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Pelvic Floor Disorder

The pelvic floor is composed of several muscles, connective tissues, nerves, tendons and ligaments that:

  • Support our organs (bladder, uterus and colon).
  • Help sexual function.
  • Help maintain continence.

Pelvic floor disorders can have various causes, including:

  • Pregnancy and childbirth.
  • Pelvic surgeries (e.g., hysterectomy).
  • Obesity.
  • Childbirth.
  • Chronic physical strain, such as lifting heavy loads.
  • Persistent coughing.

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What Is Pelvic Floor Dysfunction?

The pelvic floor is a complex group of muscles and other tissues that support the pelvic organs, including the bladder, uterus and rectum. When a person suffers from pelvic floor dysfunction, these muscles no longer function in a coordinated manner with each other and can cause urinary, intestinal, and sexual disorders.

Many women suffer from some form of pelvic floor dysfunction throughout their lives. Men can also suffer from these conditions, but usually with different signs and symptoms and for different reasons.

In its most severe form, pelvic floor dysfunction can result in incontinence or loss of control of urine, bowel or both. Talking about it can be difficult, but it's a very common problem.

Types of pelvic floor disorders

Pelvic floor disorders or diseases may include:

  • Pelvic organ prolapse.
  • Urinary and fecal incontinence.
  • Painful bladder syndrome.

What is Pelvic Organ Prolapse?

Pelvic organ prolapse occurs when the uterus, bladder, and rectum descend into the vagina due to weakening of the supporting muscles and tissues. It is a common problem that can be asymptomatic or cause symptoms such as:

  • Difficulty urinating or having bowel movements.
  • Pain during sexual intercourse.
  • Discomfort or prolonged pain when standing or during physical activity.
  • A feeling of pressure or heaviness in the pelvic area.
  • Urinary incontinence.
  • Presence of a bulge in the vagina or protrusion of tissue.

Some people may feel a fullness in the vagina or notice a protruding tissue at the vaginal opening. The diagnosis is based on a pelvic exam.

Possible treatments, to be discussed with a specialist, include:

  • Watchful waiting if the prolapse does not cause discomfort.
  • Pessary is a device that supports the prolapsed tissue.
  • Physiotherapy to strengthen the pelvic floor.
  • Surgery in more severe cases.

What is urinary incontinence?

Urinary incontinence is the involuntary loss of urine and can manifest in different forms:

  • Stress incontinence – loss of urine during coughing, sneezing, jumping, or lifting weights. It is often related to childbirth, obesity, smoking, and genetic predisposition.
  • Urgency incontinence – sudden and urgent need to urinate, often associated with an overactive bladder. It can lead to leakage if one cannot reach the bathroom in time.

Treatments vary depending on the cause and severity:

  • Lifestyle changes, such as reducing caffeine, tea, alcohol, and carbonated drinks.
  • Pelvic floor exercises to strengthen muscles and improve bladder control.
  • Bladder realignment to increase the capacity to retain urine.
  • Support devices, such as vaginal pessaries.
  • Surgery for more severe cases (e.g., mid-urethral sling implantation).

What is painful bladder syndrome?

Also known as interstitial cystitis, this condition causes pain and discomfort in the bladder and pelvic area. It primarily affects women over 40 and is often underdiagnosed. Symptoms include:

  • Pressure, discomfort, or pain in the bladder and lower abdomen.
  • Pain that may vary over time and intensify during certain periods.
  • Possible association with migraines, fibromyalgia, irritable bowel syndrome, or depression.

There is no certain cause, but treatment may include:

  • Education and stress management.
  • Dietary changes, avoiding irritating foods.
  • Tailored therapies based on the severity of symptoms.

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What Are the Signs and Symptoms of Pelvic Floor Dysfunction?

The pelvic floor muscles prevent you from urinating or going to the bathroom when you don't want to and allows you to do so when you're ready. To urinate or go to body, you need to relax the pelvic floor muscles. The signs and symptoms of pelvic floor dysfunction depend on whether the pelvic floor muscles are too tense or too loose (weak).

If the muscles are too tense, you may experience the following symptoms:

  • Difficulty emptying the bladder (retention) or bowel (constipation).
  • Painful sexual intercourse.
  • Painful urination that simulates a urinary tract infection or prostatitis.
  • Urgency and frequency.
  • Pelvic pain.

If your muscles are too loose or weak, you may experience the following symptoms:

  • Urinary or fecal incontinence (leakage).
  • Pelvic organ prolapse (women).

Types of pelvic organ prolapse (POP)

Pelvic organ prolapse (POP) occurs when the pelvic organs come out of their normal position in the body due to weakness of the pelvic floor muscles. It is a type of hernia. When a pelvic organ is prolapsed, vaginal/pelvic pressure and pain may be felt, as well as urinary and gastric symptoms.

Types of POPs are:

  • Cystocele (most common) – The bladder descends into the vagina.
  • Rectocele – Rectal prolapse in the vagina.
  • Uterine prolapse – The uterus falls into the vagina.
  • Enterocele – The small intestine descends into the vagina.
  • Urethrocele – The urethra protrudes into the vagina.

There are different degrees of POP, depending on how far the pelvic organ descends. This can be determined by the specialist, who can offer different types of treatment options.

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How Do You Treat Pelvic Floor Dysfunction?

The first step in treating pelvic floor dysfunction is a thorough medical evaluation, which includes gathering the patient's medical history and conducting a physical examination to identify any signs of the disorder.

If necessary, the specialist may request laboratory tests (such as urine analysis) and radiological investigations, including pelvic ultrasound, magnetic resonance imaging (MRI), or computed tomography (CT). Once the diagnosis is confirmed, the doctor will assess the most appropriate treatment from the following options:

  • Lifestyle modifications.
  • Physical therapy.
  • Electrical stimulation.
  • Pharmacological therapy.
  • Surgery (in more severe cases).

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Reviewed September 2024.