Pelvic Floor Disorders

Three compartments

• Anterior

  • urinary incontinence

  • urinary voiding difficulties

• Middle

  • prolapse

  • sexual difficulties

• Posterior

  • bowel evacuation difficulties

  • bowel continence problems

Prolapse

• Cystocele

• Urethrocele

• Uterocervical prolapse

• vault prolapse after hysterectomy

• rectocele

• enterocele (prolapse of bowel)

Pelvic supports

• Levator ani / pelvic diaphragm

• Endopelvice fascia - inc. uterosacral and cardinal ligaments

Predisposing factors

• Childbirth

  • prolonged active second stage

  • heavy babies

  • instrumental deliveries

  • precipitate deliveries

• Menopause

• Increased intra-abdominal pressure

  • COPD

  • obesity

  • constipation

  • intraabdominal tumours

• Connective tissue disorders

  • Marfan's

  • Ehlers-Danlos

Urinary Incontinence