Pelvic Floor Dysfunction

Pelvic floor dysfunction encompasses a broad spectrum of disorders and symptoms, including pelvic organ prolapse, fecal incontinence, dysfunctional bowel and/or bladder evacuation, urinary incontinence, and chronic pain. Challenges in treating these patients are due, in part, to inconsistent definitions and diagnostic criteria, an underreporting of symptoms, and complexities in understanding the underlying pathophysiology. Pelvic floor dysfunction is a multisystem process requiring a multidisciplinary team approach. This review describes the incidence, prevalence, and etiologic factors relating to pelvic floor dysfunction, as well as the clinical evaluation process, which includes history, physical examination, physiologic and neurophysiologic assessment, and anatomic assessment. Management of pelvic floor dysfunction is discussed. Tables include potential contributing factors in the development of pelvic floor dysfunction and anatomic and physiologic tests for pelvic floor dysfunction. Figures show an anal manometry apparatus; anorectal physiology report for a patient with fecal incontinence; pudendal nerve-stimulating electrode; pudendal nerve terminal motor latency tracing; surface electrode electromyography; anorectal ultrasound equipment; sonogram of the middle anal canal; ultrasound view of the puborectalis muscle; sonogram showing a defect in the external anal sphincter; defecography showing normal anatomy, rectocele and enterocele, sigmoidocele, and rectoanal intussusception; colonic transit study; rectocele; and enterocele. This review contains 19 figures, 2 tables, and 81 references.