Common Pelvic Disorders
- Stress urinary incontinence: Stress incontinence is the loss of urine during physical activity such as coughing, sneezing, laughing or lifting something heavy. These activities cause an increase in a woman’s abdominal pressure, which forces the urine out of the bladder. Some patients will leak only a few drops while others may leak more than a cup. Stress incontinence occurs almost exclusively in women. The most common reason is thought to be due to loss of urethral support from childbirth or aging. Excessive weight can also be a contributing factor.
- Overactive bladder and urgency urinary incontinence: Urge incontinence is a leakage of urine that is experienced when someone cannot delay the bladder's message to empty. They experience "the urge" and often cannot make it to the bathroom on time. This is the most common type of incontinence and is treated with medication. Patients may experience:
- Feeling of a weak bladder or a small bladder
- Difficulty maintaining their urine on the way to the bathroom
- Getting up frequently during the night to urinate
- Frequent , small painful urination
- The need to go to the bathroom frequently, sometimes every one to two hours
- Painful Bladder Syndrome: Also called interstitial cystitis, the chronic condition causes bladder pressure, bladder pain and sometimes pelvic pain. People with severe interstitial cystitis experience a persistent, urgent need to urinate.
- Chronic Bladder Infections
- Constipation: Bowel movements that hard to pass or infrequent – less than three movements per week.
- Fecal incontinence: Fecal incontinence is the inability to control bowel movements, causing stool (feces) to leak unexpectedly from the rectum. Also called bowel incontinence, fecal incontinence ranges from an occasional leakage of stool while passing gas to a complete loss of bowel control.
Pelvic organ prolapse: Prolapse simply means displacement from the normal position. When this word is used to describe the female organs, it usually means bulging, sagging or falling into the vagina. It can occur quickly, but usually happens over the course of many years.
- Diastasis Recti: Abdominal muscle separation that can cause back pain, constipation, urine leaks and a bulge in the middle of the abdomen.
- Painful intercourse: Dyspareunia is the medical term for painful intercourse. It is defined as persistent or recurrent genital pain that occurs just before, during or after intercourse. Treatments focus on the underlying cause, and can help eliminate or reduce this common problem.
- Pudendal Neuralgia: Long-term pelvic pain that is caused by damage to the pudendal nerve – one of the main nerves in the pelvis. The pain may feel like a prickling, shooting, crushing or burning sensation.
- Tailbone pain: Coccydynia is the name of a very painful condition that causes persistent pain at the bottom of your spine or coccyx. It can occur as a result of a fall, childbirth, repetitive strain, surgery or in rare cases by a tumor or infection.
- Vaginismus: An ailment marked by severe tightening or spasms of the vaginal muscles during penetration.
- Vulvodynia: A frustrating condition that creates burning, soreness, stinging, throbbing or itching sensations in the vulva without an identifiable cause.
- Genitourinary fistula: A vaginal fistula is an abnormal opening that connects the vagina to another organ, such as the bladder, colon or rectum. Vaginal fistulas can develop as a result of an injury, a surgery, an infection or radiation treatment. Whatever the cause of a fistula, it may need to be closed by a surgeon to restore normal function.
- Mesh complications: Surgical mesh is a medical device that is used to provide extra support when repairing weakened or damaged tissue. Most surgical mesh devices are made from synthetic materials or animal tissue. Research has shown that surgical mesh for transvaginal repair of POP can cause complications such as mesh erosion, pain, infection, bleeding, pain during sex, organ perforation and urinary problems. Many of these complications require additional treatment, including surgery.
- Rectovaginal fistula: A rectovaginal fistula is an abnormal connection between the lower portion of the large intestine — the rectum — and the vagina. Bowel contents can leak through the fistula, allowing gas or stool to pass through the vagina. A rectovaginal fistula may result from:
- Injury during childbirth
- Crohn's disease or other inflammatory bowel disease
- Radiation treatment or cancer in the pelvic area
- Complication following surgery in the pelvic area
Find an Urogynecologist Near You
Our specialists are highly experienced in providing medical and surgical options to women with pelvic floor disorders.
