Front and rear: the pelvic floor is an integrated functional structure

doi:10.1054/mehy.1997.0524

Medical Hypotheses

Volume 52, Issue 2, February 1999, Pages 147-153

https://doi.org/10.1054/mehy.1997.0524 Get rights and content

Abstract

The pelvic floor is a muscular structure, pierced by the urologic, genital and distal intestinal tract. This structure is not a frozen but a functional unit. Normal function can thus be replaced by dysfunctions of several kinds, overlapping voiding, sexual, genital and defecatory behaviour. For instance, vaginismus is akin to anismus and vesicourethral dyssynergia. Recent recognition of the medicosurgical consequences of sexual abuse has shown that many urologic, genital and digestive dysfunctions are sort of a body signature of the trauma, which must be dealt with if the symptom is to disappear. If the pelvic floor is integrated, unsuspected pathology will lie outside of the spectrum of activities of a given specialty, and thus urologists, gynecologists, gastroenterologists and colorectal surgeons should not only exchange, but should also be aware of the pathologies of neighbouring specialties. This paper elaborates on a more holistic vision of pelvic floor function including sexuality. Out of this, a number of different hypotheses are elaborated in the different spheres of activities, about different pathologies, their basic cause, and how they could be dealt with.

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Cited by (18)

Managing Pregnancy and Delivery in Women with Sexual Pain Disorders (CME)
2012, Journal of Sexual Medicine
Citation Excerpt :
Perineal and vaginal trauma, including third‐ and fourth‐degree tears may be more common in women with SPD because of inability to adequately relax the PF and allow perineal softening and stretching during the delivery. There are no data to support this hypothesis; nevertheless, a connection between SPD and an increased risk for obstetric PF damage has been previously suggested [16]. Once pregnant, patients seeking obstetrical care may or may not volunteer information regarding their condition.
Vaginismus and dyspareunia most commonly affect women in their childbearing years, yet sexual function, and not childbirth, has been the focus of most research.
The aim of this study is to discuss pregnancy and birth outcomes in women with sexual pain disorders (SPDs) and address practical concerns of patients and practitioners regarding management during pregnancy, pelvic examination, labor, and delivery.
Review of the relevant literature and recommendations based on clinical expertise of the authors.
A review of SPD, conception, and birth outcomes is provided as well as clinical recommendations for prenatal, labor, and delivery management of women with SPD.
Practitioners involved in obstetrical care should be knowledgeable about SPD and provide appropriate modifications and interventions. Rosenbaum TY and Padoa A. Managing pregnancy and delivery in women with sexual pain disorders. J Sex Med 2012;9:1726–1735.
Pelvic lymphedema: Truth or fiction?
2009, Medical Hypotheses
Pelvis is a functional shell-like unit consisting of the pelvic floor and perineum. The patients, who underwent a radical operation of the pelvis due to an oncological disease, often develop pelvic disorders. These disorders do not depend on the type of surgery or any presence of postoperative treatment (radio- and chemotherapy). The reason for this is still mostly unknown. These disorders without an appropriate treatment of rehabilitation always result in the following symptoms: fatty tissue hypertrophy and fibrosis as well as functional chronic disorders. Lymphedema is described as a progressive pathological condition with retention of protein-rich liquid in the interstitial space, fatty tissue hypertrophy and fibrosis. It is possible to assume that lymphadenectomy related to pelvic surgery results in a localized lymphedema in the pelvis developing disorders of perineum and pelvic floor: a pelvic lymphedema, or rather a blind lymphedema, i.e. with symptoms but with no signs. The clinical evidence shows that the lymphatic vessels play a relevant role in the pathology of the pelvic floor and perineum. The study of pelvic lymphedema could be the key when choosing the therapies for pelvic disorders resulting from surgery.
Multiple pelvic floor complaints are correlated with sexual abuse history
2009, Journal of Sexual Medicine
Citation Excerpt :
Farley et al. demonstrated a decreased probability of screening for cervical cancer at women who have been sexually abused, indicating that women who have been sexually abused tend to avoid routine gynecological care [38]. The clinical significance of the findings in this study suggests that a holistic view is needed in the treatment of pelvic floor dysfunction and all domains need to be assessed in a questionnaire as early as possible during history taking, as was already described by Devroede [39]. A hypothesis for complaints in more domains in the abused group could be that they are related to a general pelvic floor disorder.
The relationship between sexual abuse and urinary tract symptoms, sexual abuse and gastrointestinal symptoms, or sexual abuse and sexual dysfunction has been described before. A correlation between all these symptoms and sexual abuse has not yet been reported.
The first aim of this study was to document the prevalence rates of reported sexual abuse in a large sample of female patients with complaints of the pelvic floor. The second aim was to evaluate the frequency of complaints in the different domains of the pelvic floor, such as complaints of micturition, defecation, and sexual function, in female patients reporting sexual abuse, and comparing these data with female patients without a history of sexual abuse.
