Complete Guide to Pelvic Floor Disorders: Symptoms, Causes, and Treatment

Key Points

• Pelvic floor disorders affect nearly 1 in 4 women in the United States

• Common conditions include urinary incontinence, pelvic organ prolapse, and fecal incontinence

• Pregnancy, childbirth, aging, and menopause are major risk factors

• Many women suffer unnecessarily because they're too embarrassed to seek help

• Most pelvic floor disorders are highly treatable with conservative and medical options

• Nashville Gynecology Center offers comprehensive evaluation and personalized treatment plans
  

What Are Pelvic Floor Disorders?

Let's start with the basics. Your pelvic floor is a group of muscles, ligaments, and tissues that stretch like a hammock from your pubic bone to your tailbone. This "hammock" supports some pretty important organs, including your bladder, uterus, vagina, and rectum. It also helps control urination, bowel movements, and plays a role in sexual function.

When the muscles and connective tissues of your pelvic floor become weakened or damaged, you can develop what doctors call pelvic floor disorders. These are conditions that affect how well your pelvic organs are supported and how well they function.

At Nashville Gynecology Center, we see women with pelvic floor disorders every day. While these conditions are incredibly common, they're also incredibly undertreated because many women feel embarrassed talking about them or assume there's nothing that can be done.

Here's the truth: pelvic floor disorders are medical conditions with real solutions. You don't have to live with these symptoms.

Types of Pelvic Floor Disorders

Pelvic floor disorders come in different forms, and some women experience more than one at the same time. Let's break down the most common types:

Urinary Incontinence

This is the involuntary leaking of urine. There are several types:

Stress incontinence happens when you leak during physical activities that put pressure on your bladder, like coughing, sneezing, laughing, exercising, or lifting heavy objects. This occurs when the pelvic floor muscles aren't strong enough to support the bladder properly.

Urge incontinence (also called overactive bladder) is when you get sudden, intense urges to urinate and might not make it to the bathroom in time. Your bladder muscle contracts when it shouldn't.

Mixed incontinence is when you experience both stress and urge incontinence together.

For a deeper dive into these types, check out our article on urinary incontinence types and treatment options.

Pelvic Organ Prolapse

Prolapse happens when one or more of your pelvic organs drop down from their normal position and bulge into the vagina. This occurs when the pelvic floor muscles and tissues can't provide adequate support.

Types of prolapse include:

Cystocele (bladder prolapse) is when the bladder drops down into the front wall of the vagina. This is the most common type of prolapse.

Rectocele happens when the rectum bulges into the back wall of the vagina.

Uterine prolapse is when the uterus drops down into or even outside the vaginal canal.

Vaginal vault prolapse can occur after a hysterectomy when the top of the vagina drops down.

Fecal Incontinence

This is the inability to control bowel movements, leading to stool leaking from the rectum. It can range from occasional leakage when passing gas to complete loss of bowel control.

Pelvic Pain Disorders

Chronic pelvic pain can be related to pelvic floor dysfunction. This includes conditions where the pelvic floor muscles are too tight (hypertonic) or don't relax properly, causing pain during intercourse, urination, or bowel movements.

Common Symptoms: What to Watch For

Pelvic floor disorders can show up in different ways. Here are symptoms that should prompt you to seek evaluation:

Bladder-related symptoms:

• Leaking urine when you cough, sneeze, laugh, or exercise
• Sudden, strong urges to urinate
• Frequent urination (more than 8 times a day)
• Getting up multiple times at night to pee
• Difficulty starting urination or weak urine stream
• Feeling like you can't fully empty your bladder

Pelvic pressure and bulging:

• A feeling of heaviness or pressure in the pelvic area
• Feeling like something is falling out of your vagina
• Seeing or feeling a bulge in the vagina
• Lower back pain that gets worse as the day goes on
• Discomfort that improves when lying down

Bowel-related symptoms:

• Difficulty controlling gas or stool
• Constipation or straining during bowel movements
• Feeling like you can't completely empty your bowels
• Needing to push on the vagina or perineum to have a bowel movement

Sexual function:

• Pain during intercourse
• Reduced sensation during sex
• Difficulty achieving orgasm

Other signs:

• Pelvic pain that doesn't seem connected to your menstrual cycle
• Tampons that slip out or feel uncomfortable
• Difficulty inserting tampons

If you're experiencing any of these symptoms, you're not alone, and you definitely don't have to just deal with it. Our gynecology services include comprehensive evaluation for all types of pelvic floor disorders.