Pelvic Health
The pelvic floor is a bowl-shaped group of muscles, ligaments and connective tissues that support the bowel, bladder, uterus, vagina and rectum. They attach to your pelvic bone in the front and your tailbone in the back. For example, a pelvic floor disorder may occur when women have weakened pelvic muscles or tears in the connective tissue due to excessive strain on the pelvis due to childbirth, repeated strenuous activity, menopause, chronic disease or pelvic surgery.
About Pelvic Health Disorders
About Pelvic Health Disorders
Symptoms vary with each type of pelvic health disorder.
Different women may also experience different symptoms. Symptoms typically begin gradually and progress over time. If you experience one or more of the following symptoms, you may have a pelvic floor dysfunction:
- Constipation or infrequent bowel movements
- Difficulty starting to urinate or emptying the bladder
- Inability to hold a bowel movement
- Leakage
- Painful urination
- Pelvic pain or muscle spasms
- Painful intercourse
- Pressure or bulge in the vagina or rectum
- Urinating eight times or more in 24 hours
If you have any of these symptoms, you should discuss them with your primary physician.
You are unique and your risk factors may be different based on genetics, life stage, lifestyle and overall health.
Here are some risk factors to consider:
- Age: The strength of your pelvic floor may deteriorate as you age.
- Race: The strength of your bones, muscles and connective tissue are influenced by your genes and race.
- Pregnancy/Childbirth: Childbirth can contribute to the development of pelvic health disorders. Vaginal birth doubles the rate of pelvic health disorders compared to Cesarean deliveries or women who never gave birth.
- Menopause: Pelvic floor muscles often weaken during menopause, which can lead to the development of pelvic organ prolapse.
- Obesity: If you are overweight or obese, your bladder may experience added pressure. This will put you at an increased risk of developing pelvic organ prolapse and urinary incontinence.
- Diet: If you do not have enough fiber or water in your diet, your bowel movements are more likely to be hard or irregular. Processed foods can lead to constipation and certain dietary items, like caffeine and alcohol, can irritate your bladder and make you feel like you have to urinate.
- Smoking: If you smoke, you increase your risk of developing urinary incontinence and pelvic organ prolapse.
- Heavy lifting: If your job involves heavy lifting or exertion, it can increase your risk of developing pelvic health disorders.
- Sexual dysfunction: Pelvic floor symptoms are significantly associated with reduced sexual arousal, infrequent orgasm and painful intercourse (known in medical terms as dyspareunia).
- Constipation/Chronic straining: If you are straining with constipation, you can put significant pressure on a weak vaginal wall and further thin it out.
- Pelvic injury/Surgery: You can experience the loss of pelvic support when the pelvic floor is injured from a fall, car accidents or surgery.
- Lung conditions/Chronic coughing: If you suffer with chronic respiratory disorders, the increased pressure in the abdomen and pelvis from coughing can increase the risk of pelvic organ prolapse.
Diagnosing Pelvic Health Conditions
Diagnosing Pelvic Health Conditions
A focused physical examination will assess the vaginal area including the support of your pelvic organs. After your initial exam, your physician may recommend specialized testing or medical treatment if appropriate.
Testing may include:
- Cystoscopy: Cystoscopy uses a lighted flexible telescope to look at the inside of your bladder. The test allows Avista Pelvic Health Center experts to see if your bladder is inflamed or has other abnormalities that may be causing problems.
- Urodynamic testing: Urodynamics tell us about the bladder, its nerves, its sphincters and the pelvic floor muscles. These are simple tests done in the office that involve filing your bladder with water while specialized equipment monitors the response of your nerves and muscles. These tests are the key to understanding the cause of your symptoms.
Treating Pelvic Health Conditions
Treating Pelvic Health Conditions
There are a wide range of treatment options available to treat pelvic health conditions.
- Biofeedback: Biofeedback is a technique where a patient will learn to control specific physiological processes. This non-painful, non-surgical strategy provides improvement for many patients with pelvic floor disorders. During biofeedback, electrical activity in the muscle is recorded and displayed for the patient. The therapist can then provide feedback to help the patient improve their muscle coordination. When used in conjunction with Kegel exercises, biofeedback techniques help women gain awareness and control of their pelvic muscles.
