There are several major types of pelvic floor disorders. Often, more than one pelvic organ is affected. At the Mass General Pelvic Floor Disorders Service, patients are examined and treated by a multidisciplinary team who together determine a comprehensive course of treatment.
Types of Pelvic Floor Disorders
Some pelvic floor disorders involve organ prolapse, in which the uterus, rectum, bladder, urethra, small bowel, and/or the vagina begin to fall out of their normal positions.
Types of pelvic organ prolapse include:
- Rectocele: the rectum protrudes through the back wall of the vagina
- Cystocele: the bladder protrudes out through the anterior vaginal wall
- Sigmoidocele: the sigmoid colon slips into the rectovaginal space
- Enterocele: the small intestine protrudes through the upper vaginal supports (especially in women who have had a hysterectomy)
- Vaginal vault prolapse or uterine prolapse, in which the entire vagina or uterus sag through the vaginal opening
- Rectal prolapse, in which the lining and/or muscles of the rectum protrude out of the anus, typically during attempts at bowel movements
In some cases, an organ slips out of its original location but not necessarily outside of the body. Unless it protrudes through an orifice, a woman may not know that she has a prolapsed organ.
Rectal prolapse often affects nearby organs as well. Forty percent of women with rectal prolapse have associated uterine or bladder problems, including stress or urinary incontinence.
Other types of pelvic floor disorders are caused by muscle or nerve dysfunction or anatomical defect. These include:
- Urinary incontinence
Urinary incontinence can be caused by childbirth or other conditions that stretch the pelvic floor muscles. When these muscles cannot support the bladder properly, the bladder drops down and pushes against the vagina. Muscles that close off the urethra cannot be tightened.
- Fecal incontinence
Fecal incontinence is most common to women with obstetric injuries. However, it can also affect men and women who have gone through rectal cancer surgery or anal sphincter trauma.
Another common pelvic floor condition is constipation that does not respond to laxatives and other standard treatments. In most cases, the cause is either slow fecal transit or a pelvic floor obstruction. A full work-up is required of patients suffering from constipation to understand the underlying causes and determine the best course of treatment. For example, surgery for slow transit constipation may not be effective if the patient also suffers from obstructive constipation.