Massachusetts General Hospital

Pelvic floor disorders: What you should know

Women no longer have to suffer silently

04/May/2010

Sometimes the start of symptoms is so gradual that women get used to them, or don’t even notice them until something major occurs. But for many women, pelvic floor disorders worsen with time.

Whether it’s a frequent urge to urinate, or an inability to control bowel movements, pelvic disorders are uncomfortable and embarrassing. As a result, they are also underreported and underdiagnosed. Many people also believe that they can’t be corrected.

“In the past, incontinence was something women just suffered through silently. But today more and more women are learning that there are many options, both surgical and non-surgical to address a variety of pelvic floor disorders,” explains May Wakamatsu, MD, director of Pelvic Reconstructive Surgery and Urogynecology at the Pelvic Floor Disorders Service at Mass General.

The pelvic floor is a network of muscles, ligaments and tissues in the lower abdominal area. It acts like a hammock to support the uterus, vagina and rectum. Pelvic floor disorders are caused by tears, weakness or poor function of the muscles and nerves in the pelvic floor.

Types of pelvic floor disorders

Urinary incontinence: This is a loss of bladder control leading to urinary accidents. Two common types of urinary incontinence are urge incontinence (urinary leakage with the sudden need to urinate) and stress incontinence (urinary leakage that occurs with physical effort, such as coughing, sneezing or exercising).

Pelvic organ prolapse: Pelvic support problems occur when one or more of the organs in a woman’s pelvis—the uterus, vagina, bladder or rectum—shifts down and bulges out of the vaginal canal, making everyday activities extremely uncomfortable. Women with pelvic organ prolapse may see or feel a bulge coming out of their vaginal opening.

Fecal incontinence: This is a loss of bowel control leading to accidental passing of stool. This problem can be caused by muscle damage during childbirth, constipation, anal injury, nerve injury or rectal prolapse.

Defecatory dysfunction: This condition refers to problems emptying the bowels. Symptoms may include the frequent and uncomfortable urge to have a bowel movement, constipation, and leakage of gas, diarrhea or solid stool.

Voiding dysfunction: This term refers to a variety of conditions that lead to the inability to empty the bladder normally. Examples include weakness of the bladder muscle and mechanical obstruction.

Top 5 things to know about pelvic floor disorders

1. Nearly one in three American women has one or more pelvic floor disorders, such as urinary incontinence, fecal incontinence or pelvic organ prolapse.
2. Obesity can significantly increase your chance of getting a pelvic floor disorder.
3. Smoking leads to decreased estrogen levels and can compromise blood supply and therefore, oxygen supply to tissues, weakening them while increasing your risk of pelvic floor disorders.
4. Caffeine and alcohol speed up urine output and can contribute to urinary incontinence and frequency, including getting up at night to urinate.
5. Chronic constipation and excessive straining can cause pelvic organ prolapse and rectal prolapse.

Fortunately, many of these things can be managed with self-help measures.

Top 5 self-help measures

1. Strengthen your core. We’ve all heard of Kegel exercises. This squeeze-and-hold vaginal exercise, developed by Dr. Arnold Kegel in the 1940’s, was designed to target the pelvic floor area. Strengthening the core muscles also supports strengthening the pelvic floor muscles. . Exercises such as Pilates and yoga are excellent ways to strengthen this entire area.
2. Practice Fluid Management. Limit fluids, especially caffeine and alcohol to address symptoms of urinary incontinence and frequency. Caffeine and alcohol speed up urine output and may also make the bladder more irritable.
3. Maintain a Healthy Body Weight. Excess weight puts pressure on the pelvic area. Losing those excess pounds can reduce symptoms of pelvic floor disorders, as well as reduce your chance of developing diabetes, a condition that may also be associated with urinary incontinence. A diet high in fiber will keep your digestive system and colon happy. Reduce your use of processed foods which can also lead to constipation.
4. Avoid Smoking. Quit or limit the number of cigarettes you smoke to decrease your chances of urinary incontinence. If you can reduce coughing, you will see improvements.
5. Ignore Your Bladder. It may sound counter-intuitive, but our bladders are conditioned by our behavior. How often do you come home from work and instinctively have to use the restroom? Don’t void out of habit, retrain your bladder. The average woman should only need to void every four to six times during the day.

When to seek help

If you experience any symptoms that affect your daily activities, such as heaviness or pressure in the area of the vagina or pelvis, a bulge of tissue coming through the vaginal opening, accidental loss of urine or stool, frequent or unexpected urges to urinate, or difficulty urinating you should see a specialist. At the Pelvic Floor Disorders Service at Mass General a multidisciplinary team of gastroenterologists, gynecologists, colorectal surgeons and a nurse practitioner tests and evaluates patients to determine the best course of therapy. The center offers a range of non-surgical options, including bladder training, biofeedback, electrical stimulation, physical therapy, medication, vaginal support rings and weighted cones that address pelvic floor disorders. When non-surgical options fail or the patient prefers surgery, the most advanced, minimally invasive procedures are offered.

For information on physicians and making an appointment, visit Mass General's Pelvic Floor Disorders Service.