As a urologist, I see how common and disruptive urinary incontinence and other pelvic floor concerns can be. About one in four women over age 20 experiences a pelvic floor disorder, yet many hesitate to bring it up. My goal is to address the topic directly and respectfully—so patients feel informed, heard, and comfortable exploring options.
In addition to incontinence, pelvic floor disorders include things like, overactive bladder, and pelvic organ prolapse. Pelvic organs include structures like the bladder, bowel, rectum, uterus, vagina, and the surrounding muscles and nerves.
The pelvic floor is made of ligaments, muscles, and tissues that form a hammock that holds the pelvic organs in place. The pelvic floor acts almost like a suspension bridge.
When the cables holding up the bridge become weak or damaged, it becomes more difficult for them to support whatever is on the bridge.
Several factors including aging and genetics impact the overall function of this complex suspension bridge. As women age, the strength of the supporting cables can change.
Pregnancy and delivery can also alter and injure these support mechanisms.
During childbirth, the muscles and ligaments of the pelvis are required to stretch 350% from their baseline length. This can result in damage and injury.
Pelvic floor dysfunction doesn’t typically happen rapidly. It often takes decades for weakness from an injury or childbirth to develop into a problem.
Research shows by age 60, between 30 to 40% of women will have overactive bladder, and up to 50% of women will have some degree of stress incontinence.
In addition to pregnancy, aging and childbirth, other conditions that can affect the strength and integrity of the pelvic floor are obesity, smoking, chronic cough, chronic constipation, heavy lifting, stress, connective tissue disorders, and medical conditions that impact nerve function.
This can lead to overactive bladder or urge urinary incontinence, stress urinary incontinence, straining with bowel movements, accidental bowel leakage, pelvic pain or pain with intercourse, and pelvic organ prolapse. Pelvic organ prolapse occurs when one of the pelvic organs bulges into or out of the vagina.
Sometimes, people believe nothing can be done to help them. Conversely, some think a hysterectomy or surgical sling will be the only treatment needed.
Actually, there are a variety of treatments available including something as simple as lifestyle modifications.
Depending on the severity of a patient’s symptoms, pelvic floor physical therapy also is an option for women seeking improvement without surgery.
If your symptoms are holding you back from doing things you enjoy, it is time to explore your options. You can begin with your primary care provider and ask for a referral to a urologist for an evaluation.
Donald J. May, MD, is a board-certified urologist serving patients throughout the Denver metro area. A Colorado native, Dr. May’s clinical interests include urologic oncology and reconstruction, kidney stone surgery, care for patients with spinal cord injuries and pediatric urology.
