The “pelvic floor” is the group of muscles that form a sling or hammock across the floor of the pelvis. Together with surrounding tissues, these muscles hold the pelvic organs in place so they can function correctly. The pelvic organs include the bladder, urethra, intestines, and rectum. A woman’s pelvic organs also include the uterus, cervix, and vagina.1
A PFD occurs when the pelvic muscles and connective tissue weaken or are injured, become too tight, or activate the wrong way (1). The most common types of PFDs are the following:
Pelvic organ prolapse. “Prolapse” happens in women when the pelvic muscles and tissue can no longer support one or more pelvic organs, causing them to drop or press into the vagina. For instance, in uterine prolapse, the cervix and uterus can descend into the vagina and may even come out of the vaginal opening. In vaginal prolapse, the top of the vagina loses support and can drop toward or through the vaginal opening. Prolapse also can cause a kink in the urethra, the tube that brings urine from the bladder to the outside of the body.
Bladder problems. Urinary symptoms can include urinating too often in the day or night, strong urgency to urinate, or urinary leakage. The leaking of urine, called urinary incontinence is common among women and can happen as a result of an exertion (like a laugh, jumping, cough or sneeze) or other factors involving the bladder muscles. Common types include:
-Stress incontinence
-Urge or urgency incontinence (also called overactive bladder)
-Overflow incontinence
Bowel control problems. The leaking of liquid or solid stool from the rectum, can result from a number of reasons including damage to or weakening of the anal sphincter.
Other PFDs include pelvic pain, constipation, and sexual dysfunction. You can have more than one in combination. Most studies report the estimates of prevalence of urinary incontinence in women to be between 25% and 45%.
What is the impact?
These health conditions substantially decrease quality of life, increase depression, social isolation, caregiver burden, and economic costs to the individuals and society.
Menopause is a major risk factor for PFD. There are an abundance of estrogen receptors in the urogenital tract. With the decline in endogenous estrogen during menopause, women become vulnerable to a PFD as well as other issues such as urinary tract infection.
A significant body of knowledge implicates menopausal estrogen levels in the pathogenesis of the common symptoms of GSM, which include vaginal dryness and burning; pelvic pain and dyspareunia; and such PFDs as irritative LUTS (urinary urgency, frequency, and dysuria). These symptoms are highly prevalent, affecting up to 80% of menopausal women.
We know women are afraid of PFD and lack knowledge about what is ‘normal’ and what is a PFD. For example, is it normal for a bit of urine to leak after you have had children? PFD remains a taboo topic that women are embarrassed to get help for.
Check out our podcast with pelvic floor physiotherapist Angelique Montano-Breslin and our YouTube video with Sarah Marshall (pelvic floor physiotherapist).
Education. Learn about what your pelvic floor muscles are. Women lack knowledge about the pelvic floor structure and function. In one study for example, 1/3 of respondents believed bones and joints were part of the pelvic floor.
Prevention. Pelvic floor muscle training (PFMT) is an effective prevention strategy for PFD. A pelvic floor physiotherapist is instrumental in supporting how to do this effectively.
Treatment. Guidelines support PFMT for treating PFD. However, one study estimated that only 46% of women go for PFMT training for urinary incontinence .
✨ At PAUZ Health, we combine evidence-based medical care with personalized support from menopause-certified practitioners, pelvic floor physiotherapists, and health coaches. Because informed women make powerful health decisions — and it’s time for that to be the norm.
Additional Resources:
Neels H, Tjalma WA, Wyndaele JJ, De Wachter S, Wyndaele M, Vermandel A. Knowledge of the pelvic floor in menopausal women and in peripartum women. J Phys Ther Sci. 2016 Nov;28(11):3020-3029. doi: 10.1589/jpts.28.3020. Epub 2016 Nov 29. PMID: 27942113; PMCID: PMC5140793.
Neels H, Tjalma WA, Wyndaele JJ, De Wachter S, Wyndaele M, Vermandel A. Knowledge of the pelvic floor in menopausal women and in peripartum women. J Phys Ther Sci. 2016 Nov;28(11):3020-3029. doi: 10.1589/jpts.28.3020. Epub 2016 Nov 29. PMID: 27942113; PMCID: PMC5140793.
Boyle R, Hay-Smith EJ, Cody JD, et al.: Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev, 2012, 10: CD007471.
Buckley BS, Lapitan MC, Epidemiology Committee of the Fourth International Consultation on Incontinence, Paris, 2008: Prevalence of urinary incontinence in men, women, and children—current evidence: findings of the Fourth International Consultation on Incontinence. Urology, 2010, 76: 265–270.
Jackson S: Stress urinary incontinence: new management options. Curr Med Res Opin, 2005, 21: 1669–1675.
Botlero R, Urquhart DM, Davis SR, et al.: Prevalence and incidence of urinary incontinence in women: review of the literature and investigation of methodological issues. Int J Urol, 2008, 15: 230–234.