Overcome Incontinence, Prolapse and Other Pelvic Floor Disorders
By Sage Claydon, MD, Urogynecologist—Virtua Female Pelvic Medicine
One in 4 women over age 20 experience a pelvic floor disorder (PFD)—a condition that results from weakening muscles, ligaments and connective tissue in the pelvic floor. The symptoms of PFD can be embarrassing, frustrating and life altering, but treatment options continue to expand and improve so you don’t just have “to deal with it.”
What are pelvic floor disorders?
PFDs are caused by damage or weakness in the pelvic floor. As the pelvic floor weakens, pelvic organs don’t receive the necessary support to function properly. This may occur with aging, menopause, and pregnancy/childbirth, or injuries and health conditions that affect the nerves in the pelvis.
Factors that increase pressure on the pelvic floor, such as obesity, constipation, straining with bowel movements and heavy lifting, increase the risk of developing a PFD. Cigarette smoking is another risk factor because it weakens connective tissue throughout the body.
These are 3 of the most common PFDs.
Pelvic organ prolapse
Pelvic organ prolapse (POP) occurs when the pelvic organs drop downward due to a lack of support from the muscles and tissues in the pelvic floor. Approximately 30 percent of women age 40 and older experience some degree of POP, though many women do not experience any symptoms.
However, if you have severe POP, you may feel or see tissue coming out of your vagina. Although this can be quite scary, it’s only dangerous if the prolapse is preventing you from emptying your bladder or bowel, which is relatively rare.
Urinary incontinence, or the involuntary loss of urine, affects approximately 50 percent of women in the United States. Urinary incontinence occurs when the muscles surrounding the urethra, the tube that carries urine out of the body, are weak or poorly connected. Two of the most common forms of urinary incontinence are stress incontinence and urge incontinence.
Stress incontinence occurs when you leak urine during activities such as sneezing, coughing, laughing and exercising. Urge incontinence occurs when you have a sudden, strong urge to urinate. Some women also urinate very frequently (called overactive bladder) or have difficulty emptying their bladders.
Bowel, or fecal, incontinence
Fecal incontinence, or the involuntary loss of stool or gas, affects at least one out of every 12 people in the United States. Because the pelvic floor muscles and anal sphincter work together to hold in stool and gas, damage to the pelvic floor muscles can make it difficult to control bowel movements and gas.
How are pelvic floor disorders treated?
There’s range of treatments available for PFDs, many of which do not involve surgery. In fact, your doctor may recommend conservative treatments first.
Lifestyle and behavior changes
One of the first treatments your doctor may suggest is altering your lifestyle and behavior.
Losing weight, cutting back on foods and beverages that irritate your bladder and reducing fluid intake at certain times of day can help control urinary incontinence.
Increasing your fluid intake, eating a healthy diet and exercising often can help women suffering from constipation.
You also can perform pelvic floor strengthening exercises, called Kegels, at home, or try Pilates, yoga or tai chi to help tighten and tone your pelvic floor muscles.
If lifestyle and behavior changes don’t control your symptoms, your doctor may recommend physical therapy.
Physical therapy treats urinary and fecal incontinence with a regimen of specific, highly targeted exercises for your pelvic floor.
Your physical therapist also may work with you on behavioral approaches, such as bladder re-training, or incorporate pelvic floor electrical nerve stimulation to strengthen your muscles.
There are several types of medications available to treat urinary incontinence and overactive bladder. However, because medication doesn’t treat weakness or damage to the pelvic floor and can sometimes have bothersome side effects, it’s often used temporarily or in combination with other therapies.
A pessary is a plastic device that you insert into the vagina to provide additional support to pelvic organs. Pessaries can help control POP, urinary incontinence and fecal incontinence. There’s a range of pessary options—your doctor will guide you on what size and shape is most suitable for your need.
Botox, the same treatment used for facial wrinkles, also can treat some types of urinary incontinence.
These are devices that can help improve the communication pathways between the pelvic floor and the brain. Implantable sacral nerve stimulation devices (InterStim) can be used to treat both urinary and fecal incontinence. Temporary stimulation of a nerve in the leg, known as posterior tibial nerve stimulation (PTNS), can be used to improve urinary incontinence.
If your PFD doesn’t respond to other therapies, your doctor may recommend surgery. Although the specific surgery will vary depending on the type and severity of your PFD, there’s a variety of options ranging from simple to complex. To ensure your surgery delivers long-lasting benefits, your doctor may recommend other therapies or suggest lifestyle or behavior modifications.
Updated June 29, 2021