Pelvic floor problems

Article
2021-03-02

A PFD occurs when the muscles or connective tissue of the pelvic area are weakened or injured. The most common PFDs are urinary incontinence, fecal incontinence, and pelvic organ prolapse. PFDs are more common in older women.

NICHD supports and conducts research on PFDs. For example, studies supported by NICHD are evaluating therapies and improving ways to measure treatment outcomes and patient satisfaction.

Symptoms

Because there are different types of PFDs, symptoms of different PFDs can vary or overlap. For example, women with PFDs may ^1,2,3 :

Feel heaviness, fullness, pulling, or aching in the vagina that gets worse by the end of the day or is related to a bowel movement
See or feel a "bulge" or "something coming out" of the vagina
Have difficulty starting to urinate or emptying the bladder completely
Leak urine when coughing, laughing, or exercising
Feel an urgent or frequent need to urinate
Feel pain while urinating
Leak stool or have difficulty controlling gas
Have constipation
Have difficulty making it to the bathroom in time

Some women with pelvic floor problems do not have symptoms at first. ¹ Many women are reluctant to tell their healthcare provider about symptoms because they may feel embarrassed. ¹ In addition, many women think that problems with bladder control are normal and live with their symptoms. ³ However, bladder control problems are treatable, and these treatments can help women with pelvic floor problems.

Therapy

Treatment can often help if symptoms are bothersome or restrict a woman's activities. ^{1, 2} Some types of treatment include the following. You can also download or link to our pelvic floor disease and common treatments infographic.

Lifestyle change

Talk to your healthcare provider about ways to reduce or relieve symptoms. Your healthcare provider can recommend actions such as the following ³ :

Limit foods and drinks that stimulate the bladder. Some foods and drinks, such as caffeinated drinks, carbonated drinks, citrus fruits and drinks, artificial sweeteners, and alcoholic drinks, can stimulate the bladder and make you use the bathroom.
Eat a high-fiber diet for certain intestinal problems. Fiber helps your body digest food. It helps give the stool the right consistency, which can also prevent constipation and the chronic exertion associated with having a bowel movement when constipated. Fiber is found in fruits, vegetables, legumes (such as beans and lentils) and whole grains. Fiber supplements are also available.
Lose weight. For overweight or obese women, losing weight can reduce bladder control and symptoms of pelvic organ prolapse by reducing pressure on the pelvic organs.

Non surgical treatment

Non-surgical treatments commonly used for PFDs include ^{2, 4} :

Bladder training. This includes using the bathroom on a regular schedule to regain bladder control and applying techniques to overcome inappropriate urges to urinate. A woman starts using the bathroom at a set interval and slowly, over many months, extends that time, aiming to use the bathroom only every 2.5 to 3 hours. ³
Pelvic floor muscle training (PFMT). Often referred to as Kegel exercises, PFMT involves squeezing and relaxing the pelvic floor muscles. If done correctly and routinely, pelvic floor muscles can improve symptoms of urinary incontinence and prolapse. ^{However, 3} PFMT cannot correct prolapse. Women can do the exercises alone or with the help of a pelvic floor physiotherapist. ³ Biofeedback during pelvic floor physiotherapy is sometimes used to teach women which muscle group to compress.
Medicine. Medicines are sometimes prescribed to treat certain bladder control problems or to prevent loose stools or frequent bowel movements. ⁵
Vaginal diaphragm . This plastic device is used to prevent prolapseact. It can sometimes be used to improve bladder control. A woman or her healthcare provider inserts the diaphragm into the vagina to support the pelvic organs. A woman's doctor will fit her for a diaphragm that is comfortable in shape and size and instruct her on how to use and care for it.

Surgical treatment

In some cases, surgery is the best treatment option, especially if other treatments don't help. ^{1, 7} Some surgical treatments can be performed on an outpatient basis, which means that the patient can usually go home the same day as the procedure.

For prolapse. Surgery involves repairing the prolapse and trying to restore a well-supported anatomy. There are many ways to do this, depending on the type of prolapse and other factors. In women with uterine prolapse, the uterus can also be removed (hysterectomy). Women undergoing surgery to repair a prolapse may need surgery at the same time to correct or prevent bladder control problems. Some women choose to have an operation called colpocleisis. This surgery treats prolapse by narrowing and shortening the vagina. It works well and carries a low risk, but it is not a good choice for women who want to have vaginal intercourse. ⁷
For bladder control problems. Surgery works well to treat urinary problems that occur as a result of an activity such as sneezing, coughing, laughing, or exercising (stress incontinence). Stress incontinence occurs when the effort squeezes the bladder and leaks urine because the support around the urethra is weakened. ⁶ The most commonly used type of surgery is a mid-urethral sling. The surgeon places material under the urethra to support it and prevent urine leakage during activity. ⁶ In another procedure, "fillers" can be injected near the bladder neck and urethra to thicken the tissues and close the bladder opening. Over time, repeated injections may be required. ⁸
For bowel control problems. Surgery may be required to repair a damaged anal sphincter, inject drugs into the sphincter, or implant a stimulator for the nerves that control bowel function. ⁹

Not all women are good candidates for surgery. In general, women who want to have children should not undergo this type of surgery. ¹ Prolapse can also return even after surgery is performed to correct it. ¹ Researchers are working to develop low-risk procedures and devices that work well to treat pelvic floor problems. Researchers also compare treatment methods to see what works best. For example, the Study of Uterine Prolapse Procedures - Randomized Trial (SUPeR) found comparable effectiveness in two types of surgery to treat vaginal prolapse. The Extended Operations and Pelvic Muscle Training in the Management of Apical Support Loss (E-OPTIMAL) study found that two other surgical treatments had similar effectiveness.The effects of surgical treatment enhanced with exercise for mixed urinary incontinence (ESTEEM) study showed suggests that surgery may be beneficial for women who have both stress and urge incontinence.

Combination treatment

"Combination" can mean that a woman is being treated for more than one type of PFD, such as treatment for both uterine prolapse and urinary incontinence. It could also mean using different treatments together to address PFDs, such as using pelvic floor muscles and surgery to treat symptoms.

Researchers are studying combination treatments to find out how to get the best results for women with PFDs. For example, the outcomes after vaginal prolapse and mid-urethral sling (OPUS) recovery evaluated whether adding a procedure for treating stress incontinence at the time of surgery for pelvic organ prolapse in women who do not have symptoms of stress incontinence can help that stress incontinence occurs after surgery and without it

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