How are pelvic floor disorders (PFDs) treated?

Talk to your healthcare provider about ways to reduce or ease symptoms. Your healthcare provider may recommend actions, such as the following³:

• Limit foods and drinks that stimulate the bladder. Some foods and drinks, such as caffeinated beverages, carbonated beverages, citrus fruits and drinks, artificial sweeteners, and alcoholic beverages, can stimulate the bladder and make you need to use the bathroom.
• For certain bowel problems, eat a high-fiber diet. Fiber helps your body to digest food. It helps make stool the right consistency, which can also prevent constipation and the chronic straining associated with having a bowel movement when constipated. Fiber is found in fruits, vegetables, legumes (such as beans and lentils), and whole grains. Fiber supplements are also available.
• Lose weight. For women who are overweight or obese, losing weight may reduce bladder control and pelvic organ prolapse symptoms by relieving pressure on pelvic organs.

Nonsurgical treatments commonly used for PFDs include^2,4:

• Bladder training. This involves using the bathroom on a set schedule to regain bladder control and applying techniques to overcome inappropriate urges to urinate. A woman starts by using the bathroom at a specific interval and slowly, over many months, increases that time, with a goal of using the bathroom only every 2.5 to 3 hours.³
• Pelvic floor muscle training (PFMT). Often referred to as Kegel exercises, PFMT involves squeezing and relaxing the pelvic floor muscles. If performed correctly and routinely, PFMT may improve the symptoms of urinary incontinence and prolapse.³ However, PFMT cannot correct prolapse. Women can do the exercises on their own or with the help of a pelvic floor physical therapist.³ Biofeedback during pelvic floor physical therapy is sometimes used to help teach women which muscle group to squeeze.
• Medicine. Medicine is sometimes prescribed to treat certain bladder control problems or to prevent loose stools or frequent bowel movements.⁵
• Vaginal pessary. This plastic device is used to treat prolapse. It can sometimes be used to improve bladder control. A woman or her healthcare provider inserts the pessary into the vagina to help support the pelvic organs. A woman’s doctor will fit her for a pessary that is a comfortable shape and size and instruct her on how to use and care for it.⁶

In some cases, surgery is the best treatment option, especially when other treatments are not helpful.^1,7 Some surgical treatments can be performed as outpatient procedures, which means the patient can usually go home the same day as the procedure.

• For prolapse. Surgery involves repairing the prolapse and attempting to restore a well-supported anatomy. There are many ways to do this, depending on the type of prolapse and other factors. Women with uterine prolapse may also have the uterus removed (hysterectomy). Women who have surgery to repair prolapse may need surgery at the same time to correct or prevent bladder control problems. Some women choose to have a surgery called colpocleisis. This surgery treats prolapse by narrowing and shortening the vagina. It works well and carries a low risk, but it is not a good choice for women who want to be able to have vaginal intercourse.⁷
• For bladder control problems. Surgery works well to treat problems with urinary leakage that occur as a result of an activity such as sneezing, coughing, laughing, or exercising (stress incontinence). Stress incontinence occurs when the exertion squeezes the bladder and urine leaks out because the support around the urethra has weakened.⁶ The type of surgery used most often is a mid-urethral sling. The surgeon places material under the urethra to support it and prevent urine leakage during activity.⁶ In another procedure, “bulking agents” can be injected near the bladder neck and urethra to make the tissues thicker and close the bladder opening. Repeat injections may be needed over time.⁸
• For bowel control problems. Surgery may be needed to repair a damaged anal sphincter muscle, inject medications into the sphincter, or implant a stimulator for the nerves that control the bowel function.⁹

Not all women are good candidates for surgery. In general, women who want to have children should not have these types of surgery.¹ Also, prolapse can recur even after surgery is performed to correct it.¹ Researchers are working to develop low-risk procedures and devices that work well to treat pelvic floor problems. Researchers are also comparing treatment methods to see what works best. For example, the Study of Uterine Prolapse Procedures - Randomized Trial (SUPeR) found comparable effectiveness in two types of surgery to treat vaginal prolapse. The Extended Operations and Pelvic Muscle Training in the Management of Apical Support Loss (E-OPTIMAL) study found that two other surgical treatments had comparable effectiveness. The Effects of Surgical Treatment Enhanced with Exercise for Mixed Urinary Incontinence (ESTEEM) study found that surgery may benefit women who have both stress and urge incontinence.

“Combination” can mean a woman is getting treated for more than one type of PFD, such as a treatment for both uterine prolapse and urinary incontinence. It can also mean using different treatments together to address PFDs, such as using PFMT and surgery to treat symptoms.

Researchers are studying combination treatments to find out how to get the best outcomes for women with PFDs. For instance, the Outcomes Following Vaginal Prolapse Repair and Mid-Urethral Sling (OPUS) study evaluated whether adding a procedure to treat stress incontinence at the time of surgery for pelvic organ prolapse in women who don’t have symptoms of stress incontinence can help to prevent stress incontinence from happening after surgery and without increasing risk. The Controlling Anal Incontinence by Performing Anal Exercises with Biofeedback or Loperamide (CAPABLe) study compared different combinations of treatments for anal incontinence.