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    About Pelvic Floor Disorders

    What Are Pelvic Floor Disorders?

    The pelvic floor is a network of muscles, ligaments and tissues in the lower abdominal area. It acts like a hammock to support the uterus, bladder, vagina and rectum. Pelvic floor disorders are caused by tears, weakness or poor function of the muscles and nerves in the pelvic floor.

    Generally, pelvic floor disorders:

    • Are more common in women than in men
    • Will affect one in three women
    • Become more common with age
    • Can develop in individuals with a cancer history (rectal and uterine)

    Some pelvic floor disorders are similar to hernias, in which tissue protrudes abnormally. These include:

    • Vaginal or rectal prolapse (sagging of the vagina or rectum)
    • Rectocele (protrusion or herniation of the rectum into the vagina)
    • Cystocele (a herniation of the bladder into the vagina)
    • Enterocele (a herniation of the intestine into the vagina)
    • Sigmoidocele (a herniation of the sigmoid colon into the vagina)
    • Post-operative pelvic floor hernias

    Other pelvic floor disorders are caused by muscle dysfunction or poor muscle coordination. These include:

    • Urinary incontinence
    • Fecal incontinence
    • Constipation
    • Sexual dysfunction
    • Low anterior resection syndrome (occurs most often after rectal cancer surgery)

    Common Causes

    Both men and women can suffer from pelvic floor disorders. However, the disorders are more common in women, particularly those who have undergone vaginal childbirth.

    Factors contributing to pelvic floor disorders include:

    • Muscle strain or perineal tears associated with obstetrical delivery
    • Connective tissue disorders
    • Degenerative neurologic conditions
    • Obesity
    • Hysterectomy
    • Heavy lifting
    • Pelvic injury from a road accident or other trauma
    • Surgery or radiation for uterine, cervical, prostate, spine, bladder or rectal cancer

    Types of Pelvic Floor Disorders

    There are several major types of pelvic floor disorders. Often, more than one pelvic organ is affected. At the Mass General Pelvic Floor Disorders Service, patients are examined and treated by a multidisciplinary team who together determine a comprehensive course of treatment.

    Some pelvic floor disorders involve organ prolapse, in which the uterus, rectum, bladder, urethra, small bowel, and/or the vagina begin to fall out of their normal positions.

    Types of pelvic organ prolapse include:

    • Rectocele: the rectum protrudes through the back wall of the vagina
    • Cystocele: the bladder protrudes out through the anterior vaginal wall
    • Sigmoidocele: the sigmoid colon slips into the rectovaginal space
    • Enterocele: the small intestine protrudes through the upper vaginal supports (especially in women who have had a hysterectomy)
    • Vaginal vault prolapse or uterine prolapse, in which the entire vagina or uterus sag through the vaginal opening
    • Rectal prolapse, in which the lining and/or muscles of the rectum protrude out of the anus, typically during attempts at bowel movements

    In some cases, an organ slips out of its original location but not necessarily outside of the body. Unless it protrudes through an orifice, a woman may not know that she has a prolapsed organ.

    Rectal prolapse often affects nearby organs as well. Forty percent of women with rectal prolapse have associated uterine or bladder problems, including stress or urinary incontinence.

    Other types of pelvic floor disorders are caused by muscle or nerve dysfunction or anatomical defect. These include:

    • Urinary incontinence 
      Urinary incontinence can be caused by childbirth or other conditions that stretch the pelvic floor muscles. When these muscles cannot support the bladder properly, the bladder drops down and pushes against the vagina. Muscles that close off the urethra cannot be tightened.
    • Fecal incontinence 
      Fecal incontinence is most common to women with obstetric injuries. However, it can also affect men and women who have gone through rectal cancer surgery or anal sphincter trauma.
    • Constipation 
      Another common pelvic floor condition is constipation that does not respond to laxatives and other standard treatments. In most cases, the cause is either slow fecal transit or a pelvic floor obstruction. A full work-up is required of patients suffering from constipation to understand the underlying causes and determine the best course of treatment. For example, surgery for slow transit constipation may not be effective if the patient also suffers from obstructive constipation.

    Symptoms

    There are many symptoms of pelvic floor disorders. At Massachusetts General Hospital, our multidisciplinary team of specialists addresses the complex and often interconnected problems underlying these symptoms. Our goal is to return every patient to health and well-being.

    The pelvic floor is a network of muscles, ligaments and tissues in the lower abdominal area. It acts like a hammock to support the uterus, bladder, vagina and rectum. Pelvic floor disorders are caused by tears, weakness or poor function of the muscles and nerves in the pelvic floor. Common symptoms include:

    • A feeling of heaviness or fullness like something falling out of the vagina or rectum
    • A pulling, aching or “bulge” in the lower abdomen or pelvis
    • Difficulty emptying the bladder completely
    • Urinary incontinence
    • Fecal incontinence (inability to control bowel movements)
    • Constipation
    • Prolapse of the vagina or rectum

    Treatment Options

    Massachusetts General Hospital offers a variety of surgical and nonsurgical treatments for pelvic floor disorders, all designed to significantly improve function and alleviate pain and inconvenience. Our goal is to return every patient to health and well-being.

    Pelvic floor disorders are under-reported and under-diagnosed. That’s because many patients are uncomfortable talking about their symptoms or assume these problems can’t be corrected. In fact, a variety of surgical and nonsurgical treatments can significantly improve function and alleviate pain and inconvenience.

    Our Process

    As a first step, we do a thorough work-up to identify the underlying causes of each patient’s symptoms. We use comprehensive, state-of-the-art testing including:

    • Anorectal manometry to evaluate patients with constipation or fecal incontinence
    • Urodynamics to assess how well the bladder and sphincter muscles store and release urine
    • Pudendal nerve terminal latency testing
    • Endoanal ultrasound to determine the presence or absence of anal sphincter injury
    • Electromyography recruitment to measure the function of muscles involved in defecation or urination
    • Transit studies to assess the speed of enteric contents through the bowel
    • Defecography to identify disorders of the lower bowel that are not viewed through colonoscopy or sigmoidoscopy
    • Colonoscopy to diagnose polyps and cancers

    After identifying the underlying problem, the care team works with the patient and referring physician to determine the best course of care. This may include any (or a combination) of the following: