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WOMEN'S HEALTH
Pelvic floor disorders in women involve a range of issues that affect the pelvic floor muscles and organs, often leading to discomfort and requiring medical attention and treatment.
Pelvic Floor Disorders in Women
June 10, 2024
Pelvic floor disorders (PFDs) are one of the most common disorders among women. Unfortunately, it is often undiagnosed or undertreated, leading to many people living with symptoms that can be easily treated or managed. One out of every four women will have a PFD in her life. These numbers double to one out of every two in women who have given birth. Although most PFDs are not life-threatening, they can negatively impact the quality of life and lead to more complicated medical disorders. Pelvic floor disorders also occur in men.
What is a Pelvic Floor Disorder?
The pelvic floor comprises muscles and connective tissues that support pelvic organs and hold them in position so they can function normally. In women, pelvic organs include the bladder, the colon, and the internal reproductive organs. A pelvic floor disorder occurs when these muscles and connective tissues are weakened or damaged and can no longer adequately hold the pelvic organs in place. As a result, the muscles cannot contract and relax normally, thus interfering with the body’s natural processes of elimination, as well as causing other symptoms.
What Causes Pelvic Floor Disorders?
Many factors can contribute to the formation of pelvic muscle dysfunction. Pregnancy and childbirth are some of the primary causes of PFDs, even if you deliver via c-section. The risk seems to increase with every subsequent pregnancy. A forceps or vacuum extraction at delivery is also a risk factor for developing a PFD. Anything that puts pressure on the pelvic floor muscles can weaken them. Some other examples of conditions that can lead to PFDs include:
- Obesity
- Chronic constipation or straining with bowel movements
- Chronic coughing from smoking and other health conditions
- History of hysterectomy
- Prior surgery to correct a prolapse
- Heavy lifting
- Weaker tissues
- Radiation treatment
- Aging, especially menopause
- Connective tissue disorder like Ehlers-Danlos Syndrome
Symptoms of Pelvic Floor Disorders
Symptoms of PFDs will vary based on the type of PFD. Most women with pelvic floor problems do not have symptoms initially, and even when they do, they are embarrassed to discuss their concerns with their doctor or think it is normal to live with those symptoms. However, the earlier a PFD is managed, the better the outcome. Some symptoms of PFDs include:
- Constipation
- Difficulty starting to urinate
- Incomplete emptying of the bladder
- Feeling of heaviness, fullness, or aching in the vagina
- Leak urine with laughing, coughing, sneezing, or during exercise
- Urgent or frequent need to urinate
- Pain while urinating
- Failing to reach the bathroom in time
- Difficulty controlling gas
- Leak stool
- Distinct bulge at the vaginal opening
Types of Pelvic Floor Disorders
The most common PFDs include:
Urinary incontinence (bladder problems)
Bladder issues can include urine leakage (often after a sneeze, cough, or a big laugh), needing to urinate more frequently than usual, not being able to fully empty the bladder with urination, or having an urgent need to urinate and not being able to make it to the bathroom in time.
Fecal incontinence (bowel control problems)
If the anal sphincter (the ring that keeps the anus closed) is weakened, you might unknowingly leak liquid or solid stool. You could also experience intense, sudden urges to have a bowel movement and unable to hold your stool until you reach a bathroom.
Pelvic organ prolapse
If the pelvic muscles and connective tissues are severely weakened, they might not continue supporting one or more pelvic organs. When this happens, pelvic organs can prolapse or drop into the vagina. For instance, the cervix and uterus can descend into the vagina and come out of the vaginal opening, or the vagina can drop into the vaginal opening. You might feel pelvic pressure, have urinary incontinence, or feel something bulging out of the vagina if you have a prolapse.
How are Pelvic Floor Disorders Treated?
Lifestyle changes are the least invasive treatments for PFDs. Depending on the kind of PFD you have, weight loss, increased fiber consumption, and avoiding food and drinks that can irritate the urinary tract might be helpful.
Pelvic floor muscle training (PFMT) is often recommended. This consists of regularly performing Kegel exercises that tense and relax pelvic muscles to strengthen them. When done regularly and with the correct form, PFMT can improve urinary incontinence and the symptoms of prolapse.
Starting a bladder training program can benefit people experiencing urinary frequency and urgency. While on a bladder training program, you will use the restroom only at specific time intervals and slowly, over time, increase the time between intervals.
For prolapse, your doctor might recommend a pessary. A pessary is a small device inserted into the vagina that helps to support the pelvic organs, stop urine leakage, and relieve prolapse symptoms.
For fecal or urine incontinence, you might be prescribed medications to help regulate diarrhea, bladder stimulation, and muscle function.
In more severe cases, or if all other treatments have proven ineffective, surgery might be recommended. In the U.S. alone, approximately 200,000 surgical procedures are performed yearly to manage incontinence or prolapse. Surgery is most often performed for prolapses, stress incontinence, and for the repair of a damaged anal sphincter muscle.
How to Prevent Pelvic Floor Disorders
You might not be able to fully protect yourself from PFDs, especially if you have a connective tissue disorder or other genetic risks, but there are steps you can take to minimize your risk. Changing lifestyle factors such as diet, physical activity, weight control, and not smoking can be beneficial in preventing PFDs.
A simple and effective tool that can also help is consistent pelvic floor muscle training (PFMT) or exercising your pelvic muscles (Kegels). Regularly performed Kegels can minimize the risk of developing urinary incontinence, especially before and after pregnancy. More research is needed to determine how effective PFMT is at preventing and treating bowel-related PFDs.
Also, minimizing anything that strains your pelvic floor muscles will help protect you from developing a PFD. This might mean getting to a healthy weight to avoid putting strain on your pelvic muscles or taking steps to treat a cough. Eat foods with fiber to prevent chronic constipation to avoid pelvic muscle strain. If you regularly lift heavy loads at work or the gym, ensure you use excellent form and avoid straining your back or abdomen muscles.
Keeping your pelvic floor muscles as strong as possible and minimizing your risk factors can offer some protection against PFDs. However, if you are experiencing any symptoms of PFD, such as pelvic discomfort, urinary leakage, or fecal incontinence, it is important to talk to your healthcare provider to create an individualized treatment plan to address your symptoms and help you strengthen your pelvic floor muscles.
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