The pelvic floor: common elements of the physiotherapy and gynecological evaluation

Dysfunction of the pelvic floor muscles can cause urological, gynecological, anorectal, sexual and pain symptoms that can have a negative impact on a woman’s quality of life. Therefore, the evaluation of these muscles and the characteristics of the symptoms is fundamental for their management and treatment. Urological symptoms are related to both bladder filling, such as incontinence, frequency, urgency, nocturia, and emptying, such as urinary hesitation, intermittent, hypovalid, deviated mitt, straining, post voiding drip, sense of incomplete emptying. Anorectal symptoms are identified in anal incontinence and urgency, constipation and a sense of incomplete emptying. Alterations in the gynecological area refer to the prolapse of the pelvic organs. Sexual dysfunctions consist in the impossibility or difficulty in penetration and orgasm, in coital pain, and in the reduction of genital sensations of pleasure. Painlike symptoms refer to chronic/persistent pain in the pelvic area, including persistent vulvar pain. The common elements among professionals in the evaluation of the pelvic floor are identified in the medical history and physical examination. The first identifies symptoms and related risk factors. The latter include pregnancy, childbirth, menopause, syndromes involving persistent pelvic pain, systemic diseases involving connective tissue, skin and peripheral nervous system, oncological diseases, lifestyles that cause frequent increases in abdominal pressure or excessive contraction of the trunk and pelvis muscles, or prolonged sitting. The physical examination identifies the condition of the pelvic floor muscles, which may be excessively or poorly active. Anamnesis and physical examination then allow to plan the therapy, which can be identified in physiotherapy and rehabilitation, in psychological, pharmacological, surgical therapy.

Keywords: physical examination; manual palpation; muscle tone; muscle trophism; voluntary and involuntary motor activity; muscle pain.