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Pelvic Floor Disorders

Pelvic Floor Dysfunction

Pelvic floor dysfunction is the weakness of the pelvic floor muscles that can lead to urinary incontinence or involuntary loss of urine.

The Causes

According to a study by Kepenekci et al, 67.5% of women experience pelvic floor dysfunction of at least one major type1. This translates to millions of women in the U.S. and billions worldwide who suffer from some form of pelvic floor dysfunction. Pelvic disorders usually occur when the pelvic muscles are stretched and damaged during pregnancy and childbirth. Other contributors can be weight gain, work conditions, chronic constipation, hormones, or simply aging.

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Anything that increases pressure in the abdomen creates increased pressure on the pelvic floor muscles, and can cause them to be damaged or weaken. Weakening can be caused by pregnancy and childbirth; weight gain; women who suffer from chronic cough or constipation; certain repetitive exercises or motions in otherwise healthy athletes such as gymnasts (from repeated hard landings); long marches carrying heavy back packs (soldiers in the field).

The weakening of the pelvic floor can cause a multitude of disorders including urinary incontinence.

Pelvic floor dysfunction is known as a “silent epidemic”. ’Silent’, because women do not discuss it, and ‘epidemic’, because of the number of women who suffer from the conditions caused by pelvic floor dysfunction. With approximately 50 million women and the US and billions of women worldwide with pelvic floor dysfunction, it is more common than hypertension, depression and diabetes.

If pelvic floor dysfunction is so common, why haven’t I heard of it?
It is as embarrassing as it is uncomfortable. Who wants to talk about leaking urine? Urinary incontinence can run in families, but even close family members rarely share information about their disorder.

Why are women not seeking treatment for their conditions? Until recently, the most common solutions were medication or surgery, with all of the side effects and potential complications that go along with them. There is another solution.

In 1948, Dr. Arnold Kegel developed the first model of rehabilitation for the pelvic floor, and the idea of conservative treatment versus surgery was born. Since then, surgical procedures have come and gone, testifying to the effectiveness of any one of them in particular. As a result, pelvic floor muscle therapy (PFMT) is making a comeback. You can rehabilitate the pelvic floor muscles as you would rehab an injured back or knee. With leva, you can treat your symptoms without surgery and the associated side effects of surgery.

Pelvic floor health should be part of a woman’s annual wellness exam, just like a pap smear or mammogram. Even with professional medical organizations recommending PFMT as the first line of treatment, Urinary leakage or urinary incontinence is rarely discussed during a woman’s wellness exam unless the patient brings up the subject herself. With early diagnosis, these disorders can be easily treated. Be proactive, and discuss pelvic floor health with your doctor at your next annual wellness exam.

Urinary Incontinence

This is defined as the involuntary loss of urine.

Urinary incontinence (UI) is the most common form of pelvic floor dysfunction. There are several forms of UI including stress urinary incontinence (SUI), urge incontinence, mixed incontinence, and coital incontinence. UI can be caused by a variety of factors including pregnancy, childbirth, obesity, chronic constipation, repeated strenuous lifting, and pelvic floor weakness or damage.

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Stress Urinary Incontinence

The involuntary loss of urine caused by physical activity and/or increased abdominal pressure, such as coughing, sneezing, or exercising.

Stress urinary incontinence (SUI) is the most common form of incontinence in women. The most common cause of SUI is childbirth. Other causes include obesity, chronic constipation, and age.

Many women who suffer from SUI do not think of it as incontinence because it only occurs with stress to your pelvic floor, such as sneezing, coughing and exercising. Women with this condition often believe it is a part of aging or the price of motherhood. SUI is a treatable condition, especially when it is caught early. Be proactive; you do not have to cross your legs when you sneeze or cough!

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Urge Incontinence

Urination initiated by involuntary bladder spasms triggered by the sight, sound, or thought of water or urination. The sudden need to urinate causes the spasm and the uncontrolled release of urine.

Typically with urge incontinence (or overactive bladder), women feel the urge to urinate with less than 1 cup of urine in their bladder, when most people can hold twice that amount before feeling the need to urinate. You leak urine with urge incontinence because the bladder muscles contract at the wrong time.

PFMT, lifestyle changes, and bladder training are easy and safe methods to control urge incontinence.

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Mixed Incontinence

Mixed incontinence is a combination of stress and urge incontinence, as it shares symptoms of both.

Since mixed incontinence is a combination of stress and urge incontinence, both should be diagnosed and treated for a satisfactory result.

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1 Kepenekci I., Keskinkilic B., Akinsu F. et al: Prevalence of Pelvic Floor Dysfunction in the Female Population and the Impact of Age, Mode of Delivery and Parity. Dis Colon Rectum. 2011 Jan;54(1):85-94.

2 N ENGL J MED 362;22 NEJM.ORG June 3, 2010

3 AHCPR, Rockville Maryland, US Dept. of HHS, 1996. AHA 2001, American Family Physicians 2001