Pelvic Floor Disorders: Frequently Asked Questions

Q: What is the pelvic floor?

A: Both men and women have a pelvic floor. In women, the pelvic floor is the muscles, ligaments, connective tissues and nerves that support the bladder, uterus, vagina and rectum and help these pelvic organs function. In men, the pelvic floor includes the muscles, tissues and nerves that support the bladder, rectum and other pelvic organs.

The pelvic floor muscles stretch like a muscular trampoline from the tailbone (coccyx) to the pubic bone (front to back) and from one sitting bone to the other sitting bone (side to side). These muscles are normally firm and thick.

Just like a trampoline, the pelvic floor is able to move down and up. The bowel, bladder and uterus (for women) lie on the pelvic floor muscle layer.

The pelvic floor muscle layer has hole for passages to pass through. There are two passages in men (the anus and urethra) and three passages in women (the anus, urethra, and vagina). The pelvic floor muscles normally wrap quite firmly around these holes to help keep the passages shut. There is also an extra circular muscle around the anus (the anal sphincter) and around the urethra (the urethral sphincter).

Although the pelvic floor is hidden from view, it can be consciously controlled and therefore trained, much like our arm, leg or abdominal muscles.

Q: What are pelvic floor disorders?

A: Pelvic floor disorders occur when the "trampoline" or "hammock" that supports the pelvic organs becomes weak or damaged. The three main types of pelvic floor disorders are:

  • Fecal incontinence, or lack of bowel control.
  • Pelvic organ prolapse, such as rectal prolapse, a condition in which the bowel can bulge through the anus.
  • Obstructive defecation, or the inability to pass stool through the digestive tract out the anus.

For many people, particularly women, the pelvic floor does not work as well as it should. Almost one-quarter of women face pelvic floor disorders. Pelvic floor disorders affect about 10% of women ages 20 to 39, 27% of women ages 40 to 59, 37% of women ages 60 to 79 and nearly 50% of women age 80 or older.

Q: What are the symptoms of pelvic floor disorders?

A: People with pelvic floor disorders may experience:

  • Constipation, straining or pain during bowel movements.
  • Pain or pressure in the rectum.
  • A heavy feeling in the pelvis or a bulge in the rectum.
  • Muscle spasms in the pelvis.

Q: Are pelvic floor disorders a normal part of aging?

A: While pelvic floor disorders become more common as women get older, they are not a normal or acceptable part of aging. These problems can have a significant impact on a person's quality of life. Fortunately, these disorders often can be reversed with treatment.

Q: What causes pelvic floor disorders?

A: Common causes of a weakened pelvic floor include childbirth, obesity, heavy lifting and the associated straining of chronic constipation.

  • Childbirth is one of the main causes of pelvic floor disorders. A woman's risk tends to increase the more times she has given birth.
  • Having pelvic surgery or radiation treatments also can cause these disorders. For example, these treatments can damage nerves and other tissues in the pelvic floor.
  • Women who are overweight or obese also have a greater risk for pelvic floor disorders.
  • Other factors that can increase the risk include repeated heavy lifting or even genes.

Pelvic floor exercises are designed to improve muscle tone and prevent the need for corrective surgery.

Q: Who treats pelvic floor disorders?

A: A variety of experts can treat these problems, and often, a combination of experts provides the best outcome for patients.

Q: When should I seek help for pelvic floor disorders?

A: Many people don't feel comfortable talking about personal topics like pelvic floor disorders and symptoms such as incontinence. But these are actually very common medical problems that can be treated successfully. Millions of people have the same issues, but many don't seek treatment and compromise their quality of life.

If you have a pelvic health issue, don't hesitate to learn more about your treatment options. If your doctor doesn't treat these issues regularly, seek out an expert. The Columbia University Center for Pelvic Floor Disorders includes colorectal surgeons, a specialized pelvic floor Nurse Practitioner and other caregivers who treat their patients with dignity and compassion.

Q: What is fecal incontinence?

A: Fecal incontinence, also called bowel or anal incontinence, is the inability to control your bowels. It is the second most common pelvic floor disorder. People with fecal incontinence may feel the urge to have a bowel movement but may not be able to hold it until they reach the toilet. Or they may leak stool from the rectum.

If you have fecal incontinence, you aren't alone. More than 5.5 million American men and women of all ages are affected, although it tends to be more common in older adults. Fecal incontinence is not normal at any age and can be treated successfully. This can lead to a significant improvement in a person's quality of life.

Q: How is fecal incontinence diagnosed?

A: Your physician will start by asking questions about your medical history. Then he or she will conduct a physical exam and order some tests.

Physicians have several tools to understand the cause of fecal incontinence. These include:

  • Anorectal manometry, which checks the anal sphincter muscles that keep stool inside. This test also checks how well the rectum works.
  • Defecography, which shows how much stool the rectum can hold, how well it can hold it and how well it can empty it.
  • Magnetic resonance imaging (MRI), which is sometimes used to examine the sphincter.
  • Other tests may be ordered to look inside the rectum or colon for signs of disease or damage that could cause fecal incontinence.

Q: How is fecal incontinence treated?

