Pelvic Floor Muscle Dysfunction

Content written by Irwin Goldstein MD

OVERVIEW:

The pelvic floor muscles, also known as the levator ani and coccygeus muscles, support the internal organs and pelvis, help to maintain urine and fecal continence, and are involved in sexual function. Pelvic floor muscle dysfunction (PFMD) is used to describe when there is abnormal tone, pain, shortening, spasm, discoordination, weakness, or impaired contractile properties within the pelvic floor muscles. PFMD can be subcategorized as either being high-tone of low-tone.

CAUSES:

Symptoms: High-tone pelvic floor (HTPF) muscle dysfunction is used to describe the pelvic floor muscles when there is pain, spasm, shortening and/or tightness at rest. Myofascial trigger points and tender points within the pelvic floor musculature can also be found in cases with HTPF. HTPF is usually present in women suffering from pelvic and sexual pain syndromes. Some examples of pelvic and sexual pain syndromes includes dyspareunia, vaginismus, vulvodynia, clitorodynia, interstitial cystitis, and endometriosis. HTPF muscles feel thick, taut, hypertrophied, and resist passive stretch. Evaluation via surface electromyography (sEMG) of the pelvic floor muscles also indicates an elevated resting tone. Volitional contraction reveals a shortened excursion of movement “up and inward” and weakness is usually noted. Another commonly used term for HTPF is hypertonicity of the pelvic floor muscles.

Low- tone pelvic floor (LTPF) muscle dysfunction describes the pelvic floor muscles when there is weakness, poor recruitment upon attempted contraction, laxity, or lengthening at rest. LTPF is commonly found in women suffering from incontinence, childbirth trauma, low back pain, pudendal denervation, orgasm dysfunction, pelvic organ prolapse, and genetic hypermobility syndromes. The muscles feel atrophied or thin, loose, and the vaginal vault may feel wider.2 Upon palpation there is usually absent pain of the pelvic floor muscles. Evaluation via sEMG indicates a low resting tone. Volitional contraction reveals weakness, poor closure, poor recruitment, and decreased endurance or an inability to hold a contraction for 10 seconds. Another commonly used term for LTPF is hypotonicity of the pelvic floor muscles.

DIAGNOSTIC TESTS:

During an internal vaginal exam for women and an internal rectal exam for men, the pelvic floor physical therapist or clinician is able to palpate or feel the pelvic floor muscles manually. Using a single digit, the clinician assesses each of the muscles for tone, sensitivity to pressure, elongation to passive stretch and volitional elongation, and contractile abilities. There is also a comparison of the right vs. left sides of the pelvic floor muscles. From the internal exam the resting tone or tension of pelvic floor muscles are determined to be normal, high-tone, or low-tone. The strength of the contraction, also commonly known as a Kegel contraction, is graded on an Oxford Scale of 0 to 5 with 0 representing absent contraction and 5 indicating very strong or ideal strength. Endurance is tested by asking the patient to contract the pelvic floor muscles for a duration of 10 seconds. During a normal pelvic floor muscle contraction a strong closure and an “upward and inward” lift is present, with equality between right and left sides.

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