Pelvic Floor Disorders Overview^[condition] and NIH Women's Health Research

Pelvic floor disorders are a group of conditions that occur when the muscles and connective tissues that support the pelvic organs are weakened or injured. The pelvic floor holds the bladder, uterus, vagina, rectum, and bowel in the proper positions and helps control urination and bowel movements.^{1 - 4} When this support system is compromised, individuals may experience urinary incontinence, fecal incontinence, pelvic organ prolapse (most commonly of the bladder), or other forms of pelvic floor disorders.^{4 - 7} Signs and symptoms of these conditions include pelvic pressure or heaviness; difficulty emptying the bladder or bowels; leaking urine when coughing, lifting something heavy, or exercising; and a visible or palpable vaginal bulge in cases of pelvic organ prolapse.^{2 - 6} All of these can significantly impair daily functioning and quality of life.

The causes and risk factors for pelvic floor disorders are multifactorial and often cumulative over a lifetime. Women, especially older women, are disproportionately affected, largely because of female pelvic anatomy and reproductive life events.^{3 , 5 , 8 , 9} Vaginal childbirth is the most significant contributor, as maternal pelvic structures experience tremendous stretches and pressure during vaginal delivery that can damage pelvic soft tissues, including muscles, vaginal connective tissue, and nerves. Additional risk factors include aging, obesity, chronic constipation or straining, smoking, persistent coughing, prior pelvic surgery (e.g., hysterectomy), and certain neurologic conditions.^{1 - 6 , 9 , 10} Over time, these factors can reduce the pelvic floor’s ability to support organs and maintain continence. Hormonal changes during menopause—particularly decreased estrogen levels—further weaken pelvic tissues and reduce urethral support.^{3 , 8 , 9}

Urinary incontinence, which is the most prevalent pelvic floor disorder, is about twice as common in women as in men, affecting about half of all women.^{4 , 6 , 9 , 11} The reported prevalence of pelvic organ prolapse among women is highly variable, with examination-based studies documenting rates up to 50%, whereas symptom-based prevalence remains substantially lower (approximately 3% to 6%).^{8 , 10 , 12 , 13} These figures highlight the underreporting of this stigmatized condition as well as the discrepancy between anatomic findings and clinically meaningful disease. Fecal incontinence affects up to about 15% of women, with prevalence increasing with age.^{12 , 14 - 17} This condition negatively impacts quality of life and causes substantial economic burden to individuals and health care systems. Importantly, the prevalence of fecal incontinence is even more likely to be underestimated given the stigma associated with this condition.

Diagnosis, treatment, and research for pelvic floor disorders continue to evolve. Diagnosis typically involves a detailed medical history and physical examination, including assessments of pelvic organ support, urine leakage with exertion, bladder emptying, and function of the pelvic floor muscles and anal sphincter using validated scales.^{1 , 3 , 5 , 6 , 10 , 18} Imaging, such as pelvic ultrasound or pelvic magnetic resonance imaging, can be used when needed to assess structural changes in the pelvic supportive structures. In addition, specialized bladder and bowel functional testing, including urodynamic testing, defecography, and anorectal manometry, can be added when needed.

Treatment options range from conservative approaches—such as pelvic floor muscle training and bladder training, pelvic floor physical therapy, lifestyle modifications, medications, sacroneuromodulation, and pessaries—to surgical repairs, which can be used when conservative approaches are not successful.^{4 - 7 , 9 , 10 , 18 , 19} In cases of pelvic organ prolapse, surgery may involve vaginal or abdominal reconstructive procedures using native tissue repair or augmentation with graft materials. For women who do not plan to engage in vaginal penetrative sex in the future, closing the vaginal canal is a minimally invasive and durable option.^{3 , 7 , 10} Surgical mesh placement may also be used for pelvic organ prolapse; however, the Food and Drug Administration has raised concerns regarding transvaginal placement of mesh because of reported complications, including mesh erosion, pain, infection, urinary problems, bleeding, and organ perforation.^{7 , 10 , 20 , 21} Abdominal mesh placement, on the other hand, continues to be a safe option for durable prolapse repair, especially in cases of recurrent prolapse.

For stress urinary incontinence, urethral bulking injection or midurethral mesh slings can be used, with the latter being the most efficacious treatment option that is also safe and minimally invasive.^{3 , 22 , 23} Treatment options for fecal incontinence are more limited and involve pelvic physical therapy with biofeedback or sacroneuromodulation.^{19 , 24} Surgical repair of anal sphincter injuries is associated with a low long-term success rate.²⁵

While no single intervention universally restores normal pelvic floor function, lifestyle modifications, medications, and other interventions can alleviate symptoms.¹ For example, the Group Learning Achieves Decreased Incidents of Lower Urinary Symptoms (GLADIOLUS) study, which was funded by the National Institute on Aging (NIA) found that a one-time, 2-hour, group-administered bladder health class reduced the frequency and severity of urinary incontinence and improved the quality of life among women with this condition who were 55 years or older.²⁶

Ongoing research focuses on exploring health disparities that shape the burden of pelvic floor disorders. An example of these efforts is a 2025 study that was cofunded by NIA and the Eunice Kennedy Schriver National Institute of Child Health and Human Development (NICHD) where researchers determined that older women who experienced certain adverse social determinants of health, such as low literacy, food insecurity, or adverse economic circumstances, were more likely to have urinary incontinence.²⁷ This suggests that these factors are important targets for interventions designed to reduce disparities and improve urinary incontinence outcomes among older women. Other research efforts are focused on enhancing clinical phenotyping, understanding the pathophysiology of pelvic floor disorders, examining the effectiveness of surgical and nonsurgical interventions, developing new biomaterials––including autologous materials––for restoring or improving the function of pelvic and lower urinary tract structures, identifying predictors of treatment success, and developing long-term management strategies for women with pelvic floor disorders.^{12 , 28 , 29}

Over two decades ago, NICHD established the Pelvic Floor Disorders Network (PFDN) to advance collaborative research on pelvic floor disorders. The purpose of the PFDN is to generate high-quality evidence to guide clinical practice using a network of eight clinical centers and a Data Coordinating Center at U.S. universities and medical centers. Recent research activities include trials that have compared surgical approaches for vaginal and uterine prolapse; studies that have evaluated combinations of surgery and pelvic floor therapy for urinary incontinence; and research that has examined long-term anatomical, functional, and quality of life outcomes following surgical and nonsurgical interventions. The PFDN increasingly incorporates translational science, aiming to promote foundational investigations and to link scientific findings with clinical outcomes to further advance patient-centered care.