Pelvic Floor Disorders

If you've just been told you have a pelvic floor disorder (PFD), you are not alone. A large number of women share your pain. Yes, this is yet another one of those "female-only" problems. Approximately one-third of all women in the U.S. will be affected by one type of pelvic floor disorder in their lifetime, according to the National Institutes of Health (NIH).

The pelvic floor is a group of muscles that forms a sling across a woman's pelvis. These muscles are extremely important because they keep the pelvic organs in place; organs like the bladder, rectum, and uterus. Once there is a weakening in the pelvic floor muscles and their connective tissue, the supported organs no longer have their delicate balance. This can cause one or a number of pelvic disorders.

Types

The different types of pelvic floor disorders are named for the organ that is affected. Many of the disorders involve a bulging of tissue, similar to a hernia (Read about "Hernia"), but some are about losing control of bodily functions. According to the Pelvic Floor Disorder Network (PFDN), they include:

• Rectocele - the rectum pushes through the middle of the vaginal muscles and protrudes into the back wall of the vagina.
• Enterocele - the small intestine bulges into the vagina.
• Cystocele - the bladder drops down and protrudes into the vagina. This can be referred to as a prolapsed bladder. (Read about "Urinary System")
• Cystourethrocele - similar to a cystocele but develops when the upper part of the urethra drops down with the bladder.
• Prolapse of the uterus - the uterus drops down into the vagina. The cervix can be lower than normal and can be felt easily with the finger tip or even come out through the vagina.
• Prolapse of the vagina - the upper part of the vagina drops into the lower part so that the vagina turns inside out.
• Urinary incontinence - urine leakage (Read about "Incontinence")
• Fecal incontinence - bowel leakage (Read about "Fecal Incontinence")

Causes

Pelvic floor disorders can be caused by a combination of different factors. For example, pregnancy with a vaginal delivery may weaken or stretch some of the pelvic muscles or damage some nerves. (Read about "Childbirth") The more vaginal deliveries you have, the more at risk you may become for a pelvic floor disorder, according to the American Urological Association (AUA). Also, the older you are, the more at risk you are for developing one of these disorders. Other causes of pelvic floor disorders may include the following:

• heavy lifting
• chronic coughing
• constipation (Read about "Constipation")
• obesity (Read about "Obesity")
• menopause (Read about "Menopause")
• pelvic surgery
• radiation treatments (Read about "Radiation Therapy")
• genetics (Read about "Genetics")

Symptoms

Sometimes a woman can have more than one type of pelvic floor disorder. Many of the symptoms are easy to see and feel. Discomfort in the vaginal area, problems with urination, and painful intercourse are all indications that you could be suffering from a pelvic disorder. According to NIH, here are some of the symptoms that might appear:

• a feeling of heaviness or fullness in the vaginal area
• aching or bulging in the pelvic area
• difficulty emptying the bladder or the accidental loss of urine
• frequent urination
• painful urination
• frequent urinary tract infections (Read about "Urinary Tract Infections")
• pain in the lower abdomen, groin or lower back
• tissue protruding from the vagina
• constipation
• difficulty controlling the bowels
• vaginal bleeding and/or discharge

If severe symptoms are ignored, AUA says kidney damage or infection could occur. In some mild cases, there may be no symptoms whatsoever.

Diagnosis

A healthcare provider should be able to diagnose a pelvic floor disorder. AUA says this is usually done by taking a history of symptoms as well as performing a pelvic examination. Finding out how well the bladder and rectum are functioning may involve some simple tests. If necessary, your doctor may order one or more of the following procedures, according to AUA:

• Cystoscopy - viewing the inside of the bladder (Read about "Endoscopy")
• Urethroscopy - viewing the inside of the urethra
• Voiding cystourethrogram - an x ray taken during urination (Read about "X-rays")
• Fluoroscopy - another form of moving x-ray
• Urodynamics - bladder testing

Treatments

There are many different treatment choices for people with pelvic disorders, but those choices depend on a number of factors, according to the Agency for Healthcare Research and Quality (AHRQ). Those factors include:

• how weak the pelvic ligaments have become
• your health
• your age
• whether you want to become pregnant

Once your physician evaluates your condition, he or she can offer some options, including both surgical treatments and non-surgical treatments. Non-surgical treatments range from medications to exercises, and include some of the following according to NIH:

• Kegel exercises - these exercises can help you strengthen the pelvic muscles. They can be done by tightening your pelvic muscles like you're trying to hold the flow of urine.
• medication (for some cases of urinary incontinence)
• weight control (Read about "Losing Weight" "Fighting Weight Gain")
• changes in diet (Read about "Dietary Guidelines")
• estrogen - estrogen is sometimes prescribed to limit more weakening of the muscles and tissues that support the uterus
• pessary - a pessary is a rubber doughnut shaped device that is inserted around the cervix to help keep the pelvic organs in place
• avoidance of heavy lifting and straining

Surgery is also an option for pelvic disorders. Some women may require it. It is usually performed when a woman is in a great deal of discomfort and has decided she does not wish to have more children. AHRQ says that surgical treatments may include:

• tightening the weak muscles without removing the uterus
• hysterectomy - which is only recommended if symptoms are severe or the uterus has dropped down through the vagina (Read about "Hysterectomy")
• repositioning of the bladder

Most surgery is done through the vagina but can also be performed through the abdomen according to AHRQ. Recovery could take 4-6 weeks depending on the type of surgery you have. In most cases, pelvic disorders can be treated successfully.