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Query: UMLS:C0033377 (prolapse)
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Pelvic organ prolapse is a common condition whose incidence is increasing. Many cases of prolapse of the posterior vaginal wall occur along with other pelvic support defects. Pelvic surgeons who treat rectocele must have an excellent understanding of the normal anatomy, interactions of the connective tissue and muscular supports of the pelvis, and the relationship between anatomy and function. Pelvic pressure, the need to splint the perineum to defecate, impaired sexual relations, difficult defecation, and faecal incontinence are some of the symptoms that have been described in patients with rectocele.
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PMID:Prolapsed uterus with huge rectocele and omentocele following cervical amputation: a rare and unusual case presentation. 1860 77

To compare pelvic anatomy, using magnetic resonance imaging, between postpartum women with or without pelvic floor disorders. We measured postpartum bony and soft tissue pelvic dimensions in 246 primiparas, 6-12-months postpartum. Anatomy was compared between women with and without urinary or fecal incontinence, or pelvic organ prolapse; P < 0.01 was considered statistically significant. A deeper sacral hollow was significantly associated with fecal incontinence (P = 0.005). Urinary incontinence was marginally associated with a wider intertuberous diameter (P = 0.017) and pelvic arch (P = 0.017). There were no significant differences in pelvimetry measures between women with and without prolapse (e.g., vaginal or cervical descent to or beyond the hymen). We did not detect meaningful differences in soft tissue dimensions for women with and without these pelvic floor disorders. Dimensions of the bony pelvis do not differ substantially between primiparous women with and without postpartum urinary incontinence, fecal incontinence and prolapse.
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PMID:Magnetic resonance assessment of pelvic anatomy and pelvic floor disorders after childbirth. 1884 11

Pelvic floor dysfunctions involving some or all pelvic viscera are complex conditions that occur frequently and primarily affect adult women. Because abnormalities of the three pelvic compartments are frequently associated, a complete survey of the entire pelvis is necessary for optimal patient management, especially before surgical correction is attempted. With the increasing use of magnetic resonance (MR) imaging in assessing functional disorders of the pelvic floor, familiarity with normal imaging findings and features of pathologic conditions are important for radiologists. Dynamic MR imaging of the pelvic floor is an excellent tool for assessing functional disorders of the pelvic floor such as pelvic organ prolapse, outlet obstruction, and incontinence. Findings reported at dynamic MR imaging of the pelvic floor are valuable for selecting patients who are candidates for surgical treatment and for choosing the appropriate surgical approach. This pictorial essay reviews MR imaging findings of pelvic organ prolapse, fecal incontinence, and obstructed defecation. Supplemental material available at http://radiographics.rsnajnls.org/cgi/content/full/e35v1/DC1.
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PMID:Dynamic MR imaging of the pelvic floor: a pictorial review. 1927 71

Pelvic floor disorders such as pelvic organ prolapse, urinary incontinence, and fecal incontinence affect a large number of women each year. The pelvic floor can be thought of as a biomechanical structure due to the complex interaction between the vagina and its supportive structures that are designed to withstand the downward descent of the pelvic organs in response to increases in abdominal pressure. Although previous work has highlighted the biochemical changes that are associated with specific risk factors (i.e. parity, menopause, and genetics), little work has been done to understand the biomechanical changes that occur within the vagina and its supportive structures to prevent the onset of these pelvic floor disorders. Human studies are often limited due to the challenges of obtaining large tissue samples and ethical concerns. Therefore, it is necessary to investigate the use of animal models and their importance in understanding how different risk factors affect the biomechanical properties of the vagina and its supportive structures. In this review paper, we will discuss the different animal models that have been previously used to characterize the biomechanical properties of the vagina: including non-human primates, rodents, rabbits, and sheep. The anatomy and preliminary biomechanical findings are discussed along with the importance of considering experimental conditions, tissue anisotropy, and viscoelasticity when characterizing the biomechanical properties of vaginal tissue. Although there is not a lot of biomechanics research related to the vagina and pelvic floor, the future is exciting due to the significant potential for scientific findings that will improve our understanding of these conditions and hopefully lead to improvements in the prevention and treatment of pelvic disorders.
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PMID:Tissue mechanics, animal models, and pelvic organ prolapse: a review. 1928 76

