Pelvic Muscle Function and Continence

Help for Musculature of the Bladder and Other Organs of the Pelvic Floor

The pelvic floor is a collection of muscles (and ligaments and connective tissue), wrapping down from the front of the pelvis to the back, that holds the organs and structures of the lower abdomen in place and that thus affects urologic, colorectal, and sexual function. For conditions related to the pelvic floor, the Center for Gynecology & Women's Health provides a special Pelvic Muscle Function and Continence Program.

For simplicity sake, we talk about the "pelvic muscle" and think of it as supporting, among other structures, the bladder, the vagina, the rectum, and the urethra.  Tension in this muscle that is too high or too low, or that is irregular or has lost is coordination, can lead to a variety of symptoms and conditions.

Causes of pelvic muscle problems include:

• aging;
• childbirth;
• high-impact activities;
• hereditary weakness;
• injury;
• surgery;
• constipation;
• and muscle spasm.

Problems Caused by Pelvic Floor Condition
Symptoms of pelvic muscle dysfunction include:

• urinary incontinence;
• pain in the pelvis, vagina, or back;
• vaginal prolapse;
• pain with intercourse;
• and irregularities in bowel function, especially inability to control bowel gas.

For patients who don't respond adequately to conservative care and need surgery, referral for implantation of a bladder,
ureteral or pelvic sling has
helped to change treatment
for incontinence.

Women alter their lives to deal with these problems.  They may stop certain activities that they enjoy. They may wear pads to avoid leakage. Their intimate relations may suffer.

But women need to realize that proper care can often correct these problems. Their most common reaction after their first appointment in the program is, "Why didn't I come sooner?"

Among common problems that we can address in pelvic-floor-related care and treatment are:

 urinary leakage. Bladder incontinence is significant issue for many women.  This form of incontinence can affect women of at any age, in different ways and circumstances.  Something as simple as a trip to the bathroom, or even a cough, sneeze, or laugh, can cause leakage in women disposed to the problem. Urinary leakage the most common manifestation of pelvic muscle disorder.  And yet, many women do not seek treatment, even though most can appreciate significant improvement by doing so.

 overactive bladder.  This condition is defined as urinary frequency and urgency.  Frequency means urinating more often than normal (e.g., more than eight times per day).  Urgency means that the sensation of needing to urinate is an intense one, accompanied by the feeling of need for prompt release.  Urinary leakage may occur with these symptoms.

 vaginal prolapse. In some women, the vaginal wall pushes out of its normal position, sometimes entering or even dropping through the vagina.  Displacement of the uterus, or sometimes of the rectum or bladder, into the vagina is usually the cause.  Symptoms may be incontinence, pressure in the vagina, slow urinary stream, or the sensation in the vagina that something has "dropped down."

 sexual dysfunction.  Pelvic floor disorder can make sexual intercourse difficult, due to vaginal pain or obstruction.

 bowel-gas leakage / stool incontinence.  Reduced strength and tonality in the pelvic floor can also cause women to lose ability to control passage of bowel gas or stool. 

Rehabilitation Program
For patients who have bladder or urination symptoms, or other signs related to pelvic muscle condition, our group can offer a specially structured treatment program that reconditions the pelvic floor to improve its tone and function.  The Center for Gynecology & Women's Health  has focused experience and resources for this care.

The center uses an established system of interventions that rehabilitate the pelvic floor, including:

• pelvic muscle re-education;
• behavioral techniques;
• and stimulation therapy.

This program teaches women to normalize tension in, and regain control of, their pelvic muscle. It takes advantage of the most up-to-date and recently developed forms of exercise, physical therapy, and muscle stimulation.  Through this approach, women achieve better bladder control, decreased muscle spasms, and better pelvic support.

For conditions not related to the pelvic muscle, or for pelvic muscle conditions that will not respond to conditioning and training alone, the center's full-service gynecologic group can offer other types of treatment.  These include pessaries (devices to support the vagina), medications, or surgical interventions.  The staff also provides knowledgeable education about surgical options.  With this comes referral to — and multidisciplinary care and collaboration with — urologic and colorectal physicians or other specialists, as needed.  our urologists have had increasing success with minimally invasive implantation of slings that support that bladder base.

In the evaluation appointment for the Pelvic Muscle Function and Continence Program, women will undergo:

• a physical examination that includes review of personal and family medical history;
• urine testing;
• muscle testing;
• and education.

After just a few visits for pelvic floor conditioning and training, most women see an improvement in symptoms.