3 Things Women Need to Know About Pelvic Floor Disorders

Age and childbirth take their toll on a woman’s body. But problems with bowel and bladder control (and sex) from a weakened pelvic floor are often fixable. Women tend to put themselves last. And cope. And not complain. But some personal problems, like sexual discomfort and accidental bladder and bowel leakage, are really troublesome. The painful embarrassment these symptoms cause won’t go away on its own. Luckily, help for these common pelvic floor ailments is at hand.

What is the pelvic floor exactly?

The pelvis is the ring of bones attached to your legs at the hips. This ring forms a basin that supports the rest of your body. The pelvic floor is the sling of muscles, ligaments, connective tissues and nerves that covers the bottom of the basin. This sling holds up organs in the pelvis such as the bladder, rectum, uterus (womb) and vagina. Besides keeping them in place, the pelvic floor helps organs work appropriately. In other words, it controls bladder and bowel function, keeps the organs in their proper place and allows women to have enjoyable intercourse.

How do I know if I have a pelvic floor problem?

Just as elastic wears out over time, the pelvic floor muscles can become weak and the ligaments and other tissues can be stretched or damaged. Extra strain in this area increases the chance of developing a problem. Past pregnancies with vaginal delivery, obesity, chronic coughing, heavy lifting or straining during bowel movements increase the risk. Aging and decreased estrogen levels, as from menopause or certain cancer treatments, also add to the risk. So can any medical condition that affects the nerves, or surgery or radiation in the pelvic area. Almost 30 percent of women — and some men, too — will, at some time in their lives, develop a pelvic floor disorder. Problems with the pelvic floor can lead to many symptoms. A frequent complaint is bowel or bladder control problems. Muscle weakness and/or nerve damage in this area can cause urine leakage or incontinence, overactive bladder, bladder pain or frequent bladder infections. It can also cause incontinence of stool, chronic constipation or difficulty evacuating your bowels. In addition, some patients suffer from pelvic organ prolapse. Prolapse means that organs, such as the bladder, rectum, uterus or vagina, are not well supported and sink lower than they should. Eventually they can protrude outside the vaginal opening. If a woman lives to be 80 years old, she has an 11 percent chance of having an operation for prolapse. Other common problems include pelvic pain, painful intercourse and a variety of things that can contribute to female sexual dysfunction.

What treatment options are there?

Many treatment options exist. These are tailored for each individual patient after initial testing. Therapy often combines approaches. Simply educating a patient on her condition or making simple changes in behavior sometimes does the trick. Nutritional counseling can also help a patient avoid certain foods that may worsen his or her condition, or eat a high-fiber diet to help soften stool. Sometimes physical therapy and biofeedback are used. These treatments can help patients learn to identify, strengthen and relax their pelvic muscles in order to improve bladder and bowel function, and decrease pelvic pain. Medications are used to treat pelvic floor disorders such as overactive bladder, the thinning of tissues in the genital area and certain pain syndromes. Another available treatment option is a pessary. A pessary is a small plastic or silicone medical device inserted into the vagina or rectum. This device can help support the pelvic organs and keep them from falling out of place (prolapsing). Surgery may be recommended if symptoms persist after other less-invasive options have been tried. Most surgical options are minimally invasive. This kind of surgery is generally less painful, with less scarring and a quicker recovery than standard surgery.

Mickey Karram, MD, is Medical Director of The Christ Hospital Pelvic Floor Center and Professor of
 OB/GYN and Urology at the University of Cincinnati.