Pelvic floor disorders, including urinary and anal incontinence, pelvic organ prolapse (POP), sexual dysfunction, and pelvic pain consist of an array of functional and anatomical diseases that significantly impact the quality of life (QOL) of women. Central to the diagnosis and treatment of these disorders is the amount of bother and impact on QOL women experience from their pelvic floor problems. For the majority of pelvic floor disorders, no universally accepted definition of the disease state on physical examination or on ancillary testing exists. For this reason, diagnosis of disorders must not only take into account anatomic and functional measures, but also must include evaluation of symptom severity and impact on QOL. This is not meant to trivialize the importance of the diagnosis and treatment of these problems, but rather to emphasize the need for pelvic floor disorders to be evaluated within the context of the patients’ personal experience. In this chapter, we review the clinical and QOL evaluation of the women with pelvic floor dysfunction; detailed descriptions of specific tests will not be presented here, but will be covered in more detail in chapters addressing specific pelvic floor dysfunctions.
CLINICAL EVALUATION OF A PATIENT WITH PELVIC FLOOR DYSFUNCTION
Pelvic floor disorders comprise a group of diseases that patients may find difficult to bring up during a medical interview. Although common, many patients are reluctant to discuss these problems with providers because of embarrassment or because women are unaware of treatment options. In addition, many providers are not familiar with the diagnosis and treatment of pelvic floor dysfunction or feel that these disease states can only be treated by a specialist. Family members may believe that the lack of urinary or bowel control is volitional. Challenges faced by families are underlined by the fact that incontinence is a major reason for nursing home admissions in the elderly.1
The National Center for Quality Assurance emphasized the importance of screening for pelvic floor problems by determining that a quality indicator for primary care provider is to identify individuals with urinary incontinence.2 In a busy primary care or obstetrics and gynecology practice, finding time to ask about incontinence or prolapse may be challenging. Many providers ask women general questions about whether or not they have bowel, bladder, or sexual complaints on their intake history. This simple intervention opens the door for women to feel more comfortable to seek treatment. Often patients have more than a single disorder; it is critical that women who present with a single disorder be screened for others as well. Because of their central importance in detection and evaluation of functional problems, following is a discussion of the psychometric properties of questionnaires in general and a brief ...