Pelvic floor disorders

One in three women will experience a pelvic floor disorder (PFD) in her lifetime.

PFDs occur when women have weakened pelvic muscles or tears in the connective tissue, which may cause pelvic organ prolapse, bladder control problems, or bowel control problems.

PFDs include bladder control problems, bowel control problems, and pelvic organ prolapse.

• Pelvic organ prolapse is the dropping of the bladder, urethra, cervix and rectum caused by the loss of normal support of the vagina. In severe cases, women may feel bulging tissue protruding through the opening of the vagina.
• Bladder control problems include the inability to hold urine long enough to reach the restroom (urge incontinence), frequent urination during the day and night (urge frequency), and urine leakage caused by increased abdominal pressure (stress incontinence). Urgency frequency and urge incontinence are also defined as overactive bladder.
• Bowel control problems include the loss of normal control of the bowels that can lead to constipation or fecal incontinence (FI). FI, leakage of solid liquid stool or gas, is also called anal incontinence (AI) and accidental bowel leakage (ABL).

No. Women do not have to suffer in silence or simply manage a PFD with pads. There are several non-surgical and surgical treatment options. PFDs can be effectively treated by working with a trained urogynecologist to develop a treatment plan for your individual needs. Other options may include

• Pelvic floor physical therapy
• Medications
• Pessaries and other vaginal supports
• Bladder Botox
• Nerve stimulation (interstim, percutaneous tibial nerve stimulation)
• Innovative new strategies

No, not really. PFDs are not a normal part of aging, although they become more common as women get older. With the help of a specialist, there are effective treatments for PFDs.

Yes. Childbirth can contribute to the development of PFDs. Vaginal births double the rate of pelvic floor disorders compared to Cesarean deliveries or women who never gave birth. However, Cesarean deliveries pose several risks and are not recommended for prevention of PFDs.

A general practitioner can help decide if you need a specialist. A specialist in female pelvic medicine and reconstructive surgery (FPMRS) or urogynecologist, is a physician with specialized training to evaluate and treat women with pelvic floor disorders.

Urogynecologists are physicians with special training in urology and gynecology. They focus on the evaluation and treatment of non-cancerous conditions concerning the female pelvic organs and supporting muscles and tissues and are trained in pelvic reconstructive surgery. The sub-specialty of urogynecology, now known as female pelvic medicine and reconstructive surgery, was created in the 1990s. In 2013, it became a specialty recognized by the American Board of Medical Specialties (ABMS) and certified by the American Board of Obstetrics and Gynecology (ABOG) and the American Board of Urology (ABU). Urogynecologists/FPMRS specialists complete medical school and do a residency in obstetrics and gynecology or urology. They then complete additional years of highly specialized training in FPMRS. This includes surgical training in the skills of pelvic and reconstructive surgery in addition to training in nonsurgical management of pelvic floor disorders. Women who had to see multiple specialists for urinary, reproductive and gastrointestinal problems can now see one. At the Center for Women’s Pelvic Health at UCLA all of our doctors are board certified in their primary specialty (obstetrics and gynecology or urology) and in FPMRS.

Urogynecologists treat pelvic organ prolapse, urinary incontinence, fecal incontinence and other pelvic floor disorders. Approximately one in three women will experience one of these conditions. Urinary and fecal incontinence involves a lack of control over those functions. The pelvic floor is the system of muscles, ligaments and tissues that support the bladder, urethra, uterus, vagina, small bowel and rectum in the pelvic area. Pelvic floor disorders are conditions involving a weakening of support for those organs, often leading to prolapse.

Pelvic organ prolapse happens when one or more of a woman's organs in the pelvic area drops (prolapses) from its normal position to push against the walls of the vagina. Prolapse occurs because the downward pressure of the pelvic organs is greater than the strength of the supporting pelvic floor muscles and ligaments. With pelvic organ prolapse, many women feel pressure or fullness in the vagina, and as the prolapse increases, tissue may protrude from the vagina.

Urinary and fecal incontinence and pelvic floor disorders may be caused by several things, including damage that harms the pelvic floor muscles, nerves or supporting tissues, childbirth and genetics. Aging, repeated heavy lifting, chronic diseases, genetics or surgery are also known risk factors. Smoking and obesity can also contribute to urinary incontinence.

Depending on your particular circumstances, there are several things you can do to treat incontinence:

• Doing exercises (such as Kegel exercises) to strengthen your pelvic floor muscles can help with your bladder control and can even prevent pelvic floor disorders from occurring.
• Eating foods that are high in fiber can ease the stress on bowels, and avoiding caffeine and certain other dietary triggers can improve your bladder control.
• Behavior modification in the form of fluid restriction, medication manipulation, and bladder training can help control the timing of urination.
• Maintaining proper weight, not smoking and avoiding excessive stress in lifting can help reduce your risk of pelvic floor disorders.

Prolapse and incontinence can certainly be embarrassing, but talking about it with a urogynecologist shouldn't be. The UCLA CWPH are specialists knowledgeable in these issues and compassionate in talking with women about such problems. Ultimately their goal is the same as yours: to relieve or eliminate your pelvic floor problems. Many women tolerate urinary and fecal incontinence in silence and do not seek the medical help that can greatly improve quality of life. It's important to know that many conditions can be improved or cured and the first step is talking to a urogynecologist.

Pelvic floor disorders and urinary and fecal incontinence problems often occur in various degrees, caused by differing factors and conditions. Treatments vary widely beginning with simple lifestyle changes. Management may also involve medications, the use of organ supporting devices, or minimally-invasive surgery to more complex surgeries.

Our specialists will fully evaluate you and formulate recommendations, and you will be involved and in charge of what treatments you choose to pursue.

It is unlikely that a pelvic floor disorder will go away on its own. In some cases of pelvic organ prolapse, a urogynecologist may suggest doing nothing and observe the situation over time, depending on the severity of your symptoms and level of bother. Depending on the problem, it is also possible that if left untreated, incontinence or pelvic floor disorder often remains unchanged or may worsen.

In the past, "bladder lifts" and incontinence procedures had a reputation for high recurrence rates. However, the field of FPMRS/urogynecology has progressed and continues to develop every day. New procedures have evolved, and urogynecologists are more specifically focused on these procedures and conditions, resulting in improved success rates. Many factors are important in this decision-making process. Your urogynecologist will discuss all aspects of possible surgery so you are well prepared to make the ultimate decision on your treatment.

This is a reconstructive surgery and the body should be given ample time to heal without undue physical stress. Many women can return to work or their daily life soon after surgery, as long as they do not bend, lift, squat or otherwise stress their pelvic floor. This period of limited activity may last for up to three months, depending on the surgical procedure, or may be much shorter. Your physician will prepare you with lifestyle changes that will protect your pelvic floor during recovery and afterward.

*Adapted from Voices for PFD website