What Causes Pelvic Floor Disorders?

Understanding what puts you at risk can help you take preventive steps and know when to seek help. Here are the main causes:

Pregnancy and Childbirth

This is the biggest risk factor. Pregnancy puts stress on your pelvic floor for nine months as your baby grows. Vaginal delivery can stretch or even tear the pelvic floor muscles and the nerves that control them.

The risk increases with:

• Multiple pregnancies
• Large babies (over 9 pounds)
• Long labor or difficult delivery
• Forceps or vacuum-assisted delivery
• Multiple vaginal births

Even if you had a C-section, pregnancy itself can weaken your pelvic floor.

Aging and Menopause

As you age, muscles throughout your body naturally lose some strength, including those in your pelvic floor. Menopause compounds this because declining estrogen levels affect tissue strength and elasticity throughout the pelvic region.

To learn more about how hormonal changes affect your pelvic health, read our post on how menopause affects bladder control.

Chronic Straining

Anything that repeatedly increases pressure in your abdomen can weaken your pelvic floor over time:

• Chronic constipation
• Chronic coughing (from smoking, asthma, or other conditions)
• Heavy lifting (especially with poor form)
• Chronic straining during bowel movements

Weight and Obesity

Extra weight puts constant additional pressure on your pelvic floor. Studies show that obesity significantly increases the risk of all types of pelvic floor disorders.

Genetics and Family History

Some women are born with naturally weaker connective tissue, which can make them more susceptible to pelvic floor disorders. If your mother or sisters have had these issues, your risk may be higher.

Previous Pelvic Surgery

Hysterectomy and other pelvic surgeries can sometimes affect pelvic floor support, especially if the surgery removed structures that were helping to support other organs.

Medical Conditions

Certain conditions can increase your risk:

• Connective tissue disorders
• Neurological conditions that affect muscle control
• Diabetes
• Chronic respiratory conditions

How Pelvic Floor Disorders Are Diagnosed

If you're experiencing symptoms, getting a proper diagnosis is the first step toward feeling better. Here's what you can expect during your evaluation at Nashville Gynecology Center:

Initial Consultation

Dr. Larry D. Gurley will start by asking detailed questions about your symptoms, medical history, pregnancies and deliveries, lifestyle factors, and how the symptoms are affecting your daily life.

We might ask you to keep a bladder diary for a few days, tracking when you urinate, how much, when leaks occur, and what triggers them.

Physical Examination

A pelvic exam allows us to assess:

• Pelvic floor muscle strength
• Whether any organs have dropped from their normal position
• How well you can contract and relax your pelvic floor muscles
• Any areas of pain or tenderness

This isn't painful and is similar to a regular gynecological exam.

Specialized Testing

Depending on your symptoms, we might recommend:

Ultrasound can help visualize your pelvic organs and assess prolapse. We offer in-office ultrasound for convenience and quick results.

Other tests might include urine tests to rule out infections, pad tests to measure the amount of urine leakage, or referral for additional imaging if needed.

The goal of all this testing is to understand exactly what's happening so we can create the most effective treatment plan for you.

Treatment Options: From Conservative to Surgical

The good news is that most pelvic floor disorders can be significantly improved or even resolved with treatment. We always start with the least invasive options and only move to more aggressive treatments if necessary.

Conservative Treatments

Pelvic Floor Physical Therapy

This is often the first-line treatment and can be incredibly effective. A specialized physical therapist teaches you exercises to strengthen weak muscles or relax tight ones, uses biofeedback to help you learn proper muscle control, and provides techniques for bladder and bowel training.

Pelvic Floor Exercises (Kegels)

When done correctly, these exercises can strengthen the muscles that support your pelvic organs. The key is proper technique, which we can teach you during your visit.

To do them right: Squeeze the muscles you'd use to stop urine flow, hold for 3-5 seconds, relax for 3-5 seconds, and repeat 10-15 times, three times a day.

Lifestyle Modifications

Simple changes can make a big difference:

• Losing weight if you're overweight
• Treating chronic cough or constipation
• Avoiding heavy lifting or learning proper lifting techniques
• Quitting smoking
• Reducing bladder irritants like caffeine and alcohol
• Staying hydrated (yes, you still need to drink water!)

