By now, most of us have heard about the importance of Kegels, but unless you’ve had a baby and have experienced first-hand the wonder that is your pelvic floor, you may not know much else. The part of our anatomy that is responsible for supporting our pelvic organs, enhancing pleasure from sex, and aiding in all of our bathroom business, the pelvic floor is extremely important and often overlooked. It’s only when things may begin to go awry that many women pay attention to it.
To break things down into lay-woman's terms, we spoke with Dr. Jaclyn Bonder, medical director of women’s health rehabilitation at New York-Presbyterian/Weill Cornell Medical Center, for her expert insight on the pelvic floor, pelvic floor dysfunction, and its effect on fertility.
"Pelvic floor dysfunction (PFD) is the term used to describe a set of conditions that occur as a result of the problems with the muscles of the pelvic floor," Bonder explains. "Because these muscles help control bowel and bladder function, when there is a problem with pelvic floor muscles (PFM), patients may experience several symptoms, including but not limited to urinary incontinence, fecal incontinence, constipation or problems releasing a bowel movement, pelvic pain, sexual dysfunction, and pelvic organ prolapse."
PFD is surprisingly common too. “It has been said that 50 percent of women will experience PFD of some kind during their lifetime, but it is difficult to generalize into this number given the different conditions that exist and the fact that it is likely underreported,” Bonder suggests. But it is known for sure that a PFD diagnosis “increases with age and parity,” which is the number of babies a woman has birthed.
While anyone can develop PFD, there are many risk factors of note. Bonder says, “Most causes of PFD can be categorized into problems that develop as a result of weakness of the pelvic floor muscles, spasm of the PFM (often called high-tone PFD), and impairment in coordination of the PFM.”
There are also a number of signs and symptoms of PFD that include “difficulty holding in urine or feces, leakage of urine/fecal material, pelvic pain, including pain with intercourse (dyspareunia), and pain from the muscles themselves (myofascial or myalgia), and problems with releasing stool or urine when having the urge to defecate or urinate (often termed dyssynergia because of incoordination of the muscles),” according to Bonder.
Another symptom of PFD involves the sensation of a pressure feeling or bulge in either the vagina or rectum, which could be indicative of a pelvic organ prolapse.
Luckily, for anyone suffering from PFD, there are ample treatment options, ranging from conservative through surgical. According to Bonder, “Physical therapy can help improve most types of PFD. The therapists will work with a patient to retrain the muscles to function properly again and help correct the muscle dysfunction or decrease pain.”
Trigger point injections, botulinum toxin (Botox) injections, supportive devices like pessaries, and surgical options to help correct prolapse or urinary/fecal incontinence are also available for patients who have not noticed improvement from other, less invasive therapies.
In some comforting news for those with PFD, a direct correlation between PFD and infertility does not appear to exist. “To my knowledge and based on a literature review, there is no connection between PFD and a women’s fertility; however, recently there was a study that showed women with polycystic ovarian syndrome, a cause of infertility in some women, had higher prevalence of POP (pelvic organ prolapse) than controls,” explains Bonder. She continues, “Conversely, women with endometriosis, another cause of infertility, may have high-tone PFD prior to pregnancy as a result of a comorbid chronic pain syndrome in which the muscles are tense due to a guarding reflex. Again, though, once pregnant, this state of high-tone should not affect a woman’s fertility or ability to get pregnant. It is the endometriosis that causes the difficulties in getting pregnant.”
For moms-to-be, it’s comforting to know there is no direct effect of PFD on a developing baby. There may, however, be elevated risks of leakage issues for a pregnant woman. Bonder explains, “Patients with weak muscles and PFD may experience increased risk of urinary or bowel leakage during pregnancy due to increased pressure on the bladder, rectum, and muscles from the enlarging uterus.”
For patients with PFD from high-tone muscles, a major problem in pregnancy is not likely. However, “these patients usually experience pain in the nonpregnant state," says Bonder. "As such, if they are on medications for the PFD and pain syndrome, they may need to come off of their medications for pregnancy.” As far as delivery options, Bonder shares, “It has also been hypothesized that a vaginal delivery may be more difficult with high-tone PFD, but this is not well studied. Some believe that a vaginal delivery may help improve this type of PFD postpartum.”
It’s important to note that PFD is unique to the patient and is “not a one-size-fits-all diagnosis.” Bonder stresses, “There are many types of PFD, and medical treatment and advice need to be given on a patient’s individual history, risk factors, and symptoms.”