Management of Concomitant Pelvic Disorders: The Urologic Perspective

Abstract

The pelvic floor is a crossover of various complex functions, and can be considered from three aspects: urological, gynaecological, and coloproctological. The pelvic floor is at risk of damage in females because of its anatomy, since the pelvic organs are positioned in dynamic tensile structures that are subject to weakness over time. There are many factors to be considered, both intrinsic and extrinsic. Intrinsic factors induce the reduction of collagen production, which might lead to deterioration of the fibroelastic support. Extrinsic factors (i.e., constipation, cough, and physical activities) induce an increase in abdominal pressure. Two critical moments in the life of a woman are pregnancy and delivery, which can result in injury. Birth trauma may lead to muscle and neurological lesions, and damage due to stretching. Further alterations are brought about by hormonal changes in the menopause. Symptoms of damage are voiding dysfunction, incontinence, urinary retention, gynecological disorders (such as dyspareunia or vaginal prolapse), and coloproctology dysfunctions (such as constipation and fecal incontinence). An overactive pelvic floor is frequently associated with voiding difficulties of the bladder, and constipation, dyspareunia, and chronic pelvic pain. A reduced tone of the pelvic floor is associated with urinary stress incontinence and/or fecal incontinence, vaginal prolapse, and sexual problems. The most frequent urological symptom in females is stress urinary incontinence (SUI) due to sphincter deficiency, with involuntary loss of urine during activities requiring effort.