Houston Methodist Pelvic Health Care

Symptoms vary depending on the type of pelvic floor disorder and organs involved.

Women with a pelvic floor disorder may experience:

• Bulging or pressure in the vagina
• Pelvic pressure
• Lower backache
• Painful intercourse

Both women and men may experience:

• Constipation
• Difficulty starting to urinate, emptying the bladder fully or making it to the bathroom in time
• Feeling an urgent or frequent need to urinate
• Feeling pain while urinating
• Leaking stool or inability to control gas
• Leaking urine when coughing, laughing or exercising

A pelvic floor disorder occurs when the muscles or ligaments of the pelvic area weaken or are injured. The most common pelvic floor disorders are urinary incontinence, fecal incontinence and pelvic organ prolapse (in women). While pelvic floor disorders can occur at any age, they are more common among older women.

The pelvic floor is composed of muscles, ligaments and connective tissue that stretch from the pubic bone to the tailbone and extend toward each side of the pelvis to form a supportive sling.

In women, these muscles and ligaments work together to support pelvic organs such as the vagina, cervix, uterus, urethra, bladder and bowel, as well as vaginal childbirth and sexual function. In men, pelvic floor muscles support the urethra, prostate, bladder, bowel and sexual function.

Factors that can contribute to the development of pelvic floor disorders include:

• Aging
• Childbirth
• Chronic constipation
• Chronic cough
• Heavy lifting
• Obesity
• Surgery, like hysterectomy

A health care provider may be able to diagnose a pelvic floor disorder with a physical exam. In some cases, a woman’s health care provider will see or feel a bulge during a routine pelvic exam that suggests a prolapse. In other cases, a woman may see her doctor about symptoms she is experiencing, such as problems with bladder or bowel control. In addition to a physical exam, a doctor will ask about medical history, including whether a woman has been pregnant, has had surgery and takes any medicines.

Depending on the findings from the exam or the severity of the symptoms, a health care provider may do tests. Some tests used to help with the diagnosis or treatment planning include:

• Colonoscopy or sigmoidoscopy
• Cystoscopy
• Dynamic defecography
• Urinalysis
• Urodynamics

Treatment can often help when symptoms are bothersome or restrict a person’s activities. Some types of treatments include:

• Lifestyle changes: limit food and drinks that stimulate the bladder, such as caffeinated, carbonated, artificially sweetened, citrus or alcoholic beverages; eat a high-fiber diet; lose weight
• Nonsurgical treatment: bladder training; pelvic floor muscle training; medicine; vaginal pessary
• Surgical treatment: for prolapse, and bladder or bowel control
• Combination treatment: a multifaceted approach that could include a mix of lifestyle changes, nonsurgical treatment and surgical treatment, depending on your unique circumstances

Without treatment, symptoms can get worse and may affect your self-esteem, your ability to do your job, your relationships, and many other aspects of daily living. In addition, buying products to deal with the symptoms of bladder or bowel control problems can be costly. You should make an appointment if you:

• Feel a bulge or lump on the outside of your vagina
• Feel lower back pain or increased pelvic pressure
• Have irregular vaginal spotting or bleeding
• Have frequent urinary incontinence, urinary tract infections, urge to urinate or difficulty urinating
• Have difficulty or pain during sexual intercourse