Functional Anatomy of the Pelvic Floor and Lower Urinary Tract (original) (raw)
Related papers
The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction
American Journal of Obstetrics and Gynecology, 1996
This article presents a standard system of terminology recently approved by the International Continence Society, the American Urogynecologic Society, and the Society of Gynecologic Surgeons for the description of female pelvic organ prolapse and pelvic floor dysfunction. An objective site-specific system for describing, quantitating, and staging pelvic support in women is included. It has been developed to enhance both clinical and academic communication regarding individual patients and populations of patients. Clinicians and researchers caring for women with pelvic organ prolapse and pelvic floor dysfunction are encouraged to learn and use the system. (Am J Obstet Gynecol 1996;175:10-7.)
International Urogynecology Journal, 2016
Introduction: The terminology for female pelvic floor prolapse (POP) should be defined and organized in a clinicallybased consensus Report. Methods: This Report combines the input of members of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS), assisted at intervals by external referees. Appropriate core clinical categories and a sub-classification were developed to give a coding to definitions. An extensive process of fourteen rounds of internal and external review was involved to exhaustively examine each definition, with decision-making by collective opinion (consensus). Results: A Terminology Report for female POP, encompassing over 230 separate definitions, has been developed. It is clinically-based with the most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in all the different specialty groups involved in female pelvic floor dysfunction and POP. Female-specific imaging (ultrasound, radiology and MRI) and conservative and surgical managements are major additions and appropriate figures have been included to supplement and clarify the text. Emerging concepts and measurements, in use in the literature and offering further research potential, but requiring further validation, have been included as an appendix. Interval (5-10 year) review is anticipated to keep the document updated and as widely acceptable as possible. Conclusion: A consensusbased Terminology Report for female POP has been produced to aid clinical practice and research.
Pathophysiology of Pelvic Organ Prolapse
Obstetrics and Gynecology Clinics of North America, 1998
Pelvic organ prolapse is a prevalent and disabling condition with suboptimal treatment. Multiple mechanisms have been hypothesized as contributors to the development of prolapse, but none fully explain the origin and natural history of this process. Epidemiologic studies indicate that vaginal birth and aging are two major risk factors for the development of pelvic organ prolapse. 1 Other factors include increased abdominal pressure, increased body mass index, and connective tissue disorders. Hence, there is little doubt that pelvic organ prolapse is multifactorial in etiology and may involve more than one pathology to exhibit full anatomic loss of support. Furthermore, loss of support that evolves decades after vaginal delivery may involve an initial insult compounded by loss of support associated with aging. Currently, it is believed that a complex of pathologies are involved in failure of pelvic organ support. These pathologies include those related to genetics, loss of pelvic floor striated muscle support, and loss of connective attachments of the vaginal wall to striated muscles and structures of the pelvis. In this article, we review the potential mechanisms for loss of pelvic organ support in women and new insights into the role of elastic fibers in the pathophysiology of pelvic organ prolapse. FAILURE OF PELVIC ORGAN SUPPORT: POTENTIAL MECHANISMS The pelvic floor comprises several different tissue types that act in concert to provide support and maintain normal physiologic function of the rectum, vagina, urethra, and bladder. All tissue types of the pelvic floor are important for normal support of the Grant support: National Institutes of Health AG 028048.
International urogynecology journal, 2016
The terminology for female pelvic floor prolapse (POP) should be defined and organized in a clinically-based consensus Report. This Report combines the input of members of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS), assisted at intervals by external referees. Appropriate core clinical categories and a sub-classification were developed to give a coding to definitions. An extensive process of fourteen rounds of internal and external review was involved to exhaustively examine each definition, with decision-making by collective opinion (consensus). A Terminology Report for female POP, encompassing over 230 separate definitions, has been developed. It is clinically-based with the most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in all the different specialty groups involved in female pelvic floor dysfunction and ...
Clinical anatomy of the pelvic floor
Acta chirurgica iugoslavica, 2006
The pelvic floor forms the supportive and caudal border of the human's abdominopelvic cavity. A detailed anatomical understanding of its complex architecture is mandatory for the pelvic floor surgeon (general surgeon, gynaecologist and urologist) and for fundamental mechanisms of anorectal as well as urogenital dysfunctions as different anatomical systems join here. The diagnosis and treatment of complex anorectal disorders, however, require a multidisciplinary approach.
The Standardization of Terminology for Researchers in Female Pelvic Floor Disorders
International Urogynecology Journal, 2001
The lack of standardized terminology in pelvic floor disorders (pelvic organ prolapse, urinary incontinence, and fecal incontinence) is a major obstacle to performing and interpreting research. The National Institutes of Health convened the Terminology Workshop for Researchers in Female Pelvic Floor Disorders to: (1) agree on standard terms for defining conditions and outcomes; (2) make recommendations for minimum data collection for research; and (3) identify high priority issues for future research. Pelvic organ prolapse was defined by physical examination staging using the International Continence Society system. Stress urinary incontinence was defined by symptoms and testing; 'cure' was defined as no stress incontinence symptoms, negative testing, and no new problems due to intervention. Overactive bladder was defined as urinary frequency and urgency, with and without urge incontinence. Detrusor instability was defined by cystometry. For all urinary symptoms, defining 'improvement' after intervention was identified as a high priority. For fecal incontinence, more research is needed before recommendations can be made. A standard terminology for research on pelvic floor disorders is presented and areas of high priority for future research are identified.
Current opinion in urology, 2017
The purpose of this review is to critically analyze the relationship between symptoms of abnormal emptying of the bladder, urgency, pelvic pain, anorectal dysfunction and pelvic organ prolapse (POP) and to present evidence in order to show how many of the above mentioned symptoms can be cured or substantially improved by repair of specific pelvic ligaments. In this review, we provide evidence to show how often these dysfunctions occur and how they can be cured in 42-94% by appropriate pelvic floor surgery in the longer term, up to 2 years. Laxity in ligaments and/or vaginal membrane due to damaged connective tissue may prevent the normal opening and closure mechanism of urethra and anus, because muscles need finite lengths to contract properly. Hypermobility of the apex can irritate the pelvic plexus causing chronic pelvic pain. In consequence, dysfunctions as abnormal emptying of the bladder, urgency, pelvic pain, fecal incontinence and obstructed defecation can occur in women with...
Correlation of symptoms with location and severity of pelvic organ prolapse
American Journal of Obstetrics and Gynecology, 2001
The purpose of this study was to compare the symptoms that are related to pelvic floor dysfunction with the location and severity of the coexisting prolapse. STUDY DESIGN: Two hundred thirty-seven consecutive patients with symptomatic pelvic organ prolapse came to Johns Hopkins Medicine during a 24-month period beginning in July 1998 and completed a symptom-specific Likert scale questionnaire that included standardized questions that were compiled from commonly used validated instruments. All questionnaires were completed by the patients before they were seen by a physician. Further evaluation included a standardized physical examination that included the International Continence Society's system for grading uterovaginal prolapse. Symptoms were categorized according to both severity and associated anatomic compartment. Symptoms that were related to urinary and anal incontinence and voiding, defecatory, sexual, and pelvic floor dysfunction were analyzed with respect to location and severity of pelvic organ prolapse with the use of the nonparametric correlation coefficient, Kendall's tau-b.