June 23, 2020

Ask the Doctor: Pelvic Floor Health

Sarah Bradley

Sarah Bradley, MD

Sarah Bradley, MD, of Western Carolina Women’s Specialty Center, answers some questions about pelvic floor health.

Q: What is the pelvic floor and what does it do?

A: The pelvic floor is a group of muscles in the pelvis that support the organs in the pelvis, including the rectum, vagina, uterus and bladder. Contraction and relaxation of these muscles allows for proper evacuation of the bowels and bladder, and helps maintain continence. The pelvic floor and ligaments in the pelvis suspend the pelvic organs in the normal anatomic position.

Q: What kind of training makes you a pelvic floor expert?

A: After completing my residency in Obstetrics and Gynecology, I chose to further subspecialize and do what is called a fellowship. My three-year accredited fellowship was in Female Pelvic Medicine & Reconstructive Surgery at Georgetown University and MedStar Washington Hospital Center in Washington, DC. There are other types of pelvic floor experts that Ialso work closely with, such as pelvic floor physical therapists, to provide the best treatment for pelvic floor muscular and connective tissue problems.

Q: Do pelvic floor disorders only affect women who’ve given birth?

A: While the biggest risk factor known for most pelvic floor disorders is vaginal childbirth, we know there is a large genetic component. There are many women who never develop these issues despite having multiple births and some women who have never been pregnant or have cesarean deliveries can also develop them. We are still learning a lot about the factors that lead to developing these symptoms. About one-third of women who have delivered one or more children may experience prolapse symptoms, and one out of nine (11 percent) may undergo surgery for prolapse in their lifetime. Urinary incontinence related to pelvic floor weakness after childbirth is also common, affecting about 40 percent of women postpartum. Often, these symptoms resolve after pregnancy. In some women they persist or they may develop symptoms years later in life.

Q: How does having a baby affect the pelvic floor?

A: Having a baby can affect the pelvic floor in several ways. Stretch of the tissue in this area for long periods of time may cause damage to the nerves that control the bladder, rectum and pelvic floor muscles. Stretching of the muscles or ligaments that support the pelvic organs may cause muscle laxity or tears. Disrupting the connective tissue and muscle of the pelvic floor can allow for movement of the pelvic organs leading to incontinence or prolapse. There is higher risk of this with vaginal childbirth, particularly with forceps or vacuum deliveries. However, it may occur in women that undergo cesarean delivery during labor prior to delivery or the pressure on the pelvis during the pregnancy itself.

Q: How can a woman keep her pelvic floor healthy?

A: Preventive strategies are aimed at strengthening these pelvic floor muscles and reducing stress to them when possible. Going to pelvic floor physical therapy with a trained physical therapist is an invaluable tool to teach women how to perform these exercises correctly. There is some evidence that yoga and Pilates can improve pelvic strength and support as well. Ways to decrease stress to the pelvic floor include maintaining a healthy body weight, strategies for decreasing constipation and bowel movement straining, quitting smoking cigarettes and using proper technique when lifting heavy objects.

Q: Do pelvic floor muscles affect sex?

A: Yes, they can. Painful intercourse can be a result of muscles that are overly contracted and difficult to relax. Often, patients are unaware that these muscles are strained and tender. A detailed pelvic exam by a provider can assess these muscles, and the most effective way to treat these muscles is going to a practitioner such as a pelvic floor physical therapist who can teach patients also how to target and actively relax these muscles.

Q: What are signs a woman should see a doctor or specialist?

A: It is important for women to know that there are treatments for incontinence and prolapse. Many women have been living with these disruptive conditions for many years before a provider assesses for these symptoms or a woman seeks care herself. We, as medical providers, are getting better at screening women for these symptoms during annual exams. However, if you are experiencing incontinence of bowel or bladder, or pelvic organ prolapse symptoms such as a vaginal bulge, please feel empowered to discuss these with your provider as there are nonsurgical and surgical treatments available.

Sarah Bradley, MD, is a provider at Western Carolina Women’s Specialty Center, an Affiliate of Mission Health. To schedule an appointment, call 828-670-5665.

To find a women’s care provider in your area, visit missionhealth.org/womens.