Pelvic health/dysfunction covers a broad spectrum of disorders and issues, including incontinence, endometriosis, sexual health, and interstitial cystitis. Many women go decades without relief from their symptoms because they haven’t been diagnosed, let alone treated. In this post, we’ll go over the basics of the pelvic floor and common pelvic health issues so you can get the help and treatment you need.
What Is a Pelvic Floor?
The pelvic floor refers to a group of muscles and ligaments that work to support the bladder, uterus, and bowel [1]. A strong pelvic floor is critical to prevent incontinence and bladder, uterus, and bowel prolapse, or lack of support. The pelvic floor muscles play an integral role in helping you control your bladder and bowel.
Dr. Jocelyn Fitzgerald, urogynecologist and pelvic reconstructive surgeon at the University of Pittsburgh Medical Center, calls the female pelvis extremely complex. "It has to be right," she said, "It's the machinery that builds the human race from scratch. So it has a reproductive system, it has a bladder, and it has a rectum. It has the bony pelvis, it has the pelvic floor muscles, and all of the nerves that keep all of those things in communication and functioning properly."
Common Pelvic Health Issues
Some of the most common pelvic health issues women of all ages experience include:
Chronic pelvic pain: Pain in your pelvic region that lasts for at least six months is considered chronic pelvic pain. The pain may be steady or may come and go. "And the thing about pelvic pain, and I hope one of the take-home messages of this panel will be that the female pelvis today is extremely complex, it has to be right," Dr. Fitzgerald. said. "It's the machinery that builds the human race from scratch."
Endometriosis: Chronic pelvic pain or pain during your menstrual cycle may be due to endometriosis. If not addressed early on, it can be difficult to treat. Endometriosis is characterized by the presence of tissue that resembles the lining of the uterus (endometrium) outside of the uterus. This leads to an inflammatory reaction that can cause scar tissue in the pelvis and other areas of the body.
Sexual health concerns: Women who suffer from incontinence often worry about leaking urine during sex. Other sexual health concerns that weakened pelvic health can cause include pain during sex and sexual dysfunction.
Interstitial cystitis: This chronic condition causes bladder pressure, pain, and pelvic pain. The pain ranges from feelings of mild discomfort to severe pain. "Interstitial cystitis is a syndrome of symptoms that mimic a urinary tract infection, like urgency and pain, but the tests show no sign of an infection," Dr. Fitzgerald explained.
Uterine/vaginal prolapse: Damage to the pelvic floor during childbirth may cause structures in the pelvis to sag or protrude into the vagina and even beyond the vaginal opening. As we get older, uterine and vaginal prolapse become more common.
What Is a Urogynecologist?
A urogynecologist is a doctor who diagnoses and treats pelvic floor conditions and disorders, including:
Overactive bladder
Weakened pelvic muscles
Reproductive issues
Incontinence
Urogynecologists evaluate, diagnose, and treat patients with pelvic floor issues.
"A urogynecologist first trains as an ob-gyn and then continues their training in the subspecialty of pelvic medicine and reconstructive surgery. A Urogynecologist diagnoses and treats pelvic floor conditions," explained Dr. Fitzgerald.
To find a urogynecologist, you should ask your primary care physician or ob-gyn for a referral. A urogynecologist will help diagnose and treat pelvic health issues.
What Is Pelvic PT?
Pelvic floor physical therapy, or pelvic PT, refers to treatment for pelvic floor problems, including exercises that can help relieve symptoms and disruptions to the patient’s quality of life.
When you start pelvic floor PT, a physical therapist will evaluate you to learn more about your symptoms and the severity of your condition. They will check the strength of your core muscles and your core endurance. They will also have you take part in activities and positions to check your pelvic floor muscles’ coordination.
The goal of pelvic PT is to ease your symptoms to allow you to get back to enjoying your everyday life, including controlling your bladder and taking part in activities you enjoy.
Your primary care physician should also be able to refer you to a pelvic PT.
You may be able to attend your sessions with a urogynecologist or pelvic PT via telehealth. This option is great for people who may not live close to these specialists or who don't have the flexibility in their schedules to take off large chunks of time to commute to doctor's appointments.
If you are having symptoms, including pelvic pain and discomfort, it's important to consult with a physician who can refer you to a urogynecologist and/or pelvic physical therapist. Don’t let anyone tell you, “it's all in your head.”
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