The pelvic floor is composed of muscles and ligaments that form a sling across the opening of the pelvis. Muscles and ligaments work together in women to support pelvic organs such as the vagina, uterus, bladder and bowel. Pelvic floor disorders are caused by weakening support of the muscles, ligaments and connective tissue in the pelvic area.

Incontinence occurs when women have trouble controlling their urine (urinary incontinence) or their bowels (fecal incontinence). There are many possible causes of incontinence. The two most common forms of urinary incontinence are stress incontinence and urge incontinence. Others are Overflow incontinence and Mixed incontinence.

Stress incontinence happens when something you do – such as coughing, laughing, sneezing jumping, lifting or exercising – increases the pressure in your abdomen enough that it pushes urine past the urethra. In other words, some external force pushes on the bladder and urine squirts out.

Urge incontinence happens when women are not able to wait until they empty their bladder. They find that "When I have to go, I have to go." This occurs because the normal ability to tell the bladder to wait until it is the right time is weakened. With urge incontinence, when a woman feels the need to empty her bladder, telling the bladder to wait simply doesn't work anymore.

Overflow incontinence happens when the bladder gets overfilled and over flows. This can occur with medical conditions that desensitize the bladder sensor. This may also occur when certain prolapses prevent complete emptying of the bladder. Mixed Incontinence is a combination of one or more of the above.

Urodynamic testing is a series of bladder tests that are done in order to observe how your lower urinary tract reacts under certain conditions. It is usually done to see if you have problems with loss of urine (urinary incontinence) or to figure out what type of incontinence you may have. Testing usually consists of filling your bladder with sterile water, then observing the pressure and how your bladder reacts under these conditions. When the test begins, the physician inserts a small soft catheter in your bladder and a tube is hooked up to a bag of sterile water. Your bladder is then filled to around 250 cc (approximately one cup), which most women can hold without needing to urinate. A second catheter, which is connected to a machine or computer, also is inserted. This catheter measures the pressures within your bladder. Once the bladder is filled, you will be asked to cough and strain in order to see how much urine you leak.

Treatment options include habit training, prompted voiding, pelvic muscle rehabilitation (Kegel exercises), pessaries, medications and surgery. Surgery is the only permanent treatment for prolapse and stress incontinence.

It may not happen quickly but, if left untreated, over time the condition often worsens. In rare instances, prolapse can cause urinary retention that may lead to kidney infection or damage. In these cases, treatment is necessary. Otherwise, the decision to treat the prolapse should be based on your symptoms.

Prolapse is the bulging or dropping of the uterus, rectum or bladder into the vagina. There are several different types of pelvic organ prolapse and it is common to have more than one type at the same time. While prolapse is not considered a life threatening condition, it may cause a great deal of discomfort and distress. The various types are:

• Cystocoele - when the bladder falls down into the vagina
• Uterine prolapse - when the womb drops down into the vagina
• Vaginal vault prolapse - when the vagina itself falls down
• Enterocoele - when the small bowel pushes against the vagina causing a bulge
• Rectocoele - when the rectum falls

Anal incontinence is the involuntary leakage of gas, liquid stool or solid stool.

Like other pelvic floor disorders, anal incontinence usually occurs because of childbirth injuries. Even normal easy vaginal deliveries can result in direct injury to the anal sphincter muscle or to the innervations of the rectum and sphincter. About 15% of the time, anal incontinence occurs because of a direct injury to the anal sphincter. This may or may not be because of a direct injury to the anal sphincter. This may or may not be recognized during childbirth. After childbirth you can often compensate for this problem. However, as you age, the weakness in these muscles may become more apparent. There are other conditions that can lead to this disorder. Some of the more common include; Hemorrhoids or Hemorrhoid Surgery, Inflammatory Bowel Disease, Radiation Enteritis, Multiple Sclerosis, Parkinson's Disease, Spinal Cord Injuries, Stroke, Dementia, Diabetic Neuropathy, Rectal Prolapse and Descending Perineum Syndrome.

There are different approaches to treating anal incontinence and it often depends on which condition is causing it. A complete history and physical will help identify potential problems. Anal manometry, Trans anal ultrasound and pudednal nerve motor latency studies are diagnostic tests that may be helpful in the evaluation. Treatment options include dietary changes, weight loss, bowel management, biofeedback physical therapy, anal sphincter repair, rectocele repair, and sacral nerve Neuromodulation.

There are different approaches to treating anal incontinence and it often depends on which condition is causing it. A complete history and physical will help identify potential problems. Anal manometry, Trans anal ultrasound and pudednal nerve motor latency studies are diagnostic tests that may be helpful in the evaluation. Treatment options include dietary changes, weight loss, bowel management, biofeedback physical therapy, anal sphincter repair, rectocele repair, and sacral nerve Neuromodulation.

• If you have any concern at all about any condition with your body
• If you feel a bulge or lump on the outside of your vagina
• If you have lower back pain or increased pelvic pressure that interferes with your daily activities
• If you have irregular vaginal spotting or bleeding
• If you experience frequent urinary incontinence, urinary tract infections, difficulty urinating, frequent urination or any of the symptoms listed here that interfere with your daily routine
• If you are experiencing any problems with your bowels mentioned above.
• If sexual intercourse is painful or difficult

When you see your doctor, you will have a health history taken in order to get a thorough explanation of your symptoms. A pelvic exam is necessary to diagnose pelvic organ prolapse. If you do have prolapse, your urogynecologist will determine which organs are involved and how severe the prolapse is. Other tests might be ordered, based on your individual examination.

If you choose to have surgery, you are asked to wait to have intercourse for a period of time (maximum 6 weeks), after which women report an improved sex life.

If you choose to have surgery, you are asked to wait to have intercourse for a period of time (maximum 6 weeks), after which women report an improved sex life.

• The doctor will take a thorough history of your symptoms
• Pelvic examination
• Evaluation of pelvic support
• Evaluation for loss of urine or stool
• Neurological examination
• Evaluation of pelvic muscles
• Some blood tests
• Make follow-up appointments or schedule surgery