This article reviews sexual function questionnaires used in urogynecology, impact of pelvic floor dysfunction (PFD) on sexual function, and impact of surgical treatment of PFD on sexual function, with a focus on the experience and publications of validated sexual function questionnaires in the urogynecologic literature. A review of the literature was performed to obtain data on sexual function and PFD focusing on those studies that utilized validated sexual function questionnaires. Validated questionnaires assure data that are reliable, quantifiable, and reproducible. Quality-of-life questionnaires, such as The King's Health Questionnaire and the Incontinence Impact Questionnaire, include a few questions addressing sexual function but really deal with the overall impact of incontinence and/or prolapse on the patient's QOL or well-being and do not focus on sexual function. General questionnaires focused on sexual function include the Female Sexual Function Index and the Sexual History Form 12, which were designed to evaluate sexual function and have undergone validation and reliability testing in a general population. General questionnaires are not condition-specific and may not be sensitive enough to detect differences due to PFD. The Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire (PISQ) is a condition-specific questionnaire focused on sexual function for use in women with PFD and has undergone rigorous validation and reliability testing. Many recent publications examining the impact of urinary incontinence (UI), fecal incontinence, and pelvic organ prolapse (POP) using validated generalized and disease-specific questionnaires have reported poorer sexual function in women with PFD. The PISQ has been used most commonly to evaluate sexual function after surgery for PFD, with increased PISQ scores in approximately 70%. Significant improvement is noted for sexual function related to physical and partner-related factors, with no changes for orgasm, desire, or arousal after surgical repair of PFD. Studies which used generalized sexual function questionnaires mainly found no change in sexual function following surgical treatment of POP and/or UI. In summary, the use of validated questionnaires shows that PFD is associated with a negative impact on sexual functions. Surgical correction of POP and/or UI improves sexual function in approximately 70% of patients, although some studies show no change with the use of non-condition-specific questionnaires.
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PMID:Assessment of sexual function in women with pelvic floor dysfunction. 1944 Jul 82

Approximately 11% of U.S. women undergo surgery for pelvic floor dysfunction, including genital organ prolapse and urinary and fecal incontinence. The major risk factor for developing these conditions is giving vaginal birth. Vaginal birth is a remarkable event about which little is known from a biomechanical perspective. We first review the functional anatomy of the female pelvic floor, the normal loads acting on the pelvic floor in activities of daily living, and the functional capacity of the pelvic floor muscles. Computer models show that the stretch ratio in the pelvic floor muscles can reach an extraordinary 3.26 by the end of the second stage of labor. Magnetic resonance images provide evidence that show that the pelvic floor regions experiencing the most stretch are at the greatest risk for injury, especially in forceps deliveries. A conceptual model suggests how these injuries may lead to the most common form of pelvic organ prolapse, a cystocele.
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PMID:On the biomechanics of vaginal birth and common sequelae. 1959 14

