About Pelvic Floor Disorders

Affecting the bladder, bowel or genital tract, pelvic floor disorders can be unpleasant and even debilitating. We provide surgical and non-surgical therapies to restore your comfort and quality of life.

The pelvic floor is a combination of muscles, ligaments and connective tissues that support the pelvic organs – the bladder, vagina, uterus and rectum. The pelvic floor can be weakened by a combination of factors including childbirth, repeated heavy lifting, the effects of menopause and aging, surgery, and chronic medical and neurological conditions.

Pelvic floor disorders are common, affecting over 50 percent of women, and significantly impacting quality of life. They can lead to depression, social isolation, and avoidance of physical and sexual activity due to discomfort and embarrassment.

Despite common misconceptions, women who develop pelvic floor dysfunction do not have to learn to live with it. We’ll work with you to recommend the treatment methods with the greatest potential to achieve or even exceed your goals for recovery.

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Descriptions below include links to fact sheets published by the American Urogynecologic Society (AUGS).

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Prolapse of vagina or uterus

Prolapse occurs when the ligaments or musculature supporting an organ are weakened or injured, causing the organ to drop or bulge. The causes of pelvic organ prolapse vary and include vaginal delivery, heavy lifting, menopause, and repeated straining in association with chronic coughing or constipation.

Pelvic organ prolapse tends to worsen over time, so discuss your symptoms with your physician. A physical examination is the first step in diagnosing the type and severity of pelvic organ prolapse. Other types of testing are available including imaging such as cystoscopy, bladder function testing, ultrasound and MRI.

Download fact sheet on pelvic organ prolapse (pdf) »

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Urinary incontinence

Loss of bladder control is not only bothersome but often debilitating. It is also common. In fact, approximately one in three women experience leakage of urine in their lifetime.

Urinary incontinence is treatable and often curable at all ages, often without surgery. The best treatment for you depends on factors including your lifestyle and preferences, as well as the type of incontinence you are experiencing.

• Urge incontinence / overactive bladder (OAB) is characterized by having the urge to go to the bathroom, but leaking small amounts of urine before you can actually get to a toilet.
  Download fact sheet on overactive bladder (pdf) »
• Stress incontinence is urine leakage that occurs during activities such as coughing, sneezing, laughing or exercise.
  Download fact sheet on stress urinary incontinence (pdf) »
• Urinary retention is the inability to empty the bladder completely, which can lead to problems with the urinary tract, such as infections or kidney damage.
• Nocturia / night time voiding is the frequent need to make trips to the bathroom and urinate during the night.

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Birth-related injuries

Regardless of mode of delivery, many women who give birth are likely to experience some degree of pelvic floor symptoms or injury.

• Perineal lacerations / episiotomy complications can leave women with pain in the perineum and problems having bowel movements after giving birth.
• Stress incontinence is urine leakage that occurs during activities such as coughing, sneezing, laughing or exercise.
  Download fact sheet on stress urinary incontinence (pdf) »
• Pelvic organ prolapse results when the ligaments, connective tissue and muscles supporting the pelvic organs (bladder, uterus, rectum) lose their strength, causing the organ to slip or protrude through the muscle wall. We evaluate and treat both vaginal prolapse and uterine prolapse.
• Birth-related fistula is an injury typically caused by the unrelieved pressure of the fetus pressing against the soft tissue of the pelvis, restricting blood flow to that area of the womb.

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Complications from surgical mesh

Patients who have had transvaginal mesh implants may experience complications – caused by the surgical procedure or problems related to the mesh – that require mesh removal.

Transvaginal mesh is considered a permanent implant, and over time the body’s tissue grows into and around it. Our surgeons are highly skilled at procedures to remove vaginal mesh. During surgery, they delicately work to remove as much of the mesh as possible without damaging tissue and surrounding organs. Each surgery and the amount of mesh the surgeon is able to remove varies based on a patient’s anatomy and the type of mesh used in the original surgery. Subsequent surgery may be necessary to correct the original prolapse and/or other complications related to the mesh.

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Bowel disorders

There are many types of bowel disorders that affect millions of Americans each year. Our physicians evaluate and treat patients who are experiencing fecal incontinence or constipation.

• Bowel incontinence is the loss of normal control of the bowels, which leads to stool or gas leaking from the rectum at unexpected times.
• Constipation is a symptom, not a disease. It affects everyone, although it becomes more common as people age. Women report constipation two to three times more often than men. Because of the seriousness of side effects, persistent constipation should be evaluated and treated by a physician.
  Download fact sheet on constipation (pdf) »

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Gynecologic fistulas

A fistula is an abnormal connection that develops between the urinary or bowel tract and the genital tract, which may cause leakage of urine or bowel material into the vagina. Gynecologic fistulas can be divided into birth-related and non-obstetric categories.

• Non-obstetric fistulas are most likely to occur in post surgical patients, radiation patients, women with endometriosis and women with diverticulitis.
• Birth-related fistulas may result from a prolonged or obstructed delivery. This injury is usually caused by the unrelieved pressure of the fetus pressing against the soft tissue of the pelvis, restricting blood flow to that area of the womb.

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Procedures and treatment

Our physicians perform numerous procedures for the treatment of pelvic floor disorders.

For urinary incontinence, outpatient procedures include the midurethral sling (tension free vaginal tape,TVT) procedure and sacral neuromodulation. To treat pelvic organ prolapse, common short stay procedures performed include laparoscopic and robotic-assisted sacral colpopexy and vaginal reconstruction with native tissue repair. Our specialists are highly skilled in explantation of mesh when needed.

Download fact sheet on midurethral sling (pdf) »

Our physicians also provide innovative office procedures including neuromodulation, peripheral nerve electrode placement and botulinum toxin (Botox^®) intramuscular bladder injections for severe urge incontinence, trigger point injections for pelvic muscle pain, and transurethral bulking agent injections for stress incontinence.

In certain cases, pelvic floor disorders can be treated with physical therapy. Our physicians work closely with Washington University’s pelvic rehabilitation physical therapists when a patient may benefit from this mode of treatment.