Aging and the Pelvic Floor

Abstract

To define the unique effects of age on the pelvic floor muscle and to outline current treatments of pelvic floor dysfunction in the older population. Aging has muscular, hormonal, and neurological effects on the pelvic floor that may lead to pelvic floor dysfunction. Muscular changes lead to decreased force output and weakness on clinical examination. Hormonal effects exacerbate pelvic tissue changes, most notably in the postmenopausal woman. Neurological changes are less well-defined, but gradual denervation of the pelvic floor, especially noted in parous women, has been implicated as a possible cause of pelvic floor weakness and dysfunction. Medical treatments include pessaries, medications, implanted electrical stimulation, and surgery. Pelvic floor physical therapy, including strength training and coordination training, as well as pain-relieving modalities at the level of the pelvic floor muscle, is an effective conservative management option for older adults with pelvic floor dysfunction. The literature available regarding treatment of pelvic floor dysfunction is more robust for older females compared to males. There are numerous unique considerations in the treatment of the older adult with pelvic floor dysfunction, due to muscular, hormonal, and neurological changes with age. Conservative management, including physical therapy, should be considered prior to surgical intervention. Further research is especially needed regarding the effects of age and the treatment of age-related pelvic dysfunction in the older male.