Pelvic floor dysfunction

Pelvic floor dysfunction is defined as a herniation of the pelvic organs through the pelvic organ walls and pelvic floor. The condition is widespread, affecting up to 50 percent of women at some point in their lifetime. About 11 percent of women will undergo surgery for urinary incontinence or pelvic organ prolapse by age 80. Women who experience pelvic floor dysfunction are more likely to report issues with arousal combined with dyspareunia. For women, there is a 20.5% risk for having a surgical intervention related to stress urinary incontinence. The literature suggests that white women are at increased risk for stress urinary incontinence. Though pelvic floor dysfunction is thought to more commonly affect women, 16% of men have been identified with pelvic floor dysfunction. 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. ==Causes==

Mechanistically, the causes of pelvic floor dysfunction are two-fold: widening of the pelvic floor hiatus and descent of pelvic floor below the pubococcygeal line, with specific organ prolapse, graded relative to the hiatus. ==Diagnosis==

, bladder prolapse through the anterior vaginal wall is called a cystocele, and prolapse of the small bowel is an enterocele. 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. ==Treatment==

There are several approaches to treatment of pelvic floor dysfunction, and often several approaches are used in combination. Physical therapy Pelvic floor muscle (PFM) training, sometimes referred to as urotherapy in pediatric and continence care contexts, is vital for treating different types of pelvic floor dysfunction. Two common problems are uterine prolapse and urinary incontinence both of which stem from muscle weakness. 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. Being able to control the pelvic floor muscles is vital for a well functioning pelvic floor. Without the ability to control the pelvic floor muscles, pelvic floor training cannot be done successfully. Pelvic floor muscle therapy strengthens the muscles of the pelvic floor through repeated contractions of varying strength. PFM training can also increase female sexual satisfaction by improving sexual function and the ability to orgasm. In men, PFM exercises can also help maintain a strong erection. The use of telerehabilitation is also strongly recommended for the benefit of patients suffering from pelvic floor dysfunction in order to ensure that the treatment for their pelvic floor dysfunction is effective, maintained, and efficient. Without the continuation of the effective treatment, this could make patients more susceptible to secondary injuries or worsening symptoms and affects to their daily living. One of the greatest benefits that come from telerehabilitation is that it is a great tool to use for pelvic floor dysfunctions when access to rehabilitation is limited. However, due to the rare use of it in this area of health care, research on pelvic floor muscle training as it pertains to telerehabilitation is limited. In addition, abdominal muscle training has been shown to improve pelvic floor muscle function. By increasing abdominal muscle strength and control, a person may have an easier time activating the pelvic floor muscles in sync with the abdominal muscles. Many physiotherapists are specially trained to address the muscle weaknesses associated with pelvic floor dysfunction and can effectively treat pelvic floor dysfunction through strengthening exercises. Overall, physical therapy can significantly improve the quality of life of those with pelvic floor dysfunction by relieving symptoms. Medication Overactive bladder can be treated with medications, including those in the class of antimuscarinics and beta 3 agonists. Antimuscarinics are the most commonly used, however, beta 3 agonists can be used for those that are unable to take antimuscarinics due to side effects or other reasons. This treatment is useful for individuals who do not want to have surgery or are unable to have surgery due to the risk of the procedure. Some pessaries have a knob that can also treat urinary incontinence. To be effective, pessaries must be fitted by a medical provider and the largest device that fits comfortably should be used. Other devices train the pelvic floor via internal exercises with biofeedback mechanisms. Lifestyle modifications Treatment for pelvic floor dysfunction, especially the symptom of urinary incontinence, is essential, but so is prevention. Patients are usually encouraged to change their lifestyles; interventions such as reducing body weight, limiting the use of stimulants, quitting smoking, limiting strenuous efforts, preventing constipation and increasing physical activity can help prevent pelvic floor dysfunction. There are various procedures used to address prolapse. Cystoceles are treated with a surgical procedure known as a Burch colposuspension, with the goal of suspending the prolapsed urethra so that the urethrovesical junction and proximal urethra are replaced in the pelvic cavity. Uterine prolapse is treated with hysterectomy and uterosacral suspension. With enteroceles, the prolapsed small bowel is elevated into the pelvis cavity and the rectovaginal fascia is reapproximated. Rectoceles, in which the anterior wall of the rectum protrudes into the posterior wall of the vagina, require posterior colporrhaphy, also known as repair of the vaginal wall. Though pelvic floor dysfunction is more common in women, there are also proven methods to assist men. In severe cases of pelvic floor dysfunction causing urinary incontinence, a radical prostatectomy followed by postoperative pelvic floor muscle therapy is an option. ==See also==