What women need to know about pelvic floor disorders

Women often find it embarrassing to talk about pelvic floor disorders—a broad category of issues also called pelvic floor dysfunction. These issues often stem from weakening or injury of the muscles and connective tissues of the pelvis. But these conditions are common, and women should feel comfortable discussing them with their doctor.

A 2014 study found that 25 percent of U.S. women have at least one pelvic floor disorder. That’s only the number of women who have reported it; the actual number is likely quite a bit higher. By age 80, half of U.S. women will experience some type of pelvic floor disorder.

25% of U.S. women have at least 1 #pelvicfloor disorder. via @MedStarWHC

Women often believe that the symptoms of these disorders are just a part of getting older or a side effect of having children, and there’s nothing that can be done. But that’s not true. While aging and giving birth do increase the risk, there are techniques and treatments available to give women relief.

Types and causes of pelvic floor disorders

There are several forms of pelvic floor disorders, such as:

  • Pelvic organ prolapse: Downward movement or dropping of the pelvic organs, including the uterus, vagina, bladder and rectum.
  • Stress urinary incontinence: Leaks of urine that can happen when a woman coughs, exercises or sneezes.
  • Urgency incontinence: Problems holding back the urge to urinate.
  • Fecal incontinence: Leakage from the bowel, ranging from gas to stool.

Many factors can contribute to a woman developing a pelvic floor disorder, including:

  • Pregnancy and delivery
  • Injuries during a hysterectomy or some other surgical procedure in the pelvic region
  • Obesity
  • Strain in the abdomen, or belly, such as lifting heavy objects

Pelvic floor disorder treatments

Women may be able to improve mild symptoms through changes in their behavior. Decreasing the amount of fluid you drink per day means the bladder isn’t as full, which can make it easier to hold back urine. Scheduled bathroom breaks or Kegel exercises to strengthen the muscles of the pelvic floor also can help.

Another non-surgical option for urinary leakage and pelvic floor relaxation is a “pessary,” which is a device similar to a diaphragm used for birth control. The device is inserted into the vagina and provides support for the pelvic organs. Some women use pessaries all the time, while some only use them during the daytime. They need to be cleaned regularly to prevent infections.

Surgery for pelvic floor disorders

If behavioral changes or a pessary don’t work, or if a woman doesn’t want to try a pessary, minimally invasive surgery is an option to treat many pelvic floor disorders. The more surgeries a doctor or hospital does to treat these conditions, the better outcomes are for patients. Our pelvic floor disorder program is the largest such program in the country.

Surgery to correct pelvic floor disorders used to be very invasive, but nearly all of these procedures are minimally invasive today. We can perform these surgeries either through the vagina or laparoscopically, which involves tiny incisions in the abdomen. These surgeries are often performed as an outpatient, without the need for a hospital stay.

Minimally invasive surgical procedures have several advantages over traditional surgery, such as:

  • Fewer complications
  • Less pain and discomfort
  • Shorter hospital stay, if a stay is needed at all
  • Quicker return to work and normal activities

Some women may have been told in the past that they’re not good candidates for minimally invasive surgery to treat these issues. There are very few reasons nowadays for women to need open surgery for pelvic floor disorders. This might be more of a reflection of the surgeon’s expertise than anything else.

Our program is well known for our expertise in this area of surgery. When I came to MedStar Washington Hospital Center in 2005, I was the first surgeon in Washington to perform a minimally invasive sacralcolpopexy, which is a procedure to lift the vagina. And we were one of the first centers in the world to perform robot-assisted pelvic floor surgery. In fact, we are a recognized Center or Excellence in the treatment of pelvic floor disorders, and are one of the largest programs in the country training doctors in female pelvic medicine and reconstructive surgery.

Bathroom trouble and pelvic relaxation aren’t just normal symptoms of getting older. These are common conditions that we have the tools and expertise to treat. I urge all women who are suffering with these symptoms to ask their doctors for help. We can help you get your life back.

Request an appointment with one of our urogynecologists to explore your options for treating pelvic floor disorders.

