The Investigation and Treatment of Female Pelvic Floor Dysfunction

Overview

Journal Dtsch Arztebl Int

Specialties General Medicine
Public Health

Date 2015 Sep 11

PMID 26356560

Citations 31

Authors

Katharina Jundt

Ursula Peschers

Heribert Kentenich

Affiliations

Soon will be listed here.

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.

Citing Articles

Pelvic floor dysfunction in postpartum women: A cross-sectional study.

Gao Q, Wang M, Zhang J, Qing Y, Yang Z, Wang X PLoS One. 2024; 19(10):e0308563.

PMID: 39361594 PMC: 11449369. DOI: 10.1371/journal.pone.0308563.

Technologies for Evaluation of Pelvic Floor Functionality: A Systematic Review.

Forstl N, Adler I, Suss F, Dendorfer S Sensors (Basel). 2024; 24(12).

PMID: 38931784 PMC: 11207910. DOI: 10.3390/s24124001.

Current Status and Role of Artificial Intelligence in Anorectal Diseases and Pelvic Floor Disorders.

Aleissa M, Osumah T, Drelichman E, Mittal V, Bhullar J JSLS. 2024; 28(2).

PMID: 38910957 PMC: 11189024. DOI: 10.4293/JSLS.2024.00007.

Electromyographic activity of pelvic floor muscles in different positions during the use an innovative vaginal educator: Cross-sectional study.

Duarte N, Azevedo Y, Furtado E, Araujo L, Bendelack R, Rodrigues C PLoS One. 2024; 19(3):e0291588.

PMID: 38536803 PMC: 10971574. DOI: 10.1371/journal.pone.0291588.

Pelvic Floor Dysfunction among Reproductive-Age Women in Israel: Prevalence and Attitudes-A Cross-Sectional Study.

Fisher-Yosef T, Lidsky Sachs D, Edel S, Nammouz H, Zoabi A, Adler L Healthcare (Basel). 2024; 12(3).

PMID: 38338275 PMC: 10855918. DOI: 10.3390/healthcare12030390.

References

Wiegersma M, Panman C, Kollen B, Vermeulen K, Schram A, Messelink E . Pelvic floor muscle training versus watchful waiting or pessary treatment for pelvic organ prolapse (POPPS): design and participant baseline characteristics of two parallel pragmatic randomized controlled trials in primary care. Maturitas. 2013; 77(2):168-73. DOI: 10.1016/j.maturitas.2013.10.014. View

Vigod S, Stewart D . Major depression in female urinary incontinence. Psychosomatics. 2006; 47(2):147-51. DOI: 10.1176/appi.psy.47.2.147. View

Olsen A, Smith V, Bergstrom J, Colling J, Clark A . Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997; 89(4):501-6. DOI: 10.1016/S0029-7844(97)00058-6. View

Noblett K, McKinney A, Lane F . Effects of the incontinence dish pessary on urethral support and urodynamic parameters. Am J Obstet Gynecol. 2008; 198(5):592.e1-5. DOI: 10.1016/j.ajog.2008.02.004. View

Dickie K, Shek K, Dietz H . The relationship between urethral mobility and parity. BJOG. 2010; 117(10):1220-4. DOI: 10.1111/j.1471-0528.2010.02649.x. View

Lucas M, Bosch R, Burkhard F, Cruz F, Madden T, Nambiar A . EAU guidelines on surgical treatment of urinary incontinence. Actas Urol Esp. 2013; 37(8):459-72. DOI: 10.1016/j.acuro.2013.02.002. View

Gyhagen M, Bullarbo M, Nielsen T, Milsom I . Prevalence and risk factors for pelvic organ prolapse 20 years after childbirth: a national cohort study in singleton primiparae after vaginal or caesarean delivery. BJOG. 2012; 120(2):152-160. DOI: 10.1111/1471-0528.12020. View

Abramov Y, Gandhi S, Goldberg R, Botros S, Kwon C, Sand P . Site-specific rectocele repair compared with standard posterior colporrhaphy. Obstet Gynecol. 2005; 105(2):314-8. DOI: 10.1097/01.AOG.0000151990.08019.30. View

Bjelic-Radisic V, Dorfer M, Tamussino K, Greimel E . Psychometric properties and validation of the German-language King's Health Questionnaire in women with stress urinary incontinence. Neurourol Urodyn. 2004; 24(1):63-8. DOI: 10.1002/nau.20092. View

10.

Fong E, Nitti V . Review article: Mid-urethral synthetic slings for female stress urinary incontinence. BJU Int. 2010; 106(5):596-608. DOI: 10.1111/j.1464-410X.2010.09544.x. View

11.

Imamura M, Abrams P, Bain C, Buckley B, Cardozo L, Cody J . Systematic review and economic modelling of the effectiveness and cost-effectiveness of non-surgical treatments for women with stress urinary incontinence. Health Technol Assess. 2010; 14(40):1-188, iii-iv. DOI: 10.3310/hta14400. View

12.

Hunskaar S . A systematic review of overweight and obesity as risk factors and targets for clinical intervention for urinary incontinence in women. Neurourol Urodyn. 2008; 27(8):749-57. DOI: 10.1002/nau.20635. View

13.

Chapple C, Khullar V, Gabriel Z, Muston D, Bitoun C, Weinstein D . The effects of antimuscarinic treatments in overactive bladder: an update of a systematic review and meta-analysis. Eur Urol. 2008; 54(3):543-62. DOI: 10.1016/j.eururo.2008.06.047. View

14.

Jelovsek J, Barber M, Karram M, Walters M, Paraiso M . Randomised trial of laparoscopic Burch colposuspension versus tension-free vaginal tape: long-term follow up. BJOG. 2007; 115(2):219-25. DOI: 10.1111/j.1471-0528.2007.01592.x. View

15.

Mariappan P, Alhasso A, Ballantyne Z, Grant A, Ndow J . Duloxetine, a serotonin and noradrenaline reuptake inhibitor (SNRI) for the treatment of stress urinary incontinence: a systematic review. Eur Urol. 2006; 51(1):67-74. DOI: 10.1016/j.eururo.2006.08.041. View

16.

Ward K, Hilton P . Prospective multicentre randomised trial of tension-free vaginal tape and colposuspension as primary treatment for stress incontinence. BMJ. 2002; 325(7355):67. PMC: 117136. DOI: 10.1136/bmj.325.7355.67. View

17.

Jundt K, Scheer I, Schiessl B, Pohl K, Haertl K, Peschers U . Physical and sexual abuse in patients with overactive bladder: is there an association?. Int Urogynecol J Pelvic Floor Dysfunct. 2006; 18(4):449-53. DOI: 10.1007/s00192-006-0173-z. View

18.

Farrell S, Baydock S, Amir B, Fanning C . Effectiveness of a new self-positioning pessary for the management of urinary incontinence in women. Am J Obstet Gynecol. 2007; 196(5):474.e1-8. DOI: 10.1016/j.ajog.2006.11.038. View

19.

Veenboer P, Bosch J . Long-term adherence to antimuscarinic therapy in everyday practice: a systematic review. J Urol. 2013; 191(4):1003-8. DOI: 10.1016/j.juro.2013.10.046. View

20.

Walters M, Taylor S, SCHOENFELD L . Psychosexual study of women with detrusor instability. Obstet Gynecol. 1990; 75(1):22-6. View