Treatment for Common Pelvic Floor Disorders
October 19, 2023
From frequent urination to discomfort and pain, these conditions affect many women. Learn how to get relief.
A woman’s pelvic floor is made up of muscles that support the uterus, bladder and bowel. Like any muscle, these can weaken, leading to uncomfortable and sometimes painful disorders that can affect a woman’s daily life. It can be uncomfortable to sit, intercourse may become painful and unenjoyable, and urine or stool may leak uncontrollably.
One in 3 women will experience a pelvic floor disorder, often the result of pregnancy, childbirth, age, menopause or obesity. Still, many do not seek treatment. They often assume that their symptoms, such as a leaky bladder or frequent urge to urinate, are natural parts of aging. And because symptoms can include fecal or urinary incontinence, some women may also feel uncomfortable sharing their concerns during primary care visits. Providers, however, can talk about symptoms with compassion and understanding and offer treatment options to restore comfort.
Here, we share common pelvic floor disorders, what they feel like and how they are treated.
Pelvic Floor Dysfunction
The pelvic floor muscles act like a sling or hammock to support the bladder, bowel and uterus, suspending them gently above the rectum and cervix. The muscles contract and relax to control the flow of urine, stool and gas. When the muscles stay tense or can’t tense properly, it leads to pelvic floor dysfunction.
Muscles that are too tense mean the body can’t relax enough to pass stool or urine, resulting in constipation or delay in urination. Muscles that are too loose can cause urinary or fecal incontinence. Both cases can lead to pain in the back, pelvic region, genitals and rectum, in addition to pelvic muscle spasms and discomfort during intercourse.
Pelvic floor dysfunction is most common in women, though men can experience it, too. In the United States, defecation disorders account for 1.2 million physician visits annually.
Pelvic floor dysfunction can lead to two types of incontinence:
When the rectal and anal muscles are unable to contract properly, stool can leak unexpectedly. This can be caused by frequent constipation and straining during bowel movements, which weakens muscles. The muscles can also weaken with age, because of a vaginal tear during childbirth or as a result of nerve damage. Your provider may recommend anti-diarrheal medication, fiber supplements and dietary changes to avoid foods that can cause diarrhea. A physical therapist can help you strengthen the anal and rectal muscles to reduce leakage.
This occurs when a person is unable to effectively control the bladder, often due to weak pelvic floor muscles. With stress incontinence, pressure on the bladder from sneezing, lifting or laughing can cause leakage. With urge incontinence, people often feel a sudden and frequent urge to urinate, along with lack of control. Pregnancy, childbirth, menopause and weakening muscles with age can result in urinary incontinence. A fiber-rich diet, and weight loss for obese people can reduce symptoms. People with urinary incontinence should also avoid caffeine, alcohol, acidic foods and smoking, as these can irritate the bladder.
Pelvic floor exercises such as Kegels are another way to strengthen your muscles. To do this, start by focusing on your pelvic floor muscles, which you use to stop urination midstream. Contract the muscles by lifting up, then hold this for five seconds. Be sure to breathe in and out while you hold this position. Next, relax your muscles for five seconds. Repeat this exercise 10 to 15 times, three times a day.
Pelvic Organ Prolapse
When the bladder, uterus or bowel slips from its usual position, the condition is called pelvic organ prolapse. This often stems from weak pelvic floor muscles, which can happen as a woman ages or after a pelvic injury related to childbirth.
Symptoms of pelvic organ prolapse include leaking urine, inability to empty the bladder completely, back pressure, pain during intercourse, constipation, and a feeling of heaviness around the pelvic region or genitals. People with bladder prolapse, also known as fallen bladder, may feel the frequent urge to urinate but often don’t feel relieved after urinating. They can also be susceptible to frequent urinary tract infections. In some cases, prolapse is severe and women may feel or see tissue bulging from the vagina.
One in 4 women in their 40s experience pelvic organ prolapse, with that number increasing to half of all women by their 80s. Aging and hormonal changes that come with menopause can cause prolapse, as can obesity, pelvic floor injuries, hysterectomy and some genetic disorders that weaken connective tissue. Constipation, heavy coughing due to lung disease or smoking, high-impact exercises and heavy lifting can also cause or worsen prolapse.
Pelvic floor exercises, such as Kegels, can strengthen the pelvic muscles, while a fiber-rich diet can reduce straining during defecation that can cause or worsen prolapse. In some cases, particularly when organs bulge out of the vagina, minimally invasive surgery is necessary to return organs to their normal position and provide adequate support.
When an injury occurs in the pelvic region, a gap or tunnel-like hole can form between two organs, known as a fistula. For women, fistulas commonly form between the bladder and vagina or between the rectum and vagina, causing urine or feces to leak into the vagina.
This condition can result from an injury during pelvic surgery, such as a hysterectomy (removal of the uterus), or from vaginal tearing during childbirth. Fistulas in the pelvic region or other organs can also be caused by prolonged labor, pelvic fractures, cancer treatment in the pelvic area and inflammatory bowel disease.
Because bladder or fecal matter can leak into the vagina, fistulas can produce vaginal soreness or infection, pain during intercourse, abdominal pain, fever, nausea, vomiting and weight loss. Providers may prescribe antibiotics to resolve an infection around the fistulas. Fistulas often do not heal on their own, so skilled surgeons can remove them and repair the tissue to prevent further leakage.