Being one of the most common problems facing women, pelvic floor dysfunction, may affect approximately 50 percent of all women - the majority of whom may not seek professional help. In addition to urinary incontinence, pelvic floor dysfunction may cause fecal incontinence, sexual dysfunction, vaginal pain or discomfort and abdominal discomfort. Many women experience significant changes in daily activities and even self-identify because of these conditions. Abnormal function results from a variety of medical conditions as well as normal changes associated with childbirth and aging. FAQs (Frequently Asked Questions) »
Women with pelvic floor disorders - the most common of which is urinary incontinence followed by fecal incontinence and organ prolapse - often fail to receive appropriate treatment for their condition. As a result, they frequently give up participating in favorite activities, exercise and travel. Self-esteem and intimacy suffer, and many lapse into depression or are reluctant to leave their homes.
With women living longer beyond menopause than ever before, pelvic floor disorders demand serious attention from healthcare providers. UCLA offers comprehensive and compassionate care for all pelvic floor disorders in a women-only setting.
Our program draws on the expertise of specialists in urogynecology, chronic pelvic pain, colorectal and digestive diseases and physical therapy. This collaboration of physicians from various specialties is important because pelvic floor dysfunctions often have a shared pathophysiology. A single structural defect in the pelvic floor, for example, can be responsible for dysfunction of the bladder, bowel and even genital tract. Moreover, the multidisciplinary arrangement eliminates the inconvenience and emotional stress of seeking out physicians in multiple locations.
As specialists with long experience in the diagnosis and treatment of pelvic floor disorders, UCLA physicians handle complex and recurrent cases. The program also offers general gynecologic care and other women's medical services, such as bone-density scanning and hormone therapy.
Age and obesity are common risk factors for all three pelvic floor disorders, while childbirth is a factor in urinary incontinence and organ prolapse. Other risk factors for urinary incontinence include hysterectomy, vaginal surgery, lung disease, smoking and radiation.
UCLA takes advantage of the most up-to-date diagnostic services and tools, among them pelvic ultrasound, genitourinary radiology, cystoscopy for examination of the bladder and urethra, and anal ultrasound to assess sphincter injury.
When more sophisticated testing is required, physicians use multi-channel urodynamics to measure bladder function, dynamic magnetic resonance imaging (MRI) for the evaluation of the urogenital compartment and pelvic floor organs, and anorectal manometry for the diagnosis of fecal incontinence.
Our program focuses on education as a powerful tool to empower women to gain control over their bladders. Many women find they can obtain a measure of relief by decreasing or eliminating certain beverages or foods from their diets. Home biofeedback and exercise can often bring relief by strengthening pelvic floor and anal muscles.
For prolapse and incontinence cases requiring surgery, program physicians use the latest minimally invasive procedures. UCLA surgeons can perform robotically assisted laparoscopy for prolapse repair. This technique shortens hospitalization and recovery time and may add to the durability and efficacy of the repair. Uterine-sparing surgery is often possible.
1) How common are pelvic floor disorders?
One in three women will experience a pelvic floor disorder (PFD) in her lifetime.
PFDs occur when women have weakened pelvic muscles or tears in the connective tissue, which may cause pelvic organ prolapse, bladder control problems, or bowel control problems.
Women do not have to suffer in silence or simply manage a PFD with pads. There are several non-surgical and surgical treatment options. PFDs can be effectively treated by working with a trained Urogynecologist to develop a treatment plan for your individual needs. Other options may include
4) Are PFDs a normal part of aging?
No, not really. PFDs are not a normal part of aging, although they become more common as women get older. With the help of a specialist, there are effective treatments for PFDs.
Yes. Childbirth can contribute to the development of PFDs. Vaginal births double the rate of pelvic floor disorders compared to Cesarean deliveries or women who never gave birth. However, Cesarean deliveries pose several risks and are not recommended for prevention of PFDs.
6) What should I do if I think I may have a PFD?
A general practitioner can help decide if you need a specialist. A urogynecologist, or urogyn, is a physician with specialized training to evaluate and treat women with pelvic floor disorders.
7) What is a urogynecologist?
