The North American Menopause Society has coined the term “Genitourinary Syndrome of Menopause.” This recognizes that many women after menopause experience bothersome symptoms that affect the vagina, vulva, bladder, and the pelvic musculature. This syndrome refers to changes in the tissues of the vagina and vulva that become thin and dry with loss of estrogen after menopause. Another contributor related to aging is muscle weakness which occurs in all parts of our body, and the pelvic muscles are no exception. The pelvic floor is the group of muscles that are attached to the pelvic bones, and form a sling that supports our internal organs (uterus, badder and bowel) , as well as allow passage of the urethra, vagina, and rectum from internal to external. This complex system facilitates and accommodates childbirth, as well as control of urination and defecation. As muscles weaken with age and childbirth, and as the vaginal tissue thins with lack of estrogen, function can change.
Some women experience urinary problems that include frequency, urgency, incontinence, and increased urinary tract infections. Fecal incontinence and uncontrolled passage of gas are embarrassing and limiting. The use of pads and diapers is extremely common among the elderly. Vaginal atrophy and thinning of the vaginal wall can make intercourse painful, and even impossible. Gynecologists often prescribe vaginal estrogen to improve the vaginal mucosa and decrease burning with intercourse. Although there can be some improvement with urinary symptoms, many patients may face surgical procedures for prolapse and stress incontinence.
Gynecologists are now paying more attention to the pelvic floor muscles. Pelvic floor physical therapy and pelvic floor muscle training can teach the optimal function of the pelvic muscles and improve pain and dysfunction including incontinence, frequency, painful intercourse, and fecal incontinence of stool and gas. Other symptoms of pelvic floor dysfunction may include the feeling of incomplete defecation, painful urination, and pain in the pelvis, genitals or rectum.
In order to determine if you have pelvic floor dysfunction, a history and pelvic exam are performed. An exam can determine if there is atrophy of the tissues of the vagina and vulva, and prolapse of the organs. Muscle activity can be tested by using probes that measure the degree of muscle contraction of the vagina and the rectum. More sophisticated testing includes cystometrics which studies bladder function, and x-rays which can be used to evaluate the process of defecation.
Pelvic floor muscle training and physical therapy should always be considered as a first-line therapy when pelvic floor dysfunction is suspected. Pelvic floor muscle training uses probes or sensors to measure and teach the correct use of pelvic muscle contraction and relaxation. It is not painful at all. Improvement can be expected in about 75% of patients. Vaginal estrogen products can be used to improve vaginal tissue thickness and blood flow. Muscle relaxers can be used to relax the pelvic muscles if increased contractions are noted. There are also many medications available for overactive bladder. Surgery is an option for patients with prolapse of the bladder, rectum or uterus, or for patients with severe stress incontinence that is not corrected by non-surgical approaches.
Marilyn Jerome, MD
Foxhall OB-Gyn Associates
Cleveland Clinic, June 2, 2017
Pelvic Floor Dysfunction