The investigation and treatment of female pelvic floor dysfunction

Abstract

Background: 25% of all women report involuntary loss of urine, and 7% may require treatment.

Methods: This review is based on a selection of pertinent literature, including guidelines and Cochrane reviews.

Results: The assessment of pelvic floor dysfunction in women begins with a basic evaluation that is followed by special diagnostic tests if indicated. The physician taking the clinical history should inquire about the patient's behavior, personality, social and other stressors, and eating and drinking habits, as well as any mental disorders that may be present, including anxiety disorders, depression, somatization disorders, and disorders of adaptation. Conservative treatment consists mainly of lifestyle changes, physiotherapy, and medication. Stress incontinence is most commonly treated with pelvic floor exercises, with a documented success rate of 56.1% vs. 6% without such treatment (relative risk 8.38, 95% confidence interval 3.67-19.07). If incontinence persists, surgery may be indicated ( implantation of suburethral tension-free slings, or colposuspension). Feedback and biofeedback training can be used to treat an overactive bladder. If these techniques and drug therapy are unsuccessful, botulinum toxin injections can be considered.

Conclusion: Well-validated treatments for pelvic floor dysfunction are available. Psychosomatic factors must be taken into account and can have a major effect on treatment outcomes.

Figure 1

Figure 1: The prevalence and significance of urinary incontinence (1). Figure reproduced with the kind permission of the Robert Koch Institute. UI, urinary incontinence.

Figure 2

Prolapse of the anterior vaginal wall down to the hymenal edge (grade II) (photograph reproduced with the kind permission of Prof. John DeLancey, Ann Arbor, USA).

Figure 3

Total prolapse of the vagina after hysterectomy, with ulcerations of the vaginal mucosa (Grade IV).

Figure 4

Ultrasonic imaging to determine urinary residual volume: abdominal image in three planes.

Figure 5

Stepwise treatment algorithm for urge incontinence. OAB, overactive bladder syndrome. (With the kind permission of the Overactive Bladder Guideline Comittee of the German Society of Gynecology and Obstetrics [Deutsche Gesellschaft für Gynäkologie und Geburtshilfe]) (18]).