Women’s Institute A Woman’s Guide to Pelvic Health Conditions In women the pelvic floor is muscles, sexual abuse or pelvic fractures a group of muscles that form can result in a number of health problems a hammock-like support across the if not properly treated. opening of a woman’spelvis. These muscles, together with connective Women may experience: tissues, ligaments and nerves, keep all • Feeling a bulge and/or pressure of the pelvic organs, such as the bladder, of the uterus, bladder, vagina or rectum uterus, vagina and rectum, in place and • Loss of bladder control, leakage help these pelvic organs function. of urine, frequent urination • Sense of urgency to empty the bladder Sometimes the pelvic floor can be • The inability to hold a bowel movement compromised. Surgery, childbirth, • Pelvic pain scarring, chronic spasm of the pelvic 2 A Woman’s Guide to Pelvic Health Rectal prolapse: Rectal prolapse is differentiated from Pelvic organ rectocele in that with rectal prolapse the rectum actually protrudes out the anus rather than protruding into the vagina. prolapse (POP) Uterus or womb (uterine prolapse): When a group of ligaments (uterosacral and cardinal ligaments) at the top of the vagina Pelvic organ prolapse (POP) occurs weaken, causing the uterus to drop. when pelvic muscles and tissues become weakened, stretched or are injured. Some possible causes of injury include childbirth, chronically Stages of uterine prolapse: elevated intra-abdominal pressures (due to chronic cough, chronic constipation and obesity) or surgery. Stage 1 Stage 2 Stage 3 When the pelvic floor tissues which hold pelvic organs in place become weakened or stretched, it can cause the pelvic organs to bulge (or prolapse) into the vagina. In some cases, the pelvic organs may prolapse past the vaginal opening. The uterus descends The uterus descends The cervix, located at Pelvic organ prolapse is a common, treatable into the upper portion to the opening the opening of the uterus, medical condition which affects an estimated of the vagina. of the vagina. sags past the vaginal opening and may protrude one-third of all women – and half of all women outside the body. ages 55 and older. While pelvic organ prolapse can affect women of all ages, the risk of developing Stage 4: The uterus is completely out of the body. This condition also is called POP increases with age. Post-menopausal women complete prolapse (procidentia). are at the highest risk for developing POP. Pelvic organ prolapse may include one (or more) of Vaginal vault (apical vaginal prolapse): Vaginal vault prolapse the following conditions, including prolapse of the: may occure following a hysterectomy surgery (removal of the uterus). About 10 percent of women who undergo Bladder (cystocele): When the wall of the vagina overlying the a hysterectomy develop some degree of vaginal vault prolapse, bladder weakens and the bladder pushes against the vagina, where the top of the vagina drops toward the vaginal opening. producing a bulge. Pelvic pressure or protrusion are common Just like uterine prolapse, vaginal vault prolapse is staged syptoms. Urinary incontinence, inability to fully empty the according to the severity of the prolapse. bladder or recurrent bladder infections may also be a symptom. Rectocele: When the vaginal wall overlying the rectum weakens and the rectum pushes against the vagina, producing a bulge. Pelvic pressure, protrusion and difficulty with bowel movements may result. Summa Health 3 Visit summahealth.org/pelvic for more information and a list of our specialists and locations. Bladder Function • Medications, such as sedatives Fecal incontinence may be caused or muscle relaxants by a variety of factors, including: Women of all ages may have • Urinary tract infection • Diarrhea bladder control issues and • Constipation • Constipation may experience: • Muscle damage or weakness Persistent UI: of the anal sphincter muscles Bladder urgency and frequency: • Pregnancy • Nerve damage of the anal Frequent urination means needing • Childbirth injury sphincter muscles to urinate more often than usual. • Advanced age • Loss of elasticity (stretch) in the rectum Urgent urination is a sudden, strong • Menopause • Childbirth injury urge to urinate, along with discomfort • Hysterectomy • Hemorrhoids or rectal prolapse in your bladder. • Obstruction • Rectocele • Neurological disorders • Inactivity Painful bladder syndrome: Causes recurring discomfort or pain in the bladder and the surrounding pelvic region. Bowel Function Pelvic Pain Many people take normal Pelvic pain refers to pain Urinary incontinence (UI): bowel function for granted. in the lowest part of the torso, A loss of bladder control resulting in the However, this is a delicate in the area below the abdomen leakage