To diagnose pelvic floor dysfunction, we first need to know what pelvic floor dysfunction is. While I suggest you read my blog on what is pelvic floor dysfunction, I would like to direct your attention to an analogy that is important to understand going forward. If pelvic floor dysfunction was a title to a book, it would have many chapters that unfortunately, when it comes to treatment, the health care community look at each chapter as if it is its own book. Urinary incontinence, bowel incontinence, constipation, pelvic pain, painful intercourse, pain in the tailbone, testicular pain, vulvodynia, weak pelvic floor, poor posture, lower back pain, sacroiliac pain, difficulty breathing, anterior pelvis, and hip pain are the names of each chapter. Read the list and you will see that even you, might have looked at each one as if they were their own separate incident and unrelated.
We tend to address each complaint by itself and go see a practitioner who may or may not even look at it holistically and THAT is the number one problem with pelvic floor dysfunction diagnosis.
Who diagnosis pelvic floor dysfunction?
Unfortunately, for each ‘chapter’ of pelvic floor dysfunction, this healthcare system has a specialist and none of them seem to communicate to each other. You see a urologist for perhaps a bladder or testicular pain, see a gastroenterologist for constipation, depending on the gender may seek advice from a gynecologist or urogynecologist, maybe take medicine for the lower back, hip and sacroiliac pain, see a physical therapist or a chiropractor. For the weak pelvic floor see a pelvic floor therapist that may or may not be a physical therapist.
A pelvic floor therapist is aware of the importance of breathing, posture and is aware of the connection of the hips, lower back and sacroiliac joints to the structure that ‘houses’ the pelvic floor muscles but hardly any time is spent on bringing the ‘house’ to a better alignment and stability. The question I always ask is how can you think about the floor when the house is not stable?
How is pelvic floor dysfunction diagnosed?
Pelvic floor dysfunction is only diagnosed thoroughly by the healthcare practitioner who looks at the whole picture holistically, asks questions that are beyond the immediate pain, engages in taking detailed history (sometimes from childhood injuries and habits), looks at your current lifestyle and activity type and level, looks at your detail medical history and is fully aware and trained to examine you posturally, assess your breathing style, look at your skeletal and muscular system. This may or may not include the internal manual exam.
Frankly, by the time patients come to me, they have had many sessions of internal manual work, have seen their urologist or gynecologist and at times, have had invasive studies done with no definitive answer. Even if the studies were indicative of a specific problem, you should not forget that the structure that holds the floor, the areas of pain and dysfunction still need to be looked at. It is possible to have a floor issue and a plumbing issue while some of the walls of the house may need reinforcement, right?
I already answered how pelvic floor dysfunction is diagnosed but who do you go to for the diagnosis?
Who diagnosis pelvic floor dysfunction?
As mentioned above, different components of pelvic floor dysfunction can be diagnosed by different specialists but the real diagnosis of the dysfunction is truly understood by those who actually deal with the pelvic floor and that is the pelvic floor therapist who may or may not be a physical therapist. For instance, I am a chiropractor that focuses on postural neurology and developmental kinesiology with training in pelvic floor. It is the pelvic floor dysfunction that I treat and I leave the internal work to my colleagues who wish to focus on that “chapter” of the pelvic floor dysfunction.
Why is pelvic floor dysfunction on the rise?
While traditionally pelvic floor issues are looked at as weak pelvic floor, urinary incontinence because of pregnancy and childbirth, maybe trauma or older age, this no longer applies. We are seeing more and more people with pelvic floor dysfunction that are young, never have been pregnant or given birth, are young and not even female.
It is our sedentary lifestyle leading to poor posture that is creating a havoc in our country and most are oblivious to what is happening. If your daily job requires over 5 hours of sitting, and using devices, you are already at some stage of pelvic floor dysfunction. Should you wait for more severe symptoms to alert you into doing something about it? I so hope not.