Problems that cause incontinence and other embarrassing symptoms affect millions of American women. Once diagnosed, these conditions can be treated.

Few people like to talk about it, but one in four American women suffers from at least one pelvic floor disorder (PFD) that can cause incontinence and other problems as organs shift out of position.

PFDs become more common with age. Ten percent of women ages 20 to 39 have them, as do 50 percent of women 80 and older. Still, these conditions aren't a normal part of aging that women must endure. PFDs are medical conditions that can be treated successfully. However, many women who suffer from PFDs are too embarrassed to tell their doctors.

Learning about PFDs can help you recognize these problems and seek effective treatment.

Q. What are PFDs?
A: A pelvic floor disorder occurs when a woman's pelvic muscles and connective tissues in the pelvic area are weakened or injured. The three most common disorders include:

• Pelvic organ prolapse, when the pelvic muscles become too weak to hold the organs in place. The womb, bladder, or other organs can shift out of position. Symptoms of a prolapse include a feeling of pelvic heaviness, a bulge in the vagina, aching or pressure in the lower abdomen or pelvis, and pelvic pressure that worsens with standing, lifting, or coughing.
• Urinary incontinence, when the bladder slips down into the vagina. The symptoms of this disorder are urine leakage, an urgent need to urinate, and frequent or painful urination.
• Anal incontinence, when a bulging rectum makes bowel control difficult.

Q. What causes PFDs?
A: The main cause of PFDs is injury to the pelvic floor muscles due to vaginal delivery of a baby. Other causes include aging, menopause, pelvic surgery, and intense physical activity.

Anything that worsens pressure on the abdomen can increase the risk for pelvic organ prolapse. Such factors include being overweight, being constipated, straining to have bowel movements, and chronic coughing.

Q. How are PFDs treated?
A: The need for treatment varies with the severity of symptoms. Some PFDs can be treated with dietary changes and weight loss. Treatment may also include surgery, prescription medication, or use of a pessary, a device that helps keep the pelvic organs in place. Exercises known as Kegels can help strengthen the pelvic muscles.

You can often manage urinary incontinence by reducing your fluid intake and avoiding caffeine, artificial sweeteners, citrus juices, and other bladder irritants. Urinating on a regular schedule can help, too.

Q. How should I talk with my doctor about PFD?
A: Many women suffer needlessly from PFDs because they find it hard to discuss their symptoms with their doctors. But if you don't let your doctor know about your symptoms and seek treatment, you'll continue to suffer. If your primary care physician is unable to treat you, he or she may refer you to a specialist called a urogynecologist.

To start the conversation, tell your doctor about your symptoms, how long you've had them, and how often they occur.

If embarrassment is holding you back from receiving treatment, do yourself a favor: Commit to making an appointment with your doctor and bringing up the subject. You'll be glad you did.

Barbara Floria, senior writer for Vitality.

For more information, visit the American Urogynecologic Society at www.mypelvichealth.org.

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