The pelvic area is an intricate arrangement of muscles, nerves, tendons, blood vessels, and connective tissue. It keeps the uterus, bladder, and bowels in place and supports sexual intercourse.

Women can develop a wide range of pelvic health issues, ranging from mildly annoying to debilitating. According to a recent study funded by the National Institutes of Health, nearly 24 percent of women in the United States experience one or more pelvic health issues.

Causes

Fundamentals

Women’s pelvic health issues can stem from various causes, including gynecologic problems, urinary and bowel disorders, muscle tension, or bone and joint conditions. For example, endometriosis can cause pain, cysts, and fibrous bands of scar tissue (adhesions) that form around your uterus.

Pelvic floor disorders occur when the muscles and tissues that support the uterus, bladder, and rectum no longer work as they should. These problems are widespread, affecting about one in three women.

Fortunately, they are treatable with the right plan. For example, your team may recommend medications to control the symptoms and physiotherapy that strengthens your pelvic floor. They might also suggest biofeedback, stress-relief techniques, or surgery to implant a device under your skin that sends signals to your bladder and pelvic floor nerves to help you control your bladder and bowel movements.

According to Keck Medicine urogynecologist Christina Dancz, the most important thing is to recognize when you have a problem and seek medical attention. Women who put off seeking treatment for their incontinence or prolapse are likely to suffer more and live with a lower quality of life.

Symptoms

Women’s pelvic health issues include a wide range of symptoms that problems with the muscles and tissues in the pelvic area can cause. These can include difficulty passing a bowel movement, urinary incontinence, or pain during sex.

The pelvic floor consists of muscles and ligaments that support the bladder, rectum, and uterus (if present). Contracting and relaxing these muscles controls urination, bowel movements, and sexual intercourse.

Pelvic floor dysfunction, also known as stress incontinence, occurs when these muscles become weak. Treatments can include Kegel exercises, physical therapy, and minimally invasive surgery.

Another common issue is a condition called pelvic organ prolapse. It occurs when the pelvic muscles, tissue, and ligaments weaken and allows the bladder, uterus, or rectum to protrude abnormally through the pelvic wall, often into the vaginal cavity.

This occurs in almost one-half of all women 50 years and older, even though these organs normally don’t move very much. Risk factors include age, pregnancy, obesity, and chronic constipation.

Uterine prolapse occurs when the uterus or part of it drops down into the vaginal canal, often after a woman has had her uterus surgically removed (hysterectomy). Symptoms include a heavy feeling in the lower abdomen, discomfort in the womb, a bulging sensation in the vagina, and pressure in the lower back.

Diagnosis

Many women have issues with their pelvic health without realizing it. And they may not see their primary care provider until the symptoms have become bothersome, says Keck Medicine urogynecologist Christina Dancz.

Women with these issues sometimes go years without getting the care they need. In addition, experts say that they feel embarrassed to bring up their discomfort.

Symptoms can range from mild to severe. They can include urinary and fecal incontinence, a feeling of pressure in the vagina, and a hard time emptying their bowels.

These problems aren’t life-threatening or increase your risk of developing cancer, but they can cause embarrassment and disrupt your quality of life. They’re also sometimes caused by other medical conditions, so it’s important to talk with your doctor about them.

Pelvic health issues are diagnosed by physical examination and imaging tests. For example, a pap test can tell your doctor whether you’ve had a tubal pregnancy or an ectopic pregnancy (where one or more of the organs outside the uterus are growing). A sigmoidoscopy is a diagnostic tool that uses air to inflate the intestine and allow your doctor to view it. Ultrasound can help detect abnormalities in the uterus, bladder, and rectum. Cystoscopy, a miniature instrument that looks inside the bladder or urethra, can help your doctor see the problem better.

Treatment

Fortunately, many of these conditions are treatable and often do not require surgery. For some, simple lifestyle changes and physical therapy are enough to help improve their situation.

For others, more severe problems may require a pelvic floor surgeon to perform an outpatient procedure. Regardless of the type of problem, Valley Health has a comprehensive team of specialists to help you receive the care you need.

Doctors such as urogynecologists and urologists specialize in these issues and can conduct precise tests to diagnose the problem. They also work with physical therapists, advanced practice specialists, and nurses to develop individualized treatment plans.

Pelvic floor physical therapy, often called Kegel therapy, can help reduce pain, tension, weakness, and tightness in the pelvic floor muscles. Physical therapists learn about your symptoms, assess the function of the muscles in the pelvis and teach you specific exercises to relieve your discomfort and control your symptoms.

Your therapist will use external manual techniques and internal biofeedback to determine the muscles that need to be strengthened and toned. They will also use an internal perineometer to measure the strength of your pelvic floor contractions.

Some women respond quickly to this therapy, while others need more time to get a feel for the muscle and learn how to contract it effectively. Your therapist will also use pelvic floor massage to help ease your discomfort and stabilize the muscles in the pelvis.