How to Manage the Patient After History and Examination

Abstract

The complete management of incontinence and prolapse is not just a surgical exercise! You need to think about the patient’s medical problems as they relate to their pelvic floor problem. Collaboration with physicians and other surgeons may be needed. From a medical point of view, referral to a respiratory physician, endocrinologist (for hypothyroid-related obesity, diabetes), dietician, or neurologist may be required. If the patient has truncal obesity and cannot lose weight, order tests for serum insulin levels at 0, 1, and 2 h after 75 g glucose load; if she has insulin resistance, metformin therapy is likely to help her lose weight. From a surgical point of view, referral to an ENT surgeon, thyroid surgeon, or colorectal surgeon may be needed. The urogynecologist should treat constipation and atrophic vaginal symptoms.