What are Pelvic Floor Disorders?

What are pelvic floor disorders?

The term "pelvic floor" refers to the group of muscles that form a sling or hammock across the opening of a woman’s pelvis. These muscles, together with their surrounding tissues, keep all of the pelvic organs in place so that the organs can function correctly.

A pelvic floor disorder occurs when the pelvic muscles and connective tissue in the pelvis weaken or are injured.

An estimated one-third of all U.S. women are affected by one type of pelvic floor disorder in her lifetime. Disorders may result from pelvic surgery, radiation treatments, and, in some cases, pregnancy or vaginal delivery of a child.

What are the most common pelvic floor disorders?

There are a variety of problems related to the pelvic floor. The most common include:

Pelvic organ prolapse – A "prolapse" occurs when the pelvic muscles and tissue become weak and can no longer hold the organs in place correctly. In uterine prolapse, the uterus can press down on the vagina, causing it to invert, or even to come out through the vaginal opening. In vaginal prolapse, the top of the vagina loses support and can drop through the vaginal opening.

Some symptoms of pelvic organ prolapse may include:

• A feeling of heaviness or fullness or as if something falling out of the vagina.
• Some women also feel a pulling or aching or a "bulge" in the lower abdomen or pelvis.
• Prolapse may also cause a kinking in the urethra, making it harder for a woman to empty her bladder completely, or causing frequent urinary tract infections.

Urinary incontinence – This can occur when the bladder drops down into the vagina. Because the bladder is not in its proper place, a key symptom of urinary incontinence is urine leaking without a woman’s control. Other symptoms might include urgency to urinate, frequent urination, and painful urination.

Anal incontinence – This can occur when the rectum bulges into or out of the vagina, making it difficult to control the bowels. It can also occur when there is damage to the anal sphincter, the ring of muscles that keep the anus closed.

What are the treatments for pelvic floor disorders?

Many women don’t need treatment for their pelvic floor disorder. In other cases, treatment for symptoms includes changes in diet, weight control, and other lifestyle changes. Treatment may also include surgery, medication, and use of a device placed in the vagina called a pessary that helps support the pelvic organs.

Recent NICHD research has found that combining repair surgery with a second surgical procedure can help prevent urinary incontinence later.

Exercises for the pelvic floor muscles (known as Kegel exercises) can often help strengthen the muscles around the openings of the urethra, vagina, and rectum. Treatments for incontinence can also include medication and bladder or bowel control training.

What is Pelvic Pain?

What is pelvic pain?

Pelvic pain is a general term that health care providers use to describe pain that occurs mostly or only in the lower abdomen area. It may be steady pain, or pain that comes and goes.

In some cases the pain may be severe and might get in the way of daily activities. In other cases, the pain might be dull and occur only during the menstrual cycle. Pelvic pain also describes pain that occurs during sexual intercourse.

What conditions cause pelvic pain?

In general, pelvic pain signals that there might be a problem with one of the organs in your pelvic area: uterus, ovaries, fallopian tubes, cervix, vagina, urinary tract, lower intestines, or rectum. Or the pain might be a symptom of infection. Sometimes pelvic pain can be caused by muscular and skeletal problems.

There are some common health conditions that are often associated with pelvic pain, including:

• Vulvodynia - describes chronic pain or discomfort of the vulva (the external female genitalia). Vulvodynia can cause burning, stinging, irritation, or rawness of the vulva. The type of pain can be different for each woman. Pain may move around or always be in the same place. It can be constant, or come and go.
• Endometriosis - occurs when tissues that usually line a woman’s uterus instead grow outside the uterus. These tissues often grow on the surfaces of organs in the pelvis or abdomen, where they are not supposed to grow. The two most common symptoms of endometriosis are pain and infertility.
• Uterine Fibroids - are the most common, non-cancerous tumors in women of childbearing age. The fibroids are made of muscle cells and other tissues that grow within and around the wall of the uterus. Symptoms can include heavy or painful periods, pain during sex, and lower back pain, among others.

What is the treatment for pelvic pain?

It may be difficult to find the cause of your pelvic pain. Your health care provider will likely run a number of tests to find the cause of your pain. Treatment will depend on what is causing your pelvic pain, how intense the pain is, and how often the pain occurs.

Your health care provider may prescribe pain medication or antibiotics to treat the pain. For other conditions, treatment may be more involved, such as surgery for endometriosis.

Premature Ovarian Failure

What is premature ovarian failure?