A: Treatment can improve or restore bowel control for most people with fecal incontinence. Often, a treatment plan includes many approaches, depending on the cause of the problem. These may include:

  • Diet changes, such as eating smaller meals and avoiding caffeine, which relaxes the sphincter muscles and can make incontinence worse.
  • Medication, which may be appropriate for some people to help slow down the bowel.
  • Biofeedback, which helps people learn to strengthen their pelvic muscles so they can control their bowel movements.
  • Surgery, which may help people whose fecal incontinence is caused by damage to the pelvic floor or anal sphincter. Surgeons can repair the anal sphincter using advanced techniques that restore bowel function. Surgeons also can improve bowel control by injecting bulking agents into the anus or stimulating the nerves in the lower pelvis.

Q: What is pelvic organ prolapse?

A: Pelvic prolapse is the third most common pelvic floor disorder. A prolapse occurs when the pelvic muscles and other supporting tissues becomes weak, which causes the organs in the pelvis to fall out of place.

Rectal prolapse occurs when part or all of the wall of the rectum slides out of place, sometimes sticking out of the anus.

Rectocele occurs when the lower wall of the vagina loses support and the rectum bulges upward into the vagina.

While these conditions are usually not associated with serious health risks, they can cause symptoms such as:

  • A heavy feeling or discomfort from something that feels like it is "falling out" of the vagina.
  • A pulling or "bulge" in the lower abdomen or pelvis.
  • Frequent urinary infections, caused by a reduced ability to release urine from the urethra.

Q: How do you treat prolapse?

A: There are several nonsurgical treatment options for pelvic organ prolapse. These include:

  • Kegel exercises and other pelvic floor exercises that can help strengthen the muscles that support the pelvic organs.
  • To repair rectal and multi-organ pelvic organ prolapse, surgery may be the best option for some women. Often, these procedures can be done using minimally invasive techniques. At Columbia University Center for Pelvic Floor Disorders, surgeons regularly use robotic technology that allows them to see inside the pelvis and perform very delicate procedures. Minimally invasive procedures reduce scarring and complications, and speed recovery time.

Q: What is pelvic floor dysfunction, and what are the symptoms?

A: Pelvic floor dysfunction is when you are unable to control the muscles that help you have a complete bowel movement. It can affect women and men. The symptoms include:

  • Constipation, straining and pain with bowel movements.
  • Unexplained pain in the lower back, pelvis, genitals or rectum.
  • Pelvic muscle spasms.
  • A frequent need to urinate.
  • Painful intercourse for women.

Experts do not know for sure what causes pelvic floor dysfunction. However, people who have it tend to contract their pelvic floor muscles rather than relax the muscles, which allows the bowel to empty.

Q: How is pelvic floor dysfunction treated?

A: Treatment can have a dramatic effect on pelvic floor dysfunction. For most people, this usually involves:

  • Behavior changes, such as avoiding pushing or straining when urinating and having a bowel movement. This also might include learning how to relax the muscles in the pelvic floor area. For example, warm baths and yoga can help relax these muscles.
  • Medicines, such as low doses of muscle relaxants like diazepam.
  • Physical therapy and biofeedback, which can help you learn how to relax and coordinate the movement of your pelvic floor muscles.

Common Myths

There are many myths about pelvic floor muscle exercises.

Pelvic floor muscle exercises are easy to do

A: Pelvic floor muscle exercises are not always easy to do. The pelvic floor muscles are complicated muscles which are hard to isolate.

You learn pelvic floor muscle exercises from a pamphlet

A: Pelvic floor muscle exercises can be learned from a pamphlet by some people, but research shows that up to 50% of women trying to do pelvic floor muscle exercises from a pamphlet get the technique wrong. For both men and women, practicing the wrong technique will not help and could even make the problem worse.

Pelvic floor muscle exercises don't work

A: Research shows that pelvic floor muscle exercises can help fecal incontinence when the cause of the problem is a weak pelvic floor. However, they will not work if there are other causes of urine or bowel motion leakage (for example, infection, inflammation or underlying bowel disease).

There is ample evidence to show that pelvic floor muscle exercises are effective when the exercises are done correctly and when taught and supervised by a physiotherapist who specialises in continence and women's health or a Continence Nurse Advisor. If your 'do-it-yourself' pelvic floor muscle exercise program did not work, then chances are they were not done the right way. Get help from a health professional to confirm that your technique is correct and have an individualised training program specifically developed for your problem and the condition of your pelvic floor muscles.

I'm too old for pelvic floor muscle exercises

A: Some people say "Pelvic floor muscle exercises won't work for me, I'm too old". This is not true. Age is no barrier to the benefits of pelvic floor muscle exercises. There is evidence to suggest that older people are just as likely to benefit from pelvic floor muscle exercises for incontinence as younger people.

I've had a baby, the damage is done

A: Just because you've had a baby doesn't mean pelvic floor muscle exercises won't help. Postnatal pelvic floor muscle exercises have been shown to assist in the recovery of pelvic floor muscle function and to reduce or cure the likelihood of urinary incontinence in women who have had instrumental births or big babies.

I don't need to do pelvic floor muscle exercises

A: Everyone (including women who haven't had a baby, and men) can benefit from doing pelvic floor muscle exercises. For women, pelvic floor muscle training is important to control incontinence which may start during pregnancy. Pelvic floor muscle exercises done during pregnancy will help the recovery of pelvic floor muscle function and bladder control after the birth of the child.

I can't sit on the floor therefore I can't do them

A: Some people think that pelvic floor muscle exercises are done on the floor. In reality however, these exercises can be done in any position. The word 'floor' merely refers to their position at the bottom (or floor) of the pelvis. In fact, they should especially be done standing up as control of urine leakage is usually most necessary when upright.

Men don't have a pelvic floor

A: Men do have pelvic floor muscles.