From the Guidelines
The most recent and highest quality study on gynecologic pelvic floor disorders recommends a comprehensive assessment of all pelvic compartments to identify and repair defects during a single procedure, using a combination of clinical diagnostic tests and radiologic tests such as MRI, ultrasound, and fluoroscopy 1.
Key Findings
- The initial assessment of patients with pelvic floor dysfunction should include a clinical evaluation with history and physical examination, as well as focused diagnostic tests such as urodynamic studies and anal manometry 1.
- Radiologic tests such as MRI, ultrasound, and fluoroscopy provide global information about the pelvic floor and can help identify defects that may not be apparent on physical examination 1.
- A global assessment of all pelvic compartments allows for the repair of all defects during a single procedure, reducing the need for multiple surgeries and improving patient outcomes 1.
Diagnostic Tests
- MRI of the pelvic floor can be performed with or without contrast and can provide detailed information about the pelvic floor compartments 1.
- Ultrasound of the pelvic floor is an emerging tool that can provide real-time dynamic evaluation of pelvic floor dysfunction and can be used to assess patients who have undergone mid-urethral sling or vaginal mesh implants 1.
- Fluoroscopy of the pelvic floor can be performed with oral, rectal, bladder, and vaginal contrast and can provide information about the pelvic floor compartments during defecation 1.
Treatment Options
- While previous studies have shown the efficacy of combined pelvic floor muscle training and behavioral therapy in improving urinary incontinence symptoms 1, the most recent study emphasizes the importance of a comprehensive assessment and treatment approach that takes into account the individual patient's needs and defects 1.
- Vaginal pessaries and other conservative management options may still be effective for some patients, but the most recent study highlights the importance of a multidisciplinary approach that combines surgical, behavioral, and pharmacological interventions 1.
From the Research
Overview of Pelvic Floor Disorders
- Pelvic Floor Dysfunctions (PFDs) are a group of disorders characterized by inter-related symptoms of urology, gynaecology, colorectal or general pelvic pain 2
- PFDs can cause voiding or defecation disorders, pelvic organ prolapses, sexual dysfunctions and pelvic pain, and adversely impact various domains of women's life including psychological, physical, social and sexual well-being 2
Treatment and Management
- Pelvic Floor Rehabilitation (PFR) has been recommended as part of a multidisciplinary approach for evaluation and management of the multiple PFDs 2
- Physical, complementary, and alternative treatments for pelvic floor disorders, such as pelvic floor muscle physiotherapy (PFMT) and biofeedback (BF), have shown benefits for patients suffering from bladder dysfunction, bowel dysfunction, pelvic organ prolapse, and sexual dysfunction 3
- Combination of PFMT and BF has shown improved results compared to PFMT alone, and some studies find that electrical stimulation can augment the benefit of BF and PFMT 3
- Acupuncture and cognitive behavioral therapy have also shown to be effective treatments for pelvic floor disorders, particularly with respect to pelvic pain 3
Assessment and Diagnosis
- Assessment of the pelvic floor and associated musculoskeletal system is crucial for accurate diagnosis and referral of patients with pelvic floor disorders or pelvic pain 4
- A thorough description of physical therapy assessment and treatment is included with clinical relevance, and assessment and treatment by qualified physical therapists are integral to pelvic health care 4
- A guide for musculoskeletal assessment of the pelvis and associated structures can be used for both clinical and research purposes, and is designed for health care providers caring for women with pelvic floor disorders 4
Pelvic Floor Function and Dysfunction
- The pelvic floor functions as a holistic entity, and its dysfunction is related to a variety of pelvic pain syndromes and organ problems of continence and evacuation 5
- Prior to treatment, it is necessary to understand which part(s) of the system may be causing the dysfunction, and non-surgical treatment of PFD requires correct diagnosis and correctly supervised pelvic floor training 5
- The interpretation of pelvic floor biomechanics is complex and involves multiple theories, and the Integral Theory's explanations of function and dysfunction have been accorded significant weight 5