Pelvic-Floor Problems

More than 16 million American women suffer from urinary incontinence-and countless others are plagued by the inability to control their bowels.

Although women's incontinence problems have dozens of potential causes, one of the most common is pelvic-floor prolapse.

"The pelvic muscles form a hammock-like structure designed to support the bladder, rectum, uterus and vagina," explains UCI urogynecologist Dr. Karen Noblett. "When strenuous activities such as childbirth or chronic coughing weaken them, the pelvic organs can push through the muscular framework that normally supports them." In the process, delicate nerves can be damaged. For some women, this complex sequence of events results in urinary or bowel incontinence.

That gotta-go feeling.

"Wetting accidents can occur when a woman simply laughs or sneezes," explains Noblett. Known as stress incontinence, this condition is sometimes combined with urge incontinence-an intense need to go to the bathroom, coupled with the sudden loss of urine. Adult diapers can camouflage the problem. But for women with bowel incontinence, the uncontrolled passage of liquid or solid stool cannot be hidden as easily.

"Many patients are too embarrassed to discuss the problem with their doctor," says Noblett. "But the longer they wait, the more they compromise their quality of life. For adults, Incontinence is not normal at any age."

The first step to finding a cure is having a medical evaluation. If prolapse-related urinary incontinence is the problem, therapy may include exercises, physical therapy, biofeedback and behavioral therapy. Some patients also benefit from functional electrical stimulation, a passive method of strengthening the pelvic-floor muscles. Several minimally invasive procedures also can help women, including radiofrequency energy to restore the bladder and urethra (the tube through which urine flows out of the bladder) to their proper positions, and sacral nerve stimulation to reactivate nerve pathways between the bladder and brain. A vaginal tape is also being used by doctors to reposition the urethra so it will remain closed during strenuous activities.

Bowel problems.

Bowel incontinence caused by weakened pelvic-floor muscles and related nerves can be treated successfully in a majority of cases. Once it's been determined that pelvic-organ prolapse is responsible for the condition, dietary changes are often the first line of defense. "Fiber, usually considered a laxative, is beneficial because it bulks up stool and slows bowel function," explains Noblett. "Consuming enough liquids, eating well-balanced meals and avoiding certain foods help the gastrointestinal tract work at optimum levels."

Bowel incontinence also can be improved by radiowave treatments that produce scarring to disrupt faulty nerve impulses. Additionally, special exercises and biofeedback are very helpful for some women. So are daily laxatives or tap-water enemas, which can be used to establish a predictable pattern of bowel movements. If non-invasive treatments fail, surgery may be the answer. "With the proper treatment, most women will recover control of urinary and bowel functions," comments Noblett.