What is a "Pelvic Floor Disorder?"

Pelvic floor disorder is a major life altering condition that can result in some of the most common and feared health problems faced by women. The effects of childbirth, aging, menopause, connective tissue disorders, prior pelvic surgery, and chronic straining on the female pelvic floor, may contribute to pelvic floor disorders.

Pelvic floor disorders can include:

• fecal incontinence (involuntary loss of feces)
• urinary incontinence (involuntary loss of urine)
• constipation
• rectal pain
• vaginal and/or rectal prolapse
• pelvic pain/trauma
• sexual dysfunction

These are the facts:

• Women who suffer from pelvic floor disorders tend to underreport their condition due to embarrassment.
• More than 50% of women age 55 and older suffer one or more of the problems caused by pelvic floor dysfunction.
• 1 out of every 9 women will undergo surgery for a pelvic floor disorder.
• 8 times more women than men suffer from a pelvic floor disorder.
• 1 out of 3 women will suffer sphincter muscle damage due to vaginal childbirth. This damage may lead to fecal incontinence.
• 30% of urinary incontinent patients also suffer from fecal incontinence.
• 20% of patients suffering from genital prolapse also have fecal incontinence.
• The lifetime risk of undergoing surgery for pelvic organ prolapse or incontinence is 11%.
• 60% of nursing home occupants and the elderly, suffer from fecal incontinence.

The “pelvic floor” refers to the pelvic diaphragm, the sphincter mechanism of the lower urinary tract, the upper and lower vaginal supports, and the internal and external anal sphincters. It is a network of muscles, ligaments and other tissues that hold up the pelvic organs (vagina, rectum, uterus and bladder). When this system weakens, the organs may shift, bulge and push outward or against each other. As a result, women may suffer from urinary or fecal incontinence or obstruction, vaginal prolapse or pain, sexual dysfunction, and other problems. Women who vaginally delivered several children and those who suffered birth injuries, are at higher risk for pelvic floor disorders.

Disorders

Loss of Bowel Control - The loss of control of bowel movements or gas is known as fecal incontinence. Unfortunately the condition is reasonably common, particularly in women who have had children. Statistics show that at least 30% of women sustain occult anal sphincter injuries during childbirth, and the symptoms which lead to fecal incontinence may not become clinically evident for decades.

Our physicians and staff understand the potentially traumatic consequences of having to live with loss of bowel control. We empathize with this socially debilitating condition, and do not wish for women to suffer in silence. There are options available for treating and managing this disorder.
Our colorectal specialists work with patients to find the cause of incontinence which may include disorders of the colon and rectum, the anus, and/or the pelvic floor. Treatment depends on the cause and severity of fecal incontinence, and may include medication, dietary changes, biofeedback and exercise programs to strengthen anal and pelvic muscles, or surgery. In addition to evaluation of the muscles and nerves of the anus and rectum, we offer some of the latest therapies available in clinical trials for patients who have failed traditional types of therapy. Alternative therapies under evaluation include:

• Artificial Bowel Sphincter
• Sacral Nerve Stimulation
• Radio Frequency injury/bulking to the anal submucosa/internal sphincter

Many patients with problems of bowel control also have an overactive bladder and suffer from urinary incontinence as well. Our specialists will screen for these associated problems and make the appropriate referrals as needed.

In the Anorectal Physiology Laboratory, equipment is available to analyze the pressure of the anal sphincter muscles (which controls continence) and ultrasound can be used to image these muscles. The tests allow a decision to be made about an approach to repair these muscles. In some cases, surgery is not required.

Obstructed Defecation – When a patient presents with fecal obstruction, various tests are performed to ascertain the reason for this disorder. Fecal obstruction may be due to dietary habits, colonic inertia, or gastrointestinal dysfunction.

Vaginal Organ Prolapse – Prolapse comes from the Latin word, “to fall.” In medicine, this term indicates that an organ has slipped out of its proper place. People with pelvic floor disorders may suffer as a result of the rectum protruding through the anal canal, or the bladder or uterus protruding through the vaginal canal. When rectal prolapse occurs, this damages the anal sphincters which control continence. The effect of this prolapse can be fecal incontinence. When an organ prolapses vaginally, it can be indicative of an unusually difficult labor during childbirth, obesity or constant straining on the female pelvic floor.

Prolapse can also involve the slippage of an organ out of its original location but not necessarily outside the body. Unless an organ protrudes through a genital orifice, a woman may not know that she has a prolapsed organ. Symptoms of urinary incontinence, rectal and/or vaginal pain, constipation, and discomfort or pain experienced during sexual activity, may indicate vaginal organ prolapse.

Sexual Dysfunction - Women suffering from a pelvic floor disorder may experience dyspareunia or apareunia. Dyspareunia indicates a woman’s inability to engage in sexual intercourse due to pain. Apareunia is a woman’s physical inability to allow sexual intercourse to occur because an organ is blocking entrance to the vaginal canal.