Pelvic floor dysfunction (PFD) involves the inability to properly relax or coordinate the muscles that form the supportive base of the pelvis. These muscles support organs such as the bladder, uterus, and rectum, and their coordinated function is necessary for normal urination and defecation. Hematuria, the medical term for blood in the urine, is a symptom caused by various conditions affecting the urinary tract, from the kidneys to the urethra. While PFD does not directly cause bleeding, it can create conditions within the urinary system that lead to the presence of blood cells in the urine. This article explores the relationship between PFD and urinary function and clarifies the indirect pathways through which PFD may contribute to hematuria.
Understanding Pelvic Floor Dysfunction and Urinary Mechanics
The pelvic floor muscles must alternate between contraction to maintain continence and relaxation to allow for elimination. PFD occurs when these muscles are either chronically too tight (hypertonic state) or too weak (hypotonic state). Both conditions disrupt micturition, the act of urination.
In a hypertonic state, overly tense muscles fail to relax completely during voiding. This muscular constriction mechanically impedes urine flow through the urethra, causing symptoms like urinary hesitancy, a slow stream, and a feeling of incomplete bladder emptying. Conversely, a hypotonic state often results in a lack of urethral support, manifesting as stress or urge urinary incontinence.
The primary symptoms of PFD relate to storage and emptying issues, including increased urinary frequency, urgency, and pelvic pain. The inability to fully empty the bladder, known as urinary retention or high post-void residual volume, is a particularly significant symptom. This retention is crucial because it sets the stage for secondary complications, as discoordination of the pelvic floor muscles physically obstructs the natural flow of urine.
Indirect Ways PFD May Be Related to Hematuria
PFD is related to hematuria through secondary effects, primarily by hindering complete bladder emptying. Chronic incomplete voiding leaves a small volume of urine (post-void residual) in the bladder. This residual urine creates a static environment where bacteria multiply, significantly increasing the risk of a urinary tract infection (UTI).
A UTI, especially one progressing to bladder inflammation (cystitis), is a common cause of hematuria. The bacterial invasion irritates and inflames the bladder wall lining, causing micro-abrasions and minor bleeding. This bleeding may be visible (gross hematuria) or only detectable under a microscope (microscopic hematuria). PFD’s role is creating the urinary retention that leads to the infectious cause of the bleeding.
A less common indirect link involves severe straining during bowel movements, often associated with PFD-related constipation or defecation dysfunction. Chronic, forceful straining increases pressure on pelvic structures, potentially causing minor trauma to the urethra or surrounding tissues. This micro-trauma can contribute to microscopic hematuria, particularly if the straining is repetitive. In these scenarios, PFD acts as an underlying factor that contributes to the conditions causing the bleeding, rather than being the direct source of the bleeding itself.
Primary Medical Causes of Blood in Urine
Since PFD is only an indirect contributor, any episode of blood in the urine warrants a comprehensive medical evaluation to rule out other primary causes. One common cause is urolithiasis, or stones in the urinary tract (kidney or bladder stones). These hard mineral deposits scrape the lining of the urinary tract as they move, causing pain and gross hematuria.
Malignancy is a serious cause, as bleeding can be the first sign of bladder or kidney cancer. The risk of cancer-related hematuria is higher in individuals with risk factors like smoking or occupational chemical exposure. Kidney diseases, including various forms of glomerulonephritis, also cause hematuria by affecting the kidney’s filtering units, allowing red blood cells to leak into the urine.
Other potential causes include physical trauma to the abdomen or kidneys, which is a straightforward cause of bleeding. Certain medications, especially blood thinners, can also exacerbate or unmask a source of bleeding. Distinguishing between gross hematuria, where the urine appears pink, red, or brown, and microscopic hematuria, where blood is only seen under a microscope, is often the first step in diagnosis.
Next Steps in Diagnosis and Management
Experiencing both PFD symptoms and hematuria requires a dual-focused diagnostic approach to address the cause of the bleeding and the underlying muscle dysfunction. The first step involves a urinalysis and urine culture to confirm the presence of blood and check for an active infection. If an infection is found, it must be treated promptly with antibiotics to resolve the cystitis and associated bleeding.
If hematuria persists or if malignancy risk factors exist, further investigation is necessary. This includes imaging tests, such as a CT scan or renal ultrasound, to examine the kidneys and ureters for stones or tumors. A cystoscopy, where a small camera is inserted into the bladder, is often performed to directly visualize the bladder lining and identify the source of the bleeding.
Once the direct cause of the hematuria is identified and treated, management focuses on the PFD itself. This typically involves referral to a specialized pelvic floor physical therapist who uses techniques like biofeedback and targeted exercises to restore normal muscle function and coordination.