Pelvic floor


The pelvic floor consists of bone, muscles, and connective tissue which provide support to the pelvic organs, spine, and pelvic girdle.

The pelvic floor assists with urination, defecation and sexual function.

The pelvic floor functions require relaxation and coordination of pelvic floor muscles, urinary and anal sphincters.

Pelvic floor disorders, including urinary incontinence, anal incontinence, and pelvic organ prolapse are common in women worldwide.

Pelvic floor disorder‘s are associated with childbirth, parity, and are more common after vaginal birth versus Cesarean birth.

Approximately 25% of women in the US have at least one pelvic floor disorder, with the rate more than doubled for women older than 80 years.

Up to 50% of parous women have vaginal wall laxity, with 10-20% being symptomatic.

Pelvic floor disorders are common with nearly one in four women having at least one pelvic floor condition.

Lifetime risk of undergoing surgery to correct a pelvic floor dysfunction is estimated at 20%.

The 10 year reoperation rate is estimated to be 17%.

Disorders include: urinary incontinence, pelvic organ prolapse, fecal incontinence, and sensory and emptying abnormalities of the lower urinary and gastrointestinal tracts.

Pelvic floor muscle dysfunction symptoms include a lower urinary tract symptoms, bowel symptoms, sexual dysfunction, prolapse symptoms and pain.

Pelvic floor disorders caused by relaxing pelvic floor muscles, which include pelvic organ prolapse and urinary incontinence are more easily identifiable than symptoms related to non-relaxing pelvic floor muscle dysfunction.

Non-relaxing pelvic floor dysfunction has been known as pelvic floor tension myalgia, pyriformis syndrome and levator ani syndrome.

In non-relaxing pelvic floor dysfunction impaired relaxation or excessive contraction can lead to impaired for eating, defecation, pelvic pain, and sexual dysfunction.

Prevalence of non-relaxing pelvic floor disorders is unknown, but the incidence of defacatory disorders is 16 per 100,000 person years (Sinaki M et al).

Prevalence of lowering urinary tract symptoms in women is as high as 76% (Coyne KS et al).

Lifetime prevalence of sexual pain disorders ranges from 17-19% and population based studies (Paik A et al).

Women with pelvic floor disorders generally have multiple types symptoms, including urinary tract symptoms, defecation disorders, sexual dysfunction, chronic pelvic pain, impairing quality of life.

As many as 10% of women have surgery for urinary incontinence, pelvic organ prolapse, or both during their lifetime and 30% of those patients have 2 or more surgical procedures (Olsen AL).

Disorders due to vaginal delivery, episiotomy, macrosomic infant, epidural analgesia, increased maternal age at the time of delivery, younger age at first delivery, high BMI, history of gynecological surgery, prior hysterectomy and menopause.

Support for the pelvic organs derives from the bony pelvis, pelvic muscles, endopelvic fascia and nerves.

The levator ani muscles: pubococcygeus and puborectalis and illococcygeus act associated a shelf and encircle the pelvic viscera at the urogenital hiatus.

Muscles of the pelvic floor create a muscular sling that encircles the genital hiatus and contraction of these muscles pull the rectum, vagina and urethra anteriorly towards the symphysis pubis.

Resting tone of pelvic muscles provide the support of the pelvic organs.

Basal tone of the levator ani maintains the closure of the urogenital hiatus maintaining continence with the urethral and anal sphincters.

The external anal sphincter and urethral sphincter are innervated by the pudendal nerve, sacral nerve roots S2, S3, and S4.

The levator plate is innervated by the anterior sacral nerve roots S2, S3 and S4.

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