3 common pelvic floor issues—and what to do about them

The pelvic floor is a powerhouse part of the body—it stabilizes your core, and supports your bladder, bowel, and reproductive organs. It also helps with some very important functions, such as going to the bathroom and having sex. But over time, this hardworking group of muscles and connective tissues can become too loose (or too tight). This can cause issues like leaking urine while sneezing or feeling pain while having sex.

But thankfully there are many treatment options available for pelvic floor issues, which can improve your health and your quality of life. Here’s what you need to know:

What weakens the pelvic floor?

Your pelvic floor muscles play an important role in your body’s everyday function. After all, they keep your pelvic organs—the vagina or prostate, uterus, bladder, urethra, and rectum—in place.

Over time, however, these muscles can get weaker—particularly after menopause, due to a decrease in the body’s production of estrogen. Being pregnant and delivering a baby vaginally also increases the likelihood of pelvic floor weakness, especially if you’ve had large babies or multiple pregnancies.

Other risk factors for pelvic floor issues include:

• Repeated heavy lifting
• Chronic coughing or straining from constipation
• Having a large body size or obesity
• Having certain medical conditions that can cause nerve damage, including diabetes and multiple sclerosis (MS)
• Undergoing certain surgical procedures, such as a hysterectomy

Issues linked to pelvic floor weakness

When your pelvic floor loses its strength, it can lead to several different health issues. If the pelvic organs aren’t supported adequately, they can drop down (picture a hammock trying to support a team of football players). This may result in urine leakage or issues emptying the bladder completely, difficulty having bowel movements, fecal incontinence (more on this later), and lower back or pelvic pain. In some cases, the pelvic organs may actually protrude from the vagina or anus.

These issues may sound alarming, but they are fairly common: One in five people born female in the United States experiences a pelvic floor condition at some point. Some of the issues that can occur with the pelvic floor:

Pelvic organ prolapse (POP). This happens when pelvic floor muscles weaken and allow one or more of the pelvic organs to descend into the vagina. People who develop POP may experience a range of symptoms, such as:

• A bulge in the vagina
• Pelvic pressure or pain during sex or other physical activities
• Pelvic pressure that worsens throughout the day, particularly while standing or coughing
• Leaking urine or having issues with bowel movements
• Difficulty inserting tampons

“If a patient is complaining and symptomatic, the first thing the provider is going to do is a thorough medical history, an evaluation, and testing,” says Adrian Marimon, MD, FACOG, an OBGYN at Kendall Regional Medical Center in Miami, Florida.

Depending on your particular condition, lifestyle, and preferences, treatment options may include:

• Using a pessary—a removeable silicon device shaped like a disk, ring, or donut that is inserted into the vagina to help support your pelvic organs
• Pelvic floor physical therapy, which includes exercises to help strengthen the pelvic floor muscles
• Dietary changes, such as eating more high-fiber foods to help make stools softer and more regular
• Surgery, which can help repair the prolapse and support the pelvic floor

Urinary incontinence. When the pelvic floor weakens it can cause you to leak urine—which can range from a few drops when you laugh to much more significant accidents.

“There are three types of urinary incontinence: stress incontinence, urge incontinence, and mixed incontinence,” Dr. Marimon explains. “Stress incontinence occurs when there’s increased abdominal pressure by coughing, laughing, sneezing, or heavy lifting that results in a leakage of urine. Urge incontinence is when you have the need or desire to void and feel like you’re not going to make it to the restroom. And mixed incontinence is a mixture of the two.”

Depending on the type of incontinence you have, you may feel the need to go more frequently, wake up at night to use the bathroom, have pain while urinating, or even leak urine while asleep.

Incontinence typically affects twice as many people with female reproductive organs as those with male reproductive organs. This can be due to pregnancy, childbirth, and menopause, which can all weaken or damage the pelvic floor. But there are many other possible causes for urinary incontinence, Marimon points out. “So, it’s important to see a urologist for medical history, testing, and treatment,” he advises.

It’s important to remember that incontinence is not just one of those things you have to deal with as you get older—it can be treated. Talk to your health care provider (HCP) about starting with nonsurgical options, such as lifestyle changes, physical therapy, and bladder training. If you’re overweight, losing even a few extra pounds can ease pressure on the pelvic floor and help prevent urine leakage. Skipping that last glass of water before bedtime, limiting your intake of alcohol and caffeine, doing exercises to strengthen the pelvic floor, and trying biofeedback—using sensors to locate the muscles you need to strengthen—can also help. Pessaries, which come in a variety of shapes and sizes, can help prevent bladder leaks, as well.

If those treatments don’t give you relief, your HCP may recommend medication, electrical nerve stimulation, bulking agents to narrow the bladder opening and prevent leakage, or possibly surgery.

Fecal incontinence. This is similar to urinary incontinence, except it happens when you have to poop. In some cases, you might feel the urge to go, but can’t make it to the bathroom before having a bowel movement. In other cases, you might leak stool without even knowing it’s happening until you see it in your underwear (this is called passive fecal incontinence).

Though it's not often discussed, fecal incontinence is actually very common: It’s estimated to affect as many as one in three people. If you are experiencing any issues with incontinence, talk to your HCP about it‚ especially if it’s frequent or severe.

Some non-invasive treatments—including dietary adjustments, bowel training, pelvic floor exercises, and medication—can be very effective. In fact, they can improve symptoms by about 60 percent, and they resolve fecal incontinence altogether in up to 1 in 5 cases. If these options don’t work for you, your HCP may discuss other therapies such as biofeedback, sacral nerve stimulation, vaginal balloons, nonabsorbable bulking agents, or surgery.

Talking to your HCP

While some HCPs test for pelvic floor strength regularly, many people with pelvic floor issues are hesitant about bringing up the topic. First, be assured that this is all in a day’s work for HCPs. Talking about your symptoms can help you get the treatment you need.

“Start the conversation,” Marimon says. “Then your provider can ask about your medical history, do a physical examination and other testing, and follow up to see if there’s any progression.”

Don’t wait. It’s better to bring it up sooner than later. Once you’ve begun a dialogue, you and your HCP can outline steps to improve your pelvic health and keep you laughing and smiling without having to worry about running to the bathroom.