The pelvic floor is a highly complex structure made up of skeletal and striated muscles, support and suspensory ligaments, fascial coverings and an intricate neural network. Its dual role is to provide support for the pelvic viscera (bladder, bowel and uterus) and maintain functional integrity of these organs. In order to maintain good pelvic floor function, this elaborate system must work in a highly integrated manner. When this system if damaged, pelvic floor failure ensues. The aetiology is inevitably multi-factorial, and seldom as a consequence of a single aetiological factor. It can affect one or all the three compartments of the pelvic floor, often resulting in prolapse and functional disturbance of the bladder (urinary incontinence and voiding dysfunction), rectum (faecal incontinence), vagina and/or uterus (sexual dysfunction). This compartmentalisation of the pelvic floor has resulted in the partitioning of patients into urology, colo-rectal surgery or gynaecology, respectively, depending on the patients presenting symptoms. In complete pelvic floor failure, all three compartments are inevitably damaged resulting in apical prolapse, with associated organ dysfunction. It is clear that in this state, the patient needs the clinical input of at least two of the three pelvic floor clinical specialities. Whilst the primary clinical aim is to correct the anatomy, it must also be to preserve or restore pelvic floor function. As a consequence, these patients need careful clinical assessment, appropriate investigations, and counselling before embarking on a well-defined management pathway. The latter includes behavioural and lifestyle changes, conservative treatments (pelvic support pessaries, physiotherapy and biofeedback), pharmacotherapy, minimally invasive surgery (intravaginal slingoplasty, sacrospinous fixation and mid-urethral tapes) and radical specialised surgery (open or laparoscopic sacrocolpopexy). It is not surprising that in this complex group of patients, a multi-disciplinary approach is not only essential, but also critical, if good clinical care and governance is to be ensured.
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PMID:Complex pelvic floor failure and associated problems. 1964 90

The evolution of the multidisciplinary approach to the management of chronic conditions is a reflection of how medicine has evolved from a singular to a plural effort recognising the complex causations and consequences of such disorders. This thinking should not be confined to tertiary centres alone and should be adapted where local expertise is available. Such an approach is especially important in pelvic floor disorders, where the correlation between structure and function is not always straightforward. There is a need to avoid over-investigation by accurate clinical assessment allied to tailored investigation, leading to a step-wise approach to treatment (which may include behavioural, physiotherapy, medical or surgical management). The algorithms here on faecal incontinence, obstetric trauma, pelvic floor prolapse and chronic pelvic pain attempt to provide such a logical approach to patients.
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PMID:Organising a clinical service for patients with pelvic floor disorders. 1964 93

The pelvic floor represents the neuromuscular unit that provides support and functional control for the pelvic viscera. Its integrity, both anatomic and functional, is the key in some of the basic functions of life: storage of urine and feces, evacuation of urine and feces, support of pelvic organs, and sexual function. When this integrity is compromised, the results lead to many of the problems seen by clinicians. Pelvic floor dysfunction can involve weakness and result in stress incontinence, fecal incontinence, and pelvic organ prolapse. Pelvic floor dysfunction can also involve the development of hypertonic, dysfunctional muscles. This article discusses the pathophysiology of hypertonic disorders that often result in elimination problems, chronic pelvic pain, and bladder disorders that include bladder pain syndromes, retention, and incontinence. The hypertonic disorders are very common and are often not considered in the evaluation and management of patients with these problems.
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PMID:Pathophysiology of pelvic floor hypertonic disorders. 1993 22

Colpocystodefecography (CCD) and dynamic MRI with defecography (MRId) permit an alternation between filling and emptying the hollow organs and the maximum abdominal strain offered by the defecation. The application in imaging of these two principles reveal the masked or underestimated prolapses at the time of the physical examination. Rigorous application of the technique guarantees almost equivalent results from the two examinations. The CCD provides voiding views and improved analysis of the anorectal pathology (intussusceptions, anismus) but involves radiation and a more invasive examination. MRId has the advantage of providing continuous visibility of the peritoneal compartment, and a multiplanar representation, enabling an examination of the morphology of the pelvic organs and of the supporting structures, but with the disadvantage of still necessitating a supine examination, resulting sometimes in an incomplete evacuation. The normal and abnormal results (cystoptosis, vaginal vault prolapse, enterocele, anorectal intussuception, rectocele, descending perineum, urinary and fecal incontinence) and the respective advantages and the limits of the various imaging methods are detailed. Morphological and dynamic imaging are essential complementary tools to the physical examination, especially when a precise anatomic assessment is required to understand the functional complaint or when a reintervention is needed.
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PMID:[The role of medical imaging in the exploration of pelvic floor disorders]. 1996 65


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