Pelvic Floor Disorders Related to Urology and Gynecology

  • Nouf Y. Akeel
  • Brooke GurlandEmail author
  • Tracy Hull


Multicompartment pelvic floor disorders are common. Twenty three percent of patients undergoing surgery for fecal incontinence or rectal prolapse have both urinary incontinence and genital prolapse. A focused, yet comprehensive pelvic floor history and physical exam identifies patient who suffer from anterior, middle and posterior pelvic floor pathologies. In those patients, it is preferable to address any coexistent pelvic defect/problem simultaneously. This chapter will focus on the evaluation and management of urinary incontinence and pelvic floor prolapse.


Pelvic floor disorders Multicompartment pelvic floor disorders Urinary incontinence Stress urinary incontinence Urge urinary incontinence Pelvic organ prolapse 


  1. 1.
    Wu JM, Matthews CA, Conover MM, Pate V, Jonsson Funk M. Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery. Obstet Gynecol. 2014;123(6):1201–6.CrossRefGoogle Scholar
  2. 2.
    Jelovsek JE, Barber MD, Paraiso MFR, Walters MD. Functional bowel and anorectal disorders in patients with pelvic organ prolapse and incontinence. Obstet Gynecol. 2005;193(6):2105–11.Google Scholar
  3. 3.
    Rortveit G, Subak LL, Thom DH, et al. Urinary incontinence, fecal incontinence and pelvic organ prolapse in a population-based, racially diverse cohort: prevalence and risk factors. Female Pelvic Med Reconstr Surg. 2010;16(5):278–83.CrossRefGoogle Scholar
  4. 4.
    González-Argenté FX, Jain A, Nogueras JJ, Davila GW, Weiss EG, Wexner SD. Prevalence and severity of urinary incontinence and pelvic genital prolapse in females with anal incontinence or rectal prolapse. Dis Colon Rectum. 2001;44(7):920–5.CrossRefGoogle Scholar
  5. 5.
    Kapoor DS, Sultan AH, Thakar R, Abulafi MA, Swift RI, Ness W. Management of complex pelvic floor disorders in a multidisciplinary pelvic floor clinic. Color Dis. 2008;10(2):118–23.Google Scholar
  6. 6.
    Quiroz LH, Munoz A, Shippey SH, Gutman RE, Handa VL. Vaginal parity and pelvic organ prolapse. J Reprod Med. 2010;55(3-4):93–8.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Hallock JL, Handa VL. The epidemiology of pelvic floor disorders and childbirth: an update. Obstet Gynecol Clin N Am. 2016;43(1):1–13.CrossRefGoogle Scholar
  8. 8.
    Gyhagen M, Bullarbo M, Nielsen T, Milsom I. Prevalence and risk factors for pelvic organ prolapse 20 years after childbirth: a national cohort study in singleton primiparae after vaginal or caesarean delivery. BJOG. 2013;120(2):152–60.CrossRefGoogle Scholar
  9. 9.
    Morkved S, Bo K. Effect of pelvic floor muscle training during pregnancy and after childbirth on prevention and treatment of urinary incontinence: a systematic review. Br J Sports Med. 2014;48(4):299–310.CrossRefGoogle Scholar
  10. 10.
    Turner CE, Young JM, Solomon MJ, Ludlow J, Benness C. Incidence and etiology of pelvic floor dysfunction and mode of delivery: an overview. Dis Colon Rectum. 2009;52(6):1186–95.CrossRefGoogle Scholar
  11. 11.
    Maher C, Feiner B, Baessler K, Schmid C. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2013;4:CD004014.Google Scholar
  12. 12.
    Steinauer JE, Waetjen LE, Vittinghoff E, et al. Postmenopausal hormone therapy: does it cause incontinence? Obstet Gynecol. 2005;106(5 Pt 1):940–5.CrossRefGoogle Scholar
  13. 13.
    Bump RC, Mattiasson A, Bø K, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Obstet Gynecol. 1996;175(1):10–7.Google Scholar
  14. 14.
    Jorge JMN, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum. 1993;36(1):77–97.CrossRefGoogle Scholar
  15. 15.
    Shumaker SA, Wyman JF, Uebersax J, McClish D, Fantl JA. Health-related quality of life measures for women with urinary incontinence: the incontinence impact questionnaire and the urogenital distress inventory. Qual Life Res. 1994;3(5):291–306.CrossRefGoogle Scholar
  16. 16.
