Office Management of Female Pelvic Floor Dysfunction

Abstract

As the population of the United States ages, more women will present to their primary care provider or gynecologist with symptoms of pelvic floor dysfunction. Pelvic floor dysfunction includes urinary incontinence, voiding difficulties, and pelvic organ prolapse. A thorough history and physical exam is important to rule out any pelvic pathology, such as bladder cancer, which could present with overactive bladder symptoms. While a patient who wishes to proceed with surgical management for these issues may need referral to a specialist, many of these patients can undergo conservative management initially with office-based therapies. Pessaries are effective for managing prolapse and in certain cases of stress incontinence. Behavioral and medical management can improve urge incontinence and voiding dysfunction. The general gynecologist should be familiar with the basic evaluation of pelvic floor disorders, office-based treatments, and the appropriate terminology for these disorders to assist with communication when referral is indicated.