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Pelvic Floor Dysfunction
Pelvic floor dysfunction occurs with abnormal activity of pelvic floor musculature and is associated with hypertonicity, hypotonicity, and inappropriate coordination of pelvic floor muscles. A combination of urologic, gynecologic, and colorectal conditions can contribute to pelvic floor dysfunction. Common concerns of pelvic floor dysfunction include difficult urination, urinary incontinence, cystocele, and uterine, vaginal, or rectal prolapse. Other conditions include dyspareunia, constipation, pelvic pain, and proctalgia fugax. Pelvic muscular pain may result from posture, gait, and skeletal asymmetry, and pelvic floor dysfunction may be a side effect of a spinal nerve or lower back injury, a degenerative neuromuscular disease, or atrophic vaginitis.
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Pelvic Floor Dysfunction Diagnosis
A general, urologic, gynecologic, and colorectal history of the patient should be reviewed for pelvic floor dysfunction diagnosis. Voiding, defecation, pain, and dietary diaries are useful in the evaluation of a patient’s symptoms. The physical exam for pelvic floor dysfunction diagnosis may include visual inspection, cotton swab test, speculum exam, bimanual exam, and rectal digital exam. In addition to the physical exams, other areas should be evaluated. This includes pelvic floor contraction, anal sensation, palpation of urogenital triangle, and digital palpation fo pelvic floor muscles.
Pelvic Floor Dysfunction Podcasts
Listen to leading physicians discuss pelvic floor dysfunction on the BackTable Urology Podcast. Get tips, tricks, and expert guidance from your peers and level up your practice.
Dr. Jose Silva talks with Urologist Dr. Yahir Santiago from UC San Diego Medical Center about the diagnosis and treatment of pelvic floor dysfunction in women.
Pelvic Floor Dysfunction Treatment
Pelvic floor dysfunction can be managed with lifestyle modifications and medications. Pelvic floor exercises and core exercises along with decreasing alcohol and caffeine consumption are important behavioral changes for managing pelvic floor dysfunction. Medications such as topical vaginal estrogen, anticholinergics, or beta-3 agonists are used for treating an overactive bladder. Physical therapy and patient splinting are common forms of manipulating the pelvic floor to control pain and mobilization. When non-invasive measures fail to relieve pelvic floor dysfunction, cystoscopic intravesical injection of botox can be used to treat an overactive bladder. Surgical options vary with the anatomical prolapse of the patient. Colposuspension, sacrocolpopexy, rectopexy, and mid-urethral sling are surgical interventions that can be performed.
Pelvic Floor Dysfunction Articles
Read our exclusive BackTable Urology Articles for quick insights on pelvic floor dysfunction, provided by physicians for physicians.
Sling surgery is the most common type of surgery to treat female incontinence. This article explains the differences between different types of sling surgery including TOTs, TVTs, and mini-slings. Sling surgery recovery guidelines are also discussed.
Non-surgical options for female incontinence treatment are important for patients who don’t want to have surgery. They include anticholinergics, pessaries, bulking agents, and pelvic floor physical therapy.
 Grimes, W. R., & Stratton, M. (2021, July 1). Pelvic floor dysfunction. StatPearls [Internet]. Retrieved January 13, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK559246/
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