The term premature ovarian failure describes a stop in the normal functioning of the ovaries in a woman younger than age 40. Some people also use the term primary ovarian insufficiency to describe this condition. It is also known as hypergonadotropic hypogonadism.

Health care providers used to call this condition premature menopause, but premature ovarian failure is actually much different than menopause.

• In menopause, a woman will likely never have another menstrual period again; women with premature ovarian failure are much more likely to get periods, even if they come irregularly.
• A woman in menopause has virtually no chance of getting pregnant; a woman with premature ovarian failure has a greatly reduced chance of getting pregnant, but pregnancy is still possible.

What are the symptoms of premature ovarian failure?

The most common first symptom of premature ovarian failure is skipping or having irregular periods.

Some women with premature ovarian failure also have other symptoms, similar to those of women going through natural menopause. These may include:

• Hot flashes and night sweats
• Irritability, poor concentration
• Decreased interest in sex or pain during sex
• Drying of the vagina
• Infertility

Premature ovarian failure also puts women at risk for some other health conditions, some of them serious, including:

• Osteoporosis – loss of bone strength and bone density. Getting enough calcium, vitamin D, and weight-bearing physical activity can help reduce this risk.
• Low thyroid function – affects metabolism and can cause very low energy. Replacing the thyroid hormone can treat the problem.
• Addison’s disease – an autoimmune disorder in which the body has trouble handling physical stress, such an injury or illness, because of problems with the adrenal glands. About 3.2 percent of women with premature ovarian failure also have Addison’s disease. Addison’s can be dangerous for women who don’t know they have it. This condition can’t be prevented, but can be managed with help from your health care provider.
• Heart disease – estrogen replacement therapy, along with keeping a healthy body weight and getting regular, moderate, physical activity, can help reduce this risk.

Also, it is important to know that people who are carriers for the gene for Fragile X syndrome, or who have the premutation for the condition, are more likely than other people to get premature ovarian failure. If you are a Fragile X carrier or have a premutation, it is important to get tested for premature ovarian failure.

Are there treatments for the symptoms of premature ovarian failure?

There is no proven treatment to make a woman’s ovaries work normally again. However, there are treatments that can help some of the symptoms of premature ovarian failure.

• Estrogen replacement therapy (ERT), also called hormone replacement therapy (HRT) gives women the estrogen and other hormones their bodies are not making. HRT can help women have regular periods and lower their risk for osteoporosis.
• Current research is looking into giving women the hormone testosterone to help prevent bone loss in women with premature ovarian failure.

How is premature ovarian failure diagnosed?

Because one of the most common signs of premature ovarian failure is irregular periods, women should pay close attention to their menstrual cycles and tell their health care provider about any changes.

If your health care provider thinks you may have premature ovarian failure, he or she may do a blood test to measure the level of a hormone called follicle stimulating hormone that is normally present in the body. This test will help determine whether the ovaries are working properly or not.

What causes premature ovarian failure?

Researchers know that in women in premature ovarian failure something happens to stop the normal functioning of the ovaries; but in most cases, the exact cause is not clear.

Most research focuses on a problem with the follicles in the ovaries. Follicles in the ovaries start out as microscopic seeds. These seeds mature into eggs, which travel to the uterus for fertilization. Follicles also release the hormone estrogen, which is important for a woman’s overall health and bone health.

Most women have enough follicles to last until menopause. However, this may not be the case in women with premature ovarian failure.

Women with premature ovarian failure may fall into one of two groups:

• A woman with follicle depletion has no follicles left in her ovaries and there is no way to make more.
• A woman with follicle dysfunction may have follicles in her ovaries, but they are not working properly.

About 10 percent to 20 percent of women with premature ovarian failure have a family history of the condition. This finding suggests that some cases of premature ovarian failure can be genetic. However, genetics is not the only cause of premature ovarian failure.

How does premature ovarian failure affect fertility?

Women with premature ovarian failure are unlikely to get pregnant because their ovaries do not work correctly. At this time there is no proven treatment to improve a woman’s ability to have a baby naturally if she has premature ovarian failure.

However, between 5 percent and 10 percent of women with premature ovarian failure become pregnant without fertility treatment. There is also a type of fertility treatment, known as egg donation, which may be an option for women with premature ovarian failure.

What is Rett Syndrome?

Rett syndrome is a neurological and developmental disorder that mostly occurs in females. Infants with Rett syndrome seem to grow and develop normally at first, but then stop developing and even lose skills and abilities.

For instance, they stop talking even though they used to say certain words. They lose their ability to walk properly. They stop using their hands to do things and often develop stereotyped hand movements, such as wringing, clapping, or patting their hands.

