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Pelvic organ prolapse and incontinence

Pelvic organ prolapse (POP) and urinary and fecal incontinence are frequently referred to as pelvic floor dysfunction (PFD) because the pelvic floor is considered to be the combined denominator in these complaints. | 23 Pelvic Organ Prolapse and Incontinence Mark E. Vierhout and Kirsten B. Kluivers INTRODUCTION Pelvic organ prolapse POP and urinary and fecal incontinence are frequently referred to as pelvic floor dysfunction PFD because the pelvic floor is considered to be the combined denominator in these complaints. It is also referred to as urogynecology and in the developed world urogynecology is now an established sub-specialty of general gynecology. Next to prolapse and incontinence problems like overactive bladder vaginal atrophy sexual dysfunction and pelvic pain are also considered as part of urogynecology. PFD is highly prevalent in the western world. It is estimated that one in every five to nine women will be operated on at least once in her life for one of these symptoms and of these at least one in three will need a second or next operation. Due to increasing aging the demand for care of these women is steadily increasing. Prevalence studies on urinary incontinence have shown that involuntary urine loss occurs in 50 of middle-aged women however only some of these will seek help and the majority is not seriously bothered by the incontinence. POP is diagnosed in 40 of women when performing a physical examination but only 10-12 will have the typical symptoms of experiencing a vaginal bulge. Fecal incontinence is less frequent but is highly prevalent in the very old age group and especially in nursing homes. Prevalence on data of symptoms of PFD in the developing world is scarce. However POP is known to be highly prevalent in certain countries. Data are available amongst others countries from Gambia Ghana Nepal Nigeria and Pakistan with a mean prevalence for prolapse of 19.7 and 28.7 for urinary incontinence1. FUNCTIONAL ANATOMY The pelvic floor consists of muscles and connective tissue which together function as a barrier to prevent downward movement of the pelvic organs like the bladder uterus and rectum Figure 1 . The most important muscle is the levator ani muscle