Pelvic Floor Disorders

Pelvic floor disorders are extremely common and treatable. They can develop when your pelvic floor muscles are weakened or damaged.

If you’re living with a pelvic floor disorder, you’re not alone. Around 1 in 4 women develop a pelvic floor disorder — and wait over six years to get help treating it.* Many pelvic floor disorders have similar symptoms, so it’s important to see a specialist so you can receive the right diagnosis. Once we know exactly what’s going on, your condition and symptoms can be treated effectively.

What is the pelvic floor?

The pelvic floor is the “hammock” of muscles that supports the organs in your pelvis. Your pelvic floor does a lot of the heavy lifting in your body. It supports your core and keeps everything in place in your body.

The pelvic organs include:

• The bladder (the pouch holding your urine).
• The uterus and vagina (in women).
• The prostate (in men).
• The rectum (the area at the end of the large intestine where your body stores solid waste).

Symptoms of pelvic floor disorders

You may be living with symptoms of a pelvic floor disorder without realizing that it’s something you can fix. We’ll work with you to identify, diagnose, and treat:

• Leaking when you laugh, cough, or sneeze
• Pain during sex
• Pelvic pain
• Bulges or pressure in your vagina, also known as a prolapse
• Urinary issues, like pain when you pee or having to go frequently
• Constipation, bowel straining, or leakage

Examples of pelvic floor disorders

The most common pelvic floor disorders include urinary and fecal incontinence (lack of bladder and bowel control) and pelvic organ prolapse (when the bladder, uterus, or rectum sag into the vagina and cause a bulge in the vaginal canal).

Incontinence

Incontinence means not being able to control your urine (pee) or stool (poop). It’s not all or nothing. It might mean leaking or dribbling a little bit of urine when you laugh, sneeze, or exercise. Or maybe double-checking your underwear after you pass gas, or wearing absorbent products like a pantyliner or incontinence underwear every day.

Urinary incontinence is the loss of bladder control and uncontrolled leakage of urine. Some of the kinds of urinary incontinence are called stress incontinence, urge incontinence, and overactive bladder.

Fecal incontinence, also called anal incontinence, is when you can’t control your bowel movements. Stool leaks out the rectum at unwanted times.

Pelvic organ prolapse

A pelvic organ prolapse is a vaginal bulge or pressure that happens when one of the organs in your pelvic area shifts out of place from an injury or weakness. A pelvic organ prolapse may involve organs such as your bladder, rectum, bowel, or uterus.

The different types of pelvic organ prolapse are:

• Vaginal vault prolapse: The top of the vagina (known as the “vaginal vault”) droops down into the vaginal canal. This usually occurs in women who have had a hysterectomy (removal of the uterus).
• Uterus prolapse: The uterus bulges or slips into the vagina, sometimes so far that it comes out of the vaginal opening.
• Cystocele: The bladder drops into the vagina.
• Rectocele: The rectum bulges into or out of the vagina.
  
• Enterocele: The small intestine bulges against the back wall of the vagina. An enterocele and vaginal vault prolapse often occur together.

Pelvic floor dysfunction

Pelvic floor dysfunction occurs when the pelvic floor muscles are too tight or tense, which can cause vaginal pain, painful sex, and pain during other activities. This can also make it hard for the muscles in your pelvic floor to relax and work together to empty your bladder or bowel. Learn more about pelvic floor dysfunction.

Causes of pelvic floor disorders

A pelvic floor disorder occurs when the pelvic muscles and connective tissue are too weak, too tight, or are damaged. Some things that may increase the risk of developing a pelvic floor disorder are:

• High-impact cardio exercise or weightlifting
• Pregnancy and childbirth
• Obesity
• Chronic constipation
• Aging
• Menopause
• Radiation therapy to treat gynecological cancers
• Prior pelvic surgery

Diagnosing pelvic floor disorders

Tell your OB-GYN or primary care provider if you’re having any of the symptoms above. A urogynecologist, someone who specializes in pelvic floor disorders, can evaluate and diagnose you with the following:

• Medical and family history and physical examination – The first office visit consists of an interview and consultation followed by a physical exam and pelvic exam. Following the exam, the doctor may recommend specialized testing.
• Urine examination – A urine test and analysis are performed to detect infection, inflammation, blood, or other underlying kidney problems.
• Cystoscopy – This in-office test helps the physician to look directly inside the bladder through a small camera inserted through the urethra. It is a common test used to detect inflammation, kidney stones, or tumors.
• Urodynamics – Urodynamic testing evaluates the bladder's function. These in-office tests are helpful for women with urinary incontinence or urinary frequency.

Depending on your symptoms, additional tests may be used to recommend the best treatment to help you.

Some of these more advanced tests are:

• Anorectal manometry – A test that measures how well the rectum and surrounding muscles work together.
• Defecography – An X-ray test that shows changes in the rectal canal during a bowel movement.
• Anal ultrasound – An exam that uses high-frequency sound waves to look at the layers of tissue in your anal sphincter.
• Pelvic magnetic resonance imagery – An MRI, or scan, that uses magnets and radio waves to see the bones, organs, blood vessels, and tissue in your pelvis. 

How to treat pelvic floor disorders

We have several nonsurgical and minimally invasive surgical treatment options for pelvic floor disorders, such as:

• Medications and supplements to help with incontinence and having a complete bowel movement.
• Pelvic floor therapy to strengthen and control weakened pelvic floor muscles.
• Therapies to treat overactive bladder, urinary urgency, frequency, and urge incontinence. These include nerve stimulation and onabotulinum toxin type A injections in the muscles of the bladder wall.
• Minimally invasive surgeries like midurethral sling (a procedure that puts a thin piece of synthetic mesh under your urethra to treat incontinence) and transurethral bulking (injections of a substance, like collagen, that help keep the urethra closed).

Urogynecology services at Allegheny Health Network: Why choose us?

We understand if you’ve been hesitant to mention your symptoms to your provider. It’s a very sensitive, intimate topic that you may feel uncomfortable bringing up. Choosing to receive treatment for a pelvic floor disorder is a big step toward regaining control of your body and your life. We look forward to helping you with:

• Highly focused care: The AHN Center for Women’s Pelvic Health is home to physicians with specialized training in female pelvic medicine and reconstructive surgery. We are experienced at identifying pelvic floor conditions and using advanced treatment options.
• Advanced surgery alternatives: We offer noninvasive, specialized alternatives to surgery, including pelvic floor physical therapy, prosthetic devices, medications, and lifestyle modifications.
• Minimally invasive treatment: At AHN, we want you to get treated and get on with your life. Our minimally invasive surgical options help you do that with same-day procedures that have less downtime than a traditional surgery.
• Convenience: You can choose from several facilities close to home and throughout western Pennsylvania, so you can start treatment for a pelvic floor disorder quickly and more easily.

Contact us

Call (412) DOCTORS (412) 362-8677 to request an appointment with an AHN urogynecologist.