Celebrated Physician: Lee Ann Richter, MD

Lee Ann Richter, MD, is one of the few urologists in the country with obstetrics and gynecology-based training in Female Pelvic Medicine and Reconstructive Surgery. That combination of specialized training, which she completed at MedStar Georgetown University Hospital and MedStar Washington Hospital Center’s National Center for Advanced Pelvic Surgery, make Dr. Richter uniquely qualified to treat all female urology and urogynecologic issues, including pelvic organ prolapse, urinary and fecal incontinence, hematuria, kidney stones and other pelvic floor disorders.

“One of every three women will have pelvic floor disorder in their lifetime,” Dr. Richter says. “Fortunately, there are many treatment options to help them. As more women undergo these treatments to improve their quality of life, they’re sharing their experience with others, and encouraging them to get help too.”

Starting in Public Health

Dr. Richter has a longstanding interest in bringing quality medical care to those most in need. Before entering the University of Connecticut School of Medicine, she spent a year teaching public health and nutrition in a rural village in Ecuador.

“I originally thought I’d go into public health, either on a policy level, or working with individuals,” she explains. “The exposure to an entirely different culture and set of needs solidified my desire to become a physician.”

And it was through her husband, who works for the non-profit Save the Children, that Dr. Richter learned about the prevalence of urinary fistula in the developing world. “That was surgical expertise I wanted to have,” she says, “so I focused my fellowship in order to perform those procedures here and wherever else they were needed.”

Life Outside MedStar Washington Hospital Center

Now, along with her busy schedule at the Hospital Center and teaching at the Georgetown University School of Medicine, Dr. Richter travels to Rwanda each year to perform fistula surgeries through the International Organization for Women and Development.

“It’s exciting to be an advocate for women with urogynecological issues, regardless of who my patients are, or where they live,” she says.

Given her world view and hectic schedules, it’s hardly surprising that Dr. Richter is an avid runner, and has completed several marathons. She also loves spending time outdoors with her husband and two children, aged 6 and 3.

All About Your Pelvic Health: Pelvic Floor Disorder

Pelvic Floor Disorder: A Common Problem

It’s a fact that one in three women over the age of 45 suffers from a pelvic floor disorder (PFD). The most common pelvic floor disorders are urinary incontinence, fecal incontinence, and pelvic organ prolapse. The condition can significantly impact a woman’s quality of life. There are easy ways to treat the disorder, but women are oftentimes unwilling to discuss the symptoms they are experienceing because they are too embarrassed.

The older a woman gets, the greater the chance of developing a PFD. In general, pelvic floor disorders are caused by a laxity in the pelvic floor ligaments and connective tissue in the lowest part of the pelvis and weakness of the pelvic floor muscles. The pelvic floor supports organs, including the bowel, bladder, uterus, vagina, and rectum. But when the muscles are weakened or the connective tissue tears, that's when problems can begin. Why does this happen? It’s a natural part of the aging process, hormonal changes after menopause plays a role as well pregnancy, childbirth and obesity.

Identifying Symptoms

Pelvic organ prolapse is the most common disorder, and it happens when the pelvic floor muscles and ligaments become too weak to hold organs in the correct position in the pelvis. As the condition progresses, women can feel bulging tissue protruding through the opening of the vagina. When this happens, women may have problems controlling their bladder and bowels. Also, some have pain in the lower back, pelvis or bladder.  All women may not experience the same symptoms, but it’s important to seek help if any pain or discomfort persists.

While an OB/GYN may be aware of the symptoms, women should seek out a urogynecologist, a physician with special training and significant expertise in female pelvic medicine and reconstructive surgery, if symptoms persist.

They used to just say it was a ‘female problem,’” said Jeanne McMahon, 58, who lived with bladder and uterine prolapse for more than 20 years before having surgery in the fall of 2015. With the help of nationally-recognized and highly skilled urogynecologist at MedStar Washington Hospital Center, Dr. Cheryl Iglesia, Jeanne is now playing tennis and hiking again, and is grateful she has her life back.   

 Dr. Iglesia, and her patient Jeanne, discuss PFDs in this Washington Post article.


Have any questions?

We are here to help! Contact us for more information about pelvic floor disorders or to schedule an appointment. Call us at 202-877-3627.

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