Rett syndrome is considered one of the autism spectrum disorders. Most cases of Rett syndrome are caused by a mutation on the MECP2 gene, which is found on the X chromosome.

What are the symptoms of Rett syndrome?

Beginning between 3 months and 3 years of age, most children with Rett syndrome start to show some of the following symptoms:

• Loss of purposeful hand movements, such as grasping with fingers, reaching for things, or touching things on purpose.
• Loss of speech.
• Balance and coordination problems, including losing the ability to walk in many cases.
• Stereotypic hand movements, such as hand wringing.
• Breathing problems, such as hyperventilation and breath holding, or apnea when awake.
• Anxiety and social-behavioral problems.
• Intellectual disability/mental retardation.

There are a number of other problems common among those who have Rett syndrome. But having these problems is not necessary to get a diagnosis of Rett syndrome. These problems can include:

• Scoliosis, a curving of the spine that occurs in approximately 80 percent of girls with Rett syndrome.
• Seizures.
• Constipation and gastro-esophageal reflux.
• Cardiac or heart problems, specifically problems with the rhythm of their heartbeat.
• Problems feeding themselves, trouble swallowing and chewing.
• Problems with sleep, specifically disrupted sleep patterns at night and an increase in total and daytime sleep.

What is the usual course of Rett syndrome?

Health care providers view the onset of Rett syndrome symptoms in four stages:

• Early Onset Phase – Development stalls or stops.
• Rapid Destructive Phase – The child loses skills (regresses) quickly. Purposeful hand movements and speech are usually the first skills lost.
• Plateau Phase – Regression slows, and other problems may seem to lessen or improve. Most people with Rett syndrome spend most of their lives in stage 3.
• Late Motor Deterioration Phase – Individuals may become stiff or lose muscle tone; some may become immobile.

Most girls with Rett syndrome live until adulthood. They will usually need care and assistance throughout their lives

What is the treatment for Rett syndrome?

There is currently no cure for Rett syndrome. However, girls can be treated for some of the problems associated with the condition. These treatments generally aim to slow the loss of abilities, improve or preserve movement, and encourage communication and social contact.

People with Rett syndrome often benefit from a team approach to care, in which many kinds of health care providers play a role, along with family members. Members of this team may include:

• Physical therapists, who can help patients improve or maintain mobility and balance and reduce misshapen back and limbs.
• Occupational therapists, who can help patients improve or maintain use of their hands and reduce stereotypic hand movements.
• Speech-language therapists, who can help patients use non-verbal ways of communication and improve social interaction.

Other options, such as medication (such as for constipation or heart problems) or surgery (to correct spine curvature or correct heart defects) are also effective for treating some of the symptoms of Rett syndrome.

What are Uterine Fibroids?

What are uterine fibroids?

Uterine fibroids are the most common, non-cancerous tumors in women of childbearing age. The fibroids are made of muscle cells and other tissues that grow within and around the wall of the uterus.

Who is at risk for uterine fibroids?

There are several risk factors for uterine fibroids:

• African American woman are at three- to five-times greater risk than white women for fibroids.
• Women who are overweight or obese for their height are at greater risk.
• Women who have given birth are a lower risk.

What are the symptoms of uterine fibroids?

Many women with uterine fibroids have no symptoms. Symptoms of uterine fibroids can include:

• Heavy or painful periods, or bleeding between periods
• Feeling "full" in the lower abdomen
• Urinating often
• Pain during sex
• Lower back pain
• Reproductive problems, such as infertility, multiple miscarriages, or early labor

Most women with fibroids do no have problems with fertility and can get pregnant. Some women with fibroids may not be able to get pregnant naturally. But advances in treatments for infertility may help some of these women get pregnant.

What are the treatments for fibroids?

If you have uterine fibroids, but show no symptoms, you many not need any treatment.

Women who have pain and other symptoms might benefit from these treatments:

1) Medications can offer relief from the symptoms of fibroids and even slow or stop their growth. But, once you stop taking the medicine, the fibroids often grow back.

2) There are several types of fibroid surgery:

• Myomectomy – Removes only the fibroids and leaves the healthy areas of the uterus in place.
• Uterine Artery Embolization (UAE) – Cuts off the blood supply to the uterus and fibroids, making them shrink.
• Hysterectomy - A more major procedure that removes the uterus; this type of surgery is the only sure way to cure fibroids.

What is Vaginitis?

Vaginitis is a term for any infection or inflammation of the vagina.

What are the symptoms of vaginitis?

