Symptoms of pelvic floor disorders, and when it’s time to seek treatment

While it can be uncomfortable to talk about, pelvic floor dysfunction is more common than you might think. In fact, half of women will experience a pelvic floor disorder during their lifetime, due to factors such as childbirth, chronic strain on the pelvic floor, increasing age, or a genetic predisposition.

It can affect anyone, though women who have had multiple vaginal deliveries or are post-menopausal are at higher risk.

As a urogynecologist at The Ohio State University Wexner Medical Center, I specialize in treating women with these conditions. My goal is to help improve their quality of life by reducing or eliminating symptoms through a variety of non-surgical and surgical treatment options.

If you experience the following, you may be feeling the first signs of pelvic floor dysfunction:

• vaginal pressure or fullness
• leaking urine when you cough, sneeze or exercise
• trouble controlling urine, gas or stool

What is pelvic floor dysfunction?

To understand pelvic floor dysfunction, it’s important to know what the pelvic floor is and how the muscles within it work. The pelvic floor consists of a group of muscles that attach to the bony pelvis forming a bowl. These muscles support the organs that sit in the pelvis including the bladder, urethra, uterus, cervix, vagina and rectum. When these supports become weak, are damaged during childbirth or are too tight, pelvic floor dysfunction can occur.

Common symptoms of pelvic floor dysfunction

• Urgency or frequency to urinate with or without urgency incontinence, also called overactive bladder
• Inability to fully empty your bladder
• Leaking urine when sneezing, coughing or exercising (also called stress urinary incontinence)
• Vaginal pressure, fullness or a bulge sensation (pelvic organ prolapse)
• Difficulty controlling stool or gas
• Difficulty defecating
• Discomfort with intercourse

How appointments for pelvic floor dysfunction are different from typical gynecological visits

Often, a patient will come to our Urogynecology and Reconstructive Pelvic Surgery Clinic because they’re having trouble controlling urine, gas or stool, feel or see a vaginal bulge, or are experiencing pain during intercourse. They may have been referred to our clinic by their Ob/Gyn or primary care doctor, but you can also make an appointment directly without another doctor’s referral.

In the first appointment, a urogynecologist like me will ask a variety of questions about your health history, including medical, surgical, obstetric and family histories, as well as inquire about your pelvic floor symptoms, such as bladder and bowel function, your home bowel regimen, prolapse symptoms, ability to have intercourse, and any associated pain.

Physical exams to diagnose pelvic floor dysfunction, too, are a little different from a typical pelvic exam.

During a physical exam, the provider will evaluate your anatomy while in stirrups and sometimes upon standing. They’ll ask you to cough and bear down a series of times to evaluate the pelvic support and whether prolapse or incontinence is present. A speculum will be used, similar to typical gynecologic examinations, and the provider will evaluate both pelvic floor muscle strength and pelvic anatomy with a one- to two-finger internal exam. Sometimes a one-finger rectal exam is performed as well, depending upon the patient’s concerns.

Patients are encouraged to come to the initial evaluation with a full bladder. Often, the urine will be tested to rule out infection or blood, and the ability of the bladder to empty will be evaluated by either a small catheter or a bladder scanner.

Typically, no imaging tests or blood work is required for the diagnosis of pelvic floor disorders.

How Ohio State treats pelvic floor conditions

At Ohio State, we practice evidence-based medicine, which means we stay up to date on the latest research in pelvic floor dysfunction. This enables our team to treat a range of urogynecologic issues. Depending on the condition, treatment may include:

• diet and lifestyle modifications
• medication or other non-surgical options
• pelvic floor physical therapy, which focuses on the muscles and connective tissues in the pelvic area. The goal is to improve bladder and bowel control, strengthen the pelvic floor and reduce pain.
• surgery

For patients suffering from conditions such as pelvic organ prolapse, stress urinary incontinence, fecal incontinence or refractory overactive bladder, surgery may be appropriate. We use minimally invasive approaches, including vaginal prolapse repairs, conventional laparoscopy or robotic surgery using the da Vinci Surgical System. These procedures can result in a shorter hospital stay, easier recovery and minimal scarring.

We always consider nonsurgical treatments first, but work with each patient to provide the most effective, lasting treatment possible that also meets their personal goals.

When to seek care for pelvic floor issues

If you think you may have symptoms of a pelvic floor disorder, talk to your Ob/Gyn or primary care provider, who can help get you the care you need. This may include a referral to a urogynecologist like me.

If you’re pregnant or postpartum and have bothersome pelvic floor symptoms, you can also talk to your obstetric provider.