The pelvic floor is a complex group of muscles and other tissues that support the pelvic organs, which include the bladder, uterus, and rectum. When someone experiences pelvic floor dysfunction, these muscles no longer work in coordination with one another and can lead to urinary, bowel, and even sexual complaints.
“Very often, we’ll hear that the patient has diarrhea, but when we ask further, we find when someone goes out to eat dinner, they have to know where the bathroom is because they know they’re going to make a beeline to the bathroom,” says John Reilly, MD, a UPMC colorectal surgeon at Colon & Rectal Surgeons of Erie. “They’re afraid to go out. They’re afraid to go on vacation. It’s an issue of control.”
Unfortunately, this is a common condition and according to the Office on Women’s Health, about one in five women in the U.S. experience some type of pelvic floor dysfunction in their lifetime. Men can also experience pelvic floor dysfunction but usually with different signs and symptoms and for different reasons.
“In its most severe form, pelvic floor disorders can involve incontinence or loss of control of urine, the bowels, or both,” says Dr. Reilly. “Women may be too modest or embarrassed to talk about this. It’s a very common problem.”
Signs and Symptoms of Pelvic Floor Disorders
Your pelvic floor muscles help to keep you from urinating or having a bowel movement when you do not intend to and allow you to do so when you are ready. In order to urinate or have a bowel movement, you need to be able to relax your pelvic floor muscles. The signs and symptoms that you will experience in pelvic floor dysfunction depend on if your pelvic floor muscles are too tight or too loose (weak).
If the muscles are too tight, you may experience:
- Difficulty emptying your bladder (retention) or bowels (constipation)
- Painful intercourse
- Painful urination mimicking a urinary tract infection (UTI) or prostatitis
- Urinary urgency and frequency
- Pelvic pain
If the muscles are too loose or weak, you may experience:
- Urinary or fecal incontinence (leakage)
- Pelvic organ prolapse (women)
Pelvic Organ Prolapse (POP) is when the pelvic organs drop from their normal position in the body due to weak pelvic floor muscles. This is a type of hernia. When a pelvic organ has prolapsed, you may experience vaginal/pelvic pressure and aching as well as urinary/bowel symptoms. The types of POP are:
- Cystocele (most common) – the bladder drops into the vagina
- Rectocele – the rectum pushes into the vagina
- Uterine prolapse – the uterus drops into the vagina
- Enterocele – the small intestine descends into the vagina
- Urethrocele – the urethra protrudes into the vagina
There are varying degrees of POP depending on how far the pelvic organ drops. This can be determined by your healthcare provider who can then offer different types of treatments.
Risk Factors for Pelvic Floor Dysfunction
While some women may experience this condition and have no risk factors, experts have identified some things that can be linked to pelvic floor dysfunction. These risk factors include:
- Pregnancy
- Advancing age
- Pelvic surgery, for example hysterectomy.
- Pelvic radiation or injury
- Being overweight
- Pelvic floor muscle overuse, repeated straining
- Genetics – researchers are looking into if this could be a hereditary condition
Treating Pelvic Floor Dysfunction
Treating this condition is not a one-size-fits-all solution because not all pelvic floor disorders happen for the same reason or cause the same symptoms. It is important to have a complete evaluation so that you know you are receiving the best treatment as well as to rule out other possible causes for your symptoms such as infection. The experts at UPMC offer a variety of treatment options for each type of pelvic floor dysfunction. While some women may ultimately need surgery, others may benefit from more conservative therapies that “retrain” the muscles.
Changes to your diet/weight loss
Simple changes to your diet, recommended by a doctor or nutritionist, can have a noticeable difference on your symptoms.
Pelvic floor exercises
There are pelvic floor physical therapists who are specifically trained to treat these problems, whether it be muscles that are too tight or too weak. Biofeedback is often used which can help the patient to better pinpoint and coordinate their muscles in order to “retrain” them. Kegel exercises are utilized for muscles that are too weak to help regain continence and prevent pelvic organ prolapse. Heat, massage, and relaxation exercises are recommended for the tight pelvic floor muscles.
Pessary support
A pessary is a medical device that is inserted into your vagina by a doctor. The pessary helps to hold your vaginal walls in place and support other nearby organs like the bladder, uterus, and rectum.
Medications or injections
If you are having pain in your pelvic region, your doctor may suggest that you take medicines such as non-steroidal anti-inflammatories (NSAIDs) or Tylenol. Trigger point injections are also utilized to provide relief until the cause of the problem can be corrected or improved through physical therapy.
Surgery
Surgery may be indicated for pelvic organ prolapse or a specific type of incontinence, but more conservative treatments are often recommended first. When surgery is recommended, UPMC doctors will choose to perform minimally-invasive surgery whenever possible, which will allow you to get back to your daily activities as quickly as possible with minimal recovery time.
These issues can be difficult or embarrassing to talk about but if you think that you may have a type of pelvic floor dysfunction, it is important to have an open and honest conversation with your healthcare provider. For more information or to schedule an appointment, contact the Women’s Center for Bladder and Pelvic Health at 412-641-7850.
Editor's Note: This article was originally published on , and was last reviewed on .