Pelvic floor disorders in women present with a wide range of symptoms. Perhaps a trickle of urine leaks when you sneeze or cough. Maybe you experience constipation or straining with bowel movements. Or you may have a feeling of pressure or pain in the vagina or rectum.
These are all signs of a pelvic floor disorder (PFD), a common problem that affects about one out of four women aged 20 and over, according to Voices for PFD, an online community sponsored by the American Urogynecologic Society. Men also can develop PFD.
PFD can be a somewhat sensitive concern, so it’s understandable that some patients might be embarrassed to talk to their providers about the condition. But there’s no need to be ashamed and just live with it—PFD is treatable.
“Pelvic floor disorders aren’t uncommon,” says gynecologist Sarah Stadler, MD, PLC. “If you’re experiencing symptoms that impact your quality of life, it’s important to discuss these with your provider. There are steps you can take to help you feel better.”
What is the Pelvic Floor?
The pelvic floor is a group of muscles, ligaments and connective tissue between the pubic bone and the tailbone that form a sling to support the pelvic organs, including the urethra, vagina, bladder, bowel and rectum. In men, the pelvic floor supports the prostate, as well as the bowel and bladder. PFD occurs when the pelvic muscles and/or connective tissue becomes weakened or injured. Oftentimes, women can have more than one type of PFD. The most common PFDs are:
Urinary incontinence: Lack of bladder control, including urine leakage or the frequent urge to urinate.
Fecal incontinence: Lack of bowel control, including leakage of stool.
Pelvic organ prolapse: Descent of one or more pelvic organs into the vaginal space. May cause the feeling of pressure or fullness inside the vagina, or the organs may bulge out of the vagina.
PFD can have many potential causes, including childbirth; radiation or surgery in the pelvic region; obesity; and conditions such as multiple sclerosis, Parkinson’s disease, stroke or spinal stenosis. Postmenopausal women may develop PFD due to declining estrogen levels, which causes thinning and weakening of these muscles. In men, an enlarged prostate may cause PFD.
Treatments Offer Hope
While surgery may be necessary to treat more advanced cases of PFD, a number of effective nonsurgical treatments also are available. For women, a vaginal evaluation by a doctor is needed to assess the nature of a PFD, determine which muscles are affected and develop an appropriate treatment plan.
“We’ll need to find out what’s causing the problem,” says urologist Jeffrey York, MD, of Sentara RMH Urology Specialists. “Is it simply an issue with the pelvic floor, or does the patient have another undiagnosed medical condition, like Parkinson’s disease or diabetes? That’s the first step in creating a treatment plan.”
Nonsurgical treatment options for PFD include:
Biofeedback: This technique, performed by a physical therapist or physician, involves the use of internal or external electrodes and video to monitor a patient’s attempts to contract or relax the pelvic floor muscles. The caregiver provides feedback during the treatment to help the patient improve muscle coordination.
Pelvic floor muscle training and core strengthening:Patients learn how to perform Kegel contractions, a clench-and-release exercise that strengthens the pelvic floor muscles. They also learn the proper way to strengthen their abdominal and lower-back muscles, known as the core, to help reduce the effects of PFD.
Manual therapy: Techniques such as deep-tissue massage, strain-counterstrain and joint mobility can be performed by a physical therapist to help reduce muscle spasms of the pelvic floor.
Bladder retraining: For treating urge incontinence, this method focuses on increasing intervals between trips to the bathroom by having the patient urinate on a schedule. “A healthy bladder should be able to wait between three and four hours between emptying,” says physical therapist Megan Driscoll of the Sentara Martha Jefferson Outpatient Therapy Center. “But these patients have gotten to the point where they’re going every 30 minutes to an hour—even during the nighttime.”
Pessary: This ringlike support device, similar in shape to a contraceptive diaphragm, is fitted by a physician inside the vagina to support the pelvic organs.
Nerve stimulation: For some patients who have not had success with medications or other therapies, nerve stimulation may be effective at modifying bladder and bowel activity. These procedures deliver electrical impulses to the sacral nerves, which control the bladder and bowel muscles. The nonsurgical posterior tibial nerve stimulation approach involves delivery of electrical impulses to the sacral nerve via the tibial nerve in the ankle.
Diet: Losing weight can help control PFD. Additionally, drinking more water, as well as less coffee, tea and soda (caffeinated and decaffeinated); fewer citrus drinks; and less alcohol can improve bladder and bowel control. A healthy diet that includes plenty of fruits and vegetables—while limiting dairy and fried, fattening and spicy foods—also can help to improve bowel problems.
Depending on your symptoms and the type of PFD you have, a combination of treatments may be effective. Patients seeking physical therapy must be referred by their doctor.
“A lot of women have been convinced that urinary leakage or other pelvic floor dysfunction is just what happens after you give birth to a child or reach a certain age,” notes physical therapist Linda Larson, of Sentara RMH Therapy Services. “It’s important for patients to recognize that they have treatment options, and that they don’t just have to let it happen. By seeking treatment for PFD, women have a lot to gain and nothing to lose.”