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What are Common Problems with the Pelvis?

Problems with the pelvis are common in women. The pelvis is the part of the body at the bottom of the abdomen between the belly and the thighs. A woman’s uterus, ovaries, and bladder are in the pelvis. The bones that protect these organs are also referred to as the pelvis. At the bottom of the pelvis is the pelvic floor. It is made up of muscles, ligaments, and other connective tissue that support the organs in the pelvis.

Urinary Incontinence

Urinary incontinence means leaking urine because of losing bladder control. Women can have one or both of the two main types of urinary incontinence:

  • Stress incontinence. This is when you leak urine when you cough, sneeze, laugh, or do physical activities like running. The leaking stops when the activity stops. Most people leak urine from time to time. It’s common immediately after vaginal childbirth or after a surgery involving the pelvic organs (the internal organs in the hip area). It can become an ongoing problem, for example, when the bladder drops into the vagina (prolapse). This is usually due to a problem with the pelvic floor muscles.
  • Urgency incontinence. This is when you leak urine because you have a strong urge to urinate. This happens because the muscles in your bladder contract to empty your bladder before you are ready. The cause can be anything that damages the nerves that tell your bladder muscles what to do, like a stroke or multiple sclerosis.

If you leak urine often or in large amounts — and if it gets in the way of normal activities — talk to your doctor. You may have urinary incontinence, and treatment will likely help. Your doctor will talk to you about the problem and take a urine sample. The doctor may also do other tests to see how much urine your bladder can hold, and how well your bladder releases urine.

Treatment for stress incontinence focuses on strengthening and retraining the pelvic floor muscles with pelvic floor physical therapy. In some cases, the doctor may recommend using a pessary, a device that fits in the vagina to support the pelvic organs. Or the doctor may suggest injecting a bulking agent — for example, collagen or another material — into the tissues around the urethra and lower part of the bladder. The bulking agent can thicken the tissues to help close the bladder opening.

Pelvic Inflammatory Disease

Pelvic inflammatory disease is an infection of the uterus, ovaries, or other part of a woman’s reproductive system. It is caused by some sexually transmitted diseases, like chlamydia and gonorrhea, that don’t get treated. It can also be caused by infections that are not sexually transmitted. For example, it can be caused by infection a woman can get when she has an IUD placed in the uterus for birth control.

Sometimes pelvic inflammatory disease has no symptoms. But symptoms can include:

  • Pain in your pelvic area – your lower abdomen
  • Fever
  • A discharge from your vagina with a bad smell
  • Pain or bleeding during or after sex
  • Bleeding in between periods
  • Burning feeling when you urinate

See a doctor if you have any of these symptoms or think you might have a sexually transmitted disease. If you are younger than age 25 and sexually active, consider having a test for chlamydia every year so you can find out early if you have it. Talk with your doctor about whether you should be tested for other sexually transmitted diseases.

Pelvic inflammatory disease is treated with antibiotics. While the infection can be treated, it can cause permanent damage before it’s treated. It can create scar tissue inside and outside the fallopian tubes. This scar tissue can block the egg from traveling to the uterus from the ovary. It can give you long-term pelvic pain and cause infertility.

Pelvic Floor Muscle Weakness

Just like muscles in other parts of the body, the pelvic floor muscles can become weakened or damaged. Surgery, pregnancy, and childbirth are common causes of a weakened or damaged pelvic floor in women.

Symptoms of pelvic floor problems include:

  • Urinary incontinence
  • Fecal incontinence
  • Constipation
  • Pain in lower abdomen (belly) area or vagina
  • Tailbone pain
  • Problems or pain with sexual intercourse

To diagnose your pelvic floor condition, therapists will ask you questions about your pelvic pain and symptoms. They may also look at how you walk and move. They will also examine your pelvic floor muscles.

Treatment may include:

  • Pelvic floor muscle strengthening or relaxation exercises
  • Biofeedback therapy
  • Manual therapy
  • Education and a home exercise program