Urogynecologists are physicians with special training in urology and gynecology. They focus on the evaluation and treatment of non-cancerous conditions concerning the female pelvic organs and supporting muscles and tissues and are trained in pelvic reconstructive surgery. The sub-specialty of urogynecology, now known as female pelvic medicine & reconstructive surgery, was created in the 1990s. Urogynecologists complete medical school and do a four-year residency in obstetrics and gynecology. They complete three additional years of highly specialized training in urogynecology. This includes surgical training in the skills of pelvic and reconstructive surgery in addition to training in nonsurgical management of pelvic floor disorders. Women who had to see multiple specialists for urinary, reproductive and gastrointestinal problems can now see one.
8) What medical conditions do Urogynecologists treat?
Urogynecologists treat pelvic organ prolapse, urinary incontinence, fecal incontinence and other,pelvic floor disorders. Approximately one in three women will experience one of these conditions. Urinary and fecal incontinence involves a lack of control over those functions. The pelvic floor is the system of muscles, ligaments and tissues that support the bladder, urethra, uterus, vagina, small bowel and rectum in the pelvic area. Pelvic floor disorders are conditions involving a weakening of support for those organs, often leading to prolapse.
9) What is pelvic organ prolapse?
Pelvic organ prolapse happens when one or more of a woman’s organs in the pelvic area drops (prolapses) from its normal position to push against the walls of the vagina. Prolapse occurs because the downward pressure of the pelvic organs is greater than the strength of the supporting pelvic floor muscles and ligaments. With pelvic organ prolapse, many women feel pressure or fullness in the vagina, and as the prolapse increases, tissue may protrude from the vagina.
10) What causes incontinence and pelvic floor disorders?
Urinary and fecal incontinence and pelvic floor disorders may be caused by several things, including damage that harms the pelvic floor muscles, nerves or supporting tissues, childbirth and genetics. Aging, repeated heavy lifting, chronic diseases, genetics or surgery are also known risk factors. Smoking and obesity can also contribute to urinary incontinence.
12) Should I be embarrassed to talk about my bladder control problems?
Prolapse and incontinence can certainly be embarrassing, but talking about it with a urogynecologist shouldn’t be. Urogynecologists are knowledgeable in these issues and compassionate in talking with women about such problems. Ultimately their goal is the same as yours: to relieve or eliminate your pelvic floor problems. Many women tolerate urinary and fecal incontinence in silence and do not seek the medical help that can greatly improve quality of life. It’s important to know that many conditions can be improved or cured and the first step is talking to a urogynecologist.
13) What kind of treatments should I expect?
Pelvic floor disorders and urinary and fecal incontinence problems often occur in various degrees, caused by differing factors and conditions. Treatments vary widely beginning with simple lifestyle changes. Management may also involve medications, the use of organ supporting devices, or minimally-invasive surgery to more complex surgeries.
Our Urogynecologists will fully evaluate you and formulate recommendations, and you will be involved and in charge of what treatments you choose to pursue.
14) Is it possible that my pelvic floor problem will just go away over time?
It is unlikely that a pelvic floor disorder will go away on its own. In some cases of pelvic organ prolapse, a urogynecologist may suggest doing nothing and observe the situation over time, depending on the severity of your symptoms and level of bother. Depending on the problem, it is also possible that if left untreated, incontinence or pelvic floor disorder often remains unchanged or may worsen.
15) I’ve heard that bladder surgery often doesn’t work. Is this true?
In the past, “bladder lifts” and incontinence procedures had a reputation for high recurrence rates. However, the field of Urogynecology has progressed and continues to develop every day. New procedures have evolved, and Urogynecologists are more specifically focused on these procedures and conditions, resulting in improved success rates. Many factors are important in this decision-making process. Your urogynecologist will discuss all aspects of possible surgery so you are well prepared to make the ultimate decision on your treatment.
16) If I need pelvic floor surgery, how long will it take to recover?
This is a reconstructive surgery and the body should be given ample time to heal without undue physical stress. Many women can return to work or their daily life soon after surgery, as long as they do not bend, lift, squat or otherwise stress their pelvic floor. This period of limited activity may last for up to three months, depending on the surgical procedure, or may be much shorter. Your physician will prepare you with lifestyle changes that will protect your pelvic floor during recovery and afterward.
17) Can a urogynecologist conduct my annual well woman examination?
Yes. Trained in general gynecology and obstetrics, a Urogynecologist is perfectly suited to conduct a woman’s annual wellness examination.
*Adapted from Voices for PFD website