What causes pelvic floor disorders (PFDs)?

The complete picture about what contributes to the development of pelvic floor problems is not clear and is quite complex, but the following conditions are being studied as risk factors for the development of PFDs:

• Childbirth. Pregnancy, childbirth, and their link to pelvic floor problems have been an active area of research, but the connection is not clear. A recent NICHD-funded study showed that, among first-time mothers, mode of delivery (such as vaginal versus surgical) was linked to risk for PFDs. In some studies, the risk increases with the number of children a woman has delivered.¹ The risk may be greater if forceps or a vacuum device is used during delivery.² However, because pelvic problems also affect women who have never been pregnant, and because delivering via cesarean section only reduces but does not eliminate the risk of pelvic floor problems, the relationship among pregnancy, childbirth, and PFDs remains unclear.²
• Factors that put pressure on the pelvic floor. These factors include overweight or obesity, chronic constipation or chronic straining to have a bowel movement, heavy lifting, and chronic coughing from smoking or health problems.^1,3,4
• Getting older. The pelvic floor muscles can weaken as women age and during menopause.⁴
• Having weaker tissues. Genes influence the strength of a woman’s bones, muscles, and connective tissues. Some women are born with conditions that affect the strength of connective tissues, and they are more likely to have pelvic organ prolapse.²
• Surgery. Previous hysterectomy and prior surgery to correct prolapse are associated with higher risks of PFDs.¹

Race. Certain groups of women, such as white or Latina women, appear to be at higher risks for some forms of PFDs.²