Pelvic Floor Disorders

There is a group of muscles in the pelvic area called the pelvic floor. Contracting and relaxing these muscles control bowel and bladder movements.

Disorders or dysfunction to the pelvic floor are common and can very often be successfully treated.

The three most common disorders for the pelvic floor are Incontinence, Constipation and Prolapse.


About Incontinence

There are two types of incontinence – urinary and bowel. Urinary incontinence refers to unintentionally passing urine. The condition is believed to affect millions of people. Bowel incontinence – also called faecal incontinence – means you are unable to control when and where you have a poo. Both conditions can be extremely upsetting and embarrassing


You might experience the symptoms of urinary incontinence as:

  • Total incontinence – your bladder is unable to store urine, causing you to wee constantly or to experience frequent leaking.
  • Overflow incontinence – also called chronic urinary retention, whereby your bladder does not empty properly, causing it to leak frequently.
  • Stress incontinence – urine leaks out when you laugh or cough or any time your bladder is under pressure.
  • Urge incontinence – you feel a sudden, intense urge to wee, causing urine to leak out.

Sometimes you might experience both stress and urge incontinence.

If you are suffering from bowel incontinence you might:

  • Experience a sudden urge to poo that you can’t control (if this is linked to a case of diarrhoea or food poisoning, it is not normally anything that needs further investigation).
  • Poo before you become aware that you need to go to the toilet.
  • Leak poo sometimes, for example if you pass wind.
  • Find that these symptoms are affecting your day to day life or stopping you from going out.

As distressing as these symptoms can be, you do not have to feel embarrassed about talking to a doctor about them. Neither do you have to just put up with them. There are things that can be done to help and the sooner you seek help, the sooner you will be able to get on with your normal life again.

Who might be at risk?

You might be at risk of bowel incontinence if:

  • You have Inflammatory Bowel Disease, such as Crohn’s Disease.
  • You have a condition that affects the nerves in your bottom, such as spina bifida, diabetes or stroke.
  • You have Irritable Bowel Syndrome.
  • You have severe haemorrhoids.
  • Childbirth or surgery has damaged the muscles or nerves in this area.
  • You have long-lasting severe diarrhoea or constipation.

You might be at risk of bladder incontinence if:

  • Your pelvic floor muscles and/or urethral sphincter are weakened or damaged which can occur during pregnancy and childbirth.
  • You have a family history of incontinence.
  • You are obese.
  • You are an older person, although incontinence is not an inevitable part of ageing.
  • You have a spinal injury or bladder fistula.
  • You have an obstruction or blockage in your bladder.

Common Methods of Treatment

Depending on the type and severity of incontinence you are experiencing, there are a number of possible treatments:

Non Surgical

  • Lifestyle changes – a decrease in fibre in your diet
  • Immodium
  • Biofeedback therapy


  • Sphincter repair
  • Rectovaginal fistula repair

Incontinence is extremely common although many people feel too embarrassed to talk openly about it. One in three women experience incontinence at some point in their lives. Faecal incontinence is less common, with 2% of the UK population believed to be affected.

In many cases you can retrain your bladder to overcome bladder weakness. Talk to your doctor about this. You may also be able to take medication to help you to manage your condition. On a practical level, try to ensure it is easy to get to the toilet in a hurry and that there are no obstacles in your way. If you are using incontinence pads, choose ones that fit closely to your body to minimise the chance of leaks.

Diarrhoea, constipation and muscle or nerve damage causes bowel incontinence. The muscles of the rectum and intestines stretch and weaken as we age or during childbirth. Passive incontinence means that you might not realise you need to poo until it is too late. Urge incontinence means that the need to poo comes on so suddenly that you might not make it to the toilet in time.



Constipation is a common condition that can affect people of all ages. You are likely to be constipated if:

  • You are having a poo less than three times a week
  • Your poo is larger than usual, difficult to push out, dry, lumpy and hard.


Constipation can also cause you to have a stomach ache, or feel bloated or sick.

In children, constipation can also be accompanied by:

  • Irritability or anger.
  • Lack of energy.
  • Soiling clothes.

Who might be at risk?

Constipation is common during pregnancy and for six weeks after giving birth. Rarely it is caused by a medical condition. It is most commonly due to lifestyle factors, such as:

  • Not eating enough fibre (fruit, vegetables and cereals).
  • Not drinking enough fluid.
  • Stress, anxiety or depression.
  • Inactivity.
  • Ignoring the urge to go for a poo.

Common Methods of Treatment

The most common ways of treating constipation are:


  • Increased fibre intake.
  • Laxatives.
  • Linaclotide.
  • Lubiprostone.
  • Prucalopride.

In rare cases, you may need surgery to treat severe constipation. Treatments include:

  • Colectomy.
  • Ileo-rectal anastomosis.

Dehydration is a common cause of constipation as the colon draws water out of food that is in the intestines making it firm and harder to pass through digestive tract. The longer food sits in the colon the more water is extracted making the poo harder and more painful. Drinking water and eating more fibrous food helps to relieve constipation.

Foods that have been shown to alleviate constipation are: fruit (kiwi, figs, berries and apples are particularly good); vegetables; live yoghurt; beans and pulses; flaxseed and coconut water.

Women are three times more likely suffer from constipation than men. The reasons for this are not fully understood but factors such as pregnancy and menopause are believed to play a part as the hormones cause the muscles to relax, including bowel muscles.



A prolapse – or pelvic organ prolapse – occurs when organs that are normally contained within the pelvis (womb, bowel, bladder or the top of the vagina) slip down and bulge into the vagina.


The symptoms can be painful but not life-threatening. They include:

  • A dragging pain or discomfort inside your vagina. There may also be a feeling of heaviness throughout your lower tummy.
  • Discomfort or numbness during sex.
  • Feeling or seeing something protruding into your vagina.
  • Problems urinating, which might include needing to wee more often or feeling as though your bladder isn’t emptying properly.

Sometimes there are no obvious symptoms and the condition is only picked up during a routine examination.

Who might be at risk?

A weakened pelvic floor causes Prolapse. This can occur for a number of reasons, including:

  • Childbirth, particularly if there was a difficult labour or the baby was large.
  • Menopause.
  • Obesity or being overweight.
  • Constipation or straining to lift heavy objects.
  • Having a hysterectomy

It can also be associated with some medical conditions, including Marfan syndrome.

Common Methods of Treatment

Treatments for prolapse a range of different surgical procedures, depending on the type and severity of your prolapse. These include:

  • Delormes procedure
  • Altemeire’s procedure
  • Suture rectopexy – without the use of MESH
  • Resection rectopexy – without the use of MESH

Complications can include vaginal bleeding and pain, infection, abnormal discharge, hematoma, damage to adjacent organs, recurrent UTI, urinary fistula and abscess. Mesh that becomes chronically infected can increase the risk of cancer. For this reason we avoid using mesh in prolapse repair surgery.

A prolapse tends to cause discomfort rather than acute pain. It can also interfere with the normal function of organs inside your pelvis, for example creating an urge to open your bowel more often.

A prolapse does not generally improve without surgery. In most cases a prolapse will worsen over time. Rarely a prolapse can fail to return back into the rectum and becomes very swollen, which in turn, can lead to decreased blood supply to the prolapse. If this happens, surgery becomes essential and you should attend your nearest accident and emergency department.

Experienced bowel doctor, here to help you

The sooner you seek help, the sooner your chances of returning to health and getting your life back on track.

There really is nothing to feel embarrassed about and everything to be gained by coming to talk to a specialist.

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