Concept of the Pelvic Floor as a Unit

Disorders of urinary and fecal continence, as well as genital and rectal support, are common in adult women.Clinicians who address these problems include urologists, gynecologists, and colorectal surgeons. Great advances have been made in the treatment of continence and support disorders. Unfortunately, our current model of vertical integration for care of disease entities has limited a clinician's understanding to the vertical unit in which the clinician has an expertise. This frequently leads to serial surgeries because of the lack of identification of dysfunction in an adjacent organ system of the pelvic floor. There has been little overlap in the verticalized spectrum of care provided by urologists (kidneys, ureters, bladder, urethra), gynecologists (uterus, vagina, perineum), and colorectal surgeons (colon, rectum, anus). Coexistence of dysfunction of urinary and bowel control is high and is well established. Unfortunately, clinicians who address pelvic floor dysfunction syndromes have been slow to adapt their practice styles to address all pelvic floor dysfunctions in one setting. Our concept of horizontal integration of pelvic floor dysfunction evaluation and management (Figure 1-1.1) is not new. This concept is expanding as clinicians realize the importance of a team approach to evaluation and treatment of pelvic floor dysfunction. We hoped to emphasize these principles as we prepared this textbook.