How is pelvic floor dysfunction diagnosed & treated?
As there are many different forms of pelvic floor dysfunction (PFD), there are numerous medical disciplines available for diagnosis and each have different diagnostic tools for analysis. Some examples are physical examination, urodynamic testing, ultrasound and other imaging, scopes, and biofeedback. Patients should begin discussing their symptoms and concerns with their family doctor so that they can determine if a referral is indicated and to which specialty. Gynecologists, urologists, uro-gynecologists, gastroenterologists and colorectal specialists are some of the medical specialists that you may be referred to for assessment, depending on your symptoms.
To evaluate the health of the pelvic floor muscle, your doctor may refer you to a pelvic floor physiotherapist. A physiotherapist with post-graduate education in pelvic floor health, including vaginal and rectal examinations, would complete an internal physical examination to determine the health of your pelvic floor muscle. During this assessment, pelvic floor muscle strength, endurance, responsiveness, co-ordination, ability to effectively relax, presence of myofascial trigger points, scar tissue or tension in the muscle are some elements investigated to determine the overall health of the muscle.
Many medical treatment options are available including pelvic floor physiotherapy, medication and surgery, and sometimes, a combination of approaches is appropriate. Pelvic floor physiotherapy may include pelvic floor muscle exercise and relaxation techniques, education on dietary factors and toileting patterns and biomechanics, soft tissue massage and manual therapy techniques, as well as acupuncture, neuromuscular nerve stimulation, computerized EMG biofeedback and laser therapy. When medical intervention is indicated, the American Urogynecologic Society notes that conservative management such as pelvic floor physiotherapy should be a first-line defence strategy followed by more invasive medical interventions such as pharmaceutical and surgical approaches.