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Pelvic Floor Dysfunction

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Presentation on theme: "Pelvic Floor Dysfunction"— Presentation transcript:

1 Pelvic Floor Dysfunction

2 Pelvic Organ Prolapse Lower Urinary Tract disorder Anorectal Disorder

3 Not life threatening But life quality worsening

4 Pelvic Floor

5 Pelvic Floor Pelvic diaphragm Funnel-shaped fibromuscular partition
Forms the primary supporting structure for the pelvic contents Composition Levator ani Coccygeus muscles their superior and inferior fasciae Forms the ceiling of the ischiorectal fossa


7 Pelvic Organ Prolapse

8 Pelvic Organ Prolapse (POP)
bulge or protrusion of pelvic organs and their associated vaginal segments into or through the vagina Incidence increases with aging anterior pelvic organ prolapse 34.3% posterior wall prolapse 18.6% uterine prolapse in 14.3% Vaginal delivery as a significant risk factor history of hysterectomy; obesity ; history of previous prolapse operations; race Optical surgical treatment remains elusive

9 Pathophysiology attenuation of the supportive structures
endopelvic connective tissue levator ani muscular support by actual tears or “breaks” by neuromuscular dysfunction

10 Definitions Rectocele Enterocele Cystocele Uterine prolapse

11 Definitions

12 Symptoms Pelvic organ prolapse Symptoms of voiding dysfunction
Urinary incontinence Obstructive voiding symptoms Urinary urgency and frequency Urinary retention and upper renal compromise Defecatory problems (e.g., constipation, diarrhea, tenesmus, fecal incontinence) Pelvic pain Back and flank pain Overall pelvic discomfort Dyspareunia

13 Symptoms

14 Physical examination Divide the pelvis into compartments
Apical compartment ---- Graves speculum or Baden retractor The anterior and posterior compartments ---- univalve or Sims' speculum Rectovaginal examination ---- distinguish a posterior vaginal wall defect from a dissecting apical enterocele Anterior lateral detachment defect----Baden retractor Valsalva is encouraged standing straining examination

15 Pelvic Organ Prolapse Quantitation System

16 Pelvic Organ Prolapse Quantitation System

17 Pelvic Organ Prolapse Quantitation System

18 Pelvic Muscle Function Assessment
Bladder Evaluation

19 Treatment Nonsurgical Therapy Mild to moderate prolapse
Desire future childbearing Not suitable or desire surgery

20 Conservative Management pelvic floor muscle training (PFMT)
Lifestyle intervention weight loss reduction of activities that increase intra–abdominal pressure Mechanical Devices

21 Surgical Management OPTIONAL!!! relieve symptoms
restore vaginal anatomy vaginal, abdominal, and laparoscopic routes involve a combination of repairs directed to the anterior vagina, vaginal apex, posterior vagina, and perineum None is perfect

22 Surgical Management Procedures
Restorative: use the patient's endogenous support structures Compensatory: replace deficient support with permanent graft material Obliterative: close or partially close the vagina.


24 Lower Urinary Tract Disorders

25 Normal Urethral Closure

26 Stress Urinary Incontinence
Most common type of urinary continence in women Leaking when sneezing, coughing, or exercise Urethral sphincter defect and/or urethral hypermobility Urge Urinary Incontinence and Overactive Bladder most common form of incontinence in older women involuntary leakage of urine accompanied by or immediately preceded by urgency may or may not be caused by detrusor overactivity

27 Mixed Incontinence have symptoms of both stress and urge urinary incontinence in older women mixed and urge incontinence is predominate

28 Evaluation Q–tip test Voiding Diary Urinalysis
Postvoid Residual Volume Cough Stress Test Pad Tests Urodynamics

29 Nonsurgical treatment
Lifestyle Changes Weight loss Postural change Decrease caffeine intake Physical Therapy pelvic floor muscle training Behavioral Therapy and Bladder Training

30 Vaginal and Urethral Devices

31 Urge Incontinence and Overactive Bladder
Medications Stress incontinence α– adrenergic activity Urge Incontinence and Overactive Bladder anticholinergic agents

32 Surgical Treatment for Stress incontinence


34 Key Points

35 Thank you !

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