Pelvic Floor Disorders

The pelvic floor is a group of muscles and other tissues that form a sling or hammock across the pelvis. In women, it holds the uterus, cervix, vagina, bladder, bowel, and other pelvic organs in place so that they can work properly. The pelvic floor can become weak or injured primarily as the result of pregnancy and childbirth. Other causes include being overweight, radiation treatment, surgery, and aging.

A pelvic floor disorder (PFD) occurs when the pelvic muscles and connective tissue weaken or are injured. The most common types of PFDs are the following:

Pelvic organ prolapse. A "prolapse" occurs in women when the pelvic muscles and tissue can no longer support one or more pelvic organs, causing them to drop or press into the vagina. For instance, in uterine prolapse, the cervix and uterus can descend into the vagina and even come out of the vaginal opening. In vaginal prolapse, the top of the vagina loses support and can drop through the vaginal opening. Prolapse can also cause a kink in the urethra, the tube that brings urine from the bladder to the outside of the body.

Common symptoms of pelvic prolapse include:

  • Feeling heaviness, fullness, pulling, or aching in the vagina. It gets worse by the end of the day or during a bowel movement.
  • Seeing or feeling a "bulge" or "something coming out" of the vagina
  • Having a hard time starting to urinate or emptying the bladder completely
  • Having frequent urinary tract infections
  • Leaking urine when you cough, laugh, or exercise
  • Feeling an urgent or frequent need to urinate
  • Feeling pain while urinating
  • Leaking stool or having a hard time controlling gas
  • Being constipated
  • Having a hard time making it to the bathroom in time

Bladder control problems. The leaking of urine, a problem called urinary incontinence[DR1], can occur in women or men when the bladder falls from its proper place. Other symptoms include a sudden, strong urge to urinate.

Bowel control problems. The leaking of liquid or solid stool from the rectum, called fecal incontinence, can occur in women and men when the rectum is out of place. It also can occur if there is damage to the anal sphincter, the ring of muscles that keep the anus closed.


Treatment for Pelvic Floor Disorders

For many women, pelvic floor disorders are mild and don't require treatment. For others, symptoms are bothersome and may restrict daily activities.


Nonsurgical Treatment

Ingalls pelvic pain physical therapists offer individualized treatments in a comfortable, private setting. Treatments include internal and external soft-tissue mobilization, pelvic floor strengthening and relaxation, internal and external biofeedback, and internal and external electro-stimulation.

Nonsurgical treatments commonly used for pelvic floor disorders include:

  • Pelvic floor muscle training. Also called Kegel exercises, muscle training involves squeezing and relaxing the pelvic floor muscles and may improve the symptoms of prolapse. Biofeedback is sometimes used to help teach women which muscle group to squeeze.
  • Medicine. Medicine is sometimes prescribed to treat certain bladder control problems or to prevent loose stools or frequent bowel movements.
  • Vaginal pessary. This plastic device is used to treat some types of prolapse and improve bladder control. A woman inserts the pessary into the vagina to help support the pelvic organs. A woman's doctor will fit her for a pessary that is a comfortable shape and size and instruct her on how to use and care for it.

Surgical Treatment

In some cases, surgery is the best treatment option, especially when other treatments are not helpful. Some surgical treatments can be performed as outpatient procedures.

Surgeons at Ingalls are experienced at minimally invasive and da Vinci robotic-assisted surgeries

  • For prolapse. Surgery involves repairing the prolapse and building back pelvic floor support. There are many ways to do this, depending on the type of prolapse and other factors. Women with uterine prolapse may also have the uterus removed (hysterectomy). Women who have surgery to repair prolapse often have surgery at the same time to prevent bladder control problems.
  • For bladder control problems. Surgery works well to treat problems holding in urine that occur because of pressure on the bladder, known as stress incontinence. Surgery may include a sling procedure to hold the bladder in its normal position or a procedure called "colposuspension," in which the surgeon puts the bladder back in its correct position and holds it in place by securing it to the vaginal wall and pelvic floor tissues.
  • For bowel control problems. Surgery may be needed to repair a damaged anal sphincter muscle or repair certain types of prolapse.

Not all women are good candidates for surgery. In general, women who want to have children should not have pelvic surgery. Also, prolapse can sometimes occur even after surgery is performed to correct it.

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