Did you realize that approximately one third of women in the United States will have a pelvic health problem by age 60? These problems may include abnormally heavy menstruation, stress incontinence, pelvic organ prolapse which can affect the bladder, vagina, uterus, small intestine and rectum, or uterine fibroids which are benign tumors consisting of connective tissue and muscle in The uterus.

Often women affected by pelvic health problems will not report these conditions to their health care provider and will not seek treatment, sometimes because they are embarrassed. Pelvic health problems can worsen with age, and as baby boomers begin to retire, they are likely to become more common. The reason why age can affect pelvic floor problems is that after menopause the muscles and ligaments begin to weaken and the loss of estrogen affects the strength of the pelvic floor muscles. Women who have had a hysterectomy may also notice that the surrounding connective tissues and organs are weakened because they have lost support from the uterus.

One of the most frequent problems for which women seek help is stress incontinence. It is a problem often associated with pregnancy and childbirth and is where the pelvic floor muscles become too weak and loose. Other issues that can lead to pelvic floor problems include straining too hard on the toilet, and especially if you have constipation or a chronic cough. Some people will have a chronic cough due to bronchitis or asthma. If you participate in a lot of high-impact exercise such as netball, basketball, or enjoy running, then you increase your risk of urine leakage, and it’s a problem that can affect even elite athletes.

Being overweight increases stress on the pelvic floor and can increase the risk of stress incontinence. Women who need to lift weights, for example, if they are in caring professions like nursing or have a courier job where heavy packages need to be lifted, are more at risk, or if they train too hard at the gym.

Problems with the pelvic floor can develop when the connective tissues in the pelvic area become overstretched and when the pelvic organs become displaced. Sometimes pelvic floor problems can be successfully treated by strengthening the pelvic muscles with specific exercises. Other times, more extensive treatment may be necessary, and sometimes pelvic floor reconstructive surgery is required. It is estimated that 10% of women will need surgery for pelvic floor problems, and especially when there has been a prolapse of the pelvic organs.

Surgical repair of the pelvic floor can help strengthen the muscle that supports the pelvic organs, and surgical repair is a relatively common treatment. As dramatic as it sounds, many women find that the procedure helps improve their quality of life. However, there may be less radical ways to treat pelvic floor problems, and a good doctor will always try less invasive treatments initially.

Diagnosis and treatment

Common symptoms of pelvic floor problems include urine leakage, repeated bladder infections, a feeling that your bladder is not completely empty when you urinate, or a feeling that something is coming out of your vagina. Some women will actually have to push the bladder back to get it into place to have a bowel movement or urination. Symptoms can vary depending on the type of organ prolapse that occurs, as it can affect the uterus, bladder, or rectum.

If you suspect you may have pelvic floor problems or have noticed any discomfort or urine leakage, it’s worth seeing your obstetrician or healthcare provider for a pelvic exam. Your doctor will need to review your medical history and will most likely perform a physical exam to check for muscle knots or muscle spasms. Your doctor may also check for muscle weakness. They can assess pelvic muscle control and muscle contractions with a quick internal exam.

Once your doctor has made a diagnosis, you can discuss the most appropriate treatments, and options include a wait-and-see approach that may be appropriate if you only have mild symptoms and want to avoid more invasive procedures. Sometimes good self-care at home can help improve this condition, and of course, you always have the option of surgery if the problem worsens.

Estrogen therapy may be helpful for postmenopausal women, and Kegel exercises are easy and discreet to do and help strengthen support in the pelvic area. If you require surgery, it will require a hospital visit because it is performed under general anesthesia. Recovery time can be a month or more.