Preface

Pelvic floor disorders (PFDs), which include urinary and fecal incontinence (FI) and pelvic organ prolapse (POP), are highly prevalent conditions in women. In the United States alone, this affects almost 25% of women. These disorders often affect women's daily life activities, their sexual function, their ability to exercise, and their social and psychological life. In addi‐ tion to these, the economic costs for individuals and the society can be astronomical. Conser‐ vative management is initially offered, but often enough patients have to be operated upon. In the western countries, for example, 11–21% of women undergo surgery for pelvic organ prolapse, and almost 5–10% of women who have recurrence need a second surgery during their lifetime.

This book *Pelvic Floor Disorders* includes chapters on pathophysiology of pelvic organ pro‐ lapse (POP), its treatment by the use of a new synthetic material, treatment for recurrent POP, and diagnostic urogynecology radiology suggesting the use of MRI to diagnose POP considering effects of posture and gravity.

The pathophysiology of pelvic floor disorders (PFDs) is less well understood because it in‐ cludes both anterior and posterior pelvic compartment disorders. The chapter covers both anatomy and pathophysiology of urinary and fecal incontinence and POP including updates on the subject.

Pelvic organ prolapse is usually a clinical diagnosis. There have been many systems to grade and stage the POP, and yet the diagnosis varies among the experts due to the effects of grav‐ ity and posture in which the patients are examined. If it presents with complicated symp‐ toms of posterior compartment defects, then further evaluation is required. MRI is performed in the supine position regardless of the effect of posture and gravity on POP. A full chapter is dedicated to explain in detail the use of a new protocol and advanced techni‐ que to evaluate the changes of POP in different positions using open MRI (MRO).

The use of mesh in vaginal surgery for pelvic floor disorders is very debatable. In the last few years, many of the mesh-driven surgical kits have been removed from the market, and surgeons are facing a new challenge to treat recurrent cases of both POP and stress urinary incontinence (SUI). The problems of currently used material polypropylene and designing the ideal material suggested a biodegradable material, poly-L-lactic acid (PLA). The fourth chapter describes a polymer of lactic acid, which is among the most commonly used poly‐ mers in biomedical applications.

The last chapter covers the biggest challenge of treating the recurrent cases of POP. Surgical techniques of suspending the vaginal vault with autologous tissue and synthetic mesh are

discussed according to clinical presentation and considering the grades of POP. It also in‐ cludes the role of minimally invasive surgery for recurrent cases.

We have not included the urinary incontinence because there is a separate book published last year. There is a dire need to address fecal incontinence (FI) though we have included posterior compartment defects, but FI has to be included in the upcoming editions.

A word of gratitude is due to the eminent scholars of medical science who contributed the results of their painstaking research for this book.

> **Raheela M.Rizvi** Obstetrics and Gynecology Agha Khan University Karachi, Pakistan

**Chapter 1**

**Provisional chapter**

**Introductory Chapter: Pelvic Floor Disorders**

**Introductory Chapter: Pelvic Floor Disorders**

DOI: 10.5772/intechopen.77302

The purpose of presenting this book is to provide an insight into various spectrum symptoms that the women present with pelvic floor disorders or/dysfunctions. Pelvic floor disorders and dysfunctions are overlapping terms. Pelvic floor disorders (PFDs) include urinary (UI) and anal incontinence (AI) and pelvic organ prolapse (POP) [1]. To understand pelvic floor dysfunctions, one must appreciate the role of the pelvic floor muscle (PFM). When the PFM is neglected or injured, one or multiple forms of pelvic floor dysfunctions may result, such as bladder and bowel incontinence, obstructive micturition, constipation, pelvic pain and sexual

Pelvic floor dysfunction symptoms of vaginal pain and backache is due to hypertonic pelvic floor muscle which is defined as general increase in muscle tone that can be associated with either elevated contractile activity and/or passive stiffness in the muscle [3]. Most of women present with pelvic floor defects/relaxation symptoms but pelvic floor dysfunction also include non-relaxing pelvic floor symptoms which are not widely recognized. Unlike in pelvic floor disorders caused by relaxed muscles (e.g., pelvic organ prolapse or urinary incontinence, both of which often are identified readily), women affected by no relaxing pelvic floor dysfunction may present with a broad range of nonspecific symptoms. These may include pain and problems with defecation, urination, and sexual function, which require relaxation and coordination of pelvic floor muscles and urinary and anal sphincters. These symptoms

There are many theories which explain the urinary, fecal incontinence, and pelvic organ prolapse. The risk factors such as obesity, high parity, advanced age, and life style have been

> © 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.77302

dysfunction, POP and/or low back pain [2].

may adversely affect the quality of life [4].

**2. Etiology, pathophysiology, and risk factors**

Raheela M. Rizvi

Raheela M. Rizvi

**1. Introduction**

#### **Chapter 1 Provisional chapter**

#### **Introductory Chapter: Pelvic Floor Disorders Introductory Chapter: Pelvic Floor Disorders**

DOI: 10.5772/intechopen.77302

#### Raheela M. Rizvi Raheela M. Rizvi

discussed according to clinical presentation and considering the grades of POP. It also in‐

We have not included the urinary incontinence because there is a separate book published last year. There is a dire need to address fecal incontinence (FI) though we have included

A word of gratitude is due to the eminent scholars of medical science who contributed the

**Raheela M.Rizvi**

Obstetrics and Gynecology Agha Khan University Karachi, Pakistan

posterior compartment defects, but FI has to be included in the upcoming editions.

cludes the role of minimally invasive surgery for recurrent cases.

results of their painstaking research for this book.

VIII Preface

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.77302

**1. Introduction**

The purpose of presenting this book is to provide an insight into various spectrum symptoms that the women present with pelvic floor disorders or/dysfunctions. Pelvic floor disorders and dysfunctions are overlapping terms. Pelvic floor disorders (PFDs) include urinary (UI) and anal incontinence (AI) and pelvic organ prolapse (POP) [1]. To understand pelvic floor dysfunctions, one must appreciate the role of the pelvic floor muscle (PFM). When the PFM is neglected or injured, one or multiple forms of pelvic floor dysfunctions may result, such as bladder and bowel incontinence, obstructive micturition, constipation, pelvic pain and sexual dysfunction, POP and/or low back pain [2].

Pelvic floor dysfunction symptoms of vaginal pain and backache is due to hypertonic pelvic floor muscle which is defined as general increase in muscle tone that can be associated with either elevated contractile activity and/or passive stiffness in the muscle [3]. Most of women present with pelvic floor defects/relaxation symptoms but pelvic floor dysfunction also include non-relaxing pelvic floor symptoms which are not widely recognized. Unlike in pelvic floor disorders caused by relaxed muscles (e.g., pelvic organ prolapse or urinary incontinence, both of which often are identified readily), women affected by no relaxing pelvic floor dysfunction may present with a broad range of nonspecific symptoms. These may include pain and problems with defecation, urination, and sexual function, which require relaxation and coordination of pelvic floor muscles and urinary and anal sphincters. These symptoms may adversely affect the quality of life [4].
