Get the Pelvic ‘Floor-One-One’

**By Kathleen Kobashi, MD, FACS, FPMRS**

While pelvic floor health disorders can seem alienating, it is important to know that you’re not alone and there are a variety of ways to treat bothersome symptoms.

The pelvic floor is a group of muscles in the pelvic region, that can be described as a “hammock” of ligaments that sling between the pubic bone in the front and the tailbone in the back. For women, these muscles and ligaments work to support and control the uterus, vagina, bowel and bladder; whereas for men, they support just the bowel and bladder.

As a multidisciplinary team, the members of the Pelvic Floor Center at Virginia Mason treat virtually every pelvic floor health issue that can be experienced by both men and women. In this article we’ll dive into common health problems associated with the pelvic floor and why maintaining pelvic floor health is so important. Pelvic floor disorders can become huge quality-of-life issues that can interfere with our daily activities. It is vital for us to be aware that there are successful, minimally invasive treatment options available.

Common health issues associated with the pelvic floor

When it comes to pelvic floor health issues, there are several key terms to remember, like incontinence and prolapse. Incontinence is the lack of control of bladder or bowel function resulting in leakage, while prolapse is the displacement or dropping of pelvic organs through a weak pelvic floor, much like a hernia. There are other pelvic floor disorders that may result in the opposite problem of difficulty emptying the bladder or bowel.

Mother and daughter drinking coffeeThe two most common forms of urinary/bladder incontinence are stress and urgency leakage. Stress incontinence is the involuntary release of urine from coughing, sneezing or other similar actions and is commonly (but not exclusively) experienced by women who have had vaginal delivery of babies. Aging, genetics and gravity can also play a role. Conversely, urgency incontinence is exactly as it sounds – when nature calls, you don’t always have a say in when you answer, and it is urgent. This form of incontinence can be caused by the consumption of dietary irritants, such as coffee or wine, that aggravate the bladder, as well as hormonal changes that make the bladder more irritable. In men, urgency can also be related to prostate enlargement.

Fecal/bowel incontinence (aka accidental bowel leakage) is an involuntary loss of bowel control that can result in stool abruptly leaking from the rectum. Disorders associated with bowel function can range from constipation to complete loss of control of the bowel, and everything in between.

Prolapse occurs when pelvic organs – such as the bladder, uterus, bowels, vagina or rectum – drop down into or outside of the anus or vaginal canal. Prolapse can be due to a number of issues, including pregnancy, childbirth, obesity, chronic respiratory issues, constipation and cancer in the pelvic region.

Signs to look out for and when to see your doctor

If you’re concerned you might be dealing with a pelvic floor problem, here are a few signs and symptoms:

  • Urinary/bladder incontinence – symptoms can include leakage of urine with coughing, sneezing or exercise, and can also be associated with a sudden, intense and often uncontrollable urge to urinate. Other lower urinary tract symptoms may include frequent urination, slow or dribbling streams of urine or the inability to completely empty your bladder.
  • Fecal/bowl issues – symptoms can include chronic bloating, constipation, diarrhea or involuntary loss of fecal matter.
  • Pelvic organ prolapse – symptoms can include a feeling of fullness in the pelvic floor or vagina, a feeling that something is “falling” out of the anus or vagina, discomfort with sexual intercourse, urinary or fecal incontinence, a sense of trapping of stool or the inability to completely empty your bowels.

It’s important to note that any combination of the symptoms above can occur.

The importance of pelvic floor health

Given the critical bowel, bladder and sexual functions these muscles support, keeping your pelvic floor healthy and strong is crucial. There are a variety of exercises that can be done to improve overall pelvic floor health and functionality, with some of the more common ones being Kegels. Working your pelvic floor regularly is especially important for women in order to minimize the risk of developing prolapse, incontinence or other pelvic health issues that stem from pregnancy or aging.

If you’re experiencing any one or combination of the symptoms discussed above for an extended period of time, it may be time to call and arrange a visit with your doctor. From there, they can work with you to decide your best course of treatment, whether that’s pelvic floor therapy or proceeding with some tests that can help identify the root cause of your problem and facilitate treatment planning.

