Pelvic floor disorders affect the muscles, ligaments, connective tissues and nerves supporting the organs of the pelvis. For many individuals, pelvic floor muscles may become too weak or too tense, leading to dysfunction.
- The pelvic floor muscles stretch like a muscular trampoline from the tailbone (coccyx) to the pubic bone (front to back) and from one sitting bone to the other sitting bone (side to side). These muscles are normally firm and thick.
- Pelvic floor disorders are most often found in women, but also affect men.
- Common pelvic floor disorders are urinary incontinence, fecal incontinence, and organ prolapse.
The pelvic floor includes the muscles, tissues and nerves that support the organs of the pelvis. For men and women, this includes the bladder and rectum. For women, the uterus and vagina are supported by the pelvic floor as well.
The pelvic floor muscles stretch like a muscular trampoline from the tailbone (coccyx) to the pubic bone (front to back) and from one sitting bone to the other sitting bone (side to side). The bowel, bladder and uterus (for women) lie on the pelvic floor muscle layer. Just like a trampoline, the pelvic floor is able to move down and up.
The pelvic floor muscle layer has holes to allow the anus, urethra and vagina to pass through. The pelvic floor muscles normally wrap quite firmly around these holes to help keep the passages shut. There is also an extra circular muscle around the anus (the anal sphincter) and around the urethra (the urethral sphincter).
Although the pelvic floor is hidden from view, it can be consciously controlled and therefore trained, much like an arm, leg or abdominal muscles.
There are several forms of pelvic floor disorders, which can be classified into three main types:
- Fecal Incontinence: inability to control bowel movements, causing stool leakage
- Urinary incontinence: inability to control urination, leading to leakage
- Pelvic Organ Prolapse: when one or more organs of the pelvic floor shift down from their normal position and descend into or outside of the anus or vaginal canal. There are a few types:
- Cystocele (bladder impacts the vagina)
- Enterocele (small bowel impacts the top area of the vagina)
- Rectal (internal – the wall of the rectum shifts down in the body and may impact surrounding organs, or external – the wall of the rectum shifts down in the body and sticks out of the anus)
- Rectocele (rectum impacts the vagina)
- Urethrocele (urethra impacts the vagina or impacting kidneys)
- Uterine (uterus impacts the vagina)
- Vaginal Vault (upper vaginal cuff impacts the vaginal canal)
Pelvic floor disorders occur when connective tissue or muscles of the pelvic area are injured, become too tight (hypertonic), or become too weak (hypotonic). Some causes include:
- Chronic constipation or chronic straining to have a bowel movement
- Chronic coughing
- Living with nerve-affecting conditions such as Parkinson’s disease, diabetes, stroke or back injury
- Pelvic organ cancers
- Pregnancy or childbirth. A woman's risk tends to increase the more times she has given birth.
- Radiation treatments that may have damaged nerves or tissues in the pelvic floor
- Trauma or injury, including complications after a previous procedure
While pelvic floor disorders become more common as women get older, they are not a normal or acceptable part of aging. These problems can have a significant impact on a person's quality of life. Fortunately, these disorders often can be reversed with treatment.
Pelvic floor disorders affect both women and men. Because there are different types, symptoms of pelvic floor disorders vary.
- Bulge coming out of the vagina for women
- Bulge in the rectum
- Constipation or straining with bowel movements
- Difficulty emptying the bladder completely
- Difficulty making it to the bathroom in time
- Frequent or urgent need to urinate
- Frequent urinary infections, caused by a reduced ability to release urine from the urethra.
- Heaviness, pulling, or aching in the vagina for women
- Muscle spasms in the pelvis
- Painful bowel movements
- Painful intercourse
- Painful urination
- Pressure in the rectum
- Unexplained pain in pelvis area, genitals, lower back, or rectum
- Urine leakage when laughing, coughing, or exercising
Diagnosing pelvic floor disorders usually begins with a careful medical history and physical examination from a physician. A doctor will ask questions about symptoms, risk factors, and related medical conditions, and they will use their hands to check for spasms and weakness in the muscles.
