Patient Populations

Pelvic floor dysfunction is more prevalent in some patient populations. This is important to remember when on clinical placement or starting out as a physiotherapist as something to consider for the patients you are treating. Patients may not be willing to mention their pelvic floor dysfunction when conducting a subjective interview, and knowledge of the patient types who are more at risk of these concerns can assist your clinical reasoning. These types of conditions may have been affecting a patient long-term, yet there are factors that influence their willingness to discuss this, including [8]:

Stigma

Health literacy

Shame

Social perception

Embarrassment

Perceived bother

Postnatal Women

Nearly 1 in 3 women postnatally have some form of pelvic floor dysfunction. The most common type of pelvic floor dysfunction in this group is stress urinary incontinence (SUI); other frequently experienced conditions include urinary frequency, perineal pain, constipation, prolapse, dyspareunia and faecal incontinence [9]. Things to look out for in this patient population that place women at higher risk:

Advanced age - the older a woman is giving birth, the higher the risk of pelvic floor dysfunction.
High BMI/obesity - people with increased BMI are more at risk of developing pelvic floor dysfunction due to increased weight sitting on the pelvic floor muscles.
Multi-parity - each time a woman gives birth, their risk of pelvic floor dysfunction increases. This is due to both the sustained period of increased weight on the pelvic floor, but also the trauma of birth and healing that occurs afterwards.
Long-lasting 2nd stage of labour - this stage of labour is when the woman is actually giving birth to her baby. The cervix is fully dilated and the woman can start 'pushing'. Prolonged 2nd stage of labour is defined as >2 hours from onset of the second stage [7].
Infant birth weight - the larger the baby, the more weight has been sitting on the pelvic floor and more trauma to the vagina can occur during birth.
Physical activity levels - low or high physical activity levels can increase the risk of developing pelvic floor dysfunction.
Instrumental delivery and/or perineal trauma - the use of forceps or vacuum assisted delivery for example to assist giving birth, or the event of tearing to the perineum.

Older Adults

Although this is not necessarily a risk factor in itself for pelvic floor dysfunction, there is an increased prevalence in older adults, particularly in two patient populations:

Men with Prostate Disease

Men with prostate disease (despite whether it is treated or untreated) are at risk of developing urinary and faecal incontinence.

70% of residents in aged care or supported living in Australia have urinary or faecal incontinence [1].

Post-Menopausal Women

Going through menopause, women's levels of oestrogen decrease dramatically. Oestrogen is known to be important for pelvic floor health as there are oestrogen receptors in the urethra, vagina and area called the trigone in the bladder and the pelvic floor muscles [10]. With this decrease, women have a higher risk of developing a problem. SUI and UUI are usually the most common to develop post-menopause, however if a problem already exists such as a prolapse, this can worsen.

When asked about the onset of their urinary incontinence, 70% of women associated the event to their final menstrual period [10]

Obesity

People who are overweight or obese have an increased risk of developing pelvic floor dysfunction. This is due to the increased load on the pelvic floor, chronic increase in intra-abdominal pressure and also correlates with physical inactivity of this patient population [11]. An obese person is more likely to have a higher severity of pelvic floor dysfunction [11].

Manual Labour

Any individual who has undertaken manual labour or repeated manual tasks are at an increased risk of pelvic floor dysfunction. This does not just mean tradespeople and farm labourers. This includes any kind of heavy lifting, repeated movements under load or regular weighted exercise [12]:

Factory workers
Retail workers lifting stock - e.g. supermarket workers
Recreational and high-level athletes who perform weight training - especially prevalent in functional fitness such as cross fit
Recreational and high-level athletes who require repetitive jumping and impact in their sport - e.g. volleyball, basketball, soccer
Tradespeople
Farm hands/labourers

Assessment