- Botox bladder injections: When Botox is injected into the bladder muscle, it causes the bladder to relax, increasing the bladder’s storage capacity and reducing episodes of urinary incontinence. Injecting the bladder with Botox is performed using cystoscopy, a procedure that allows a doctor to visualize the interior of the bladder while Botox is being injected.
- Medications: Medications may be prescribed and work by relaxing the bladder muscles and decreasing the amount of abnormal spasms in the bladder. They may increase the interval between voids, and help alleviate symptoms of urgency and urinary frequency.
- Pelvic floor physical therapy: Pelvic floor rehabilitation is achieved through an individualized program of treatments aimed at improving the strength of the pelvic floor, restoring function and eliminating pain or restriction in the perineum. Therapy may include pelvic muscle exercises (Kegels) and core exercises, manual therapy, biofeedback, electrical stimulation and others, depending on each patient’s individual condition. After several treatments, effective symptom relief can often be achieved.
- Periurethral bulking: Periurethral bulking agents can effectively relieve symptoms of stress incontinence by increasing tissue bulk and tightening the urethra to prevent urine from flowing out unexpectedly. The bulking agent is injected directly into the periurethral tissue as a liquid, which then solidifies to add the desired bulk to the insufficient urethral wall.
- Pessaries: A pessary is a device that is placed into the vagina to support the uterus or bladder and rectum. It is a firm ring that presses against the wall of the vagina and urethra to help decrease urine leakage. The type and size of the pessary should be fitted to meet your individual needs and anatomy. A properly fitted pessary is not noticeable when it is in place.
Before choosing which technique to use, our specialists will factor in your wishes, past medical history, previous surgeries and overall health status. You may be a candidate for these surgical treatments:
- Minimally invasive laparoscopic surgery: This surgery is done through one or more small incisions, using small tubes and tiny video cameras and surgical instruments.
- Vaginal or pelvic reconstructive surgery: The goal of all reconstructive pelvic floor procedures is to restore normal pelvic floor anatomy and give the patient her best chance at maintaining a normal quality of life, including sexual intercourse if desired.
- Robotic surgery: Robotic surgery provides a magnified, 3-D view of the surgical site, which gives the surgeon great precision, flexibility and control.
You can help control pelvic floor disorder symptoms by making lifestyle and behavioral changes like these:
- Diet and fitness. For many women, a healthy diet and fit lifestyle really makes a difference in controlling their pelvic health disorder symptoms
- Lose weight if you are overweight. Weight loss can help improve urine leakage along with pelvic muscle strengthening and other behavioral changes. If you are overweight, as little as a 5 to 10 percent reduction in your weight will reduce weekly incontinence episodes by more than half. In addition to stressing the pelvic floor, obesity affects the normal functioning of the nerves and muscles in your genital tract. This further increases your risk for pelvic floor disorders.
- Manage fluid intake. The specific recommendation for fluid intake relates to your specific symptoms. For urinary incontinence, not overdoing the fluids can translate to less trips to the bathroom. Also, restricting drinking after dinner can help reduce the number of trips to the bathroom at night. For women struggling with constipation, increasing fluids is often recommended.
- Be diet savvy. Women with urinary incontinence find it helpful to reduce bladder irritants, including caffeine found in coffee, tea, chocolate, cola and some energy drinks and artificial sweeteners. These foods may cause bladder muscle spasms, which can make you suddenly feel like they have to urinate.
- Eat plenty of fiber daily to avoid constipation. You may also need to use a stool softener if you continue to struggle with constipation to avoid excessive straining with bowel movements.
- Adjust physical activity. Regular physical activity helps keep bowel movements normal. Being active also helps with maintaining a normal body weight, decreasing your risk for urinary incontinence. However, high-intensity exercises (e.g., CrossFit) can put pressure on your pelvic floor and increase your risk for incontinence problems.
- If You Smoke, Quit Now. The risk for pelvic floor disorders doubles for women who smoke.
