What You Need to Know About Pelvic Floor Dysfunction
The woman, a lawyer in her 30s, was desperate when she went to New York City-based physical therapist Isa Herrera. The patient, Nancy (U.S. News is not identifying the woman by her real or full name to protect her privacy) was suffering from terrible pelvic pain while sitting and when she had sexual intercourse -- and her wedding was a few months away.
Nancy's doctor had given her injections of the numbing agent lidocaine in her pelvis. Nancy had also applied lidocaine on the labia of her vagina. On the advice of her doctor, the woman was on eight medications, including OxyContin, the powerful opioid painkiller. But the prescription drug made her constipated and didn't relieve her pain, Herrera says.
Nancy is suffering from pelvic floor dysfunction, a group of conditions, also known as pelvic floor disorders, that affect the pelvic floor, says Dr. R. Mark Ellerkmann, director of urogynecology, Weinberg Center for Women's Health and Medicine at Mercy Medical Center in Baltimore. (A urogynecologist is an obstetrician-gynecologist who's completed specialized training in treating women with pelvic floor disorders.) About 25 percent of women age 20 or older suffer with a pelvic floor disorder or disorders, he says. The ratio of women who suffer from a pelvic floor disorder goes up with age. For example, about 40 percent of women between ages 40 and 50 have pelvic floor dysfunction, and the figure rises to more than 50 percent for women age 60 and above, says Dr. Felicia L. Lane, division director of the female pelvic medicine and reconstructive surgery fellowship program and vice chair, department of obstetrics and gynecology at UC Irvine Medical Center in Orange, California. Men suffer from pelvic floor dysfunction at a lower rate, experts say.
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The pelvis is comprised of three bones, which form a connection point for the legs and sacrum, or lower part of the spinal column. The pelvis holds organs such as the bladder, the bowel, the rectum, the uterus (in females) and the prostate (in males). The pelvic floor includes the muscles, ligaments and connective tissue in the lowest part of the pelvis, Ellerkmann says. "These structures, along with the bones of the pelvic floor help to support internal organs, including the bowel, bladder, uterus, vagina and rectum," he says. "The pelvic floor prevents these organs from falling down or out of your body through an opening called the genital hiatus. The pelvic floor also helps the organs function properly."
Pelvic floor dysfunction is characterized by an array of symptoms, and is often overlooked by physicians or misdiagnosed, says Dr. Betsy Greenleaf, a urogynecologist and doctor of osteopathic medicine at Hackensack Meridian Health in Rumson, New Jersey. For women, symptoms of pelvic floor dysfunction include pelvic pain; pain with sexual activity; pelvic area pain while sitting; vaginal pain; urinary incontinence; constipation and pain with bowel movements. In addition to those and fecal incontinence, another common disorder is pelvic organ prolapse, which occurs when the muscles and tissues supporting the pelvic organs become loose or weak, Lane says. When that happens, one or more of the organs in the pelvis drop or press into and out of the vagina. Patients may feel that their pelvic organs are dropping out of their body and often report a vaginal bulge or pressure in the vagina.
Risk Factors for Pelvic Floor Dysfunction
In addition to age, there are several risk factors that contribute to pelvic floor dysfunction for women, Ellerkmann says. These include childbirth, which can put excessive strain on the pelvic floor during delivery, and menopause, which can contribute to the weakening and thinning of tissues. Overweight or obese women and women who smoke are at higher risk of developing pelvic organ prolapse. Genetics may also play a role.
For men and women, poor posture and bicycling could be contributing factors to developing a pelvic floor disorder, Greenleaf says. Bad posture can lead to hip and lower back disorders, she notes. "When the body's not in proper alignment, you can have compensatory spasms and tightening of the muscles which can lead to pelvic floor dysfunction," she says. Spending a lot of time riding a bicycle sitting on certain kinds of bike seats can compress the pudendal nerve, which is located near your "sitting bones," Greenleaf says. This nerve controls all the muscles and nerves that are in the pelvic floor.
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Pelvic floor disorders are highly treatable. If you are suffering from a disorder, or suspect you are, experts recommend these strategies.
Get the right diagnosis. If you're suffering with chronic urinary or fecal incontinence and other approaches haven't been effective, see a urogynecologist, Greenleaf says. Typically there's no clinical exam for patients -- like a blood test or an X-ray -- that a physician can use to diagnose pelvic floor dysfunction. A diagnosis begins with a doctor recording the patient's symptoms and conducting a physical exam. Additional lab testing, such as a urinalysis, an ultrasound or an MRI may be required.
See a physical therapist trained to work with people with pelvic floor dysfunction. Once you're diagnosed with a pelvic floor dysfunction, it would be a good idea to see a physical therapist trained in treating the condition, Lane says. A trained therapist can show you exercises and techniques to help you get better. For instance, Herrera developed a treatment regimen that worked for Nancy. The physical therapist had Nancy use a dilator (a device that resembles a sex toy) to open and stretch her vagina. The physical therapist also showed Nancy how to use a crystal wand, an S-shaped tool that Nancy inserted into her vagina, so she could press it gently into the painful spot until the pain subsided by at least 50 percent. "You have to hold the device on the painful spot for up to 90 seconds or more," Herrera says. "Imagine if you had a big knot on your neck. You'd press down on it and hold it. It's a trigger-point release."
Try relaxation techniques. Herrera also put Nancy on a yoga program to stretch the muscles connected to the pelvic floor muscles, and helped her develop a mindfulness regimen, teaching her deep-breathing techniques. Finally, Herrera showed Nancy how to use a foam roller to work her quads, gluteal muscles, the sacrum (the bony area near your butt) and her inner thighs. "She got better," Hererra says. "She's starting to be able to have sex again. She can sit better, her pain is diminished, she's off all medications but one and she's very hopeful, which is the most important thing." Herrera provides information on relieving pelvic pain on her website, pelvicpainrelief.com.
Ask about treatment options for different kinds of incontinence. Kegel exercises, which strengthen the pelvic floor muscles, can help with incontinence related to activities such as coughing, sneezing or jumping. Patients should clear these exercises with their doctor or physical therapist, Greenleaf says. For patients with spasmodic pain and patients with pelvic floor muscles that are too tight, kegel exercises can worsen pain and symptoms, Herrera says.
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Consider an array of treatments for pelvic organ prolapse. If you are suffering from pelvic organ prolapse, keep in mind the condition is treatable and there are many options. Treatment options include physical therapy (such as pelvic floor exercises using biofeedback), pessaries (silicone devices placed intra-vaginally to keep the pelvic organs in place) and minimally invasive vaginal and laparoscopic surgery, including robotic surgery.
Ruben Castaneda is a Health & Wellness reporter at U.S. News. He previously covered the crime beat in Washington, D.C. and state and federal courts in suburban Maryland, and he's the author of the book "S Street Rising: Crack, Murder and Redemption in D.C." You can follow him on Twitter, connect with him at LinkedIn or email him at [email protected].