[6 min read]
In this article:
- The pelvic floor is a group of muscles and tissues that support important organs like the bladder, urethra, anus—and in women—the uterus, cervix, and vagina.
- These muscles help keep the pelvic organs in place and sustain bladder and bowel control.
- One in four women will be affected by a pelvic floor disorder at some point in life. The condition can severly impact daily living and quality of life.
- There are surgical and non-surgical treatment options for pelvic floor disorders.
- A Providence Swedish expert offers guidance for managing the condition. To learn even more, watch the video at the end of this blog.
Pelvic floor dysfunction is a common condition in which patients have difficulty with coordination of pelvic floor muscles because of injury during childbirth or age-related changes. According to the National Institutes of Health, roughly one quarter of women women in the United States are affected with one or more pelvic floor disorders and some 300,000 surgeries are performed each year to correct pelvic floor problems. That number may in fact be much larger because many women don't speak with their physicians about symptoms, choosing instead to struggle alone with the condition. To learn more about its causes and treatments — and why it’s important to speak with your doctor or practitioner about it — we spoke with Hannah Chapman, M.D., a urogynecologist at the Swedish Gynecology Specialty Center in First Hill.
What is the pelvic floor? What does it do? Why is it important to keep it healthy and strong?
I describe the pelvic floor to my patients as a bowl of muscles and connective tissue that sit in the pelvis which connects the sacrum to the hip bones and the pubic bone. It has essential functions for continence of both bowel and bladder. It’s also an important part of the core muscle group, which many people think are just the abdominal core muscles, but I think of the pelvic floor muscles as part of that core as well. Pelvic floor dysfunction can lead to incontinence, prolapse, pelvic pain and difficulty with sexual relations.
How do pelvic floor issues affect women of childbearing age and before, during and after menopause?
A lot of our patients will think about the pelvic floor during pregnancy and childbirth and that is certainly one of the main risk factors for many pelvic floor disorders. The pelvic floor undergoes significant stress during pregnancy and childbirth. The pelvic floor has to sustain a significant amount of pressure and stretch during that period. Therefore, the pelvic floor is vulnerable to injury, especially around the time of delivery. It can lead to a lot of symptoms of prolapse, incontinence and pain. Most of the time it resolves several months postpartum, but sometimes delivery can increase the risk of those problems being persistent. For instance, having an operative vaginal delivery like with forceps or vacuum increases the risk. Larger tears that occur during delivery also increase the risk of persistent pelvic floor disorders. So, for patients who are within a year postpartum and can have persistent symptoms, treatment depends on severity of their symptoms and future family planning goals. Age and menopausal status also increase the risk of many pelvic floor disorders.
What is prolapse?
Pelvic organ prolapse is when weakness in the muscles or connective tissues of the pelvic floor allows herniation of the pelvic organs into or beyond the vagina.
Are those conditions painful?
Not typically. Prolapse usually becomes symptomatic when the prolapse is around the level of the hymenal ring. Patients with mild prolapse might not even realize that they have prolapse and instead will be informed by their doctor during pelvic exam. Other symptoms can include pressure, heaviness, fullness, pulling, seeing or feeling a bulge or something coming out of the vagina. If the prolapse progresses and part of the prolapse is outside of the body for long periods of time, sometimes that can lead to discomfort, irritation, or burning.
Could a patient have mild prolapse and not need to have it addressed because it’s not painful or affecting them significantly?
Yes, it is important for patients to know that one of treatment options is to do nothing and observe. This is not a life-threatening condition, but it can be life-altering if it's affecting quality of life. However, if it's not affecting their quality of life or bowel or bladder function then observation is a very reasonable treatment approach.
Is hormone replacement therapy a treatment option?
Systemic hormone replacement therapy has not been shown to decrease the risk of prolapse or incontinence. But topical vaginal estrogen therapy can impact some of these pelvic floor disorders. After menopause, the vaginal pH changes because of lower estrogen levels and shifts the microbiome of the vagina. We use a topical estrogen to help normalize that pH and shift the microbiome back to the pre-menopausal levels. These changes in the microbiome can help with symptoms of burning, pain and dryness.
What are other treatments outside of hormones and lubricants?
One of the most important treatment options that we utilize as urogynecologists are pelvic floor physical therapists. Pelvic floor physical therapy is a first line treatment. They are highly specialized physical therapists who use several different treatment modalities to help patients with pelvic floor disorders. They treat prolapse, incontinence, pelvic pain and a number of other pelvic floor disorders.
Learn more and find a physician or advanced practice clinician (APC)
If you need a gynecologist, women's health specialist or primary care doctor, Swedish is here for you. Whether you require an in-person visit or want to consult a doctor virtually, you have options. Contact Swedish Primary Care to schedule an appointment with a primary care provider. You can also connect virtually with your provider to review your symptoms, provide instruction and follow up as needed. And with Swedish ExpressCare Virtual you can receive treatment in minutes for common conditions such as colds, flu, urinary tract infections, and more. You can use our provider directory to find a specialist or primary care physician near you.
Information for patients and visitors
Additional resources
What Women Need to Know About Their Pelvic Floor | FDA
New Swedish Gynecology Specialty Center brings a host of women’s health services under one roof
You can thrive, not just survive, during perimenopause and menopause
Fibroids 101: A common condition with many treatment options
This information is not intended as a substitute for professional medical care. Always follow your health care professional’s instructions.
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