Initial assessment of a female patient with pelvic floor dysfunction
DOI:
https://doi.org/10.6016/ZdravVestn.2632Keywords:
pelvic floor dysfunction, pelvic organ prolapse, urinary incontinence, urogynaecologyAbstract
Urogynaecology is dedicated to diagnostics and treatment of pelvic floor dysfunction. Pelvic floor dysfunction (PFD) is a common problem that affects at least half of all women. Symptoms associated with it are numerous; however, the most common are urinary incontinence and those of pelvic organ prolapse (POP).
The initial assessment of women with PFD consists of urogynaecological history with bladder diary, urine analysis and clinical examination. Focused urogynaecological history identifies the patient’s main symptoms, established their duration, characteristics, and their effect on the patient’s quality of life. The patient should be asked about the severity of their symptoms, their triggers and onset. The amount and the type of fluid consumed during the day should be established. Complete gynaecological history and information regarding concomitant medical issues, previous surgeries and any allergies should also be obtained. The bladder diary can also be analysed, as it provides important information regarding the patient’s frequency, incontinence episodes, pad use, fluid intake, and degree of urgency and incontinence.
Clinical examination consists of general assessment, abdominal examination, and vaginal examination with POP and pelvic floor muscle (PFM) assessment. We recommend that POP assessment be performed using the POP Quantification System (POP-Q system) and that digital palpation is used for PFM assessment with contraction strength assessed either according to the six-level Oxford scale or four levels of PFM strength. Because of high prevalence of urinary tract infections in women with lower urinary tract symptoms, urine analysis and urinary culture represent an indispensable part of the initial assessment of these patients.
Downloads
References
Chittacharoen A. How to approach common urogynaecological problems? J Med Assoc Thai. 2005 Oct;88 Suppl 2:S124–8. PMID:17722326
Jeffery S, de Jong P. (ur). Textbook of urogynaecology. South Africa: University of Cape Town; 2010.
Abrams P, Andersson KE, Birder L, Brubaker L, Cardozo L, Chapple C, et al.; Members of Committees; Fourth International Consultation on Incontinence. Fourth International Consultation on Incontinence Recommendations of the International Scientific Committee: evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence. Neurourol Urodyn. 2010;29(1):213–40. https://doi.org/10.1002/nau.20870 PMID:20025020
Milsom I. (ur). Epidemiology of Urinary Incontinence (UI) and other Lower Urinary Tract Symptoms (LUTS), Pelvic Organ Prolapse (POP) and Anal Incontinence (AI). V: Abrams P, Cardozo L, Khoury S, Wein A. Incontinence. Peta izdaja. ICUD-EAU. Pariz; 2013.
Bohlin KS, Ankardal M, Nüssler E, Lindkvist H, Milsom I. Factors influencing the outcome of surgery for pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2018 Jan;29(1):81–9. https://doi.org/10.1007/s00192-017-3446-9 PMID:28894904
Vergeldt TF, Weemhoff M, IntHout J, Kluivers KB. Risk factors for pelvic organ prolapse and its recurrence: a systematic review. Int Urogynecol J Pelvic Floor Dysfunct. 2015 Nov;26(11):1559–73. https://doi.org/10.1007/s00192-015-2695-8 PMID:25966804
But I, Palfy M, Glodež S. Urinary incontinence and overactive bladder in patients attending the family practice physicians office: a pan-Slovenian cross-sectional, questionnaire-based survey. Zdrav Vestn. 2013;82:225–33.
Roškar AM. Samopodoba ženske z urinsko inkontinenco [diplomsko delo]. Maribor, Univerza v Mariboru; 2017.
Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al.; International Urogynecological Association; International Continence Society. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29(1):4–20. PMID:19941278
National Institute for Health and Care Excellence. Urinary incontinence in women: management. Clinical guideline. Dostopno 1. septembra 2016 na: https://www.nice.org.uk/guidance/cg171
Staskin D, Kelleher D. (ur). Initial assessment of urinary incontinence in adult male and female patients. V: Abrams P, Cardozo L, Khoury S, Wein A. Incontinence. Peta izdaja. ICUD-EAU. Pariz; 2013.
Kölle D, Windisch J, Kropshifer S, Marth C. Evaluation of urinary incontinence and prolapse. V: Lukanovič A, Tamussino K. Urogynecology today. Portorož: Slovene Urogynecological Society and Austrian Society for Urogynecology and Pelvic Reconstructive Surgery; 2004.
Staskin D, Kelleher D. (ur). Patient-reported outcome assessment. V: Abrams P, Cardozo L, Khoury S, Wein A. Incontinence. Peta izdaja. ICUD-EAU. Pariz; 2013.