Bladder and Bowel Training

These techniques help you regain control by:

• Scheduling bathroom trips
• Gradually increasing time between trips
• Learning to suppress urgent signals
• Establishing regular bowel routines

Medical Treatments

Pessary Devices

A pessary is a removable device inserted into the vagina to support prolapsed organs or help with incontinence. They come in different shapes and sizes and can be worn all the time or just during activities. Many women find excellent relief with pessaries.

Medications

For overactive bladder or urge incontinence, medications can help relax the bladder muscle and reduce urgency. These can be taken as pills or applied as a patch.

Hormone Therapy

For postmenopausal women, localized estrogen therapy can strengthen vaginal and urethral tissues. Our bioidentical hormone replacement therapy options are customized to your needs.

Vaginal Rejuvenation

Treatments like FemiLift non-surgical vaginal rejuvenation use laser technology to stimulate collagen production and improve tissue strength in the vaginal area, which can help with both prolapse and incontinence symptoms.

Minimally Invasive and Surgical Options

When conservative treatments aren't enough, we offer several procedural options:

Urethral Bulking Injections

Injectable materials can be placed around the urethra to improve closure and reduce stress incontinence.

Bladder Botox

For overactive bladder that doesn't respond to medications, Botox injections can help relax the bladder muscle.

Surgical Repair

For more severe prolapse or incontinence, surgical procedures can restore normal anatomy and function. Options include sling procedures for stress incontinence or surgical repair of prolapsed organs.

We specialize in gynecology, endoscopy, and alternatives to hysterectomy, always exploring less invasive options first. When surgery is needed, many procedures can be done through our surgery center with minimal downtime.

Living Well With Pelvic Floor Health

Pelvic floor disorders don't have to control your life. Whether you're dealing with occasional leaks or more significant symptoms, effective treatments are available. The key is seeking help rather than suffering in silence.

Many women wait years before getting treatment, missing out on activities they love and dealing with daily stress and embarrassment. The earlier you address pelvic floor issues, the easier they often are to treat.

Prevention Tips

While you can't prevent all pelvic floor disorders, you can reduce your risk:

• Do pelvic floor exercises regularly, even if you don't have symptoms yet
• Maintain a healthy weight
• Treat constipation and avoid chronic straining
• Practice proper lifting techniques
• Quit smoking
• Stay active with low-impact exercises like walking, swimming, or cycling
• Address any chronic cough
• Stay hydrated and eat a fiber-rich diet

Take the First Step Toward Better Pelvic Health

If you're experiencing any symptoms of pelvic floor disorders, you don't have to wait for them to get worse before seeking help. At Nashville Gynecology Center, we provide compassionate, expert care in a comfortable environment where you can feel safe discussing these sensitive issues.

Nashville Gynecology Center
300 20th Avenue North, Suite 102
Nashville, TN 37203
Phone: (615) 284-1500
Fax: (615) 432-2007

Call us at (615) 284-1500 to schedule your evaluation. We offer comprehensive bladder symptom evaluation and treatment as well as management for all types of pelvic floor disorders.

You can also learn more about our philosophy of patient-centered care or take a virtual office tour. We welcome new patients and are here to help you feel like yourself again.

Don't let embarrassment or the assumption that "this is just how it is" keep you from getting help. Pelvic floor disorders are treatable, and you deserve to live without these symptoms.

FAQs About Pelvic Floor Disorders

How common are pelvic floor disorders?

Very common! Nearly 1 in 4 women in the United States experiences some form of pelvic floor disorder. The prevalence increases with age, affecting about 1 in 3 women over age 60. Despite how common these conditions are, many women don't seek treatment because they're embarrassed or think it's a normal part of aging.

Can pelvic floor disorders be cured?

Many can be significantly improved or even resolved with proper treatment. Conservative treatments like pelvic floor exercises and lifestyle changes can cure mild to moderate cases. More severe cases might require procedures or surgery, which can provide excellent long-term results. Even in cases where complete resolution isn't possible, symptoms can almost always be improved significantly.

Do I need surgery for a pelvic floor disorder?

Not necessarily. Most women start with conservative treatments like pelvic floor exercises, lifestyle modifications, and possibly a pessary device. Many find significant relief with these approaches alone. Surgery is typically reserved for more severe cases or when conservative treatments haven't provided enough improvement. The decision depends on your specific condition and how much it's affecting your quality of life.

