Know the symptoms of pelvic floor disorder

Talking about pelvic floor disorder can be uncomfortable. Urine leakage, bowel movement difficulty and bulging in the vaginal area are just some of the many symptoms.

It mainly affects women, many of whom silently suffer instead of seeking medical help. 

Some think the disorder is simply the result of having children and nothing can be done. Still others fear only surgery can fix it.  

Not true, says Andrew Hundley, MD, urogynecologist and reconstructive surgeon at The Ohio State University Wexner Medical Center.  

“It always disappoints me when a woman says this is ‘just part of being a woman and I just have to live with it.’ No! There are things that you can do to get back your quality of life and possibly avoid having surgery down the road.”

He says pelvic floor disorder can happen at any age – although it is more common in women of childbearing age and in post-menopausal women. There is a wide variety of treatments that can help women improve their quality of life and allow them to continue doing their favorite activities without embarrassment and pain. Dr. Hundley answers questions he commonly gets about pelvic floor disorder: 

First, what exactly is pelvic floor disorder?

The pelvic floor consists of the muscles, ligaments and tissues that support the organs of the pelvis (uterus, vagina, cervix, bladder, urethra, rectum and anus). 

“Essentially, your pelvic floor keeps your organs in place and helps them function properly,” says Dr. Hundley.

If there’s a weakness in the muscles or ligaments in the pelvic floor or if the tissue becomes too stretched out, the organs can drop down or protrude into the vagina. Dr. Hundley says it’s a lot like sitting on a hammock, which stretches and sags with your body weight.

What causes pelvic floor disorder?

Pregnancy and childbirth get a lot of the blame because they can put a lot of stress on the pelvic area. But Dr. Hundley says he’s seen plenty of patients who gave birth multiple times and have never displayed any pelvic floor disorder symptoms. Other common causes:
  • Chronic constipation
  • Menopause
  • Aging
  • Prior pelvic surgery, particularly for prolapse 
  • Genetics
  • Repetitive lifting or squatting
  • Pulmonary diseases
  • Coughing

What are the symptoms of pelvic floor disorder?

  • Pressure, heaviness or a feeling of a bulge in the vaginal area
  • Urine leakage after coughing, laughing or exercising
  • An urgent and uncontrollable need to urinate
  • Constipation, leaking stool or difficulty controlling gas
  • Frequent urinary tract infections

What are the different types of pelvic floor disorder?

Pelvic organ prolapse: Weakened pelvic floor muscles can cause the uterus, bladder or rectum to descend or bulge into the vagina.

Urinary incontinence: The two most common types – ‘urinary stress’ and ‘urge.’ Urinary stress incontinence causes a small amount of urine leakage, while urge incontinence results in frequent urination or involuntary loss of a large amount of urine. What happens is the bladder squeezes when it wants to instead of when the brain tells it to, explains Dr. Hundley.

Fecal incontinence: Lack of bowel control. 

How common is pelvic floor disorder?

One in four women will have a pelvic floor disorder in her lifetime. About 41 percent of post-menopausal U.S. women suffer from pelvic organ prolapse. Dr. Hundley says the number of U.S. women with pelvic organ prolapse is projected to increase to 46 percent between 2010 and 2050 from 3.3 million to 4.9 million.

What are the treatment options?

Treatment options vary widely, depending on the type of problem and severity. If the disorder isn’t physically bothering a woman or affecting her quality of life, Dr. Hundley says just leave it alone. Some treatment options:
  • Behavioral changes such as stopping smoking, avoiding alcohol or not lifting heavy objects
  • Physical therapy
  • Kegel exercises that strengthen the muscles in the pelvic area
  • Insertion of pessaries (small silicone devices that hold up or down whatever is prolapsing into the vagina)
  • Scheduled times to urinate to reduce urinary leakage
  • Medication
  • Surgical procedures, including robotic, vaginal and laparoscopic

Can it get worse? 

Progression over time is always possible, but not a certainty, according to Dr. Hundley. If there is a change, it typically happens slowly, over years as opposed to weeks or months. 

Can you prevent it from happening?

The best approach for prevention is doing exercises, such as Kegels, on a regular basis and avoiding unnecessary stress on the pelvic floor – straining with constipation, coughing due to smoking or repetitive heavy lifting.