Anatomy & Function

The levator ani complex is the primary muscle group of the pelvic floor. It supports the pelvic organs, maintains closure of the urethral and anal sphincters, resists rises in intra-abdominal pressure and contributes to vaginal tone and sexual function.

Pelvic Floor Dysfunction

• Vaginal delivery, prolonged labour or instrumental birth
• Third or fourth degree perineal tears
• High birth weight or multiple vaginal deliveries
• Age-related connective tissue changes
• Obesity and chronically increased abdominal pressure
• Chronic constipation and repeated straining
• Menopause-related decline in oestrogen and tissue strength

Symptoms & Types

Pelvic organ prolapse occurs when the bladder, rectum, uterus or vaginal vault descends into or beyond the vaginal canal. Common symptoms include a vaginal bulge, pelvic heaviness, incomplete bladder emptying, backache and discomfort during intercourse.

Treatment Options

• Pelvic floor muscle training as first-line therapy
• Vaginal pessary providing effective mechanical support
• Surgical repair with success rates of 70–95%
• Topical oestrogen to improve vaginal tissue quality and pessary tolerance

Associated Conditions

• Vaginismus: Involuntary vaginal muscle contraction managed with physiotherapy and psychosexual counselling.
• Vulvodynia: Chronic vulval pain without an identifiable cause requiring multidisciplinary care.
• Dyspareunia: Painful intercourse associated with genitourinary syndrome of menopause, endometriosis or pelvic adhesions.