle contraction, ability to voluntarily contract and relax as well as involuntarily
Additional tests include electromyography to grade the intensity of the muscle contraction as well as muscle activity at rest(1). Also patients can be asked to keep a bladder diary for investigation of lower urinary tract symptoms, or a defecation diary for bowel symptoms(1).