Overview
Don't suffer in silence. We can help.
Pelvic floor problems aren’t as uncommon as you might think. In fact, millions of Americans suffer from a wide range of pelvic floor problems: pelvic organ prolapse, rectal prolapse, incomplete defecation, loss of bowel control, and constipation, just to name a few.
Yet, many people often don’t seek help because they’re too embarrassed or aren’t sure where to turn. The good news, however, is that effective treatments may be available.
Why choose Cleveland Clinic?
Cleveland Clinic's Colorectal Center for Pelvic Floor Disorders has the most experienced group of specialists in the region. Cleveland Clinic is one of only four programs in the country to be named a Center of Excellence: Continence Care for Women by the National Association for Continence (NAFC).
Cleveland Clinic is recognized in the U.S. and throughout the world for its expertise and care.
Using state-of-the-art diagnostics and decades of experience, we determine the cause of patients’ problems and then tailor the most appropriate treatment. You can rely on our success in both diagnosing and treating a full spectrum of pelvic floor disorders.
Don’t wait. You don’t have to let your pelvic floor problems control your life.
What We Treat
Common conditions treated at Cleveland Clinic’s Colorectal Center for Pelvic Floor Disorders include:
Chronic constipation and difficult defecation
Constipation is considered chronic when you have three or fewer bowel movements per week. Other common symptoms in constipated patients include straining, hard stools, and a feeling of incomplete evacuation. In some cases, constipation is related to difficult evacuation, which may be caused by rectal prolapse, paradoxical contraction (non-relaxation) of the pelvic floor muscles, sigmoidocele enterocele (when the sigmoid colon or pelvic floor weaken and drop),and rectocele, in which the wall between the rectum and vagina weakens.
Dietary changes and exercise as well as over-the-counter medications can frequently help. Patients may benefit from treatment with biofeedback or, in extreme cases, require surgery.
Some causes of evacuatory dysfunction include rectal prolapse, paradoxical contraction (non-relaxation) of the pelvic floor muscles, sigmoidocele enterocele (when the sigmoid colon or pelvic floor weaken and drop),and rectocele, in which the wall between the rectum and vagina weakens.
Evaluation by a Colorectal Center for Pelvic Floor Disorders physician specialist is needed to determine the appropriate treatments, among which are:
Treatment options:
- Medications – Fiber supplements, stool softeners and laxatives are often recommended.
- Pelvic floor retraining – Physical therapists specializing in the pelvic floor teach methods to strengthen and coordinate the pelvic floor muscles, as well as to heighten the awareness of the sensation related to the rectum filling with stool. Electrical stimulation is also offered.
- Botox injection – For patients with non-relaxation of the pelvic floor muscles, Botox injection into those muscles is an option to improve emptying ability.
- STARR procedure – This minimally-invasive surgical procedure, which leaves no visible scars, removes excess tissue in the rectum to allow for more effective emptying.
- Surgery for rectal prolapse – Various procedures for rectal prolapse return the rectum to its original position and anchor it in place.
- Pelvic floor repair – This surgery restores the pelvic floor, which supports the bladder, bowel and uterus.
Fecal incontinence
Fecal incontinence refers to an inability to hold on to or control liquid or solid stool. Sometimes simple changes in diet or adjustments in medications can cure incontinence. Often treatment involves a combination of therapies.
Treatment options:
- Medications – Anti-diarrheal drugs, or others medications, may be used to decrease bowel movement frequency or reduce the water content of the stool.
- Pelvic floor retraining – Physical therapists specializing in the pelvic floor teach methods to strengthen and coordinate the pelvic floor muscles, as well as to heighten the awareness of the sensation related to the rectum filling with stool.
- Sphincter repair (sphincteroplasty) – A damaged or weakened anal sphincter muscle can often be surgically repaired.
- Sacral nerve stimulation (InterStim) – This procedure improves continence by using an implantable device to modulate the nerves to the anorectum.
- Newer treatments are currently under research protocols.
Pelvic floor dysfunction
Pelvic floor dysfunction occurs when you are unable to effectively coordinate the muscles in your pelvic floor to have an easy bowel movements. People with pelvic floor dysfunction contract (tighten) these muscles rather than relax them. Because of this, they have difficulty with bowel movements: a feeling of incomplete emptying, straining, or the need for measures to assist in emptying (for example, enemas or using a finger to pull out stool).
Treatment options:
- Biofeedback – The most common treatment for pelvic floor dysfunction is biofeedback, done with the help of a physical therapist. Physical therapists may take several approaches to biofeedback. These include using special sensors and video to monitor the pelvic floor muscles as the patient attempts to relax or contract them.
- Medication – In some cases, your physician may prescribe a low-dose muscle relaxant to deal with pelvic floor dysfunction.
