Pelvic floor muscle dysfunction (PFMD) refers to a range of conditions in which the muscles of the pelvic floor don't function properly involving either increased tone or decreased tone of these muscles, leading to various symptoms and complications. Studies have indicated that  over 50% of both male and female may experience some form of PFMD in their lifetime. There are different options how to treat this medical condition,none of them has been proven to be the most effective in eliminating the existing symptoms. Thus, we decided to introduce the step-by-step algorithm, which would help healthcare specialists who work with patients muscle dysfunction of different etiology improve their life quality by restoring proper muscle function and reducing tension
The goal of our study was to both introduce and prove efficacy of implementation of an original, structured algorithm designed to manage PFMD in a short period of time.

Our retrospective study included medical histories  of 200 patients (170 women and 30 men) with a confirmed diagnosis of PFMD. The patients were divided into 3 groups: Group 1 (40%) - patients whose symptoms completely disappeared after the application of the rehabilitation algorithm.Group 2 (40%) - patients whose symptoms decreased but did not fully recover.Group 3 (20%) - patients with complex pathologies who required additional treatment, including pharmacological therapy.Pelvic floor muscle (PFM) function was assessed by performing a manual examination and using the Modified Oxford Scale, focusing on voluntary relaxation and contraction as indicators of restoration to normal muscle tone. In patients with increased muscle tone, we followed this algorithm: if a patient could relax their PFM on their own (after being shown the correct technique), we developed a personalized rehabilitation program. This included relaxation sessions lasting 2 to 5 minutes, combined with breathing exercises, performed up to five times a dayIf relaxation remained incomplete after the first stage, we incorporated manual therapy (soft tissue techniques) and stretching to relieve muscle tension. If the patient was still unable to relax their PFM, we assessed adjacent muscle groups (gluteal, adductor, rotator, and transverse abdominis) and their impact on pelvic floor function. If the аctivation of adjacent muscle groups led to the relaxation of PFM, we incorporated this technique into the rehabilitation program, encouraging both men and women to engage in targeted exercise therapy.If this approach was also ineffective, patients were prescribed physiotherapy, botox injections, and medical treatment. In patients with decreased tone the algorithm was as follows: if the PFM contracted by 3 points or more on the Oxford scale, patients were prescribed isolated exercises. If the PFM fibers contracted partially or didn't contract at all, the impact of neighboring regions was tested. If the PFM contraction increased with activation of the gluteal, adductor, rotator or transverse abdominal muscles, rehabilitation was mainly focused on these areas. Then, if the contraction didn't improve, the patient was referred to physiotherapy.

Patients who followed the algorithm described above achieved 4/5 to 5/5 scores on the Modified Oxford Scale, indicating improved voluntary control of PFM. Non-adherent patients, though, demonstrated no significant functional improvement.

Results suggest the algorithm restores PFM function effectively. High adherence resulted in significant improvements, while low adherence emphasized the importance of following all steps.Patients with complex pathologies, such as acute depression, anxiety disorders or adverse social circumstances, required personalized approach to undergo full rehabilitation and pharmacological support.

Being proved by our research, this original algorithm demonstrates promising potential as a clinical tool to personalized  PFMD management. Moreover, high commitment to the protocol correlates with significant improvements in PFM function and may be considered as a promising tool for further clinical trials.