So you didn't keep up with your Kegels after pregnancy and now you leak urine when you sneeze. Or worse, it feels like your uterus is about to fall out any minute, a sure indication of pelvic organ prolapse. Yet you carry on—because you're busy, and well, who has time to deal with one more thing? A lot of women don't, or they're too embarrassed to talk to their doctors about pelvic floor problems, instead choosing to suffer through bladder dysfunction and pelvic issues well into their later years. And while suffering isn't treatable, pelvic floor disorders are, with a wide range of noninvasive, nonsurgical, and minimally invasive surgical options available.
But first you have to let your doctor know what's going on.
According to the National Institute of Child Health and Human Development, more than one-third of U.S. women have a pelvic floor disorder, with one-quarter having one or more disorders that cause symptoms.
Recognizing symptoms and causes of pelvic floor dysfunction
Pelvic floor dysfunction is a result of weakened pelvic floor muscles or weakened or injured pelvic organs, quite commonly due to the excess weight and strain of pregnancy and childbirth as well as hormonal and physical changes associated with menopause. Obesity, repeated heavy lifting, and even genetics can also play a part in pelvic issues.
Examples of pelvic floor dysfunction include:
- Prolapsed bladder and bladder emptying issues
- Recurring urinary tract infections
- Female sexual dysfunction
Symptoms of pelvic floor dysfunction vary. Some may be similar to those of urinary or fecal incontinence, such as:
- Having to urinate urgently or frequently
- Having to have several bowel movements during a short period of time
- Not being able to urinate
You may also have these kinds of symptoms:
- Pain in the belly (because of bloating or constipation, for example)
- Pain with sexual intercourse, tampon insertion, gynecological exams
- Pain at the tail bone, lower back, and/or genitalia after sitting for long periods of time
"Unfortunately, a lot of my patients come to see me after living with uncomfortable symptoms for a long time," says Marc R. Toglia, MD, urogynecologist and chief of female pelvic medicine and reconstructive pelvic surgery at Main Line Health. "If you have any concerns about weak pelvic muscles or pelvic floor function, I encourage you to have an open conversation with your OB/GYN at your next appointment. Right now it might seem like these symptoms are an inconvenience but down the road they could significantly impact your quality of life. And all of these pelvic issues are treatable—most of them nonsurgically."
Keep in mind that although childbirth greatly increases the risk of developing pelvic floor disorders, anyone can develop them and the risk does increase with age.
Pelvic floor treatment—from pelvic floor rehab to surgical repair of the bladder
Maureen Fleagle, PT, BS, a pelvic floor physical therapist and part of the Bryn Mawr Rehab Hospital Outpatient Network, located in Wynnewood. Fleagle is specially trained in helping women overcome pelvic floor problems with therapies such as:
- Bladder retraining
- Electrical stimulation
- Targeted exercises
Other nonsurgical treatments for pelvic floor disorders commonly include:
- Behavioral therapies to help regain control of pelvic floor muscles
- Pelvic muscle rehabilitation to improve pelvic muscle tone and prevent leakage
- Medication, including drugs for incontinence as well as estrogen therapy, which may be helpful in conjunction with other treatments for postmenopausal women
"The sooner a woman seeks treatment, the quicker and easier that treatment is," says Fleagle. "If you notice even a dribble of urine when you cough, sneeze, or laugh, talk with your doctor. Typically, these problems don't improve on their own."
For some patients, surgery may be appropriate if there are structural problems such as an abnormally positioned bladder or a blockage.
Dr. Toglia was the first surgeon in the Philadelphia suburbs to perform the minimally invasive mid-urethral sling procedure and has subsequently performed more than 1,300 of these procedures to date.
"Pelvic floor surgeries have improved significantly in the past 20 years, resulting in less invasive and more successful surgical options," adds Dr. Toglia. "We focus the treatment on the underlying cause of the pelvic floor problem, which is why your sister or friend may have the same symptoms, but the causes may be different. Our treatment of each patient is unique for that reason."
Minimize your risk of pelvic floor problems
Although pelvic floor disorders are common, they're not an inevitable part of aging. Here are some things you can do to minimize your risk of having them:
- Maintain a healthy weight. Being overweight increases your risk of developing a pelvic floor disorder, and extra weight can make symptoms worse.
- Eat a healthy diet. Include lots of fluids and high-fiber foods. Try eating 25 to 30 grams of fiber per day. This can keep your bowels functioning normally, preventing constipation. Constipation and chronic straining during bowel movements can stretch some of the tissues of the pelvic floor, so preventing constipation can help reduce the risk of developing some pelvic floor disorders.
- Work out your pelvic floor. Pelvic floor exercises, or Kegel exercises, help keep pelvic floor muscles toned, decreasing your risk of developing a disorder. To do Kegel exercises, lie on the floor and squeeze the muscles you would use if you were trying to stop yourself from passing gas. Pull in these pelvic muscles and hold for three seconds, then relax for three seconds. Work your way up to 10 or 15 repetitions of this, three times a day.
- Avoid tobacco. People who smoke may develop a chronic cough, which puts stress on the pelvic floor. Talk with your doctor about getting help to quit or try SmokeFREE, Main Line Health's free, six-session behavior modification program.
Fleagle also helps women learn how to identify and reduce bladder irritants in their diets such as caffeine, alcohol, artificial sweeteners, and acidic foods like grapefruit and tomato sauce. "Sometimes one appointment is all it takes to correct a problem or learn how to prevent one," she says.
Main Line Health serves patients at hospitals and health centers throughout the western suburbs of Philadelphia. To schedule an appointment with a specialist at Main Line Health, call 1.866.CALL.MLH (225.5654) or use our secure online appointment request form.