University of California San Francisco

Pelvic Floor Dysfunction

The term "pelvic floor" refers to the group of muscles that form a sling or hammock across the opening of a woman's pelvis. These muscles, together with their surrounding tissues, keep all of the pelvic organs in place so that the organs can function correctly.

A pelvic floor disorder occurs when the pelvic muscles and connective tissue in the pelvis weaken or are injured.

An estimated one-third of all U.S. women are affected by one type of pelvic floor disorder in her lifetime. Disorders may result from pelvic surgery, radiation treatments, and, in some cases, pregnancy or vaginal delivery of a child.

What are the most common pelvic floor disorders?

There are a variety of problems related to the pelvic floor. The most common include:

  • Pelvic organ prolapse - A "prolapse" occurs when the pelvic muscles and tissue become weak and can no longer hold the organs in place correctly. In uterine prolapse, the uterus can press down on the vagina, causing it to invert, or even to come out through the vaginal opening. In vaginal prolapse, the top of the vagina loses support and can drop through the vaginal opening.

    Some symptoms of pelvic organ prolapse may include:
    • A feeling of heaviness or fullness or as if something falling out of the vagina. 
    • Some women also feel a pulling or aching or a "bulge" in the lower abdomen or pelvis.
    • Prolapse may also cause a kinking in the urethra, making it harder for a woman to empty her bladder completely, or causing frequent urinary tract infections.
  • Urinary incontinence - This can occur when the bladder drops down into the vagina. Because the bladder is not in its proper place, a key symptom of urinary incontinence is urine leaking without a woman's control. Other symptoms might include urgency to urinate, frequent urination, and painful urination.
  • Anal incontinence - This can occur when the rectum bulges into or out of the vagina, making it difficult to control the bowels. It can also occur when there is damage to the anal sphincter, the ring of muscles that keep the anus closed.

What are the treatments for pelvic floor disorders?

Many women don't need treatment for their pelvic floor disorder. In other cases, treatment for symptoms includes changes in diet, weight control, and other lifestyle changes. Treatment may also include surgery, medication, and use of a device placed in the vagina called a pessary that helps support the pelvic organs.

Recent NICHD research has found that combining repair surgery with a second surgical procedure can help prevent urinary incontinence later.

Exercises for the pelvic floor muscles (known as Kegel exercises) can often help strengthen the muscles around the openings of the urethra, vagina, and rectum. Treatments for incontinence can also include medication and bladder or bowel control training.

  • Surgery. If  pelvic floor dysfunction is the result of a rectal prolapse or rectocele, surgery may be indicated. A rectal prolapse occurs when tissue that lines the rectum falls or prolapses into the anal opening. In women, a rectocele occurs when the end of the rectum pushes through the wall of the vagina. A defecating proctogram test is used determine if these conditions are causing your pelvic floor dysfunction.