    Jelovsek JE, Chen Z, Markland AD, et al. Minimum important differences for scales assessing symptom severity and quality of life in patients with fecal incontinence. Female Pelvic Med Reconstr Surg. 2014;20(6):342–8.CrossRefGoogle Scholar
  17. 17.
    Syan R, Brucker BM. Guideline of guidelines: urinary incontinence. BJU Int. 2016;117(1):20–33.CrossRefGoogle Scholar
  18. 18.
    Fisher K, Bliss DZ, Savik K. Comparison of recall and daily self-report of fecal incontinence severity. J Wound Ostomy Continence Nurs. 2008;35(5):515–20.CrossRefGoogle Scholar
  19. 19.
    Medina CA, Costantini E, Petri E, et al. Evaluation and surgery for stress urinary incontinence: a FIGO working group report. Neurourol Urodyn. 2016;36(2):518–28.CrossRefGoogle Scholar
  20. 20.
    Haylen BT, Maher CF, Barber MD, et al. An international urogynecological association (IUGA)/international continence society (ICS) joint report on the terminology for female pelvic organ prolapse (POP). Int Urogynecol J. 2016;27(2):165–94.CrossRefGoogle Scholar
  21. 21.
    Karram MM, Bhatia NN. The Q-tip test: Standardization of the technique and its interpretation in women with urinary incontinence. Obstet Gynecol. 1988;71(6):807–11.PubMedGoogle Scholar
  22. 22.
    Richter HE, Litman HJ, Lukacz ES, et al. Demographic and clinical predictors of treatment failure one year after midurethral sling surgery. Obstet Gynecol. 2011;117(4):913–21.CrossRefGoogle Scholar
  23. 23.
    Mattison ME, Simsiman AJ, Menefee SA. Can urethral mobility be assessed using the pelvic organ prolapse quantification system? an analysis of the correlation between point aa and Q-tip angle in varying stages of prolapse. Urology. 2006;68(5):1005–8.CrossRefGoogle Scholar
  24. 24.
    Woodfield CA, Krishnamoorthy S, Hampton BS, Brody JM. Imaging pelvic floor disorders: trend toward comprehensive MRI. Am J Roentgenol. 2010;194(6):1640–9.CrossRefGoogle Scholar
  25. 25.
    American College of Obstetricians and Gynecologists. Evaluation of uncomplicated stress urinary incontinence in women before surgical treatment. committee opinion No. 603. Obstet Gynecol. 2014;123(6):1403–7.CrossRefGoogle Scholar
  26. 26.
    Garely AD, Noor N. Diagnosis and surgical treatment of stress urinary incontinence. Obstet Gynecol. 2014;124(5):1011–27.CrossRefGoogle Scholar
  27. 27.
    Winters JC, Dmochowski RR, Goldman HB, et al. Urodynamic studies in adults: AUA/SUFU guideline. J Urol. 2012;188((6):2464–72.CrossRefGoogle Scholar
  28. 28.
    Nygaard IE, Heit M. Stress urinary incontinence. Obstet Gynecol. 2004;104(3):607–20.CrossRefGoogle Scholar
  29. 29.
    Sirls LT, Richter HE, Litman HJ, et al. The effect of urodynamic testing on clinical diagnosis, treatment plan and outcomes in women undergoing stress urinary incontinence surgery. J Urol. 2013;189(1):204–9.CrossRefGoogle Scholar
  30. 30.
    Bitti GT, Argiolas GM, Ballicu N, et al. Pelvic floor failure: MR imaging evaluation of anatomic and functional abnormalities. Radiographics. 2014;34(2):429–48.CrossRefGoogle Scholar
  31. 31.
    Goodrich MA, Webb MJ, King BF, Bamptom AE, Campbeau NG, Riederer SJ. Magnetic resonance imaging of pelvic floor relaxation: dynamic analysis and evaluation of patients before and after surgical repair. Obstet Gynecol. 1993;82(6):883–91.PubMedGoogle Scholar
  32. 32.
    Gufler H, DeGregorio G, Allmann K, Kundt G, Dohnicht S. Comparison of cystourethrography and dynamic MRI in bladder neck descent. J Comput Assist Tomogr. 2000;24(3):382–8.CrossRefGoogle Scholar
  33. 33.
    Ford A, Rogerson L, Cody J, Ogah J. Mid-urethral sling operations for stress urinary incontinence in women (review). Cochrane Database Syst Rev. 2015;7:CD006375.Google Scholar
  34. 34.
