Nonrelaxing pelvic floor dysfunction

In the February 2012 issue Mayo Clinic Proceedings, Dr. Faubion and colleagues discuss the symptoms and management of nonrelaxing pelvic floor issues. In this clinical review, the authors differentiate between conditions that involve relaxed pelvic floor muscles (pelvic organ prolapse, urinary incontinence) with conditions in which non-relaxing pelvic floor muscles play a key role. When the muscles of the pelvic floor have difficulty in relaxing, this can impair the person’s function with defecation, urination, and sexual activity. The review focuses on the symptom complex called “nonrelaxing pelvic floor” so that care providers can manage the condition effectively, and in the words of the authors, provide early referral to physical therapy that can address the muscle dysfunction.

When learning about the various diagnoses for pelvic floor pain conditions, medical providers and pelvic rehab therapists are faced with a long list of terms that have overlapping symptoms. Some of the terms listed in this article include coccygodynia, levator ani syndrome, piriformis syndrome, and puborectalis dyssynergia. It is pointed out that using the description of non-relaxing pelvic floor has the ability to encompass many of these other terms without inaccuracy in diagnosis. Dr. Faubion suggests that medical providers look for the cluster of symptoms that tend to accompany non-relaxing pelvic floor conditions, including voiding dysfunctions, constipation, dyspareunia, low back pain and pelvic pain.

What is so exciting about this article from the Mayo clinic is that physical therapy is identified as a “cornerstone of management.” Oftentimes, when we read clinical practice guidelines for various dysfunctions involving the pelvic floor, physical therapy or pelvic rehabilitation rarely gets an honorable mention. To read about the recognition of PT as such an important element of healing pelvic dysfunction can help improve awareness among the medical profession and expedite referrals to pelvic rehabilitation providers. Only time will tell if "nonrelaxing pelvic floor" will catch on as a replacement for the diagnostic terms that name single muscles. In the meanwhile, this article will hopefully serve as an educational tool to increase awareness of the evaluation and treatment options available to medical providers.