Preface

Pelvic floor disorders (PFDs) refer to a group of conditions, such as urinary incontinence, fecal incontinence, and pelvic organ prolapse (POP), due to weakened or injured pelvic muscles and connective tissues. The pelvic muscles and connective tissues play an important role in supporting the pelvic organs, including the bowel, bladder, rectum, and in women, the uterus, since they form an anatomical hammock across the floor of the pelvis. Once these muscles or connective tissues are weakened or injured, the function of pelvic organs will be affected and consequently PFDs will occur.

In general, the diagnosis and management of PFDs remain a challenge because the symptoms of PFDs are various. In their chapter, Dr. Isabell Link and Christian Fünfgeld provide us with an outline of female PFDs. They describe not only are the key points of diagnosis, but also therapeutic and preventive strategies.

Understanding pelvic floor muscle activity is the basis for management of PFDs. Several studies focusing on pelvic floor muscle activity have been performed since Dr. Kegel developed an intravaginal device to measure pelvic floor muscle strength in 1948. However, the effect of different positions and breath status on pelvic floor muscle activity is still unclear. In their chapter, Prof. Monika Sorfova and Eva Tlapakova demonstrate the results of their research, which may help clinicians to develop a more efficient protocol of pelvic floor muscle training.

Pregnancy and childbirth are important acquired risk factors for female PFDs. On one hand, pregnancy and childbirth can put excessive strain on the pelvic floor, which may result in pelvic floor muscle fatigue. On the other hand, episiotomy during delivery can directly injury the pelvic muscles and connective tissues. It may minimize the occurrence of PFDs to understand the indication of episiotomy and perform this surgery properly. To understand the knowledge of gynecologists and midwives, Dr. Cristhel K. Fagerstrom-Sade et al. conducted a cross-sectional study in Chile. The results of the study provide valuable evidence in this field.

The management of PFDs mainly depends on the patients' clinical presentation. Basically, conservative therapy is considered the first-line treatment for PFDs. Magnetic stimulation, as a non-invasive therapy, has been one of the most common therapies for treating PFDs. In their chapter, Dr. Shigeo Horie et al. present current evidence in the therapeutic effect of magnetic stimulation on various PFDs. More importantly, they discuss the application of magnetic stimulation in Japan.

Interstitial cystitis/bladder pain syndrome (IC/BPS) is believed to be a kind of complicated PFD. However, because its etiology remains unclear, the diagnostic criteria are confusing, and no definitive treatments are available. Generally, IC/BPS can be classified into two types: Hunner lesion IC/BPS and non-Hunner lesion IC/BPS. It is reported that patients with Hunner lesion IC/BPS have more severe symptoms and lower bladder capacity compared to those with non-Hunner lesion IC/BPS. Thus, management of Hunner lesion IC/BPS seems to be more difficult. In their chapter,

Dr. Kwang Jin Ko and Kyu-Sung Lee not only list currently available treatments but also present evidence for the efficacy of each treatment, which can help clinicians to choose the proper therapeutic strategy.

Post-stroke urinary incontinence is a common PFD in the elderly. It is normally managed as a chronic illness because it is a sequela of stroke. In their chapter, Prof. Heltty Heltty et al. develop an integrated management model that includes a holistic rehabilitation program and continuous care at the patient's home. This therapeutic model may boost patient confidence in overcoming the disease.

Dysfunctional voiding is a common disorder in children. Traditionally, its etiology is attributed to habitual disorder and psychosocial problems. Recently, more and more studies show several factors, including learned behavior, the perpetuation of infantile patterns, maturational delay, and genetic or congenital factors, may contribute to the occurrence of dysfunctional voiding. Despite the development in understanding its etiology, there is no universal treatment so far. In their chapter, Dr. Vesna D. Zivkovic et al. present different rehabilitation protocols in details, which may allow patients to choose multimodal and individualized therapy.

POP is the dropping of the pelvic organs caused by the weakened support of pelvic muscles and connective tissues. Surgery has been the mainstream treatment for POP. In their chapter, Dr. Rodrigo García-Baquero et al. share their experience in managing POP using single-incision mesh and discuss other surgical procedures. Their case study provides important evidence in the safety of the procedure.

In this book, experts and researchers from different countries present the latest evidence in the diagnosis and treatment of PFDs. Although these chapters cannot cover all the aspects of PFDs, they provide readers with important updates. I believe a bright future in this field awaits us.

> **Ran Pang** Department of Urology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China

Section 1