    Haylen BT, De Ridder D, Freeman RM, et al. An international urogynecological association (IUGA)/international continence society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010;21(1):5–26.CrossRefGoogle Scholar
  35. 35.
    Lapitan MC, Cody JD. Open retropubic colposuspension for urinary incontinence in women. Cochrane Database Syst Rev. 2016;2:CD002912.PubMedGoogle Scholar
  36. 36.
    Ramanah R, Ballester M, Chereau E, Rouzier R, Daraï E. Effects of pelvic organ prolapse repair on urinary symptoms: a comparative study between the laparoscopic and vaginal approach. Neurourol Urodyn. 2012;31(1):126–31.CrossRefGoogle Scholar
  37. 37.
    Ayeleke RO, Hay-Smith EJC, Omar MI. Pelvic floor muscle training added to another active treatment versus the same active treatment alone for urinary incontinence in women. status and date: New search for studies and content updated (no change to conclusions). Cochrane Database Syst Rev. 2015;11:CD010551.Google Scholar
  38. 38.
    Subak LL, Whitcomb E, Shen H, Saxton J, Vittinghoff E, Brown JS. Weight loss: a novel and effective treatment for urinary incontinence. J Urol. 2005;174(1):190–5.CrossRefGoogle Scholar
  39. 39.
    Wood LN, Anger JT. Urinary incontinence in women. BMJ. 2014;349(15):4531–42.CrossRefGoogle Scholar
  40. 40.
    Dumoulin C, Hay-Smith J, Habée-Séguin GM, Mercier J. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women: a short version cochrane systematic review with meta-analysis. Neurourol Urodyn. 2015;34(4):300–8.CrossRefGoogle Scholar
  41. 41.
    Bø K, Kvarstein B, Nygaard I. Lower urinary tract symptoms and pelvic floor muscle exercise adherence after 15 years. Obstet Gynecol. 2005;105(5 Part 1):999–1005.CrossRefGoogle Scholar
  42. 42.
    Sexton C, Notte S, Maroulis C, et al. Persistence and adherence in the treatment of overactive bladder syndrome with anticholinergic therapy: a systematic review of the literature. Int J Clin Pract. 2011;65(5):567–85.CrossRefGoogle Scholar
  43. 43.
    Anger JT, Scott V, Kiyosaki K, et al. Development of quality indicators for women with urinary incontinence. Neurourol Urodyn. 2013;32(8):1058–63.CrossRefGoogle Scholar
  44. 44.
    National Collaborating Centre for Women’s and Children’s Health (UK). 2013.Google Scholar
  45. 45.
    Li J, Yang L, Pu C, Tang Y, Yun H, Han P. The role of duloxetine in stress urinary incontinence: a systematic review and meta-analysis. Int Urol Nephrol. 2013;45(3):679–86.CrossRefGoogle Scholar
  46. 46.
    Olivera CK, Meriwether K, El-Nashar S, et al. Nonantimuscarinic treatment for overactive bladder: a systematic review. Obstet Gynecol. 2016;215(1):34–57.Google Scholar
  47. 47.
    Noblett K, Siegel S, Mangel J, et al. Results of a prospective, multicenter study evaluating quality of life, safety, and efficacy of sacral neuromodulation at twelve months in subjects with symptoms of overactive bladder. Neurourol Urodyn. 2014;35(2):246–51.CrossRefGoogle Scholar
  48. 48.
    Braekken IH, Majida M, Engh ME, Bo K. Morphological changes after pelvic floor muscle training measured by 3-dimensional ultrasonography: a randomized controlled trial. Obstet Gynecol. 2010;115(2 Pt 1):317–24.CrossRefGoogle Scholar
  49. 49.
    Hagen S, Stark D. Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2011;12:CD003882.Google Scholar
  50. 50.
    Alas AN, Anger JT. Management of apical pelvic organ prolapse. Curr Urol Rep. 2015;16(5):1–7.CrossRefGoogle Scholar
  51. 51.
    Griebling TL. Vaginal pessaries for treatment of pelvic organ prolapse in elderly women. Curr Opin Urol. 2016;26(2):201–6.CrossRefGoogle Scholar
  52. 52.
    Robert M, Schulz JA, Harvey M, et al. Technical update on pessary use. J Obstet Gynaecol. 2013;35(7):664–74.Google Scholar
  53. 53.
    Fernando RJ, Thakar R, Sultan AH, Shah SM, Jones PW. Effect of vaginal pessaries on symptoms associated with pelvic organ prolapse. Obstet Gynecol. 2006;108(1):93–9.CrossRefGoogle Scholar
  54. 54.
