Breaking down the different types of pelvic floor disorders

About one in five women in the U.S. are affected by pelvic floor dysfunction. This is often an issue that many women either feel too embarrassed to speak up about or think that problems with bladder control are normal and therefore live with their symptoms.

Dysfunction occurs when there is either too much or insufficient tension in the pelvic muscles. This can contribute to issues such as urinary incontinence, constipation, pain during sex or pain in the lower back.

Urinary incontinence and pelvic organ prolapse are the most common pelvic floor disorders. Two Trinity Health Mid-Atlantic specialists—board-certified urogynecologist Patricia Zahner, MD, and physical therapist Natalia Susul, DPT—share insight about these common disorders and the exercises that experts recommend to help manage symptoms.

Urinary incontinence

Pelvic floor specialists cite urge and stress incontinence as the types they most often see. The amount of urine leaked typically depends on how full the bladder is. Some individuals will leak drops of urine, while others may fully release their bladder.

Stress incontinence is an involuntary, sudden loss of urine accompanied by increased abdominal pressure. Urge incontinence is characterized by a sudden need to use the bathroom that is difficult to delay.

“To help determine if these symptoms are urinary incontinence, your provider may recommend a urine test, ultrasound, bladder stress test, cystoscopy or urodynamics,” Dr. Zahner says. “In addition, your provider may ask you to keep track of your time spent emptying your bladder to connect any patterns and decide on the best treatment option.”

Pelvic floor prolapse

Pelvic floor prolapse occurs when the ligaments supporting the pelvic organs become weak or loose. It is most commonly caused by a dropped bladder, rectal bulge that presses into the vagina, or a dropped uterus.

“Some symptoms of prolapse include leaking urine, bowel movement issues, problems inserting a tampon and a feeling of pressure or discomfort in the pelvis,” Dr. Zahner says.

Prolapse tends to affect about three percent of women in the U.S., and some can develop both prolapse and urinary incontinence.

“Any kind of pelvic pain, new symptoms of pressure in the vagina or rectum or new symptoms of leakage warrant a follow-up with a physician to discuss treatment options,” Susul says.

Pelvic floor exercises

“Everyone is used to hearing about Kegels when it comes to the pelvic floor,” Susul says. “However, Kegels are not always helpful and sometimes can worsen the problem.”

It is recommended that anyone with a pelvic floor issue should ask their primary care provider for a referral to physical therapy.

“Everyone is used to hearing about Kegels when it comes to the pelvic floor. However, Kegels are not always helpful and sometimes can worsen the problem.” - Natalia Susul, DPT

Experts such as Susul will gather details about the issue and determine the best treatment option. However, Susul suggests an easy exercise to try at home: diaphragmatic breathing.

“When we breathe, our diaphragm moves and our pelvic floor (also known as the pelvic diaphragm) moves along with it,” she says. Just like our lungs expand and deflate when we inhale and exhale, our pelvic floor follows suit.

“Starting with a basic awareness of that area and improving coordination of those muscles is critical for everyone and diaphragmatic breathing is an exercise we prescribe to most individuals that we see in the clinic,” Susul concludes.

Learn more about pelvic floor dysfunction and treatment or to schedule an appointment, call 215.710.4490.