What are the most common pelvic floor disorders in women, and what treatment options are available?

Pelvic floor disorders (PFDs) are extremely common, affecting up to 25% of U.S. women. The most common PFDs are pelvic organ prolapse, urinary incontinence and accidental bowel leakage. There are both conservative and surgical/procedural treatment options for each of these disorders. We typically start with conservative options, such as physical therapy, and progress to surgical or procedural treatment if the initial therapy fails or does not fit with a patient’s lifestyle.

For pelvic organ prolapse (POP), the most conservative treatment option is lifestyle and behavioral modification, which may include weight loss, smoking cessation and pelvic floor muscle exercises. Pelvic floor physical therapy is another treatment option, which involves working with a physical therapist who specializes in treating women with these conditions. Vaginally placed devices, called pessaries, are also a common treatment. A pessary is a silicone device that fits in the vagina and supports the vaginal walls and/or uterus. They come in many different shapes and sizes and can be used for long periods of time if desired, but do require regular maintenance visits. Finally, there are several surgical treatment options available for prolapse. I typically work with a patient to find a surgical option that fits her lifestyle, other medical conditions and severity of her POP.

For urinary incontinence (UI), there are similar lifestyle and behavioral modifications, including timed voiding, fluid management and optimization of other health conditions. Pelvic floor physical therapy is also a good option. For stress urinary incontinence (SUI), or leakage with laugh, cough or sneeze, vaginal pessaries may be used as a conservative treatment option to support the urethra. The gold standard surgical treatment for SUI is a minor surgical procedure called a sling, which acts like a hammock to support the urethra. For overactive bladder (OAB), there are both medications and procedural treatments, including bladder Botox injections and sacral neuromodulation (SNM). SNM acts like a pacemaker for the bladder and bowel.

Finally, for accidental bowel leakage, there are lifestyle modifications and medications that can optimize stool consistency. Pelvic floor physical therapy (PT) can be extremely helpful. For patients who don’t find success with lifestyle modification or PT, there are also surgical treatments, namely SNM.

For more information about pelvic floor disorders, visit uvahealth.com/services/pelvic-floor-disorders.

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Dr. Monique Vaughan is a urogynecologist at the University of Virginia Health System specializing in pelvic floor disorders.

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