STRESS URINARY INCONTINENCE (SUI)

Involuntary loss of urine, secondary to an increase in intra-abdominal pressure (coughing, sneezing, laughing, lifting, exercise or transitional movements) where typically, only a small volume of urine is lost. This type of incontinence is generally caused by a weak pelvic floor, poor breathing patterns or an over activity in abdominal musculature (specifically obliques or “sucking in your abs” all the time).

URGE INCONTINENCE (UI)

Urge incontinence is defined as the sudden loss of bladder control secondary to a strong and overwhelming urge to go to the bathroom. You will experience urine loss before you are able to make it to the toilet. There may be a small amount of urine loss or a complete emptying of the bladder. UI is often caused by detrusor (bladder muscle) instability, weak or tight pelvic floor muscles, or an up-regulated sympathetic nervous system.

OVERACTIVE BLADDER (OAB)

Defined by frequent and sudden urges to urinate, where some of these events may lead to urge incontinence but not always. Like urge incontinence, it is often caused by the bladder muscle (detrusor) being unstable or overstimulated by the sympathetic nervous system. OAB is often worsened by depression and anxiety. It can be treated medically with anti-cholinergic medication such as Detrol or Vesicare, but is very successfully treated without medication, with appropriate treatment for the weak or tight pelvic floor as well as cognitive behavioural strategies for learning to manage the urgency. Acupuncture is also a successful technique used to stimulate the percutaneous tibial nerve to send impulses to the sacral plexus (group of nerves at the base of the spine) which regulate bladder function.

Pelvic organ prolapse is described as an annoying protrusion (bulge) at or near the vaginal opening, which may or may not be accompanied by perineal pressure (pressure between your vagina and anus) which is aggravated by standing, and relieved by lying down. It can often be asymptomatic, and is usually not associated with pain. Patients may also report urine retention and alterations in bowel function.

Many conservative strategies include postural correction, constipation management, toileting positions, and pelvic floor exercises to correct and reverse the problems associated with prolapse. Most surgeons would agree that surgical correction of a prolapse should be the last resort.

TYPES

Prolapse is described by the organ which is protruding into the vaginal canal.

Cystocele: Prolapse of the bladder

Rectocele: Prolpase of the rectum

Urethrocele: Prolapse of the urethra

Uterine prolapse: Prolapse of the uterus

Vaginal Vault prolapse: Prolapse of the top of the vagina after a hysterectomy

Enterocele: Prolapse of the intestines

SYMPTOMS

The following are symptoms that are specific to certain types of prolapse:

Difficulty emptying bowel: This may be indicative of an enterocele, vaginal vault prolapse or prolapsed uterus. A woman with difficulty emptying her bowel my find that she needs to place her fingers on the back wall of the vagina to help evaluate her bowel completely. This is referred to as splinting

Difficulty emptying bladder: This may be indicative of a cystocele, urethrocele, enterocele, vaginal vault prolapse, or prolapsed uterus

Constipation: This is the most common symptom of a rectocele

Urinary Stress Incontinence: This is a common symptom of a cystocele

Pain that increases during long periods of standing: This may be indicative of an enterocele, vaginal vault prolapse, or prolapsed uterus

Protrusion of tissue at the back wall of the vagina: This is a common symptom of a rectocele

Protrusion of tissue at the front wall of the vagina: This is common symptom of a cystocele or urethrocele

Enlarged, wide, and gaping vaginal opening: These are common symptoms of a vaginal vault prolapse

Two conditions may be the cause of painful sex or even the penetration of a tampon.

VAGINISMUS

In vaginismus, vaginal muscles tighten involuntarily despite women’s desire for sexual intercourse. Vaginismus usually begins when women first attempt to have sexual intercourse. However, it sometimes develops later, for example, when another factor makes intercourse painful for the first time or when women attempt intercourse while they are emotionally distressed. Vaginismus can also become prevalent after childbirth as these muscles become overreactive as a protective mechanism. If intercourse is thought of to be painful, women fear it. This fear makes muscles even tighter and causes or increases pain when sexual intercourse is attempted. A reflex reaction develops so that when the vagina is pressed or sometimes even just touched, the vaginal muscles automatically (reflexively) tighten. Most women thus cannot tolerate sexual intercourse or any sexual activity that involves penetration. Some women cannot tolerate the insertion of a tampon or have never wanted to try. However, most women with vaginismus enjoy sexual activity that does not involve penetration.

DYSPAREUNIA

Dyspareunia, or pain associated with intercourse, can be experienced during penetration, with thrusting, or both. It can also be used to describe the pain felt after intercourse, which may or may not be accompanied by pain during intercourse. Pain with penetration is usually described as very sharp, with burning, ripping or tearing sensations. The pain with thrusting can be sharp, or dull and achey. Deep dyspareunia from thrusting can also be described as putting pressure on a tender bruise. Pain after intercourse will often be described as an intense aching or soreness, sometimes with severe burning and occasional sharp stabs of pain.

Common causes of dyspareunia are myofacisal trigger points, connective tissue dysfunction, skin disorders in the vulva, episiotomy scars, post-partum trauma caused by forceps or other extraction devices, pudendal neuralgia, and sensitized visceral organs such as the bladder or uterus.

Anorgasmia is the medical term for regular difficulty reaching orgasm after ample sexual stimulation. The lack of orgasms distresses you or interferes with your relationship with your partner.

Orgasms vary in intensity, and women vary in the frequency of their orgasms and the amount of stimulation needed to trigger an orgasm. Most women require some degree of direct or indirect clitoral stimulation and don't climax from penetration alone. Plus, orgasms often change with age, medical issues or medications you're taking. An orgasm is a feeling of intense physical pleasure and release of tension, accompanied by involuntary, rhythmic contractions of your pelvic floor muscles. But it doesn't always look — or sound — like it does in the movies. The way an orgasm feels varies among women, and in an individual, it can differ from orgasm to orgasm.

By definition, the major symptoms of anorgasmia are the inability to have an orgasm or long delays in reaching orgasm that's distressing to you. If you're happy with the climax of your sexual activities, there's no need for concern. However, if you're bothered by the lack of orgasm or the intensity of your orgasms, a pelvic physiotherapist can help to determine a course of action if the cause is within their scope. It’s worth asking the question and starting the discussion.

Recent developments in soundwave therapy have shown to improve circulation and nerve responsiveness in genital tissue which can improve and enhance orgasm.

Pudendal nerve irritation (neuralgia or nerve entrapment) is defined as pain in the distribution of the pudendal nerve, which innervates the rectum, vagina, penis, perineum and mons pubis. It can refer to the nearby areas in the pelvis, but most pain is the areas described above.

Entrapment of this nerve occurs when there is something physically compressing the pudendal nerve along its pathway. This can occur as a result of a traumatic injury to the pelvis, where the pudendal nerve can become entrapped between the sacrospinous and sacrotuberous ligaments; common causes of this can be prolonged sitting or cycling. It can also occur after a traumatic childbirth, specifically during a forceps or other instrumentation delivery. The last situation that could lead to pudendal nerve entrapment is post-surgically when a stitch may have inadvertently occluded the path of the nerve.

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