    Grimes CL, Lukacz ES, Gantz MG, et al. What happens to the posterior compartment and bowel symptoms after sacrocolpopexy? Evaluation of 5-year outcomes from E-CARE. Female Pelvic Med Reconstr Surg. 2014;20(5):261–6.CrossRefGoogle Scholar
  55. 55.
    Altemeier WA, Culbertson WR, Schowengerdt C, Hunt J. Nineteen years’ experience with the one-stage perineal repair of rectal prolapse. Ann Surg. 1971;173(6):993–1006.CrossRefGoogle Scholar
  56. 56.
    Grody MHT. Urinary incontinence and concomitant prolapse. Clin Obstet Gynecol. 1998;41(3):777–85.CrossRefGoogle Scholar
  57. 57.
    De Gouveia DS, Claydon LS, Whitlow B, Dolcet Artahona MA. Laparoscopic versus open sacrocolpopexy for treatment of prolapse of the apical segment of the vagina: a systematic review and meta-analysis. Int Urogynecol J. 2016;27(1):3–17.CrossRefGoogle Scholar
  58. 58.
    Detollenaere RJ, den Boon J, Stekelenburg J, et al. Sacrospinous hysteropexy versus vaginal hysterectomy with suspension of the uterosacral ligaments in women with uterine prolapse stage 2 or higher: multicentre randomised non-inferiority trial. BMJ. 2015;351:h3717.CrossRefGoogle Scholar
  59. 59.
    Slieker-ten H, Marijke CPH, Pool-Goudzwaard AL, Eijkemans MJ, Steegers-Theunissen RP, Burger CW, Vierhout ME. The prevalence of pelvic organ prolapse symptoms and signs and their relation with bladder and bowel disorders in a general female population. Int Urogynecol J. 2009;20(9):1037–45.CrossRefGoogle Scholar
  60. 60.
    Bump RC, Fantl JA, Hurt WG. The mechanism of urinary continence in women with severe uterovaginal prolapse: results of barrier studies. Obstet Gynecol. 1988;72(3):291–5.PubMedGoogle Scholar
  61. 61.
    Chaikin DC, Groutz A, Blaivas JG. Predicting the need for anti-incontinence surgery in continent women undergoing repair of severe urogenital prolapse. J Urol. 2000;163(2):531–4.CrossRefGoogle Scholar
  62. 62.
    Rooney K, Kenton K, Mueller ER, FitzGerald MP, Brubaker L. Advanced anterior vaginal wall prolapse is highly correlated with apical prolapse. Obstet Gynecol. 2006;195(6):1837–40.Google Scholar
  63. 63.
    Eilber KS, Alperin M, Khan A, et al. Outcomes of vaginal prolapse surgery among female medicare beneficiaries: the role of apical support. Obstet Gynecol. 2013;122(5):981–7.CrossRefGoogle Scholar
  64. 64.
    Hale DS, Fenner D. Consistently inconsistent, the posterior vaginal wall. Obstet Gynecol. 2015;214(3):314–20.Google Scholar
  65. 65.
    Hicks CW, Weinstein M, Wakamatsu M, Savitt L, Pulliam S, Bordeianou L. In patients with rectoceles and obstructed defecation syndrome, surgery should be the option of last resort. Surgery. 2014;155(4):659–67.CrossRefGoogle Scholar
  66. 66.
    Shorvon P, McHugh S, Diamant N, Somers S, Stevenson G. Defecography in normal volunteers: results and implications. Gut. 1989;30(12):1737–49.CrossRefGoogle Scholar
  67. 67.
    Paraiso MFR, Barber MD, Muir TW, Walters MD. Rectocele repair: a randomized trial of three surgical techniques including graft augmentation. Obstet Gynecol. 2006;195(6):1762–71.Google Scholar
  68. 68.
    Nieminen K, Hiltunen K, Laitinen J, Oksala J, Heinonen PK. Transanal or vaginal approach to rectocele repair: a prospective, randomized pilot study. Dis Colon Rectum. 2004;47(10):1636–42.CrossRefGoogle Scholar
  69. 69.
    Lefevre R, Davila GW. Functional disorders: Rectocele. Clin Colon Rectal Surg. 2008;21(2):129–37.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Colorectal SurgeryCleveland Clinic FoundationClevelandUSA
  2. 2.Division of Colorectal SurgeryStanford UniversityStanfordUSA

Personalised recommendations