**Author details**

mentioned but we still lack a real understanding of the pathophysiology of pelvic floor disorders. Although it seems apparent that multiple factors combine in each woman for the development of a clinical condition like prolapse or UI, these need to be identified prior to treatment to avoid recurrence of disease. The genetic predisposition aggravated by acquired risk factors, such as childbirth, hormonal changes, and aging predisposes the women to PFD. There is a lack of strong evidence for this hypothesis. Findings of epidemiologic studies are frequently inconsistent. A clearer comprehension of the pathophysiology responsible for PFD is clinically relevant on different levels. First, identifying the patient population at risk through screening of known polymorphism can lead to preventive strategies and the avoidance of contributing risk factors. Second, it may allow the development of interventional therapies where we can locally modify the extracellular matrix (ECM) composition of pelvic floor muscles and ligaments. Future research should then focus on understanding what processes control ECM remodeling and aging using specific and standardized measurement methods

The pelvic floor disorders present with varied symptoms which are related to UI, FI, and POP. Although the women may present with clinical symptom of POP but they usually have backache, vaginal discharge in association with both urinary frequency and urgency and urinary leak while straining or during sexual intercourse. The fecal symptoms may occur after iatrogenic injury to anal sphincters during child birth. The prevalence of pelvic floor dysfunction is 24%, with 16% of women experiencing urinary incontinence, 9% experiencing fecal incontinence, and 3% experiencing pelvic organ prolapse [6]. The clinical presentation of pelvic floor disorders in an urogynecology clinic often lead to a diagnosis where a multidisciplinary approach is usually required for management of a case, which may include evaluation by an urogynecology radiologist. Complete diagnosis by clinical examination alone can be challenging, particularly in cases of posterior vaginal wall prolapse and/or a multicompartment problem. Imaging has become an important complementary tool in the assessment of pelvic floor disorders, and dynamic pelvic floor magnetic resonance imaging (MRI), or MR

MRI can simultaneously noninvasively evaluate all pelvic floor compartments and provide information about muscles and ligaments with great contrast resolution, without the use of

Since pelvic floor disorders present with site-specific defects, clinical presentation varies with grades of disease. The management really depends on the impact of disease on women's quality of life. The first line of management is always conservative which includes pelvic floor muscle physiotherapy, avoidance of risk factors like constipation and smoking but usually women do

defecography, has evolved as one of the essential imaging techniques [7].

ionizing radiation and with minimal patient discomfort [8].

**4. Treatment**

2 Pelvic Floor Disorders

and tracing them back to genetic transcription [5].

**3. Clinical symptoms and diagnosis**

Raheela M. Rizvi

Address all correspondence to: raheela.mohsin@aku.edu

Obstetrics and Gynecology, Agha Khan University, Karachi, Pakistan

## **References**


**Chapter 2**

**Provisional chapter**

**Pathophysiology of Pelvic Organ Prolapse**

**Pathophysiology of Pelvic Organ Prolapse**

DOI: 10.5772/intechopen.76629

Pelvic organ support is provided by interaction between the pelvic floor muscle, ligaments and its connective tissues. Failure of anatomical support may result in pelvic organ prolapse. Therefore in managing anterior, posterior, or apical compartments prolapse, conceptual understanding of pelvic floor anatomy is essential for the surgeons. To appropriately treat these entities, comprehension of the various theories of the pathophysiology of pelvic organ prolapse is of paramount importance. DeLancey has described vaginal connective tissue support of the pelvis at three levels that has helped us to understand various clinical manifestations of pelvic organ support dysfunction. Pelvic floor disorder is frequently associated with etiological risk factors which include aging, parity, obesity, connective tissue disorder, increased intra-abdominal pressure and hysterectomy. A better understanding of pathophysiology of muscular, collagen, and neuronal components of the pelvic organs and

their support would provide an insight of site specific defects and its prevention.

**Keywords:** prolapse, anatomy, pelvic floor muscles, compartments, collagen, risk

Approximately one-third of adult women affected with pelvic organ prolapse, have significant impact on their quality of life and emotional well-being. Epidemiologic survey of the United States showed that pelvic organs prolapse (POP) becomes more prevalent as the population age advances [1]. Women have 11.1% lifetime risk of undergoing surgery for prolapse

Pelvic organ prolapse is defined as the descent of the anterior, posterior, and/or apical vaginal compartment(s) with protrusion of one or more pelvic organs (e.g. bladder, uterus,

by age 80 [2] and a 30% risk of reoperation over a period of 4 years [3].

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

distribution, and reproduction in any medium, provided the original work is properly cited.

Additional information is available at the end of the chapter

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.76629

Lubna Razzak

Lubna Razzak

**Abstract**

factors

**1. Introduction**

#### **Pathophysiology of Pelvic Organ Prolapse Pathophysiology of Pelvic Organ Prolapse**

DOI: 10.5772/intechopen.76629

#### Lubna Razzak Lubna Razzak

Additional information is available at the end of the chapter Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.76629

**Abstract**

Pelvic organ support is provided by interaction between the pelvic floor muscle, ligaments and its connective tissues. Failure of anatomical support may result in pelvic organ prolapse. Therefore in managing anterior, posterior, or apical compartments prolapse, conceptual understanding of pelvic floor anatomy is essential for the surgeons. To appropriately treat these entities, comprehension of the various theories of the pathophysiology of pelvic organ prolapse is of paramount importance. DeLancey has described vaginal connective tissue support of the pelvis at three levels that has helped us to understand various clinical manifestations of pelvic organ support dysfunction. Pelvic floor disorder is frequently associated with etiological risk factors which include aging, parity, obesity, connective tissue disorder, increased intra-abdominal pressure and hysterectomy. A better understanding of pathophysiology of muscular, collagen, and neuronal components of the pelvic organs and their support would provide an insight of site specific defects and its prevention.

**Keywords:** prolapse, anatomy, pelvic floor muscles, compartments, collagen, risk factors
