By Bruce Kahn, M.D., Scripps Health
Following the birth of a child, it’s common to hear women talk about trying to lose the “baby weight” and get their bodies back into shape. What many women don’t talk about are problems that can develop as a result of giving birth, such as incontinence, bladder issues and pelvic pain. These and other problems are referred to as pelvic floor disorders, or PFDs, and may affect more than 28 million women in the United States.
The pelvic floor describes the muscles, ligaments and connective tissues that provide support for internal organs including the bladder, bowel, and reproductive organs. Not only does the pelvic floor hold these organs in place, it helps them to function properly. The brains sends signals to the pelvic floor muscles via nerves; if the nerves are injured, the pelvic floor muscles and tissues can be weakened. As a result, the organs they support may be impaired as well.
In addition to childbirth, the pelvic floor nerves may be damaged by trauma, surgery, stroke, diabetes, aging or other factors. Whatever the cause, PFDs include a number of unpleasant, embarrassing or even painful conditions that can interfere with everyday activities, cause physical and emotional distress.
The most common is urinary incontinence, or the involuntary loss of urine, which affects nearly 16 percent of U.S. women between the ages of 20 and 80. Fecal incontinence, which is the involuntary loss of stool, is another type of PFD. Often, patients with these conditions are too embarrassed to talk about it and may avoid social situations. Many are even hesitant to ask their physicians for help—which is unfortunate, because effective physical, medical and surgical treatments are available.
Interstitial cystitis is characterized by symptoms such as a frequent need to urinate (often with little result), stopping and starting of the urine stream, and pelvic pain. It is thought to be caused by a defect in the lining of the bladder wall which allows chemicals to leak out and results in the chronic stimulation of pelvic nerves. Most patients with interstitial cystitis can be treated effectively with non-surgical therapy.
Another PFD condition, pelvic organ prolapse, happens when the muscles and tissues of the pelvic floor become unable to support the pelvic organs properly. If the organs begin to protrude out of the pelvis, the result can be difficulty and pain during physical activity or sexual intercourse. Modern minimally invasive surgical techniques for the treatment of pelvic organ prolapse provide short recoveries and a quick return to normal activity.
Even without organ prolapse, PFDs can cause general pain and cramping in the lower back and pelvic region. PFDs are usually diagnosed during a physical examination. In addition to checking the function of the pelvic floor muscles, the physician may evaluate how effectively the patient can relax and contract the muscles voluntarily. He or she may also check for muscle spasms, weaknesses, or misalignment of the pelvic bones. Depending on the diagnosis, several treatments may be recommended.
Physical therapy has proven very effective in treating PFDs. A physical therapist specially trained in pelvic floor rehabilitation can treat problems using a variety of devices and therapies, including exercises patients can do on their own to relieve symptoms and pain, and restore the pelvic floor muscles to their proper function.
Biofeedback is another common therapy for PFDs. By following prompts displayed on a computer screen, patients can learn to relax or tighten their pelvic floor muscles as needed to relieve symptoms. Most patients see results after six to eight weeks of therapy.
In addition, therapies can help to reduce pain and retrain muscles. Electrical stimulation therapy can help to desensitize nerves and relax or contract pelvic floor muscles. Ultrasound uses high-frequency sound waves to create warming sensations that can calm muscle spasms and increase blood flow to the area.
These and other advances in pelvic medicine offer new and promising options for patients with PFDs. If you experience PFD symptoms, talk to your physician about which treatments are right for you.
Bruce Kahn, M.D., is an OB/GYN with Scripps Health. Join Dr. Kahn and a team of Scripps specialists to learn about treatments available for pelvic floor disorders at a free presentation on Monday, November 11 at 6 p.m. at the Schaetzel Center on the Scripps Memorial Hospital La Jolla campus. Please call 1-800-SCRIPPS (727-4777) to register or for more information.