A pelvic floor disorder can make life more difficult. These difficulties may not be the kind you would discuss at lunch with co-workers, but they affect millions of women nationwide.
Your pelvic muscles form a sling that holds up your bladder, uterus, and other pelvic organs. Childbirth, pregnancy, obesity, menopause, or simply the passage of time can weaken this tissue.
The result often is incontinence. Also, one or more of your pelvic organs may drop into or out of the vagina. This is called pelvic organ prolapse.
It’s estimated that 25% of U.S. women have a pelvic floor disorder. The condition is more common as you get older.
Pelvic floor symptoms in menopause: What’s normal and what’s not?
Common symptoms of a pelvic disorder:
- Urine leaks when you cough, laugh, or exercise
- Trouble having regular bowel movements
- Feelings of fullness, discomfort, or pain in your vagina
- Urine leaks before you can get to the toilet
Melissa Pytlik Monson, PA-C, is a physician assistant at Sanford Southpointe Clinic in Fargo, North Dakota, who specializes in women’s health services. Pytlik Monson and the rest of the team at the Pelvic Floor Clinic aim to normalize this topic and provide relief to patients.
“If you’re ever wondering whether something is normal or not normal, I recommend bringing it up with your provider,” Pytlik Monson said. “These topics can be awkward and uncomfortable, and patients can feel really vulnerable.”
Are symptoms associated with a pelvic disorder normal? Yes, they are normal in that they are common. But it is incorrect to assume that defining them as normal also means they’re inevitable, or untreatable.
“There are benefits in using the term ‘normal’ for things like bladder leaking because it helps patients understand that they’re not alone,” Pytlik Monson said. “I think it can help with stigma and shame, but I don’t think it’s fair that we have normalized it by saying ‘Oh, you’re going through menopause.’ Or ‘Oh, you know, you’ve had babies. Of course you’re going to pee your pants.’”
Why does menopause affect your pelvic floor?
The one-in-four ratio of women dealing with a pelvic floor disorder climbs with the onset of menopause.
Menopause causes a drop in estrogen. A lack of estrogen can weaken the pelvic floor muscles, reduce tissue elasticity, and can lead to issues like urinary incontinence, vaginal dryness, prolapse, and pain during intercourse.
The loss of estrogen also thins the urethral and vaginal tissues, making them more prone to irritation and dysfunction.
“It’s way more common than we ever acknowledged previously,” said Pytlik Monson, who has been in practice for more than eight years.
Through her work at the clinic, Pytlik Monson has treated many women who are addressing pelvic floor disorders for a second time. Perhaps decades earlier they had a procedure that fixed a problem, but now their symptoms indicate it’s time for another look.
When should you see a provider?
She encourages women to have conversations with experts before the symptoms show up.
“I’m starting to see patients who have recently had babies and understand that there are things we can do now. It doesn’t have to be that when we see a patient we have to ask them, ‘How long has this been going on?’”
For Pytlik Monson and her colleagues, conversations with patients have evolved. Providers are much more apt to ask patients specifically if they’re dealing with anything that would suggest a pelvic floor issue.
“But if we ask them, ‘Do you have any concerns about your bladder? Do you have concerns about your sex life? Do you have trouble with your bowels?’ I think sometimes it makes it easier for the patient when we put forward the question instead of expecting they’re automatically going to bring it up.”
The next part of the patient-provider conversation involves a treatment plan. Often, diet and exercise can play a role in healing, as can medicine or surgery.
What can health care providers do for pelvic floor issues?
Pytlik Monson works closely with Sanford physical therapists who help patients with exercises that influence urinary habits and other functions.
Physical therapists will cover the anatomy of the pelvic floor and changes that occur from events such as childbirth, constipation and other issues.
Additionally, they will talk about bad habits. A couple of these habits: going to the bathroom every time there is an urge even though you just went; and drinking beverages that irritate the bladder, such as pop and coffee.
They will spend time explaining Kegel exercises – that is, squeezing and relaxing the muscles you use to stop the stream of urine.
“What I’ve found is that not everybody actually knows how to do a Kegel exercise,” Pytlik Monson said. “Sometimes we’re not activating the muscles the right way. Or, in some instances, the problem might be an overactive pelvic floor. In those instances, doing Kegels could be making things worse.”
Adjusting fiber intake can help, especially in managing common symptoms like constipation or diarrhea.
“We want people to be mindful of their diet,” she said. “What am I drinking? What am I eating? Is there something that I could modify there that can help me?”
She will also review over-the-counter options – moisturizers, lubricants, and the right liners/pads, for instance – to help patients make informed purchasing decisions at their local drugstore.
“There is a lot of misinformation out there,” Pytlik Monson said. “We can talk about the options that are actually beneficial and separate that from what can be predatory marketing.”
What can patients do about pelvic floor symptoms?
Sanford women’s pelvic medicine and urogynecology specialists can help improve your condition and your quality of life. That can happen at Pytlik Monson’s clinic and throughout the Sanford Health system.
Websites like the Menopause Society and the American College of Obstetricians and Gynecologists can also provide answers to questions about your pelvic floor health.
Ultimately, if pelvic floor disorder symptoms are getting in the way of your life, it’s time to pursue care. Making it a priority pays dividends.
“There is a definite benefit in addressing pelvic floor concerns across the age spectrum,” Pytlik Monson said. “It’s really cool seeing a little bit of a transition from when I first started at the clinic and I was primarily seeing patients who were 55 and older. Now I’m also seeing patients who are in their 30s. They understand there are things we can do to help them and they’re more interested in being proactive about it.”
Learn more
- Urogynecology can help with female pelvic floor issues
- Pelvic floor rehab: The benefits of postpartum PT
- HRT for menopause symptoms: What to ask your doctor
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Posted In Fargo, Gynecology, Internal Medicine, Menopause Care, Rehabilitation & Therapy, Women's
