Obstetrics and gynecology clinics of North America
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Normal physiologic function of the pelvic organs depends on the anatomic integrity and proper interaction among the pelvic structures, the pelvic floor support components, and the nervous system. Pelvic floor dysfunction includes urinary and anal incontinence; pelvic organ prolapse; and sexual, voiding, and defecatory dysfunction. ⋯ In addition, surgical spaces of interest to the gynecologic surgeon and the course of the pelvic ureter are described. Several concepts reviewed in this article are derived and modified from a previous review of pelvic support anatomy.
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Obstet. Gynecol. Clin. North Am. · Sep 2009
ReviewClinical approach and office evaluation of the patient with pelvic floor dysfunction.
Pelvic floor disorders are common health issues for women and have a great impact on quality of life. These disorders can present with a wide spectrum of symptoms and anatomic defects. ⋯ The goal of treatment is to provide as much symptom relief as possible. After education and counseling, patients may be candidates for non-surgical or surgical treatment, and expectant management.
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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 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.