Pelvic floor dysfunction

[7][8] Common treatments for pelvic floor dysfunction are surgery, medication, physical therapy and lifestyle modifications.

[11] Women who experience pelvic floor dysfunction are more likely to report issues with arousal combined with dyspareunia.

[13] Pelvic floor dysfunction and its multiple consequences, including urinary incontinence, is a concerning health issue becoming more evident as the population of advancing age individuals rises.

Additionally, people with congenitally weak connective tissue and fascia are at an increased risk for stress urinary incontinence and pelvic organ prolapse.

[10] Recent literature demonstrates that defects in endopelvic fascia and compromised levator ani muscle function have been categorized as important etiologic factors in the development of pelvic floor dysfunction.

This includes avoiding urinating or bowel movements, obesity, use of muscle relaxants or narcotics, and use of antihistamines or anticholinergics.

[15] Pelvic floor dysfunction can be assessed with a strong clinical history and physical exam, though imaging is often needed for diagnosis.

[13] Imaging provides a more complete picture of the type and severity of pelvic floor dysfunction than history and physical exam alone.

This technique is less invasive, and allows for less radiation exposure and increased patient comfort, though an enema is required the evening before the procedure.

Both fluoroscopy and MRI assess the pelvic floor at rest and during maximum strain using coronal and sagittal views.

Lastly, a line from the pubic symphysis to the puborectalis muscle sling is drawn, which is a measurement of the pelvic floor hiatus.

Transabdominal, transvaginal, transperineal and endoanal ultrasound (EUS) are important tools for diagnosing pelvic floor dysfunction.

For EUS, an ultrasound probe is inserted into the anal canal and can be used to visualize and assess the anatomy and function the pelvic floor.

[18] Ultrasound is easily accessible and noninvasive; however, it may compress certain structures, does not produce high-quality images and cannot be used to visualize the entire pelvic floor.

Pelvic floor muscle therapy is the first line of treatment for urinary incontinence and thus should be considered before more invasive procedures such as surgery.

[24] Overall, physical therapy can significantly improve the quality of life of those with pelvic floor dysfunction by relieving symptoms.

Symptoms of urinary incontinence can also be reduced by making dietary changes such as limiting intake of acidic and spicy foods, alcohol and caffeine.

[13] Surgery is performed when desired by the patient or when less invasive treatments, such as lifestyle modification and physical therapy, are not effective.