Diagnostic Tests for Pelvic Floor Disorders
To confirm the diagnosis, additional tests may be used to evaluate the pelvic anatomy and muscle function – some include:
- Anorectal Manometry: a small, flexible tube with a balloon attached is inserted into the rectum to test anal sphincter muscles that keep stool inside
- Defecography: a series of X-ray images are taken during a bowel movement to show how much stool the rectum can hold, how well it can hold, and how well it can empty it.
- Endoanal ultrasound: used to ensure the anal muscle is intact.
- Magnetic resonance imaging (MRI): used to examine the sphincter
Pelvic floor disorders are highly treatable. Treatment for pelvic floor disorders include options for lifestyle and behavioral changes, surgical and nonsurgical treatments.
Your doctor may recommend some of these non-surgical solutions:
- Avoiding pushing or straining when urinating or having a bowel movement
- Changes in diet, such as eating smaller meals and avoiding caffeine, which relaxes the sphincter muscles and can make incontinence worse.
- Limiting drinks
- Limiting stress
- Nutritional assessment
- Strategies to relax the pelvic floor muscles
- Weight loss
- Low doses of muscle relaxants (like diazepam)
- Botox injections to treat muscle spasms
Pelvic Floor Disorder Physical Therapy
- Tissue manipulation
- Exercises that relax and coordinate the movement of pelvic floor muscles
- Bladder training and kegel exercises that could strengthen weak muscles
- A sensor is placed in the vaginal or anal canal to measure muscle tension and relaxation during gentle electric stimulation for pelvic floor disorder. Patients visualize muscle response on screen (electromyography EMG), which helps with sensory awareness of their pelvic floor and improves efficacy of exercises.
Support Through Pessaries
- Pessaries are well-fitted plastic device inserts that aid in pelvic organ prolapse.
Pelvic Floor Surgery
Surgery may help people whose fecal incontinence is caused by damage to the pelvic floor or anal sphincter. Surgeons can repair the anal sphincter using advanced techniques that restore bowel function. Surgeons also can improve bowel control by injecting bulking agents into the anus or stimulating the nerves in the lower pelvis.
To repair rectal and multi-organ pelvic organ prolapse, surgery may be the best option for some women. Often, these procedures can be done using minimally invasive techniques.
Surgical options for pelvic floor disorders can include:
- Sacral Nerve Stimulation (SNS): a surgically implanted device delivers electrical impulses to the nerves to help regulate pelvic functions
- Transanal Endoscopic Microsurgery (TEMS): surgery performed through the rectum to correct pelvic floor issues including organ prolapse
- Ventral Mesh Rectopexy: a surgical dissection is performed anterior to the rectum and mesh is fixed to the rectal wall and suspended to the sacrum
For women, almost one-quarter will face pelvic floor disorders. Pelvic floor disorders affect:
- About 10% of women ages 20 to 39
- 27% of women ages 40 to 59
- 37% of women ages 60 to 79
- Nearly 50% of women age 80 or older
The good news is that treatment is successful for pelvic floor disorders. It is estimated that 80% to 90% of women will see significant improvement or be cured of symptoms after treatment.
Many people don't feel comfortable talking about personal topics like pelvic floor disorders and symptoms such as incontinence. But these are actually very common medical problems that can be treated successfully. Millions of people have the same issues, but many don't seek treatment and compromise their quality of life.
If you have a pelvic health issue, don't hesitate to learn more about your treatment options. If your doctor doesn't treat these issues regularly, seek out an expert. The Pelvic Floor Program at Columbia includes colorectal surgeons, a specialized pelvic floor Nurse Practitioner and other caregivers who treat their patients with dignity and compassion.
To make an appointment, please call us at (212) 342-1155 today or request an appointment online today.
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