HEALTH MATTERS: Let’s Talk About Pelvic Floor Disorders


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By Alexander Berger, MD

Millions of women across the United States suffer with a pelvic floor disorder, but many are reluctant to talk about it, often keeping it a secret for months or even years.

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However, some secrets are meant to be shared.

And when it comes to pelvic floor disorders, talking about them with your doctor is the first step toward regaining control of your pelvic health.

What is the pelvic floor?

The pelvic floor is a group of muscles, ligaments and connective tissue in the lower pelvis that support your pelvic organs, including your bladder, urethra and rectum. In women, the pelvic organs also include the uterus, cervix and vagina.

The pelvic floor serves as a sling or hammock that keeps these organs in place so they can function properly.

What are pelvic floor disorders?

Pelvic floor disorders are a group of conditions that affect the pelvic floor. Two of the most common types are pelvic organ prolapse and urinary incontinence.

Pelvic organ prolapse is characterized as the bulging or herniation of one or more of the pelvic organs into or out of the vagina. This “prolapse” happens in women when the pelvic floor becomes weak and can no longer hold the organs in place.

Urinary incontinence — or the leakage of urine — can be categorized into different types, including:

• Stress incontinence, which occurs when the pelvic muscles can no longer correctly control the urethra, causing the bladder to leak with exertion, such as during exercise, coughing, sneezing or laughing.

• Urgency incontinence. The urgent need to pass urine and the inability to get to the restroom in time occurs when incorrect signals from the bladder to your nerves occur, causing a sudden bladder contraction that cannot be controlled.

• Frequency, which is urination more than seven times a day.

• Nocturia or waking up in the middle of the night to urinate.

• Mixed urinary incontinence, which is a combination of stress and urge incontinence.

Who is at risk?

While men can experience problems with their pelvic floor, including incontinence, women are at greater risk.

Consider that according to the National Institutes of Health (NIH), roughly one out of every four (25%) of U.S. women aged 20 and older is affected by a pelvic floor disorder.

Moreover, as the NIH reports, the frequency of pelvic floor disorders increases with age, affecting more than 40% of women from 60 to 79 years of age and about 50% of women 80 and older.

In addition to age, other common risk factors for pelvic floor disorders include:

• Pregnancy and childbirth, which put extra strain on the pelvic floor.

• Menopause. The pelvic floor muscles often weaken during menopause.

• Genetics. Some women are born with weaker pelvic floor muscles.

• Obesity. Overweight or obese women have increased pressure on the bladder.

• Smoking. Women who smoke have an increased risk of pelvic organ prolapse and urinary incontinence.

• Constipation. Straining during a bowel movement can put pressure on the pelvic floor, increasing the risk for prolapse.

• Repetitive strenuous activity. Heavy lifting or over-exertion can increase the risk of developing a pelvic floor disorder.

• Health conditions such as diabetes, Parkinson’s disease and stroke, which can weaken the nervous system or pelvic floor muscles.

What are the complications? 

Pelvic floor disorders may not be life threatening, but they can be life altering, impacting your relationships, work life and social life. Constant trips to the bathroom and sudden leakage can make even routine schedules difficult. People struggling with bladder control can be reluctant to leave the house, go on long trips or be away from a bathroom for too long. These conditions can cause people to turn down social invitations, lose sleep and even develop anxiety and depression.

What treatments are available?

There are many types of treatment for pelvic floor disorders, ranging from conservative measures, such as pelvic floor exercises, to surgical treatment depending on the specific condition and its severity.

Certain medications may be prescribed to help decrease urinary urgency and frequency and to increase the amount of “warning time” you have to get to the bathroom and avoid a leak.

If medication does not work or is not a good fit for the patient, Botox or a synthetic bulking material may be administered as injections to help treat incontinence.

There are also minimally invasive surgical options including an implantable support for the urethra called a pubovaginal sling. Another option is pelvic reconstructive surgery for patients who have prolapse.

At Penn Medicine Princeton Health, urogynecologists can perform minimally invasive pelvic reconstructive surgery using robotic-assisted or vaginal techniques that typically result in less pain and a shorter recovery period than traditional open surgery.

In addition, the Center for Pelvic Wellness at Princeton Medical Center offers specialized physical therapy for pelvic floor disorders.

How can you reduce your risk?

You can reduce your risk for developing a pelvic floor disorder by:

  • Maintaining a healthy weight.
  • Eating a diet high in fiber to avoid constipation and straining.
  • Not smoking.
  • Avoiding bladder irritants like caffeine, alcohol and high acid foods (including some fruit such as tomatoes, cranberries and oranges, as well as artificial sweeteners and processed foods).

Most importantly, if you are suffering with a pelvic floor disorder or are concerned about your pelvic health, talk to you doctor. Don’t keep your concerns a secret. In most cases, once diagnosed, pelvic floor disorders can be easily treated so you can enjoy your normal activities again.

To find a physician affiliated with Penn Medicine Princeton Health or for more information about the Center for Pelvic Wellness at Penn Medicine Princeton Medical Center call 888-742-7496 or visit

Alexander Berger, MD, MPH, is a board certified gynecologist specializing in urogynecology. He is a member of the Medical Staff at Penn Medicine Princeton Health.

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