**6. Diagnostics**

At the beginning, a detailed medical history should be taken regarding the complaints, previous births with complications and previous therapy attempts or operations. This should include evaluating where the patient is most distressed and which symptoms are perceived to be the most severe. Medical history should include questions regarding urinary incontinence, bladder voiding dysfunction, anal incontinence, defecation disorders and problems regarding sexuality. Using a questionnaire for evaluating medical history can help to get a first overview on the most urgent sufferings and can help to standardize and compare different group of patients. The most important tool for the diagnosis of pelvic floor disorders is the clinical examination. During the vaginal examination with two separate specula, all three compartments can be assessed at rest, during elevation and during pressing and should be classified according to the ICS/IUGA-classification [8]. A clinical distinction can also already be made between a pulsation cystocele (rugae vaginalis passed) and a traction cystocele (rugae preserved). While protrusion of the posterior vaginal wall is mostly well visible, a distinction between a rectocele or a enterocele needs additional diagnostic measures. Uterine prolapse or vaginal stump descensus is also easy to assess in clinical examination. To assess pelvic floor contractility and width of the genital hiatus, vaginal palpation should follow after speculum examination. A rectal examination with assessment of the sphincter resting tone and contractility should also be carried out routinely. Subsequently, vaginal ultrasound to evaluate the anatomy of the urethra and the bladder, but also their position and mobility, should be carried out. Is also allows direct imaging of

#### *Pelvic Floor Disorders in Females: An Overview on Diagnostics and Therapy DOI: http://dx.doi.org/10.5772/intechopen.101260*

alloplastic implant, if present. Ultrasound can also be used to distinguish between recto- and enterocele. In addition, endoanal ultrasonography can be used to assess the sphincter ani and its damage. With these easily accessible examination technique, most patients with pelvic floor disorders can be diagnosed sufficiently [8]. For complex cases, additional examination can be carried out. These can be a dynamic MRI or a defecography for anal incontinence or urodynamic examinations for urine incontinence, including uroflowmetry, cystometrogram, pressure flow study and urethral pressure profile. A cystoscopy may be helpful for some issues and an interdisciplinary presentation of the patient involving urology, proctology, surgery, and possibly neurology may still be considered. Sometimes, patients with drastic anatomical changes do not experience as many symptoms as patients who objectively only have minor clinical findings. Here, particularly in the case of dramatically described symptoms, it can be helpful to use a drinking and micturition log or a stool diary to assess and objectify the dysfunction [8].