Kathleen.KobashiKathleen Kobashi, MD, FACS, FPMRS is board-certified in urology with a subspecialty certification in female pelvic medicine and reconstructive surgery. She is the section head of Urology and director of the  Pelvic Floor Center at Virginia Mason. Dr. Kobashi is a urologist/urogynecologist who specializes in the treatment of pelvic floor disorders, including urinary and bowel incontinence, pelvic organ prolapse, and urinary tract fistulas, with expertise in pelvic floor reconstruction through open and robotic surgery.

Understanding the Pelvic Floor: Five Things Women Should Know

**By Una Lee, MD**

What is the pelvic floor and why is it important? 

The pelvic floor is not a “floor” but more like a “bowl” of muscles and connective tissues that sits within the bony pelvis. This is a critical structure because it supports urination, bowel function, sexual function, pregnancy, delivery, and physical functioning. In my opinion, the term “pelvic floor” is kind of a G-rated way of referring to parts of the anatomy that people are uncomfortable saying aloud. But even if people would rather At doctorsay “pelvic floor” than other anatomic terms, that’s OK, because it’s referring to the same area and talking about it is a good thing. Women are often embarrassed to talk about these issues, and therefore many cope with bothersome symptoms for years. There is a common myth that pelvic floor problems are a normal part of aging and nothing can be done. In actuality, pelvic floor problems are very common and there are many effective treatment options.

 How do I identify my pelvic floor?

Many women are familiar with the Kegel exercise, which involves squeezing the muscles of the pelvic floor. To find these muscles, place one or two fingers in the vagina and squeeze around your fingers. Once you’re able to do this, you don’t need your fingers to do the exercise. The sensation should feel like you are lifting your pelvic floor up and in, as if you’re trying to pull something up into the vagina. Be sure to breathe normally and not hold your breath. Avoid tensing the surrounding muscles, such as your abdomen, thighs, or buttocks. Squeeze for a count of five, then rest for 10 seconds, and repeat. If you are not sure you are doing it correctly, ask your doctor for a referral to a pelvic floor physical therapist. Doing Kegels correctly is a skill that you will serve you for a lifetime, so it will be worth the investment.

What happens when the pelvic floor fails?

We take for granted that this incredibly complex structure works perfectly most of the time. But when the pelvic floor is not working well, you will notice leakage of urine or stool, rushing to the toilet and urinating frequently, or a sensation of your pelvic organs falling down or out of place. Symptoms can range from mild to severe. Sometimes symptoms get better on their own or stay the same over time, but they can also get worse and become more bothersome. If pelvic floor symptoms are affecting your quality of life and getting in the way of doing the activities you enjoy, it’s time to see your doctor or a specialist.

Did you know that November is Bladder Health Month? Please join us for one of our free education sessions presented by pelvic floor disorder experts on November 8 and 9, at Virginia Mason’s Federal Way and Seattle medical center locations.

Did you know that November is Bladder Health Month? Please join us for one of our free education sessions presented by pelvic floor disorder experts on November 8 and 9, at Virginia Mason’s Federal Way and Seattle medical center locations. Click a location to register, or call (206) 341-0360. These events are open to women of all ages, offering the latest information on conditions and treatments in a relaxed atmosphere.

What is a urogynecologist? 

A urogynecologist is a urologist or gynecologist who dedicates themselves to being a specialist in female pelvic floor problems — primarily urinary incontinence, pelvic prolapse, fecal incontinence, and also reconstructive surgery of the female genito-urinary system. Urogynecology is the intersection of urology and gynecology, and is a new board certification. Three board-certified urogynecologists currently practice at Virginia Mason including myself (Una Lee, MD), Kathleen Kobashi, MD and Alvaro Lucioni, MD.

What helps prevent pelvic floor problems?

Maintaining a healthy weight is one of the best ways to keep the pelvic floor healthy. Excess weight puts additional pressure on the pelvic floor, but even modest amounts of weight loss, just 5 to 10 percent, can improve symptoms significantly.

Avoiding things like chronic coughing due to smoking (quit!) and straining due to constipation will also decrease stress and pressure on the pelvic floor. Maintaining your overall health through good nutrition, hydration, sleep, sexual activity, and exercise also supports a healthy pelvic floor. Just having a better understanding of pelvic floor function is a step in the right direction. It’s an amazing part of the body that rarely gets discussed, so let’s start talking about it!

Lee_UnaUna Lee, MD is a urogynecologist in the Section of Urology at Virginia Mason who enjoys sparking discussion on these intimate topics, to help raise awareness and ultimately improve the health of women.