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What are pelvic floor disorders?

The pelvic floor is the group of muscles and ligaments, shaped like a sling or hammock, that supports the pelvic organs. In women, the pelvic floor supports the bladder, uterus, vagina and rectum. While pelvic floor issues are common, women are often reluctant to discuss symptoms with their doctor.

Pelvic floor issues can occur when that group of muscles becomes weakened or damaged. These disorders can include:

  • Pelvic organ prolapse – This condition, which affects women with weakened pelvic floor muscles, occurs when the uterus, bladder or bowel fall or press against the vagina.
  • Incontinence – This includes urinary (lack of bladder control) incontinence.  
  • Overactive bladder – This involves the sudden need to urinate, sometimes paired with the loss of bladder control.
  • Bladder pain syndrome (interstitial cystitis or IC) – This syndrome is marked by a feeling of pain or pressure in the bladder and pelvic region.

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Symptoms of pelvic floor issues

While both men and women have pelvic floors, women are more likely to experience pelvic floor issues. Common symptoms a person with a pelvic floor issue may experience include:

  • Urinary issues – Including urinary incontinence, a strong urge to urinate or painful urination.
  • Pressure – Especially in the pelvic region or rectum. Some, especially women facing a pelvic organ prolapse, may experience a heavy feeling in the pelvis or a bulge in the vagina or rectum.
  • Pain – Including pain in the lower back, pelvic region, genitals or rectum. Women may also experience pain or discomfort during sexual intercourse. 
  • Constipation – Dry, hard bowel movements or going fewer than three times per week.
  • Muscle spasms – Typically experienced in the pelvis.

Causes of pelvic floor issues

Pelvic floor issues occur when the pelvic floor muscles are weakened. Common causes may include:

  • Childbirth
  • Obesity
  • Heavy lifting or straining
  • Aging
  • Genetics
  • Previous pelvic surgery or radiation treatments

Diagnosing pelvic floor issues

Our team of pelvic floor specialists have expertise in diagnosing and treating pelvic floor disorders.

To diagnose a pelvic floor issue, your doctor might:

  • Review your medical history and discuss your symptoms
  • Perform a physical exam, including a pelvic exam
  • Perform a test to evaluate bladder or bowel function
  • Order imaging studies

Treating pelvic floor issues

At Geisinger, we’ve brought a variety of specialists treating conditions of the pelvic floor together to provide care for all patients facing pelvic floor issues — from common to complex. This team includes:

  • Urogynecologists – Obstetrician-gynecologists (or OBGYNs) who have special training in treating pelvic floor disorders in women
  • Urologists – Doctors who specialize in treating issues involving the urinary tract 
  • Colorectal surgeons – Surgeons who specialize in the surgical and non-surgical treatment of conditions affecting the lower digestive tract (small intestines, colon, rectum and anus)
  • Physical therapists – Who can help you learn exercises to improve your symptoms

If you’re diagnosed with a pelvic floor disorder, your specialist will create a treatment plan that’s right for you. Depending on your situation, one or more of the following treatments may be recommended:

Physical therapy and biofeedback

Kegel exercises, or similar exercises that involve contracting your muscles, may not be enough to treat your condition. Your specialist may also suggest biofeedback therapy. Biofeedback allows your therapist to use sensors to evaluate how you relax and contract your pelvic muscles. After evaluating your muscle activity, your therapist can help you learn how to relax and coordinate the movement of your pelvic floor muscles.
Lifestyle changes

Your specialist may suggest a variety of relaxation techniques, such as yoga, stretching and warm baths, to help relax your pelvic floor muscles. They might also suggest techniques to avoid pushing too hard or straining when you use the bathroom, as well as diet and fluid intake changes.

Your specialist may prescribe medications to help with urinary urgency or overactive bladder.

If medication doesn't improve your overactive bladder symptoms, other treatment options are available. These include bladder muscle Botox injections, which can be performed in your doctor's office, and another in-office procedure called sacral neuromodulation, which can offer long-term relief from symptoms.

Vaginal pessary

A vaginal pessary is a soft, removable silicone device that’s placed in your vagina to comfortably support areas affected by pelvic organ prolapse. A pessary can also help ease symptoms of urinary incontinence, even during pregnancy.
Percutaneous tibial nerve stimulation

PTNS is a non-surgical treatment, much like acupuncture. During this treatment, a thin needle is placed near a nerve in your ankle called the tibial nerve. Connected to the thin needle is a small device that sends mild electrical pulses through your tibial nerve. These pulses can help ease symptoms of overactive bladder and urinary incontinence.

If your symptoms don’t improve with non-surgical treatments, our experienced pelvic floor specialists can help you find relief through surgery. Most surgeries are performed using minimally invasive techniques, meaning less time in the hospital and a quicker recovery time.

The following surgeries may be recommended:

  • Sling procedure – This minimally-invasive procedure is used to successfully treat urinary incontinence associated with activity and exercise.
  • Pelvic floor repair – Using minimally-invasive techniques, such as robotic surgery, your doctor can restore your pelvic floor support and function after a pelvic organ prolapse.

Pelvic floor care at Geisinger

Our pelvic floor specialists offer:

  • The knowledge you need – Our pelvic floor team consists of several specialists — all here to diagnose, treat and help manage your condition. Their focus is on delivering sensitive care, tailored to your specific needs.
  • Care where you live – With locations in central and northeastern Pennsylvania, our team provides consultations and comprehensive pelvic floor care for women, close to home.
  • Comprehensive specialty care – Our pelvic floor specialists work together to provide you with the comprehensive care you need.