What are Pelvic Floor Disorders?

Pelvic Health

Pelvic health is the study and treatment of disorders that impact the pelvic floor which are the muscles, ligaments, and connective tissues that support the pelvic organs — the bladder, vagina, uterus, and rectum. Damage to or weakening of the pelvic floor can impact the normal functioning of these organs. Patients may be hesitant to discuss concerns or symptoms though it is estimated that pelvic floor disorders will impact one in three women during their lifetime.

 

Disorders

Urinary Incontinence (UI) is defined by a loss of bladder control.  The two most common types of UI are:

  • Stress Urinary Incontinence – the loss of urine during the exertion of abdominal muscles, such as sneezing, coughing, laughing, and exercising.
  • Urge Incontinence (OAB) – the inability to hold urine long enough to reach the restroom

Other UIs are:

  • Mixed Incontinence – a combination of Stress Urinary Incontinence and OAB
  • Overflow incontinence – less common among women – leakage may occur when the bladder reaches capacity
  • Functional Incontinence – a form of OAB occurring due to physical conditions limiting one’s ability to reach the restroom in time (e.g., arthritis or using a walker)
  • Fistula – an abnormal connection between the vagina and urinary track typically due to surgery, trauma or radiation.
  • Diverticulum - urine collects in a pouch within the urethra and may leak out

There are currently several lifestyle changes, physical therapy, vaginal devices, medicines and procedures utilized in the treatment of UI.

Fecal incontinence varies from woman to woman. Some may experience accidental leakage of gas, mucus, liquid stool, or hard stool. Other women may experience frequent constipation. Leakage may occur for a variety of reasons, including injury to the bowels, nerve damage, prolapse, or fistulas. Constipation may be due to pelvic floor disorders, diet, medication, medical conditions, or an intestinal blockage.

Treatments for fecal incontinence include lifestyle changes, physical therapy, vaginal devices, medicines, and surgeries or procedures.

Pelvic Organ Prolapse, also known as POP, occurs when weakness or damage to the pelvic floor no longer enables it to support the pelvic organs, (vagina, cervix, uterus, bladder, urethra, intestines and rectum). Symptoms typically present very gradually and can vary depending on the type of prolapse, including:

  • Anterior Vaginal Wall Prolapse
  • Posterior Wall Prolapse
  • Apical Prolapse
  • Rectal Prolapse

Some women may experience discomfort in the pelvic region, lower back, or when urinating or having bowel movements. This can progress and some women may even experience a bulge near the opening of the vagina.

Currently, there are lifestyle changes, physical therapy, vaginal devices, and surgical options available to treat POP.

 

Women and PFD

Pelvic floor disorders (PFDs) may present for a variety of reasons. For some women there may be a genetic propensity. Lifestyle factors such as obesity, diet, smoking, or exertion may also be risk factors. Pregnancy, childbirth, menopause, and age can all lead to a weakening of the pelvic floor. Some women also develop PFDs while undergoing emotional stress. Health conditions relating to the nerves or lungs can also put undue stress on the pelvic floor muscles.

 

Clinical Challenges

PFDs are quite common - 50% of all women will experience symptoms throughout their lifetime. Patients may be hesitant to report symptoms due to embarrassment or a societal misunderstanding that PFDs are a normal part of aging. We, as clinicians and researchers, have limited information the biology of PFDs and a lack of preventative strategies. There are few long-term treatment options as well. This is an area of great opportunity for research that impacts a large percentage of the female population.

 

Prevalence

PFDs Prevalence


1. Wu et al Prevalence and trends of symptomatic PFD in U.S. Women
2. Wu et al Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery