Guide to Pelvic Floor Disorders

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.

Key Facts

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.

What Is the Pelvic Floor?

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.

What Are the Different Types of Pelvic Floor Disorders?

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)

What Are the Causes of Pelvic Floor Dysfunction and Disorders?

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
Obesity
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.

Are There Pelvic Floor Disorder Symptoms?

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

How Does a Doctor Diagnose Pelvic Floor Dysfunction?

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

What Are The Options For Pelvic Floor Disorder Treatment?

Pelvic floor disorders are highly treatable. Treatment for pelvic floor disorders include options for lifestyle and behavioral changes, surgical and nonsurgical treatments.

Non-Surgical Treatments

Your doctor may recommend some of these non-surgical solutions:

Lifestyle Changes

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

Medications

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

Biofeedback

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

What’s the Outlook for Patients With Pelvic Floor Issues?

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.

Next Steps

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.