Female patients with pelvic floor complaints were evaluated in a tertiary referral center. History taking was assessed by a pelvic-floor clinician. The number of domains with complaints of patients with a history of sexual abuse was compared with the number of domains with complaints of patients without sexual abuse.
The number of patients who reported sexual abuse and the frequency of complaints in the different domains of the pelvic floor. The number of domains of patients with a history of sexual abuse was compared with patients without a history of sexual abuse.
Twenty-three percent (42/185) of the patients reported a history of sexual abuse. The female patients with a history of sexual abuse had significantly more complaints in three domains of the pelvic floor (35/42) compared with the nonabused (69/143) (83% vs. 48%, P < 0.001).
Twenty-three percent of the female patients in a pelvic floor center evaluated by a pelvic-floor clinician reported a history of sexual abuse. This is comparable with the percentage of sexual abuse observed in the population at large. In our sample, the patients with multiple pelvic floor complaints (micturition, defecation, and sexual function) related to pelvic floor dysfunction were more likely to have a history of sexual abuse than the patients with isolated complaints. Beck JJH, Elzevier HW, Pelger RCM, Putter H, and Voorham-van der Zalm PJ. Multiple pelvic floor complaints are correlated with sexual abuse history.
How reliable is a self-administered questionnaire in detecting sexual abuse: A retrospective study in patients with pelvic-floor complaints and a review of literature
2007, Journal of Sexual Medicine
Citation Excerpt :
Although pelvic-floor dysfunction has long been related to the lower urinary tract and, also, more recently to lower gastrointestinal symptoms, it is now considered to be an influential factor in the normal function and behavior of the genital system in both men and women [57]. Devroede described the pelvic floor as a muscular structure, pierced by the urological, genital and distal intestinal tract [58]. Normal function can be replaced by dysfunctions of several kinds, overlapping voiding, sexual, genital, and defecatory behavior.
Sexual abuse and sexual functioning are topics that health professionals find difficult to discuss. Women who present with pelvic-floor complaints often experience sexual difficulties; therefore, questions regarding sexual function should be a routine part of screening. Furthermore, pelvic-floor complaints are correlated with sexual abuse and asking about abuse should be a routine part of screening as well. Considering the fact that many practitioners have difficulty enquiring about abuse, we have suggested that a questionnaire may be helpful in improving the recognition and management of patients who have a history of sexual abuse.
The efficiency of detecting sexual abuse by a self-administered questionnaire.
Report of sexual abuse in a self-administered pelvic-floor questionnaire before visiting our outpatient pelvic-floor department was evaluated with the Pelvic Floor Leiden Inventories (PelFIs) administered by a pelvic- floor clinician in a later stage.
The percentage of sexual abuse detected by a taken questionnaire administered by a pelvic-floor clinician not confessed during a previous self-administered questionnaire.
Sexual abuse was reported in 20 patients with pelvic-floor dysfunction during administration of the PelFIs and were also evaluated on our pelvic-floor department. Only six of the patients (30%) did not note in the self-administered questionnaire that they had a history of sexual abuse.
A self-administered questionnaire for pelvic-floor complaints is reliable in detecting sexual abuse and can be helpful in daily practice. Elzevier HW, Voorham-van der Zalm PJ, and Pelger RCM. How reliable is a self-administered questionnaire in detecting sexual abuse: A retrospective study in patients with pelvic-floor complaints and a review of literature.
The corner of the coloproctologist: What to ask to radiologist
2007, European Journal of Radiology
Citation Excerpt :
Pelvic floor is a functional integrated structure finalized not only to defecation but also to micturition, to coitus, and to delivery. That is the reason why urogynecologic and proctologic symptoms often coexist, and it is common to find dyssinergic defecation associated to dyspareunia and/or obstructed micturition [4]. We assess anorectal dysfunctions by functional and morphologic tests, both in terms of incontinence and constipation (Table 1).
Defecation disorders, fecal incontinence, often associated to urinary and genital dysfunction, represent symptoms of a large number of functional and structural alterations of pelvic floor.
They can be evaluated by functional and morphologic tests. A perfect anatomic and functional knowledge of the anorectum and pelvic floor is indispensable for a correct diagnostic and therapeutic path.
Incontinence due to sphincter lesions can be diagnosed only by imaging techniques.
In defecation disorders the issue is complex because functional and anatomic alterations can coexist. The radiological diagnosis of dyssynergic defecation is a diagnosis of confidence that enhances its value when manometric and electromyographic evidence of pelvic dyssynergia are detected. When anatomical alterations are detected the aim is to understand their physiopathology, to make a more precise diagnosis and treatment, and to minimize the errors of an inappropriate therapy.
Our attention is focused on the information provided by imaging techniques about anorectum and pelvic floor abnormalities for optimal therapeutic planning.
Early life abuses in the past history of patients with gastrointestinal tract and pelvic floor dysfunctions
2000, Progress in Brain Research

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Regular ArticleFront and rear: the pelvic floor is an integrated functional structure

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Regular Article
Front and rear: the pelvic floor is an integrated functional structure