In general, vaginitis may cause itching, irritation, or abnormal vaginal discharge.

There are a several different kinds of vaginitis, each with their own causes and symptoms:

1) Candida or "yeast" infections – Yeast infections of the vagina are probably the most familiar form of vaginitis. They occur when too much of the fungus Candida grows in the vagina.

Yeast infections produce a thick, white discharge from the vagina that can look like cottage cheese. The discharge can be watery and often has no smell. Yeast infections usually cause the vagina and vulva (the area outside the vagina) to become itchy and red.

2) Bacterial vaginosis – Bacterial vaginosis is the most common vaginal infection in women of reproductive age. It is caused by an overgrowth of bacteria that are usually present in the vagina.

Bacterial vaginosis will often cause a thin, milky discharge from the vagina that may have a "fishy" odor. Many women with bacterial vaginosis have no symptoms and only discover they have it during a routine gynecologic exam.

3) Trichomoniasis – Trichomoniasis is a sexually transmitted disease that is caused by a single-cell parasite. It can cause vaginal itching, burning, and soreness of the vagina and vulva, as well as burning during urination. Many women with trichomoniasis do not develop any symptoms.

4) Non-infectious vaginitis – This form of vaginitis is usually caused by an allergic reaction or irritation from vaginal sprays, douches, spermicidal products, soaps, detergents, or fabric softeners. It can cause burning, itching, or vaginal discharge even if there is no infection.

What are the treatments for vaginitis?

The key to treating vaginitis is knowing which kind you have. The treatment must be specific to the type of vaginitis present.

1) Yeast infections are usually treated with an anti-yeast cream or suppository placed inside the vagina. A health care provider can write a prescription for most yeast infection treatments.

Although you can also buy medicine to treat yeast infections over-the-counter, it is a good idea to see a health care provider the first time you have symptoms of a yeast infection. Because this medicine will not cure other types of vaginitis, it is important to be sure you actually have a yeast infection before using these treatments.

2) Bacterial vaginosis is treated with an antibiotic that gets rid of the "bad" bacteria and leaves the "good" bacteria. There is no over-the-counter treatment for bacterial vaginosis, so it is important to see your health care provider for a prescription.

3) Sexually transmitted forms of vaginitis need to be treated by a health care provider right away. It is important to avoid sexual contact until you have been treated to prevent spreading the infection. A woman’s sexual partner(s) will need treatment as well.

Trichomoniasis and Chlamydia are both treated by antibiotics. Neither genital herpes nor HPV can be cured, but both can be controlled with the help of your health care provider and medications.

4) Non-infectious vaginitis can be treated by stopping the use of the product that caused the allergic reaction or irritation. Your health care provider may also be able to provide medicated cream to help reduce the symptoms until the reaction goes away.

It is important to remember that each type of vaginitis has a different treatment. Therefore it is very important to see a health care provider to be sure you are using the right treatment for your condition. Also, some kinds of vaginitis have no symptoms so it is important to have regular gynecologic exams.

Can I prevent vaginitis?

There are some things you can do to lower your chances of getting vaginitis.

• If you often get yeast infections, you may want to avoid clothes that hold in heat and moisture, such as panty hose without a cotton lining, nylon panties, or tight jeans.
• Avoid douches and vaginal sprays because they can kill "good" bacteria or cause irritation.
• Sexually transmitted forms can help protect against sexually transmitted forms of vaginitis.

What You Should Know About Pelvic Exams

First you need to know just exactly what a pelvic exam is. It is an exam of the vagina, cervix and uterus that is done by a doctor or some other qualified health care professional. Pelvic exams should start to be done at least a few years after a woman begins to have sexual intercourse or at the age of 21. If young women or teenagers are having abnormal symptoms then they should also have a pelvic exam. Pelvic exams should be scheduled yearly.

During the exam the doctor will insert a speculum that will allow them to see into the vagina better. The doctor may also take samples of discharge or secretions with a cotton swab so that they can run tests for infections or disease which can help in the diagnoses of ovarian cancer.

During the process the doctor will insert two gloved and lubricated fingers into the vagina so they can feel the abdomen externally with the other hand. The doctor does this so they can check for any growth or sensitivity. If you feel any pain during this process you should let the doctor know.

Many wonder if a pelvic exam in painful and while the exam can be a little uncomfortable they are often not painful. Therefore, if you feel pain at any time during the exam you should tell your doctor immediately.

Another common question is how long a pelvic exam usually takes. Many normal pelvic exams are usually quick and will only take five to ten minutes. Pelvic exams are very important to help detect ovarian cancer.