Treatment Options for Pelvic Floor Disorders

By Dale Mitchell, M.D., Scripps Health

As any woman who has gone through childbirth can attest, carrying and delivering a baby can be a wonderful experience—but it isn’t easy on the body. Months of supporting a growing baby, followed by labor and delivery, can take a toll on the muscles, ligaments and connective tissues that make up the pelvic floor. Pregnancy and delivery may ultimately lead to descent or prolapse of the pelvic organs including the bladder, uterus and rectum. This can affect their ability to function normally, leading to problems such as pelvic pressure, pain, and incontinence. If the organs begin to descend within the pelvis, it may cause pain during physical activity or intercourse.

In the United States, pelvic floor disorders affect more than 28 million women. Typically the more pregnancies a woman has, the greater the impact on her pelvic floor, especially if labor and the pushing phase are longer. Pelvic floor disorders are much more common among Caucasian women than those of color. Often, there also is a family tendency toward the disorder.

One of the most common pelvic floor disorders is a prolapsed or dropped uterus. Symptoms may vary depending on how much the uterus has prolapsed; a woman with only a slight prolapse may have mild or no symptoms, while a woman whose uterus has descended into the lower vagina may feel considerable pelvic pressure and pain with intercourse.

Bladder symptoms can include pelvic pressure and incontinence ranging from very mild to so incapacitating that women may be hesitant to leave their homes for due to fear of urinary leakage. Most women fall somewhere between these two extremes. Rectal disorders can also cause pressure and difficulty passing stool.

Treatment for pelvic floor disorders depends on the individual patient and the severity of her symptoms.

Our first step would be to perform a thorough history and clinical exam to determine the function of the pelvic floor muscles, rule out other possible causes such as uterine fibroids or ovarian cysts, and confirm that prolapse is in fact causing the symptoms. Consideration is also given to pelvic ultrasound to ensure we aren’t missing something that may not have been evident on the clinical exam.

If urine leakage is a symptom, it is important that patients have cystometric studies done to determine exactly the nature of the problem and rule out other causative factors such as overactive bladder or neurologic problems. Some bladder conditions are better handled by a gynecologist, while others are better handled by an urologist. In some cases, these specialists may collaborate on surgical repair. Some gynecologists have additional training in urogynecology and may be more prepared to treat these conditions.

With most patients, we recommend starting with exercises they can do themselves to strengthen the pelvic floor muscles. Kegel exercises, for example, involve repeatedly contracting and relaxing the muscles that help support the pelvic floor.  If a patient is overweight this could be contributing to additional pressure on the pelvis—even moderate weight loss can have a significant impact on the amount of prolapse they might have and improvement in their symptoms.

Many patients may benefit from physical therapy as well. A physical therapist trained in pelvic floor rehabilitation may use various therapies, including targeted exercises and biofeedback, to restore the pelvic floor muscles to their proper function.

Should surgery be needed, patients should be aware of their options and ensure that the surgeon has extensive experience in the procedure being performed. In some cases, minimally invasive surgical techniques offer shorter recoveries and a quicker return to normal activity. Traditional approaches may use sutures to repair the damaged ligaments, while newer procedures may use mesh and synthetic agents to do the repairs. There is no clear evidence that one way is better; it is most important to choose the right surgeon for the procedure to achieve the best possible long-term result. As with any surgery, be sure to discuss the pros, cons and risks with your physician and surgeon.

If you experience symptoms of pelvic floor disorder, talk to your physician about which treatments are right for you.

 Dale Mitchell, M.D., is an OB/GYN with Scripps. For more information or to schedule and appointment, please call 1-800-SCRIPPS.