What is Pelvic Floor Dysfunction?
Pelvic floor dysfunction is a complex set of conditions resulting from deficient pelvic floor support, most commonly manifesting as urinary incontinence, pelvic organ prolapse, anal incontinence, and defecatory dysfunction. 1
Core Definition and Components
Pelvic floor dysfunction encompasses multiple interrelated conditions that arise when the muscular and connective tissue structures supporting the pelvic organs fail to maintain adequate support and functional control. 1, 2 The pelvic floor functions as an integrated neuromuscular unit that provides:
- Pelvic girdle stability 2
- Urinary and fecal continence 2
- Controlled voiding and defecation 2
- Sexual function 2
- Support of pelvic organs 3
Structural Basis
Support to the pelvic floor is provided by a combination of muscular and connective tissue structures. 1 When these structures are compromised through direct injury or denervation, increased stress is placed on the fascia, leading to progressive weakening. 1
The dysfunction can manifest in two primary patterns:
- Weakness-related dysfunction: Results in stress incontinence, fecal incontinence, and pelvic organ prolapse 3
- Hypertonic dysfunction: Involves dysfunctional, overactive muscles leading to elimination problems, chronic pelvic pain, bladder pain syndromes, retention, and paradoxical incontinence 3
Epidemiology and Impact
This condition is remarkably common, affecting approximately 25% to 33% of postmenopausal women. 1 At least one-third of adult women experience some form of pelvic floor dysfunction during their lifetime. 4 The lifetime risk of requiring surgical intervention for pelvic organ prolapse or urinary incontinence by age 80 is approximately 11%. 1
The annual direct costs are substantial:
- $12 billion for urinary incontinence 1
- $1 billion for pelvic organ prolapse 1
- More than $25 million for anal incontinence 1
Risk Factors
Key predisposing factors include:
- Advanced age 1, 5
- Menopause 1
- Vaginal multiparity 1, 5
- Obesity 1
- Chronic straining during defecation 1, 5
- Conditions causing chronic increased intra-abdominal pressure 1, 5
Multicompartment Nature
A critical feature of pelvic floor dysfunction is that abnormalities often involve multiple compartments simultaneously, even when patients present with a single predominant symptom. 1 Several components of pelvic floor dysfunction are frequently seen in the same patient. 1 This multicompartment involvement is often not apparent on physical examination alone, which can lead to misidentification of the compartments involved and the site of prolapse. 6
Clinical Presentation
Pelvic floor dysfunction can provoke a wide range of symptoms:
- Urinary symptoms: Incontinence, difficulty voiding, urgency 6, 7
- Bowel symptoms: Fecal incontinence, constipation, defecatory dysfunction 6
- Structural symptoms: Sensation of pelvic organ herniation through the vagina, sense of pressure 6, 7
- Pain syndromes: Chronic pelvic pain 2, 3
- Sexual dysfunction 2, 6
Treatment Goals
The primary goal of any treatment strategy is to improve the patient's quality of life, as the condition primarily causes morbidity but is not life-threatening (unless the patient cannot urinate or defecate). 1, 7 Postoperative recurrence of prolapse occurs in a significant percentage of patients, underscoring the importance of comprehensive initial assessment and treatment. 1