**3. Clinical symptoms and diagnosis**

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

MRI can simultaneously noninvasively evaluate all pelvic floor compartments and provide information about muscles and ligaments with great contrast resolution, without the use of ionizing radiation and with minimal patient discomfort [8].

## **4. Treatment**

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 require a definitive surgical treatment and few women may need a second procedure during their life time. Multi-compartment pelvic floor disorders are now increasingly being evaluated and managed jointly by urogynaecologists and colorectal surgeons in a designated pelvic floor clinic. Before embarking treatment, a comprehensive tool for symptom assessment or the use of a standard questionnaire is required. Patient should be counseled in detail about diagnosis, treatment options, success rate, and complications of a selected procedure.
