3 Pelvic Floor Issues Many Women Face—And What to Do About Them

Pelvic floor weakness can be disconcerting but talking to your healthcare provider can help you improve your quality of life.

woman talking to her doctor

Medically reviewed in October 2021

Updated on July 7, 2022

How’s your pelvic floor health?

If you’re like many women, it’s not something you really think about until something starts to feel “off” down there. Even then, some women are too embarrassed to talk about uncomfortable issues, like leaking urine while sneezing or feeling discomfort during sex.

But why suffer in silence when there are a variety of treatment options available? Learning about your pelvic floor—and some common issues women face—is important. It could not only help improve your overall health but also your quality of life.  

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

Over time, however, these muscles may weaken—particularly after menopause, since a loss of estrogen can raise your risk. 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
  • Being overweight or obese
  • Having certain medical conditions that can cause nerve damage, including diabetes and multiple sclerosis (MS)
  • Undergoing certain surgical procedures, such as a hysterectomy

Problems linked to pelvic floor weakness
Weakness of the pelvic floor can lead to a variety of health issues. If the pelvic organs aren’t supported adequately, they can drop down. This may result in urine leakage or problems emptying the bladder completely, trouble having bowel movements, fecal incontinence (more on this later), and lower back or pelvic pain. In some cases, the pelvic organs may protrude from the vagina or anus.

Though these issues are not often discussed openly, they aren’t rare. In fact, one in five women in the United States experiences a pelvic floor disorder at some point. Here are some of the most common.

Pelvic organ prolapse (POP). This disorder occurs 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 discomfort with sex or physical activity
  • Pelvic pressure that worsens throughout the day, particularly while standing or coughing
  • Leaking urine or having bowel movement problems
  • 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.

From there, depending on your individual circumstances, treatment options may include:

  • Using a pessary, or a removeable device that can be 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. If you're leaking urine—whether it’s just a few drops or you're having more significant accidents—it’s known as urinary incontinence.

“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 mixture of the two.”

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

Incontinence typically affects twice as many women as men. This is likely due to contributing factors unique to women, such as 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.

The good news is that urinary incontinence is not a normal part of aging, and it can be treated. Treatment options will likely start 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. Avoiding beverages near bedtime, limiting your intake of alcohol and caffeine, performing exercises to strengthen the pelvic floor, and trying biofeedback—using sensors to locate the muscles you need to strengthen—can also help. Pessaries, which may come in a variety of shapes and sizes, can help prevent bladder leaks, as well.

If those treatments aren’t effective, your healthcare provider (HCP) may recommend medication, electrical nerve stimulation, bulking agents to narrow the bladder opening and prevent leakage, or possibly surgery.

Fecal incontinence. This occurs when a bowel movement occurs involuntarily or can’t be prevented despite attempts to stop it. Passive fecal incontinence, on the other hand, is when bowel leakage occurs unknowingly, or without your being aware that it’s happened. 

Fecal incontinence is more common than you may think; it’s estimated to affect as many as one in three people. Though it can be embarrassing to discuss, it’s important to tell your HCP if you’re experiencing this issue‚ 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 fail, however, 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 women with symptoms related to pelvic floor disorders are too embarrassed to broach the topic. But talking about your problems can help you get the treatment you need and ease your symptoms.

“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 raise the issue sooner rather than later. Once you’ve begun a dialogue, you and your HCP can outline steps to prevent or improve pelvic floor issues.

Article sources open article sources

American College of Obstetricians and Gynecologists. Pelvic Support Problems. November 2021. Accessed July 7, 2022.
Office on Women’s Health. Pelvic Organ Prolapse Fact Sheet. March 17, 2016. Accessed July 7, 2022.
Office on Women’s Health. Pelvic organ prolapse. February 22, 2021. Accessed July 7, 2022.
Micussi MT, Freitas RP, et al. Evaluation of the relationship between the pelvic floor muscles and insulin resistance. Diabetes, Metabolic Syndrome, and Obesity. 2015 Aug 28;8:409-13.
National Association for Continence. Pelvic Floor Disorders are Common Among Patients with Multiple Sclerosis. 2022. Accessed July 7, 2022.
UCLA Health. Pelvic Organ Prolapse. 2022. Accessed July 7, 2022.
National Association for Continence. Bowel Health. 2022. Accessed July 7, 2022.
American College of Obstetricians and Gynecologists. Urinary Incontinence. July 2022. Accessed July 7, 2022.
Office on Women’s Health. Urinary incontinence. February 22, 2021. Accessed July 7, 2022.
NIH: National Institute of Diabetes and Digestive and Kidney Issues. Bowel Control Problems (Fecal Incontinence). July 2017. Accessed July 7, 2022.
Whitehead WE, Palsson OS, Simren M. Treating Fecal Incontinence: An Unmet Need in Primary Care Medicine. North Carolina Medical Journal. 2016 May-Jun;77(3):211-5.

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