Pelvic Floor Disorders

Pelvic floor disorders affect millions of women and men of all ages, often compromising their quality of life. At UT Southwestern Medical Center, our multidisciplinary team offers a full range of state-of-the-art diagnostic techniques, as well as nonsurgical, surgical, and robotic treatment options for pelvic floor disorders.

We also have comprehensive rehabilitation programs to treat pelvic-related conditions in a thorough and patient-centered manner.

Restoring Quality of Life Through Effective Treatment

Chronic pelvic pain and its associated symptoms can be truly disabling. Urinary incontinence, chronic constipation, tailbone pain, pain with intercourse, and other types of pelvic dysfunction can severely limit people’s ability to live life the way they want.

It’s possible to significantly minimize symptoms and restore quality of life with proper treatment of pelvic musculoskeletal dysfunction, even if pelvic problems are caused by a disease like endometriosis or nonbacterial prostatitis.

We take a multidisciplinary approach to diagnosing and treating pelvic floor disorders, using a team of specialists who work closely together to facilitate care and provide the best possible outcomes. Among our specialists are nationally recognized experts in the fields of:

• Colorectal surgery
• Gastroenterology
• Obstetrics and gynecology
• Physical medicine and rehabilitation
• Physical therapy
• Psychiatry
• Radiology
• Urogynecology
• Urology
  

Our collaboration with subspecialists from other fields ensures that patients have some of the best medical minds working for them, from the point of diagnosis all the way through treatment.

Conditions

Several factors can contribute to pelvic floor disorders, including aging, pregnancy, hormonal changes, and injuries. 

We treat a broad range of pelvic floor conditions, such as:

• Urinary and fecal incontinence or urgency
• Pelvic organ prolapse and mesh complications
• Pelvic pain
• Overactive bladder
• Constipation
• Sexual dysfunction
• Coccydynia (tailbone pain)
• Dyspareunia (pain with intercourse)
• Dysuria (pain with urination)
• Interstitial cystitis (bladder pain)
• Nocturia (nighttime urination)
• Chronic low back, hip, abdominal, rectal, groin, buttock, vaginal, or testicular pain
• Piriformis syndrome
• Sacroiliac joint pain or dysfunction
• Chronic nonbacterial prostatitis

Diagnosing Pelvic Floor Disorders

Patient care for pelvic floor disorders begins with a comprehensive diagnostic evaluation that includes a history, a physical examination, and a thorough discussion of symptoms.

Our physicians might do a postural and structural assessment, a neurological evaluation, and musculoskeletal and neuromuscular examinations. We also offer electrodiagnostic and radiologic evaluations, if necessary, to confirm the diagnosis.

Treatments for Pelvic Floor Disorders

We offer nonsurgical, surgical, and robotic treatment options, so patients have access to a broad range of leading-edge care. Among the pelvic floor treatments we offer are: 

Nonsurgical Options

• Biofeedback
• Botox injections
• Counseling
• Electrical stimulation
• Medications
• Percutaneous tibial nerve stimulation (PTNS)
• Physical therapy
• Pessary therapy (vaginal support device)
  

Surgical Options

• Vaginal, abdominal, laparoscopic, and robotic repair of pelvic structures
• Sling procedures
• Periurethral and injectable agents
• Sacral neuromodulation (a nerve-stimulating device that helps control overactive bladder, fecal incontinence, and urinary retention)
• Latest robotic technology (dual-console da Vinci robot)

Pelvic Floor Rehabilitation

Pelvic rehabilitation is an effective method for treating pelvic pain, pelvic muscle dysfunction, and back or pelvic pain and associated disorders resulting from pregnancy and the postpartum period. Our goal is to reduce pain, increase function, and restore quality of life.

Treatments are administered by an experienced and skilled team of physical medicine and rehabilitation physicians who specialize in treating disorders of the muscle, bone, and nerves. They’re joined by a staff of certified, specially trained therapists who are experts at working with patients who are suffering from pelvic pain and dysfunction.

Pelvic floor rehabilitation treatments we offer include:

• Biofeedback
• Bladder retraining
• Bowel retraining
• Connective tissue manipulation
• Electrical stimulation
• Home exercise program
• Interventional pain procedures
• Manual therapy
• Medication management
• Myofascial release
• Neural mobilization
• Neuromuscular re-education
• Patient education
• Physical therapy (both general and specialized for pelvic floor muscle problems)
• Psychology referral
• Strengthening/alignment/stabilization exercises
• Support devices and orthotics

Pregnancy and Postpartum Pelvic Issues

Pregnant women who suffer severe low back or pelvic pain can have trouble working, sleeping, and taking care of their families. Also, after giving birth there can be a host of new physical problems, such as urinary incontinence, pain with sexual intercourse, pelvic muscle injuries, and nerve injuries.

Proper treatment can alleviate these conditions and help patients enjoy their pregnancy and life with their new babies.

Pregnancy and postpartum conditions we treat include:

• Back or pelvic pain during pregnancy or following delivery
• Sacroiliac joint dysfunction in pregnancy or postpartum
• Pubic symphysis pain or dysfunction
• Urinary incontinence or other urinary problems during pregnancy or following delivery
• Fecal/bowel incontinence following delivery
• Constipation
• Painful sexual intercourse following delivery
• Pelvic muscle injuries during delivery
• Nerve injuries during pregnancy or delivery
• Neck or back pain with childcare/breastfeeding activities 
• Abdominal and scar pain after cesarean section
• Hip, leg, or groin pain or weakness during pregnancy or following delivery

Clinical Trials

Research being performed at UT Southwestern shows promising treatments might reduce the recurrence of pelvic floor dysfunction symptoms. An ongoing clinical trial, led by UT Southwestern’s David Rahn, M.D., is examining the effectiveness of vaginal estrogen – a supplemental, nonsurgical therapy – to reduce symptom recurrence and spare more women the risks and financial implications of revisional surgeries. We’re also studying how vaginal estrogen may impact other pelvic floor disorders such as overactive bladder, urinary incontinence, sexual dysfunction and painful intercourse, and postoperative bladder infections.