of urine from the body. This system with the potential and between the hipbones, or includes stress incontinence, which for issues to arise, such as: pelvis. The pain may be sharp is urine loss while laughing, sneezing, or similar to cramps, and it can coughing, running or other physical Coccyx (tailbone) pain: be steady or come and go. Pelvic activity or urge incontinence, which A rare condition that causes persistent pain differs from abdominal pain, is leaking urine with a sense of urgency pain in the bottom of the spine. which occurs higher in the torso. while unable to reach a bathroom in time. Constipation: Conditions include: Urinary incontinence, both temporary Bowel movements that are infrequent • Pelvic muscle spasm and persistent, may be caused by: or hard to pass. • Endometriosis • Vulvodynia Temporary UI: Fecal incontinence: • Dyspareunia (pain with sexual • Alcohol Fecal incontinence is the involuntary intercourse) • Dietary habits, including consumption loss of stool or mucous from the rectum, • Pregnancy and post-partum related pain of carbonated drinks, artificial including the inability to hold a bowel • Vaginal atrophy (dryness and pain sweeteners, corn syrup, citrus fruits movement until reaching a toilet and associated with aging tissues) and others passing stool into one’s underwear without being aware of it happening. 4 A Woman’s Guide to Pelvic Health Treatments There are a wide range of both nonsurgical and surgical treatment options available to treat pelvic floor disorders. Nonsurgical Options Women of all ages may Pelvic Floor Physical Therapy beverages with caffeine, alcohol, have bladder control Patients learn techniques that help milk or carbonated beverages them regain pelvic floor control (fizzy) may help control urinary issues. Women may and function. urgency and incontinence. experience: Behavioral and/or Dietary Pessaries Medications Modifications A small silicone device, similar Several medications can improve • Bowel training helps patients to a diaphragm, is inserted into the bladder or bowel control by blocking develop a regular bowel movement vagina to relieve symptoms of uterine the signals from the nervous system pattern. Over time, the body or vaginal prolapse. which cause urgency. becomes accustomed to a regular bowel movement schedule, Biofeedback Pelvic Exercises thus reducing constipation Electronic monitoring of a normally Kegels consist of repeatedly and fecal incontinence. automatic bodily function in order to contracting and relaxing the muscles improve bladder and bowel control. of the pelvic floor. Strengthening • Changes to diet such as eating these muscles is beneficial for the right amount of fiber can help Botox Injections bladder and bowel control. with diarrhea and constipation. Botox can be injected into the Increasing fluid intake can help bladder muscle for treatment prevent constipation. Avoiding of urge incontinence. Summa Health 5 Pelvic Floor Physical Therapy Summa Health offers pelvic Bowel Function • Sacroiliac treatment and bracing floor physical therapy to help • Bowel disorders • Soft tissue and joint mobilization women regain pelvic floor • Coccyx (tailbone) pain • Therapeutic modalities such as control and function. • Constipation ultrasound or electrical stimulation • Fecal incontinence • Vaginal dilator training The importance of maintaining a healthy pelvic floor can easily be Pelvic Pain Educational: overlooked. Surgery, natural aging, • Pelvic muscle spasm • Patient and partner education childbirth, scarring, sexual abuse, • Endometriosis • Patient education on topics such as pelvic fractures or tailbone injuries • Dyspareunia (pain with pelvic floor anatomy, bowel and bladder can result in a number of pelvic sexual intercourse) retaining and pelvic muscle function floor problems if not properly • Pregnancy and post-partum related pain • Post-operative recovery education treated. These situations can • Pre-operative pelvic floor cause excessive muscle tightness Depending on the cause, muscle education or weakness that may lead to treatment may include both muscle spasm, pain, incontinence physical and educational or constipation. techniques. Summa has specially trained physical therapists who work Restoring muscle balance through Physical: one-on-one with patients in physical therapy leads to less pain, • Anal rectal balloon retraining a comfortable, private setting. resolved incontinence issues and • Biofeedback A physician’s referral is required. an improvement in your overall • Bladder and bowel retraining Most major insurance plans quality of life. Nonsurgical, pelvic • Customized exercise program are accepted, including floor physical therapy techniques to achieve muscle balance Medicare and Workers’ may be used to successfully