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Pelvic floor disorders (PFDs) include urinary incontinence, pelvic organ prolapse, fecal incontinence, and other sensory and emptying abnormalities of the lower urinary and gastrointestinal tracts. Nearly one-quarter of all women and more than one-third of older women reported symptoms of at least 1 pelvic floor disorder. The prevalence of PFDs increase as women age. Advances in modern medicine during the last 80 years have increased the life expectancy of women well into the eighth and ninth decades. We are caring for patients longer and better than ever, effectively managing chronic medical problems such as hypertension, cardiovascular disease, and diabetes, enabling women to enjoy longer and more productive lives. Using US Census data projections, by 2030, more than one-fifth of women will be 65 years of age or older. This will result in a large population of women living up to one-third of their life after menopause, thereby introducing a whole host of medical issues and health concerns.

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A prime example of this is the problem of urinary incontinence, which has become more prevalent as the population of aging women grows. Urinary incontinence affects millions adult women in the United States. It is estimated to affect 50% of American women during their lifetime and results in substantial medical, social, and economic burdens. Despite its prevalence and estimated costs in excess of $19.5 billion annually, up to two-thirds of women do not seek help for incontinence, primarily because of social embarrassment or because they are unaware that help is available. Because of increasing awareness by both patients and physicians, the societal concept that incontinence is part of the “normal” aging process is no longer acceptable.

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Essentials of Diagnosis

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  • The symptoms of urinary incontinence involve involuntary leakage of urine.
  • History and clinical examination can often effectively diagnose the correct condition.
  • Two most common types are stress incontinence (loss of urine with physical exertion) and urinary urge incontinence (sudden urge to urinate and losing urine before toileting).
  • The term overactive bladder (OAB) is often used to describe the most common symptoms of urinary urgency, usually accompanied by frequency and nocturia, with or without urgency urinary incontinence.
  • The use of pads to protect soiling undergarments is the most common coping mechanism for women.
  • Behavioral methods such as fluid restriction, avoidance of dietary triggers, and pelvic floor muscle strengthening can be helpful to reduce symptoms.
  • Surgery, such as a midurethral sling, can be effective to cure stress urinary incontinence.
  • Medications or neuromodulation can be helpful for women with urinary urge incontinence who do not respond to behavioral methods.

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Anatomy

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The urinary and reproductive tracts are intimately associated during embryologic development. The lower urinary tract can be divided into 3 parts: the bladder, the vesical neck, and the urethra (Fig. 42–1). The bladder is a hollow muscular organ lined with transitional epithelium designed for urine storage. The bladder musculature consists of layers of smooth muscle, ...

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