What Caused My Pelvic Floor Issues (Prolapse and/or Leakage)?

In the medical world, pelvic floor issues are referred to as pelvic floor dysfunction. Pelvic floor dysfunction is a broad term that includes a wide variety of clinical conditions including urinary incontinence, anal incontinence, pelvic organ prolapse, sexual dysfunction, and several chronic pain syndromes. Development of pelvic floor dysfunction conditions is multifactorial, particularly pelvic organ prolapse, urinary incontinence and anal incontinence.

Predisposing Factors

Women can have a predisposition to pelvic floor dysfunction due to genetic factors. History of pelvic floor dysfunction in the mother or immediate family increases risk of also developing pelvic floor dysfunction. For pelvic organ prolapse, familial incidence was about 30%. Women with a history of connective tissue disorders such as Marfan and Ehlers-Danlos syndromes have higher rates of urinary incontinence and pelvic organ prolapse.

Inciting Factors

Pelvic floor trauma from delivery can also be an inciting factor for pelvic floor dysfunction. The mode of delivery can be a factor, with vaginal delivery needing forceps or vacuum assistance having the greatest negative effect. Birth weight greater than 4500 grams and prolonged labor have been associated with pelvic floor trauma.

Promoting Factors

Prevention is the key to managing promoting factors. Constipation with chronic straining as a young adult before onset of pelvic floor issues was more common in women who subsequently developed pelvic organ prolapse or stress urinary incontinence. Obesity has been cited as a factor related to the development of urinary incontinence in women. The mechanism is unknown, but it is theorized that excess body weight increases abdominal pressure. A reduction of 8 kg leads to reduction of incontinence episodes per week by 47%. Although scant, there is more support to show strenuous exercise may be a risk factor for pelvic floor dysfunction than there is for regular exercise being of benefit. Some data exists that smoking and chronic cough can contribute to pelvic floor issues.

Decompensating  Factors

Disease such as diabetes, vascular inefficiency or congestive heart failure can lead to an increase in urine output and overwhelm fragile continence reserves. A decrease in mobility may adversely affect individual’s ability to get to the toilet in time.

Ultimately, pelvic floor dysfunction results from a number of factors, some which are preventable risk factors. The good news is management options are available to care for these medical conditions. Recommend discussing with your doctor, if you are affected by pelvic floor dysfunction.

References

• Rinne KM et al. What Predisposes Young Women to Genital Prolapse? Eur J Obstet Gynecol Resprod Biol (1999); 84:23-5
• Carley ME and Schaffer J. Urinary Incontinence and Pelvic Organ Prolapse in Women with Marfan or Ehlers-Danlos Syndrome. AJOG (2000);182:5:1021-23.
• Handa VL et al. Mothers’ Outcomes After Delivery Study. Obstet Gynecol (2011);118:777-84.
• Spence-Jones C et al. Bowel dysfunction: A pathogenic factor in uterovaginal prolapse and urinary stress incontinence. Br J Obstet Gynaceol(1994) 101:147-152.
• Dwyer PL et al. Obesity and urinary incontinence in women. Br J Obstet Gynaecol (1988) 95:91-96.
• Subak LL. Weight loss to treat urinary incontinence in overweight and obese women. (2009) N Engl J Med; 360:481-90.
• Bo K. Is physical activity good or bad for the female pelvic floor? A narrative review. (2020) Sports Medicine; 50:471-84.