Pelvic Floor Disorders - Causes, Symptoms, Diagnosis, and Treatment

Introduction

Pelvic floor disorders are issues that impact the normal functioning of a woman's pelvic organs. These problems encompass the descent or drooping of the organs, bladder and bowel control issues, and the weakening of the muscles and tissues in the pelvic region. A pelvic floor disorder (PFD) arises when the muscles or connective tissues in the pelvic region become weak or suffer injury. The prevalent types of PFDs include urinary incontinence, fecal incontinence, and pelvic organ prolapse. These disorders are more frequently observed in older women. Various treatments exist to address these conditions, from exercises to strengthening pelvic floor muscles and lifestyle adjustments to nerve stimulation and surgical interventions.

What Is Pelvic Floor Disorder?

A pelvic floor disorder (PFD) occurs when the muscles and connective tissues in the pelvic region become weak or sustain injury. The most common types of PFDs include:

• Pelvic Organ Prolapse: This occurs when the pelvic muscles and tissue can no longer adequately support one or more pelvic organs. This lack of support can lead to the descent or pressing of organs into the vagina. For example, in uterine prolapse, the cervix and uterus may descend into the vagina and, in some cases, protrude from the vaginal opening. Vaginal prolapse involves the loss of support at the top of the vagina, causing it to drop toward or through the vaginal opening. Prolapse can also lead to a kink in the urethra, the tube that carries urine from the bladder to the outside of the body.

• Bladder Problems: Issues with the bladder can manifest as urinating too frequently during the day or night, a strong urgency to urinate, or urinary leakage. Urinary incontinence, the urine leakage, may occur due to exertion (coughing or sneezing) or other factors involving the bladder muscles. Common types of bladder control problems include stress incontinence, urge or urgency incontinence (also known as overactive bladder), and overflow incontinence.

• Bowel Control Problems: Leaking of liquid or solid stool from the rectum, known as fecal incontinence, can occur in both women and men. This can result from damage or weakening of the anal sphincter, the ring of muscles responsible for keeping the anus closed, or other contributing factors.

What Are the Symptoms of Pelvic Floor Disorders?

Due to the various types of pelvic floor disorders (PFDs), the symptoms can differ or overlap. For instance, women experiencing PFDs may:

• Feel a sense of heaviness, fullness, pulling, or aching in the vagina, especially worsening towards the end of the day or associated with bowel movements.

• Notice or sense a "bulge" or a sensation of "something coming out" of the vagina.

• Encounter difficulty initiating urination or completely emptying the bladder.

• Experience urine leakage during activities like coughing, laughing, or exercising.

• Feel an urgent or frequent need to urinate.

• Experience pain during urination.

• Encounter stool leakage or struggle with gas control.

• Face issues with constipation.

• Find it challenging to reach the bathroom in time.

Some women with pelvic floor problems may not initially exhibit symptoms. Many are hesitant to discuss symptoms with their healthcare providers due to embarrassment. Additionally, some women may consider problems with bladder control as normal and endure their symptoms. However, it is important to note that bladder control issues are treatable, and appropriate treatments can assist women with pelvic floor problems.

What Are the Causes of Pelvic Floor Disorders?

Understanding the complete picture of what leads to pelvic floor problems is intricate and not entirely clear. However, several conditions are being investigated as potential risk factors for the development of pelvic floor disorders (PFDs):

• Childbirth: The relationship between pregnancy, childbirth, and pelvic floor problems is an active area of research. Studies suggest that the mode of delivery (vaginal versus surgical) and the use of forceps or vacuum devices during delivery may impact the risk of PFDs, especially among first-time mothers. The risk may increase with the number of children delivered. However, because pelvic problems also affect women without a history of pregnancy, and cesarean section only reduces but does not eliminate the risk, the connection remains unclear.

• Factors Pressuring the Pelvic Floor: Conditions such as overweight or obesity, chronic constipation, persistent straining during bowel movements, heavy lifting, and chronic coughing (due to smoking or health issues) can exert pressure on the pelvic floor, potentially contributing to PFDs.

• Aging: The pelvic floor muscles may weaken with age and during menopause, increasing the risk of PFDs.

• Genetic Influence: Genetic factors determine the strength of a woman's bones, muscles, and connective tissues. Some women are born with conditions affecting connective tissue strength, making them more susceptible to pelvic organ prolapse.

• Surgery: Previous hysterectomy and surgeries to correct prolapse are associated with higher risks of developing PFDs.

• Race: Certain groups of women, such as white or Latina women, appear to have a higher risk for specific forms of PFDs, though the reasons for these disparities are not fully understood.

What Is the Diagnostic Procedure for Pelvic Floor Disorder?

A physical examination can potentially identify a pelvic floor disorder (PFD). During a routine pelvic exam, the provider may observe or feel a bulge that suggests a prolapse. Alternatively, a woman may consult her doctor due to symptoms such as bladder or bowel control issues. Alongside the physical exam, the doctor will inquire about medical history, including pregnancy, past surgeries, and medications taken. Based on the exam findings or the severity of symptoms, the healthcare provider may conduct specific tests to aid in diagnosis or treatment planning.

For Bladder Control Problems:

• Cystoscopy: Examining the inside of the bladder to identify issues like stones, tumors, or inflammation.

• Urinalysis: A urine test to detect bladder infections, kidney problems, or diabetes.

• Urodynamics: This is an evaluation of how the bladder and urethra function, which assists in determining surgical plans for certain bladder control problems.

For Bowel Control Problems:

• Anal Manometry: A test assessing the strength of the anal sphincter muscles.

• Colonoscopy or Sigmoidoscopy: These are procedures to examine the inside of the colon or sigmoid (the part of the bowel near the rectum) for signs of disease or inflammation causing symptoms.

• Dynamic Defecography: A test evaluating the pelvic floor and rectum while the patient has a bowel movement.

What Is the Treatment for Pelvic Floor Disorders?

Healthcare providers can address pelvic floor dysfunction without resorting to surgery. Treatment options include:

• Pelvic Floor Physical Therapy: A physical therapist can assist in identifying tense pelvic floor muscles. They will teach exercises to stretch these muscles and enhance their coordination.

• Biofeedback: It is a common treatment for pelvic floor dysfunction, often combined with physical therapy. Sensors and video monitoring are used during sessions to observe and guide the relaxation or contraction of pelvic floor muscles, improving coordination.

• Medications: Daily medications may be recommended to maintain soft and regular bowel movements. Over-the-counter options like Polyethylene glycol, Docusate, senna, or generic stool softeners may be suggested.

• Relaxation Techniques: Healthcare providers or physical therapists may recommend relaxation methods such as meditation, warm baths, yoga, exercises, or acupuncture to alleviate tension in pelvic floor muscles.

• Trigger Point Injections: If physical therapy and biofeedback prove insufficient, a pain injection specialist may be consulted. These specialists can identify overly tense muscles and inject numbing medications with a small needle to induce relaxation.

Conclusion

In conclusion, pelvic floor disorders encompass a range of issues affecting women's pelvic organs, including organ descent, bladder and bowel control issues, and weakening of pelvic muscles and tissues. These disorders are prevalent among older women and can present various symptoms. While the causes are multifaceted, factors such as childbirth, pressure on the pelvic floor, aging, genetic influences, previous surgeries, and race contribute to their development. Diagnosis involves physical examinations and specific tests, with treatment options ranging from pelvic floor physical therapy and biofeedback to medications and relaxation techniques, providing non-surgical alternatives for managing pelvic floor dysfunction.