Can pelvic floor disorders affect younger women?

Yes. While these conditions become more common with age, younger women can develop pelvic floor disorders, especially after pregnancy and childbirth. Women in their 20s and 30s can experience stress incontinence or prolapse, particularly if they've had multiple pregnancies, large babies, or difficult deliveries.

Will my pelvic floor disorder get worse if I don't treat it?

Not always, but it's possible. Some pelvic floor disorders remain stable, while others can progress over time. Even if symptoms don't worsen, leaving them untreated means continuing to deal with symptoms that could be improved. Early treatment is often more effective and can prevent progression in some cases.

Can I still exercise if I have a pelvic floor disorder?

Absolutely! In fact, appropriate exercise is beneficial. However, you might need to modify certain activities. High-impact exercises like running or jumping might worsen stress incontinence initially. Low-impact options like walking, swimming, cycling, or yoga are usually well-tolerated. Pelvic floor physical therapy can help you strengthen your muscles so you can eventually return to high-impact activities if desired.

Is it normal to have bladder leaks after having a baby?

While it's common, it's not "normal" in the sense that you should accept it as permanent. Many women experience some incontinence in the weeks and months after delivery, and symptoms often improve naturally over time. However, if leaking persists beyond 6-12 months postpartum or is significantly affecting your life, it's worth seeking evaluation and treatment.

Can I prevent pelvic floor disorders if I have risk factors?

While you can't eliminate all risk, you can reduce it significantly. Maintaining a healthy weight, doing regular pelvic floor exercises (even before pregnancy), avoiding smoking, treating constipation, and practicing proper lifting techniques all help protect your pelvic floor. Even if you have risk factors like multiple pregnancies, preventive measures can make a difference.

FAQs About Nashville Gynecology Center

What pelvic floor disorder services does Nashville Gynecology Center offer?

We provide comprehensive care including initial evaluation and diagnosis, pelvic floor strength assessment, pessary fitting and management, hormone therapy for postmenopausal tissue changes, referrals to specialized pelvic floor physical therapists, minimally invasive procedures, and surgical options when needed. We take a personalized approach to find the right treatment combination for each patient.

How long does a pelvic floor disorder evaluation take?

Your initial appointment typically lasts 30-60 minutes. This includes a detailed discussion of your symptoms and medical history, a physical examination, and development of an initial treatment plan. If specialized testing like urodynamics is recommended, that's usually scheduled as a separate appointment.

Do you offer non-surgical treatments for prolapse?

Yes! We offer several non-surgical options including pessary devices (which many women find very effective), pelvic floor physical therapy referrals, hormone therapy for postmenopausal women, vaginal laser treatments, and lifestyle modification guidance. We always explore conservative options before discussing surgery.

Is Dr. Gurley experienced with pelvic floor disorders?

Absolutely. Dr. Larry D. Gurley is board-certified in obstetrics and gynecology with extensive experience treating all types of pelvic floor disorders. He takes a conservative, patient-centered approach and believes in thoroughly exploring non-surgical options before recommending procedures. His philosophy is to treat each woman as an individual with unique needs and concerns.

Will I need to see multiple specialists?

Not necessarily. We provide comprehensive evaluation and treatment for most pelvic floor disorders right in our office. If you would benefit from pelvic floor physical therapy, we can refer you to specialists we trust. For complex cases requiring additional expertise, we'll coordinate your care, but most patients find that we can address all their needs in one location.

Does insurance cover pelvic floor disorder treatment?

Most insurance plans cover evaluation and treatment of pelvic floor disorders as these are recognized medical conditions. Coverage varies by plan for specific treatments like pessaries, procedures, or surgery. Our office staff can verify your coverage and help you understand your benefits before starting treatment. Call (615) 284-1500 with your insurance information.

What should I bring to my first appointment?

Bring your insurance card, a list of current medications and supplements, any relevant medical records (especially from previous pelvic surgeries or difficult deliveries), and if possible, a bladder diary showing when you urinate and when leaks occur over 2-3 days. It's also helpful to write down questions you want to ask so you don't forget anything during your appointment.

Ready to address your pelvic floor concerns and improve your quality of life? Contact us today to schedule your confidential consultation with Dr. Gurley and take the first step toward feeling better.