- Relaxation techniques – Your physician or physical therapist may recommend relaxation techniques such as warm baths, yoga, and exercises.
- Surgery – If your physician determines that your pelvic floor dysfunction is the result of a rectal prolapse or rectocele, surgery may be necessary.
Rectal prolapse
Rectal prolapse occurs when the rectum (the last section of the large intestine) falls from its normal position within the pelvic area. (The word "prolapse" means a falling down or slipping of a body part from its usual position.)
Treatment options:
- Abdominal surgery – The rectum may be secured into its normal position (rectopexy) via a robotic or laparoscopic abdominal surgery.
- Rectal (perineal) surgery – These procedures are performed via the anus, not requiring any incisions in the abdomen.
Rectovaginal fistula
This is a type of anal fistula in which an abnormal passageway develops between the rectum and vagina. A rectovaginal fistula can occur in women after trauma during childbirth, from surgery or from inflammatory conditions.
Treatment options:
- Advancement flap repair – In this surgical procedure the rectal lining is used to cover the internal opening in the anus.
- Rectovaginal plug – A biologic material can be implanted to close the fistula.
- Anal sphincter repair – The anal sphincter muscle is used to reinforce a repaired opening.
- Abdominal repair – Reconstructive surgery via the abdomen may be needed to close the fistula in some cases.
Cleveland Clinic's Colorectal Center for Pelvic Floor Disorders also has a research group that is actively working to improve treatment options for our patients. This means that qualifying patients benefit from having access to clinical trials. These research studies not only provide treatments otherwise unavailable, but they also help us expand our overall understanding of pelvic floor disorders.
Related information
- Download a free Pelvic Floor Disorders Treatment Guide.
- Listen to Cleveland Clinic’s Butts & Guts podcast as Dr. Sarah Vogler provides insight into pelvic floor disorders.
- Watch Grand Rounds: Fecal Incontinence – Treating Structure and Function.
What to Expect
We want to make your appointment with us as comfortable as possible. As your visit approaches, we understand you'll have questions. That's why we've put together information that will give you an overview of what to expect when you come to us.
What to expect during your visit to the pelvic floor clinic in the exam room
- After checking in at the front desk, you will meet the members of our team. This may include nurses, medical student or fellows and colorectal staff. Each one may ask you questions about your medical history and present condition.
- Be prepared with your list of medication, prior surgeries, colonoscopy reports and imaging (for example, X-ray or cat scans) related to your condition.
- You will undergo a physical examination. This may include anal, rectal and genital examinations. To examine the anus internally, a short cylindrical instrument may be gently inserted into the anal canal. When indicated, a vaginal examination may be required. For this examination, no patient preparation is needed.
- At the conclusion of your visit, you and your doctor will establish a plan of care.
- Before you leave, make sure that you have a clear understanding of your treatment and follow-up care.
Before you leave
- Make sure you are satisfied with your doctor's plan of testing and treatment.
- Make sure your questions are answered.
- Have a means of communicating with your doctor/nurse (visiting card/phone number).
- Do you have a follow-up scheduled?
- If you are not satisfied with your instruction, please talk to the doctor/nurse before you leave.
- Please complete all questionnaires that you are asked to fill.
Demographic and insurance information
We want to ensure that we have the most up to date information on your address, telephone number, date of birth, emergency contact and health insurance. We may ask you to verify this information.
Thank you for your cooperation and understanding of the numerous questions we ask and the variety of methods used to collect this information. Our goal is to provide you with the most effective care so we thank you for choosing Cleveland Clinic’s Digestive Disease & Surgery Institute to partner with you in improving your health.
Our Doctors
 Anna Spivak, DO Staff |
Meaghan Beal, CNP |
 Abby Turza, CNP |
 Taylor Boice, PAC |
Mary Ann Valentino, RN Clinical Care Coordinator |
 Nanette Stanley Administrative Assistant |
Tracy Hull, MD Staff |
Outcomes
Quality counts when referring patients to hospitals and physicians.
Make an Appointment
Call 216.444.7000 to make an appointment with any of our experts at Cleveland Clinic’s Colorectal Center for Pelvic Floor Disorders.
Virtual second opinions
If you cannot travel to Cleveland Clinic, help is available. You can connect with Cleveland Clinic specialists from any location in the world via a phone, tablet, or computer, eliminating the burden of travel time and other obstacles.
If you’re facing a significant medical condition or treatment such as surgery, this program provides virtual access to a Cleveland Clinic physician who will review the diagnosis and treatment plan. Following a comprehensive evaluation of medical records and labs, you’ll receive an educational second opinion from an expert in their medical condition covering diagnosis, treatment options or alternatives as well as recommendations regarding future therapeutic considerations. You’ll also have the unique opportunity to speak with the physician expert directly to address questions or concerns.
