The pelvic floor is a muscular and ligamentous structure whose function is to keep the pelvic organs in place. It is crossed by three openings: the vagina, the anus, and the urethra. When these muscular structures fail, pelvic floor dysfunction occurs, significantly affecting patients’ quality of life.

CausasCausasCauses

Causes

The prevalence of this condition is high, ranging between 20% and 50% of women in different studies. It increases with age, number of children, type of delivery (vaginal vs. cesarean section), and overweight. Other risk factors include race (more frequent in white women) and menopause.

With increased life expectancy and a growing demand for better quality of life, consultations related to pelvic floor dysfunction have become an important health issue in developed societies.

SintomasSintomasSymptoms

Symptoms

The most important symptoms of pelvic floor dysfunction include:

  • Pelvic organ prolapse: Descent of pelvic organs such as the uterus, bladder, urethra, or rectum. It often presents as a genital bulge, a sensation of heaviness, constipation, and difficulty emptying the bladder.
  • Urinary incontinence: Stress, mixed, or urge incontinence.
  • Defecatory dysfunction: Fecal or gas incontinence, constipation, or pain during bowel movements.
  • Sexual dysfunction.

Depending on which muscle-ligament structures are affected, different types of problems may occur. Organs that may prolapse include:

  • Bladder (cystocele)
  • Urethra (urethrocele)
  • Uterus (uterine prolapse or uterocele)
  • Rectum (rectocele)

There may also be impaired continence of urine, stool, or gas, with or without associated prolapse. In many cases, several of these conditions coexist to varying degrees.

DiagnosticoDiagnosticoDiagnosis

Diagnosis

Diagnosis is based on:

  • A detailed medical history
  • Validated questionnaires to quantify symptom severity
  • Physical examination in a specialized pelvic floor unit
  • Urodynamic studies
  • Functional pelvic floor ultrasound

These evaluations help accurately classify the condition and determine the most effective and safest treatment.

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Treatment

Treatment should begin after a thorough diagnosis and may involve different specialists depending on symptom severity and the organs affected.

Non-Surgical Treatments

In cases of urinary incontinence without associated genital prolapse:

  • Medications:
    • Anticholinergics and α-adrenergic antagonists for urge urinary incontinence
    • Selective serotonin and norepinephrine reuptake inhibitors (SNRIs) for mild to moderate stress urinary incontinence
    • Estrogen therapy (local or systemic) may significantly improve symptoms
  • Pelvic floor rehabilitation:
    Conducted by specialized physiotherapists in pelvic floor units. Physiotherapy complements other treatments, improves outcomes, and reduces recurrence.
  • Vaginal laser therapy:
    A minimally invasive treatment that improves certain types of urinary incontinence by enhancing vaginal mucosa and connective tissue quality. It may also help improve sexual dysfunction associated with pelvic floor disorders.

Surgical Treatment

In patients where non-invasive treatments are not effective or applicable, or in cases of symptomatic genital prolapse, surgery may be indicated. Surgical options include:

  • Repositioning or removal of prolapsed organs (e.g., hysterectomy if childbearing is complete)
  • Reconstruction of pelvic support structures using the patient’s own tissues or synthetic mesh

These procedures usually achieve highly satisfactory results.

Because pelvic floor disorders are multifactorial and involve muscular and ligamentous structures, physiotherapy should complement any treatment approach. In many cases, combining different therapies is necessary to achieve optimal results.

Specialties:
  • Gynecology and Obstetrics