Q: What are pelvic floor disorders, and how are they treated?

A: The pelvic floor is a group of muscles that support organs such as the uterus, bladder and rectum. The pelvic floor muscles should contract or relax optimally during bowel movements, urination and sexual intercourse. Any imbalance in these muscles can cause dysfunction of the pelvic organs.

About one in four women in the U.S. experiences moderate to severe pelvic floor disorders during her lifetime. Yet many cases go undiagnosed, unreported or untreated until the symptoms turn severe. Knowing the signs, symptoms and treatments available for pelvic floor disorders can help you manage pain and improve your quality of life.

Symptoms of pelvic floor disorder vary from patient to patient. Some common symptoms include, but are not limited to:

  • Pelvic pain

  • Urinary leakage when coughing or sneezing

  • A feeling of heaviness in the pelvic area by the end of the day

  • Inability to hold urine when running to the bathroom

  • Inability to completely empty bladder

  • Constipation

  • Pelvic muscle tension or tightness

There are several different types of pelvic floor disorders. Dyspareunia is difficult or painful intercourse. Urinary incontinence can range in severity from a frequent need to urinate, to leakage when you jump, sneeze or laugh. Prolapse, sometimes seen after pregnancy, vaginal birth or surgery, is a serious condition in which the uterus or rectum descends through the vaginal opening because the surrounding muscles cannot provide enough support.

Lifestyle factors can play a role in many pelvic floor symptoms and dysfunctions. People who are overweight or obese have higher risks of developing pelvic floor disorders, as are those with chronic constipation or chronic coughing from smoking. Pregnancy and childbirth can cause a drop in the pelvic floor, which may lead to prolapse. For people undergoing cancer treatment, radiation can damage tissues and muscles in the pelvic region. Hysterectomy — surgery to remove a woman’s uterus— raises the risk of a pelvic floor disorder. But there are several treatment options available to patients.

Pelvic rehabilitation. A non-surgical approach that may include behavioral strategies, manual therapies, therapeutic exercise, education and functional re-training.

Behavior modifications. For urinary incontinence, patients can relieve symptoms by losing weight, cutting back on irritating foods and beverages, decreasing liquid intake at certain times of day, or retraining the bladder. For constipated patients, increasing fluid intake, maintaining a healthy diet, and exercising can help.

Relaxation techniques. By learning to better coordinate the contraction and relaxation of pelvic muscles with your breathing, you can help relieve the tension in your muscles.

Strengthening exercises. The most common are Kegel exercises, which involve squeezing and relaxing the pelvic floor muscles. However, it is important to do them with correct instructions and pair them with other core-strengthening exercises to produce the best results.

Surgery. In some cases, surgery can be a beneficial option, but the resulting scar tissue in the pelvic area can cause tightness and pelvic pain. Manual techniques – such as hands-on massage or stretching, dilation and pressure-point release can help relax and strengthen the pelvic floor.

A combination of methods should be used for optimal results. If you are at risk for pelvic floor disorders or suffer from symptoms of pelvic floor disorders, talk to your doctor about treatment options.

Ruchita Parikh is a physical therapist at Mercy Fitzgerald Hospital who treats patients in the pelvic floor physical therapy program.