What you need to know about pelvic floor issues and how to treat them

There is a wide range of pelvic floor disorders that can cause painful symptoms, from urinary and bowel incontinence to pain and sexual dysfunction.

What are pelvic floor issues?

According to Mitchell Berger, MD, PhD, a female pelvic medicine and reconstructive surgery specialist with Main Line Health, there are four categories of pelvic floor disorders:

Sometimes, the cause isn't clear, but age, obesity, and previous pregnancies are thought to increase a woman's risk of developing a pelvic floor disorder. Diagnostic and imaging tests can help your doctor identify what's behind your symptoms and get you started on the right treatment plan.

Pelvic floor disorders are very common; however, many women experiencing pelvic symptoms put off treatment. Pelvic floor issues can significantly impact quality of life, so if you're experiencing any bladder or bowel symptoms or pelvic pain, talk to your doctor. There are several treatment options available, ranging from lifestyle changes and medications to minimally invasive surgeries that can alleviate your pain and improve your quality of life.

What to know about bladder issues

Urinary incontinence involves unintended leakages of urine often triggered by coughing, sneezing, or laughing. Having an overactive bladder is another common condition in which people feel an urgency to go to the bathroom, often during the night.

Diagnosis begins by asking the patient about when the leakage or bladder symptoms occur, says Berger. This is usually accompanied by a pelvic exam to evaluate the health of your tissues and determining if there are any masses like cysts, fibroids, or a tumor that may be pushing on the bladder. Your doctor may also collect a urine sample to make sure there is no urinary tract infection (UTI), bladder infection, or kidney stone. A urodynamic test can help your physician evaluate how the bladder responds to filling and emptying.

Many patients are initially advised to make behavioral or lifestyle changes. Foods and beverages, including coffee, tea, soda, and those containing caffeine and artificial sweeteners can irritate the bladder. According to Berger, people tend to consume too little or too much water. A good strategy is to hydrate based on the color of your urine, which you want to be a clear light-yellow color. If it is as clear as water, you're probably drinking too much water. If it's dark, you're dehydrated. Pelvic exercises, like Kegels, can help address your pelvic floor muscle issues as can physical therapy to treat pelvic floor disorders. Weight loss and a healthy diet can improve bladder symptoms, too.

If you've made lifestyle changes and the symptoms persist, medications can be prescribed to help manage inappropriate contractions and reduce urgency or leakage. Some women may opt for pessaries, or devices that are inserted into the vagina to support the bladder and urethra. In more serious cases, patients can receive:

What to know about bowel problems

Two of the most common bowel issues associated with pelvic floor conditions are constipation and bowel fecal incontinence.Constipation symptoms include hard, lumpy stools or infrequent bowel movements. Accidental bowel leakage involves inadvertently passing stool or gas. According to Berger, it's normal to experience bowel movements anywhere from once every three days to three times a day. If you are going less or more than that, it's something to look into, he says.

For women experiencing fecal incontinence, there may be a fistula, or hole somewhere in the digestive tract. Other causes include childbirth, injury from surgery, or cancer. Diagnosing pelvic floor-related bowel issues is heavily based on the patient's medical history and bowel habits. There are exams and tests that can be conducted to see how the pelvic muscles move during squeezing and pushing. An ultrasound of the sphincter can also identify tears from childbirth or surgery.

The least invasive treatment option entails tweaking your diet to ensure you're getting enough fiber. Berger also teaches patients good toileting behaviors. Women often put off going to the bathroom, which can cause long-term problems, or sit in a position that may impact bowel movements.

There are exams and tests that can be conducted to see how the pelvic muscles move during squeezing and pushing. An ultrasound of the sphincter can also identify tears from childbirth or surgery.

Pelvic floor exercises can help fix your pelvic floor muscle issues for better bowel control. Depending on the cause, medications, such as calcium supplements, laxatives, anti-diarrheal medications, and stool softeners, can help facilitate healthy bowel movements. Nerve stimulation and surgical procedures are available to repair fistulas and tears.

What to know about pelvic organ prolapse

With pelvic organ prolapse, the reproductive organs or the internal organs around the pelvis and vagina are dropping through the vagina.

People experiencing prolapse commonly feel pressure, bulging, or heaviness in the vaginal area. "Some women can feel or see tissue coming outside," says Berger. Prolapse is associated with many bowel or bladder symptoms, though they don't always occur together. Though rare, some women with prolapse experience no symptoms.

Prolapse is diagnosed through a pelvic exam. The patient will be asked to cough, push, or move around so the physician can assess the organs. Occasionally, physicians will conduct imaging tests to confirm the diagnosis. Treatment for prolapse includes pelvic exercises, pessaries (devices that are inserted into the vagina and mechanically lift the walls of the vagina or uterus), and various surgeries depending on the patient's symptoms. "There are a lot of different surgeries for prolapse," says Berger.

What to know about pelvic pain and sexual dysfunction

Pelvic pain and sexual dysfunction vary between patients. Your provider will want to know where you feel the pain and if it flares up during certain activities. A pelvic exam can help your provider determine if there are masses, tender muscles, damaged tissues, or prolapse triggering your symptoms. Occasionally, physicians will conduct imaging tests to better assess the condition.

Pelvic floor symptoms are very common, though they are rarely talked about openly. According to Berger, many women experiencing pelvic floor disorders suffer in silence and feel as though they are the only ones dealing with the condition.

The treatments for pelvic pain and sexual dysfunction are very broad, and can include creams, pills, physical therapy, and surgery. "It depends on what's causing the pain or what's causing the sexual dysfunction," Berger says. "The treatments are going to be focused on what the underlying issue is."

If you are experiencing any pelvic floor issues or symptoms, talk to your doctor. Pelvic floor symptoms are very common, though they are rarely talked about openly. According to Berger, many women experiencing pelvic floor disorders suffer in silence and feel as though they are the only ones dealing with the condition. Pelvic floor issues can be very distressing, so if the symptoms are impacting your quality of life, seek care. There are many treatment options available that can be tailored based on your medical history, preferences, and goals. As Dr. Berger notes, "The most gratifying part of my job is when a patient tells me that she now has her life back!"

Main Line Health serves patients at hospitals and health centers throughout the western suburbs of Philadelphia. To schedule an appointment with a specialist at Main Line Health, call 1.866.CALL.MLH (225.5654) or use our secure online appointment request form.

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