Bodies change as they age, especially after physically demanding experiences like pregnancy. Many of those changes don’t have to be permanent, including ones that can be the most uncomfortable to talk about. 

One in four women over the age of 20 suffers from at least one pelvic floor disorder, which can include urinary incontinence, fecal incontinence, and pelvic organ prolapse, according to a 2008 study in the Journal of the American Medical Association.

Evelyn Hall, a urogynecologist and clinical professor of obstetrics and gynecology at Tufts University School of Medicine, said despite the prevalence of these disorders in women, most won’t seek treatment when they’re experiencing symptoms simply because they feel ashamed or are unaware that options are available.

“I see women in my clinic on a regular basis who have been suffering from pelvic floor dysfunction, like bladder leakage, for years,” Hall said. “We have research that shows people suffer for a median of seven years before they see a doctor. There is this feeling that these conditions are dirty or gross or problematic. People are nervous to talk about them.”

When working with patients in her clinic who may be evaluated for symptoms like a frequent urge to urinate, leaking urine, and a general feeling of heaviness in the vagina, Hall reminds women that the pelvis is an area of the body that is required to carry immense weight throughout a lifetime, regardless of pregnancy experience.

“Those muscles actually serve as integral support systems to those vital organs,” Hall said. “During pregnancy, especially with vaginal delivery, a massive amount of stretch and strain is put on those muscles, which can be torn. Women can also experience nerve damage in the pelvic region. All these injuries tend to weaken the muscles further over time.”

Hall wants women to know that although these may seem like unique cases that must be dealt with privately, the opposite is true, and that the stigma associated with them is changing. 

“There's a lot of data that talks about social isolation because of pelvic floor dysfunction,” Hall said. “People often are very embarrassed to talk to their family or to talk to their friends, but I encourage people to realize that this is something that we can help folks with, and these issues are very common.”

For more pronounced symptoms, providers may recommend interventions like a pessary, which is a small dish that is inserted in the vagina to help support the muscles and relieve a feeling of heaviness, or oral medications which can alleviate symptoms like an overactive bladder.

Before a treatment plan is developed, Hall works to make patients comfortable throughout the diagnosis process, which typically includes a comprehensive questionnaire, an ultrasound to examine the bladder, and a pelvic exam to physically evaluate the pelvic floor. 

“I always tell patients that it’s their body and they can stop the exam at any time,” Hall said. “I utilize trauma-informed practices to make people feel safe and ensure they know they have control.” 

Based on the findings, Hall will sit with the patient and have a conversation about what is going on in their body and what type of treatment options are available. “This is very much quality of life-focused,” Hall said. “It’s about a partnership.” 

Hall shares each option and asks about the patients’ priorities and what treatments they’re most interested in trying. If they are a candidate for physical therapy, Hall will refer them to a practicing pelvic floor PT, which she notes can be weird, but can also be life changing if the patient gives it time and effort.

“As with any physical therapy, the most important thing is consistency,” Hall said. “For patients with urgency and frequency symptoms, physical therapists will work on strengthening the muscles and behavioral retraining exercises. For those with hypertonic pelvic floors, which causes a constricting of the muscles, they will work on stretching out the pelvic floor so that the pelvic length may be maintained, which should eliminate things like pain during intercourse and the feeling of urinary urgency.”

Physical therapy has a 50% to 60% improvement rate, Hall notes, and patients should begin to see positive change by the fourth session. And if symptoms aren’t changing for the better with physical therapy, it’s a good idea to get back in touch with a provider for a follow-up appointment.