Pelvic Floor Dysfunction

Abstract

The pelvic floor is a tunnel or dome-shaped muscular sheath made up of striated muscle and is positioned to enclose and support the genitourinary and anorectal compartments. The pelvic floor forms the inferior boundary of the abdominopelvic cavity extending from the pubic symphysis anteriorly to the coccyx posteriorly and between the two pelvic side walls. There are four layers: the endopelvic fascia, the muscular diaphragm or levator plate, the perineal membrane or urogenital diaphragm, and the superficial transversus perinei. The pelvic floor has a dynamic mechanization of complex voluntary and involuntary muscles, supporting ligaments, fascial encasings, and complex neural wiring. Pelvic floor dynamics is crucial in maintaining continence and evacuation of the bladder/bowel, supporting the pelvic organs, maintaining the dynamics of the birth canal, and optimized sexual function. The functional dynamics of the pelvic floor results in myriad clinical presentations. It is necessary to understand the possible symptom complexes in relation to different compartments of the pelvic floor. The three compartments, i.e., anterior, middle, and posterior, relate to symptomatology arising from the urinary, genital, and defecatory system complexes, respectively. These three compartments act like “the spokes of a wheel,” i.e., the pelvic floor (Agarwal et al. 2012). The colorectal surgeon deals mostly with the defecatory aspect of the pelvic floor. Constipation is an index symptom of anorectal dysfunction which in itself is an index parameter of pelvic floor dysfunction (Agarwal et al. 2013). Pelvic floor dysfunction refers to a wide range of disorders which occur due to weakness or tightness of muscles of the pelvic floor. Apart from constipation, pelvic floor dysfunctions include fecal incontinence, urinary incontinence, overactive bladder, pelvic discomfort/pain syndromes, sexual dysfunction, and pelvic organ prolapse (rectocele, cystocele, urethrocele, and rectal prolapse). The most common and definable conditions include fecal incontinence, urinary incontinence, and pelvic organ prolapse. The interdependence and interplay of all these symptoms are clinically relevant as they are just like different spokes in the wheel of pelvic floor dysfunction (Aschkenazi and Goldberg 2009; Keller and Lin 2012).