Pelvic floor symptoms can be uncomfortable to experience and even harder to talk about. Many people assume bladder leakage, pelvic pressure or bowel control problems are a normal part of childbirth or aging. While these conditions become more common with age and after pregnancy, they are not symptoms people have to automatically accept as part of their daily life.
Pelvic floor disorders affect approximately one in four women in the United States according to the U.S. Food and Drug Administration. “Symptoms of pelvic floor dysfunction may significantly impact quality of life and can have profound impacts on mental, physical, social and sexual health,” says Alec Szlachta-McGinn, MD, a WashU Medicine urogynecologist. The good news is that a wide range of treatments is available, from lifestyle changes and pelvic floor physical therapy to medications, office-based procedures and minimally invasive surgery.
What is the pelvic floor?
The pelvic floor is a group of muscles, ligaments and connective tissues that stretches from the pubic bone to the tailbone and between the sides of the pelvis. It functions like a supportive hammock for internal organs. In women, the pelvic floor also supports the upper vagina and uterus.
Because of this structure, the pelvic floor plays an important role in bladder and bowel control, sexual health, core stability and support of the pelvic organs. Pelvic floor dysfunction is a broad term for pelvic symptoms caused by weakness, injury, poor coordination or structural changes in these muscles and tissues.
What are symptoms of pelvic floor dysfunction?
Symptoms can vary depending on which muscles, tissues or organs are affected. Common signs include:
- Urinary leakage, difficulty emptying the bladder or changes in the urinary stream
- Constipation or accidental leakage of stool
- Pelvic pain
- Pain during intercourse
- Vaginal pressure, heaviness or a bulging sensation
- Bladder or urethral discomfort
Some people begin changing their routines to avoid accidents, discomfort or embarrassment. They may stop exercising, avoid social events, limit travel or change their sexual activity. When symptoms begin affecting daily life, it is worth talking with a healthcare provider.
What is pelvic organ prolapse?
Pelvic organ prolapse occurs when one or more pelvic organs, such as the bladder, uterus or bowel, drop down into the vagina. Patients may notice vaginal pressure, heaviness or a bulging sensation. Some also have difficulty emptying the bladder or bowel or experience discomfort during physical activity or intercourse. Pelvic organ prolapse is usually not dangerous. Treatment depends on how bothersome the symptoms are and what approach best fits the patient’s goals.
One nonsurgical option is a pessary, a removable support device that is placed in the vagina to help hold the pelvic organs in position. Pessaries are typically made from medical-grade silicone and come in different shapes and sizes. When properly fitted, most patients should not feel them.
Minimally invasive vaginal or laparoscopic surgeries are also available. A urogynecologist can help patients choose the option that is best for them.
What is urinary incontinence?
Urinary incontinence means any involuntary leakage of urine. The two most common types are stress urinary incontinence and urgency urinary incontinence (overactive bladder). Stress urinary incontinence causes leakage during activities that increase pressure on the bladder, such as coughing, sneezing, laughing, exercising or lifting. Urgency urinary incontinence involves a sudden, overwhelming need to urinate that may be difficult to control. It is often associated with overactive bladder.
For stress urinary incontinence, pelvic floor physical therapy, pessaries, or minimally invasive surgeries are available. Initial treatment options for overactive bladder may include pelvic floor physical therapy, adjusting fluid intake, reducing bladder irritants such as caffeine, carbonation and alcohol or using prescription medication. More advanced treatment options exist too such as neurotoxin injections and sacral neuromodulation (mild electrical pulses that stimulate nerves).
What is fecal incontinence?
Fecal incontinence refers to accidental leakage of stool (poop). It can range from occasional minor leakage to more frequent loss of bowel control. Treatment often begins with improving stool consistency because both constipation and diarrhea can make symptoms worse. Depending on the cause, a care plan may include dietary changes, fiber supplements, medications for chronic diarrhea, stool softeners, gentle laxatives or pelvic floor physical therapy. Minimally invasive surgical procedures are available for cases where the incontinence is not improving. Because several conditions can contribute to fecal incontinence, patients should receive a medical evaluation rather than trying to manage symptoms on their own.
Who is at risk of developing pelvic floor problems?
Pregnancy, childbirth and aging are among the most significant risk factors for pelvic floor dysfunction. Other factors may also increase a person’s risk, including:
- Chronic coughing or constipation
- Obesity
- Previous pelvic surgery, including hysterectomy
- A family history of pelvic floor disorders
Not everyone with these risk factors will develop symptoms. Pelvic floor dysfunction varies widely from person to person and may result from several contributing factors rather than one single cause.
What are my treatment options?
Treatment for pelvic floor dysfunction can range from lifestyle changes, pelvic floor physical therapy and medications to a pessary, office-based procedures or surgery.
Pelvic floor physical therapy is individualized. Some patients need strengthening, while others need help relaxing or coordinating the muscles, which is why Kegel exercises are not always the right solution.
When surgery is appropriate, many procedures can be performed using minimally invasive vaginal or laparoscopic techniques. A urogynecologist can help patients choose the option that best fits their symptoms, health and goals.
WashU Medicine urogynecologists can help
Pelvic floor disorders are common, but embarrassment often prevents people from seeking care. Living with leakage, pain or pelvic pressure can lead to isolation, reduced physical activity and changes in relationships. Talking with a healthcare provider is an important first step toward understanding the cause and learning about available treatments.
WashU Medicine urogynecologists see patients with these difficulties every day. To make an appointment with a specialist like Dr. Szlachta-McGinn, please call 314-747-1402.