Your pelvic floor is the hammock of muscles at the base of your pelvis. It supports your bowel, bladder, and (in women) the uterus, controls your continence, and coordinates the act of going to the toilet.
Pelvic floor dysfunction is a broad term covering any condition where these muscles do not work the way they should — either being too weak (so they cannot hold things in), too tight or overactive (so they cannot relax for things to come out), or poorly coordinated (squeezing when they should relax, or vice versa).
Many people put up with pelvic floor symptoms for years before seeking help because they feel embarrassed or assume it is just part of getting older. Please know: these problems are very common, well-understood, and respond very well to the right treatment.
Several specific conditions sit under the umbrella of pelvic floor dysfunction, often overlapping in the same person:
Pelvic floor dyssynergia — the muscles squeeze when they should relax during bowel motions, blocking things up. Rectocele — the wall between rectum and vagina weakens, allowing the rectum to bulge forward (see the Rectocele & ODS page). Rectal intussusception — the rectum telescopes into itself during straining. Rectal prolapse — the rectum prolapses fully through the anus. Faecal incontinence — poor control of the back passage. Obstructed defaecation syndrome (ODS) — difficulty emptying despite the urge. Chronic pelvic pain, including levator ani syndrome. And in women, prolapse of the bladder, uterus, or rectum (often together).
Many people have a combination of these. The good news is the assessment and treatment approach is similar regardless of which combination you have.
Common contributors include: vaginal childbirth (particularly multiple deliveries, large babies, or difficult deliveries), getting older (the tissues weaken over time), chronic straining (from constipation, heavy lifting, or chronic coughing), previous pelvic surgery, obesity, and sometimes a family tendency to weaker connective tissues.
Habit and learned behaviour also play a role — long years of straining or rushing on the toilet can train the pelvic floor into unhelpful patterns. That is a hopeful thing in a way: behaviour and habits can be retrained.
Symptoms depend on which part of the pelvic floor is misbehaving, but common ones include: difficulty emptying the bowel, a feeling of incomplete emptying, the need to splint (press on the vagina or perineum to help empty), prolonged time on the toilet, faecal incontinence — to wind, liquid, or solid — urgency, a sensation of a vaginal or rectal bulge, and chronic pelvic pain or pressure.
These symptoms can feel isolating, but they are extraordinarily common. You are not the only one dealing with this.
Assessment starts with a careful, unhurried conversation about your symptoms and a gentle examination. Specific tests are chosen based on what is suspected — not everyone needs every test.
Common investigations include: anorectal manometry (a thin pressure sensor that measures how well the sphincter and pelvic floor muscles work and coordinate); defaecating proctography (an X-ray taken while you empty contrast on a special toilet, showing exactly what your pelvis does during evacuation); endoanal ultrasound (a small ultrasound probe that maps the sphincter muscle structure); and sometimes pelvic MRI for multi-compartment problems. These tests are not painful — just informative.
Treatment is tailored to what is going on, but almost always starts conservatively — and most patients improve significantly with these measures alone.
The cornerstones are: pelvic floor physiotherapy with a specialist physiotherapist (often using biofeedback — see the Pelvic Floor Physiotherapy article); dietary and bowel-habit changes; fibre and fluid optimisation; and treating contributing conditions like constipation.
For faecal incontinence that does not improve with conservative measures, sacral neuromodulation is an effective option — see the Sacral Neuromodulation page. Surgery is reserved for specific anatomical problems (such as full-thickness rectal prolapse or a large rectocele with associated symptoms) that have not responded to conservative treatment.
Pelvic floor dysfunction rarely responds well to a single intervention. Mr Nguyen's approach is multidisciplinary — working with pelvic floor physiotherapists, gynaecologists (for combined prolapse), and the wider pelvic floor team to take care of the whole picture.
For almost everyone, the first step is referral to a specialised pelvic floor physiotherapist, with at least a 3-month trial before further interventions are considered. This is not delay — it is the most effective first treatment.
Please do not feel you have to put up with these symptoms. See your GP for a referral if you have any of: persistent difficulty emptying your bowel, faecal incontinence (even just to wind or small amounts of liquid), a sensation of a vaginal or rectal bulge, chronic pelvic pain, or any combination of these. Earlier assessment really does mean simpler treatment.
A detailed history is taken, you are examined respectfully and gently, and the right investigations are arranged. In almost all cases, the next step is referral to a pelvic floor physiotherapist who specialises in this area. The Pelvic Floor Physiotherapy article explains exactly what that involves.
No. Men can have pelvic floor problems too — particularly dyssynergia (muscle coordination issues), faecal incontinence, and chronic pelvic pain. Women are more affected by prolapse-type problems because of the additional impact of childbirth and gynaecological anatomy, but pelvic floor physiotherapy and the conditions described here apply to men too.
Most people do not. The majority improve substantially with pelvic floor physiotherapy and simple measures. Surgery is reserved for specific anatomical problems that persist after a proper trial of conservative treatment — and even then, it is offered only when the operation is likely to make a real difference.
Most patients are offered a course of 4–6 sessions over 2–3 months, with home exercises in between. Meaningful improvement is usually evident within this timeframe. For more on what to expect from physiotherapy itself, see the Pelvic Floor Physiotherapy article.
Sacral neuromodulation is a well-established option for faecal incontinence and urgency that has not responded to conservative measures. It is less applicable to obstructed defecation. One of its great strengths is that there is a test phase before any permanent device — so you can find out whether it works for your specific symptoms before committing. See the Sacral Neuromodulation page.
Have questions about pelvic floor dysfunction?
Mr Nguyen sees patients at his consulting rooms in Heidelberg and operates at Warringal Private and Epworth Eastern. A GP or specialist referral is required.