Brittany Mahomes, wife of Kansas City Chiefs quarterback Patrick Mahomes, recently shared her story of back trouble stemming from pelvic floor dysfunction. “Once you have kids, take care of your pelvic floor,” Mahomes wrote on her Instagram. “Seriously.” Going public with her medical condition helped more women than she probably knew.

What is pelvic floor dysfunction?

The pelvic floor is a set of muscles within the pelvis that support the bladder, uterus, and bowel. By supporting these organs, the pelvic floor supports bowel and bladder health, reproductive and sexual health, and physical posture and stability.

Pelvic floor dysfunction is an umbrella term that covers a range of conditions, including urinary or fecal incontinence, pelvic prolapse, pelvic pain syndromes, and female sexual dysfunction. Since the organs that the pelvic floor supports are all connected, symptoms of pelvic floor dysfunction may overlap. For example, a tense, overactive and uncoordinated pelvic floor could cause back or hip pain, painful defecation, or pain during intercourse while a weak pelvic floor could cause symptoms of urinary or fecal urgency, leakage, constipation, and pelvic prolapse.

Some 40% of women over 40 will have a pelvic floor condition. Yet, more common than the diagnosis itself is women’s reluctance to discuss it. I’m grateful that Mahomes, with her ability to reach the masses, has helped to destigmatize the condition. We need to normalize the topic of pelvic floor conditions and dysfunction.

What are risk factors for pelvic floor conditions?

Anything that puts pressure on your pelvic floor over time can increase your risk for some of the more common conditions of the pelvic floor, like urinary incontinence and pelvic prolapse, by weakening the pelvic floor muscles. This could include pregnancy itself, chronic constipation, continual and heavy coughing, high-impact exercise, chronic coughing, and obesity. Other factors that may weaken the pelvic floor include: hormonal changes of menopause, which thin the connective tissues and muscles in the pelvic area; genetics; or direct damage to the pelvic floor (through childbirth, accidents, or assault).

What are symptoms of pelvic floor conditions?

Symptoms of pelvic floor conditions vary because the nature of pelvic floor problems also vary and occur at different touchpoints in a woman’s life. Urinary symptoms can range from urgency and frequency of urination, nighttime urination, and incontinence with or without exertion or pressure on the pelvic floor.

Pelvic organ prolapse often elicits symptoms of vaginal pressure, feeling like something is in the vagina and a feeling that organs are falling or out of place. Uncoordinated or tense muscle dysfunction can cause painful sex, or bladder or bowel habit changes. While urinary incontinence and pelvic prolapse are often associated with pregnancy and childbirth, it is not uncommon for me to see women in their teens and 20s with these conditions, or often, women after menopause when these conditions have begun to significantly and negatively impact quality of life.

What are the best treatment methods for pelvic floor issues?

There are surgical and non-surgical treatments for pelvic floor conditions, depending on the severity and nature of symptoms.

To start, discuss your symptoms with your primary care provider or OB-GYN. Either can refer you to a specialist, typically a urogynecologist, who can evaluate you and present various treatment options.

If you have a pelvic prolapse — the dropping of your internal organs into your vagina — or incontinence, strengthening your pelvic floor may improve symptoms. Physical therapists may approach this goal differently, often with Kegel exercises or biofeedback. If you experience pain with sex, on the other hand, then a therapist may work to release your tight pelvic muscles. (Because the pelvic floor stores trauma, its muscles can remain tense and overactive, even if an event occurred long ago.)

Stress incontinence causes urine leakage when you cough, sneeze, laugh, or exert yourself in any other way, and treatment can start with strengthening the muscles that support the urethra with Kegel exercises and other modes of physical therapy. In some cases women may want to trial a pessary, a removable device, that can also offer support. Commonly, a urogynecologist will suggest minimally invasive measures, such as injecting a water-based solution directly into the urethra to further close the urethral opening and temporarily improve symptoms, or inserting a small sling vaginally to support the urethra. The sling procedure is done under mild anesthesia, allows you to go home the same day, and resume regular activities in two weeks. We advise against inserting anything inside your vagina for six weeks. This procedure has excellent success in completely resolving stress incontinence long term.

If you have an overactive bladder, which can cause an urgent or frequent need to urinate, or leakage before making it to bathroom, then we may prescribe Kegel exercises, medications, an acupuncture-like treatment that stimulates the tibial nerve, Botox injections into the wall of the bladder muscle, or direct stimulation to the nerve in the lower back. All these procedures have varying success rates, and a specialist can review options that are tailored to your symptoms.

If you have a pelvic prolapse, then a urogynecologist can evaluate its severity by having you bear down to put pressure on your pelvic floor, and determine which organs are descending. Once your organs protrude into the vagina, like any other hernia in the body, they are unlikely to return to their original position or reverse themselves, though Kegel exercises or physical therapy may improve symptoms. A removable device like a pessary can support the organs to also improve symptoms in a non-invasive way. Surgery is the most effective and definitive therapy.

Our goal in surgery is to restore your anatomy by repairing the prolapse and putting everything back in the right place. We do this vaginally by reducing the hernias and/or attaching the vagina to surrounding ligaments, or we approach treatment robotically by suspending the vagina to the ligaments of the sacrum. Expect different urogynecologists to have different ways of fixing pelvic prolapse. You may talk to multiple surgeons and hear multiple variations in surgical approach. Whichever surgeon or procedure you choose, know that we all share the same goal: to restore your quality of life.

Pelvic floor conditions like pelvic prolapse and incontinence are not life-threatening, but they can be life-altering. If you feel you have a pelvic floor condition that is negatively impacting your quality of life, the most important advice I can give is to share this with a health care provider who can evaluate you or send you to a specialist who can share their expertise and offer options, both non-invasive and invasive, that may improve the way you live. These conditions are common, but that does not mean they are normal, and there are teams of providers who are trained to assist you in improving and restoring your quality of life.