Farrell SA, Epp A, Flood C, Lajoie F, MacMillan B, Mainprize T, et al.; Urogynaecology Committtee; Executive and Council of the Society of Obstetricians and Gynaecologists of Canada. The evaluation of stress incontinence prior to primary surgery. J Obstet Gynaecol Can. 2003 Apr;25(4):313–24. https://doi.org/10.1016/S1701-2163(16)31034-9 PMID:12679823
Peschers UM, Gingelmaier A, Jundt K, Leib B, Dimpfl T. Evaluation of pelvic floor muscle strength using four different techniques. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12(1):27–30. https://doi.org/10.1007/s001920170090 PMID:11294527
Persu C, Chapple CR, Cauni V, Gutue S, Geavlete P. Pelvic Organ Prolapse Quantification System (POP-Q) - a new era in pelvic prolapse staging. J Med Life. 2011 Jan-Mar;4(1):75–81. PMID:21505577
Bump RC, Mattiasson A, Bø K, Brubaker LP, DeLancey JO, Klarskov P, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996 Jul;175(1):10–7. https://doi.org/10.1016/S0002-9378(96)70243-0PMID:8694033
Hall AF, Theofrastous JP, Cundiff GW, Harris RL, Hamilton LF, Swift SE, et al. Interobserver and intraobserver reliability of the proposed International Continence Society, Society of Gynecologic Surgeons, and American Urogynecologic Society pelvic organ prolapse classification system. Am J Obstet Gynecol. 1996 Dec;175(6):1467–70. https://doi.org/10.1016/S0002-9378(96)70091-1 PMID:8987926
Rosier PF. (ur). Urodynamic testing. V: Abrams P, Cardozo L, Khoury S, Wein A. Incontinence. Peta izdaja. ICUD-EAU. Pariz; 2013.
Mattison ME, Simsiman AJ, Menefee SA. Can urethral mobility be assessed using the pelvic organ prolapse quantification system? An analysis of the correlation between point Aa and Q-tip angle in varying stages of prolapse. Urology. 2006 Nov;68(5):1005–8. https://doi.org/10.1016/j.urology.2006.05.030 PMID:17095054
Kim SO, Chung HS, Hwang EC, Oh KJ, Kwon D. Point Aa of the POP-Q system as a predictive value of urethral mobility in women. Int Urogynecol J Pelvic Floor Dysfunct. 2011 Jun;22(6):687–91. https://doi.org/10.1007/s00192-010-1316-9 PMID:21104403
Salvatore S, Serati M, Uccella S, Koelbl H, Artibani W, Cardozo L, et al. Inter-observer reliability of three different methods of measuring urethrovesical mobility. Int Urogynecol J Pelvic Floor Dysfunct. 2008 Nov;19(11):1513–7. https://doi.org/10.1007/s00192-008-0671-2PMID:18604464
Latini JM, Zimmerman MB, Kreder KJ Jr. Association between valsalva and cough leak point pressures and pelvic organ prolapse quantification in women with stress incontinence. J Urol. 2005 Apr;173(4):1219–22. https://doi.org/10.1097/01.ju.0000152323.78869.93PMID:15758756
Pollak JT, Jenkins P, Kopka SL, Davila GW. Effect of genital prolapse on assessment of bladder neck mobility by the Q-tip test. Obstet Gynecol. 2003 Apr;101(4):662–5. PMID:12681867
Crystle CD, Charme LS, Copeland WE. Q-tip test in stress urinary incontinence. Obstet Gynecol. 1971 Aug;38(2):313–5. PMID:5105346
Noblett K, Lane FL, Driskill CS. Does pelvic organ prolapse quantification exam predict urethral mobility in stages 0 and I prolapse? Int Urogynecol J Pelvic Floor Dysfunct. 2005 Jul-Aug;16(4):268–71. https://doi.org/10.1007/s00192-005-1315-4 PMID:15856131
Zyczynski HM, Lloyd LK, Kenton K, Menefee S, Boreham M, Stoddard AM; Urinary Incontinence Treatment Network (UITN). Correlation of Q-tip values and point Aa in stress-incontinent women. Obstet Gynecol. 2007 Jul;110(1):39–43. https://doi.org/10.1097/01.AOG.0000267190.09976.81 PMID:17601894
Larrieux JR, Balgobin S. Effect of anatomic urethral length on the correlation between the Q-tip test and descent at point Aa of the POP-Q system. Int Urogynecol J Pelvic Floor Dysfunct. 2008 Feb;19(2):273–6. https://doi.org/10.1007/s00192-007-0429-2 PMID:17687500
Cogan SL, Weber AM, Hammel JP. Is urethral mobility really being assessed by the pelvic organ prolapse quantification (POP-Q) system? Obstet Gynecol. 2002 Mar;99(3):473–6. PMID:11864676
Robinson BL, Geller EJ, Parnell BA, Crane AK, Jannelli ML, Wells EC, et al. Diagnostic accuracy of visual urethral mobility exam versus Q-Tip test: a randomized crossover trial. Am J Obstet Gynecol. 2012 Jun;206(6):528.e1–6. https://doi.org/10.1016/j.ajog.2012.02.015PMID:22459346
Rosencrantz M, Menefee SA, Lukacz ES. The correlation of urethral mobility and point Aa of the pelvic organ prolapse quantification system before and after surgery. Am J Obstet Gynecol. 2006 Dec;195(6):1841–5. https://doi.org/10.1016/j.ajog.2006.06.064 PMID:17014817
Tapp K, Connolly A, Visco AG. Evaluation of Aa point and cotton-tipped swab test as predictors of urodynamic stress incontinence. Obstet Gynecol. 2005 Jan;105(1):115–9. https://doi.org/10.1097/01.AOG.0000146642.68543.69 PMID:15625151
Serdinšek T, But I. Anterior compartment descent: A new measure in the assessment of urethral hypermobility in women with urinary incontinence. Int J Urol. 2017 Jul;24(7):548–52. https://doi.org/10.1111/iju.13370 PMID:28556438
Tubaro A. (ur). Imaging, Neurophysiological Testing and Other Tests. V: Abrams P, Cardozo L, Khoury S, Wein A. Incontinence. Peta izdaja. ICUD-EAU. Pariz; 2013.
Downloads
Published
Issue
Section
License
The Author transfers to the Publisher (Slovenian Medical Association) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Slovenian Medical Association) has the right to transfer the rights of acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.
