Both men and women have a pelvic floor, however, pelvic floor issues are far more common in women because of the anatomy of their pelvic area.
The pelvic floor in women is made up of a system of muscles and ligaments that support and protect the vagina, uterus, bladder and rectum, somewhat like a sling or hammock. However, over time the pelvic floor can become weak and lose its integrity, causing issues with these organs.
Pelvic floor issues are common for women, particularly those that have had children. Here we take a look at the different types and what you can do to help.
This is fairly common, affecting roughly 25% of women in varying degrees. Let’s take a look at some of the most common disorders associated with pelvic floor issues, why they occur and what treatment may be involved.
Common Pelvic Floor Issues
Urinary incontinence – This is the most common pelvic floor issue. Urinary incontinence is the accidental or involuntary loss of urine. It may be caused by damage to the pelvic floor muscles. Urine loss occurs when there is increased intra-abdominal pressure, such as when you sneeze, cough or lift something heavy.
Faecal incontinence – This is the accidental loss of faeces, and similar to urinary incontinence, it may be caused by damage or weakening of the pelvic floor muscles or anal sphincter. It may also be triggered by increased intra-abdominal pressure.
Bladder prolapse – This is when damage or weakness in the pelvic floor muscles supporting the bladder causes it to fall and protrude into the vagina. This will cause urinary incontinence to a degree, depending on the severity of the prolapse. A prolapsed bladder is known as a cystocele.
Vaginal prolapse – This is when issues with the supportive tissue in the upper vagina cause it to fall into the lower part, causing the vagina to essentially turn inside out. A total prolapse is when the vagina actually protrudes outside the body. This is quite severe and can cause a range of issues
Rectal prolapse – This is when the supportive muscles that hold the rectum in place weaken, causing it to protrude into the back wall of the vagina. This can cause issues with bowel movements.
Uterine prolapse – This is when the connective tissues and supportive muscles that surround the uterus weakness or are damaged, causing the uterus to drop down into the vagina.
Why Do They Occur?
Pelvic floor issues vary in severity. Mild cases are quite common. They tend to affect women as they get older. There are a few factors that can contribute to the weakening of the pelvic floor:
• Childbirth – Having a child places great strain on the pelvic region, and is most the common reason the pelvic muscles weaken.
• Ageing – As you get older, general wear and tear can cause the pelvic floor to become weak.
• Injury – A traumatic injury or injury from surgery (such as a hysterectomy) may cause issues with the pelvic floor.
• Obesity – The pressure that being overweight places on the pelvic floor can affect the strength and integrity of muscles and ligaments.
Treating Pelvic Floor Disorders
Treatment of pelvic floor disorders will depend on the type and severity of the condition. There are very effective management techniques that can be used to treat mild cases, and in more severe cases, surgery may be required.
Pelvic floor exercises are often used to manage mild conditions, such as a urinary incontinence or a mild prolapse. Kegel exercises are a great way to strengthen the supportive muscles that surround the vagina, rectum, uterus and bladder.
Kegel exercises are very simple and can be done anywhere at any time. It simply involves tightening the pelvic floor muscles (as though you were trying to hold in an urge to go to the bathroom) holding tight for a few seconds, relaxing for a few seconds, and repeating (10-15 repetitions is recommended). It is important to do this a couple of times a day.
Using a Pessary
In the case of a mild or moderate prolapse, a pessary may be required to help manage symptoms. A pessary is a small device that is placed into the vagina to help support the pelvic floor muscles. They come in a range of shapes and sizes, so it is always possible to find a comfortable solution. They can be worn constantly or they can be removed and replaced as you please. Talk to your doctor about the different options available.
In the case of a severe prolapse, or if symptoms persist (or get worse) after using a pessary, surgery will be required. This will involve locating the weakened supportive structures and repairing them. In some cases, removal of an organ may be required.
For example, for a prolapsed uterus, this may be the most effective treatment (if the patient doesn’t wish to have children in the future). Surgery can either be done vaginally or abdominally. For the vast majority of women, a normal sized uterus does not need to be removed to fix prolapse. Hysterectomy can predispose to prolapse and has no role in its correction.
If you have any questions about pelvic floor issues or any other gynaecological conditions, please don’t hesitate to get in touch. Dr Bevan Brown is one of the most trusted gynaecologists and obstetricians in Sydney.