User:Bluemermaid21/Pelvic floor dysfunction

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Pelvic floor dysfunction can include overactive bladder, pelvic organ prolapse

Diagnosis
Endoanal ultrasound (EUS) is an important tool for diagnosing pelvic floor dysfunction. This technique, in which an ultrasound probe is inserted into the anal canal, can be used to visualize and assess the anatomy and function the pelvic floor. Ultrasound performed transabdominally, transvaginally and transperineally can also be useful. Ultrasound is easily accessible and noninvasive, however it may compress certain structures, does not produce high quality images and cannot be used to visualize the entire pelvic floor.

Treatment
There are several approaches to treatment of pelvic floor dysfunction, and often several approaches are used in combination.

Surgery
There are various procedures used to address prolapse. Cystoceles are treated with a surgical procedure known as a Burch colposuspension, with the goal of suspending the prolapsed urethra so that the urethrovesical junction and proximal urethra are replaced in the pelvic cavity. Uterine prolapse is treated with hysterectomy and uterosacral suspension. With enteroceles, the prolapsed small bowel is elevated into the pelvis cavity and the rectovaginal fascia is reapproximated. Rectoceles, in which the anterior wall of the rectum protrudes into the posterior wall of the vagina, require posterior colporrhaphy, also known as repair of the vaginal wall. Though pelvic floor dysfunction is more common in individuals with ovaries, there are also proven methods to assist individuals with testes. In severe cases of pelvic floor dysfunction causing urinary incontinence, a radical prostatectomy followed by postoperative pelvic floor muscle therapy is an option.

Medication
Overactive bladder can be treated with medications, including those in the class of antimuscarinics and beta 3 agonists. Antimuscarinics are the most commonly used, however, beta 3 agonists can be used for those that are unable to take antimuscarinics due to side effects or other reasons.

Devices
A pessary is a plastic or silicone device that may be used for women with pelvic organ prolapse. This treatment is useful for people that do not want to have surgery or are unable to have surgery due risk of the procedure. Some pessaries have a knob that can also treat urinary incontinence. To be effective, pessaries must be fit by a medical provider and the largest device that fits comfortably should be used.

Physical Therapy
Pelvic floor muscle (PFM) training is vital for treating different types of pelvic floor dysfunction. Two common problems are uterine prolapse and urinary incontinence both of which stem from muscle weakness. Being able to control the pelvic floor muscles is vital for a well functioning pelvic floor. Without the ability to control the pelvic floor muscles, pelvic floor training cannot be done successfully. Through vaginal palpation exams and the use of biofeedback, the tightening, lifting, and squeezing actions of these muscles can be determined. Biofeedback can be used to treat urinary incontinence as it records contractions of the pelvic floor muscles and can help patients become aware of the use of their muscles.

In addition, abdominal muscle training has been shown to improve pelvic floor muscle function. By increasing abdominal muscle strength and control, a person may have an easier time activating the pelvic floor muscles in sync with the abdominal muscles. Many physiotherapists are specially trained to address the muscle weaknesses associated with pelvic floor dysfunction and can effectively treat pelvic floor dysfunction through strengthening exercises.

Lifestyle Modifications
Treatment for pelvic floor dysfunction, especially the symptom of urinary incontinence, is essential, but so is prevention. Patients should be encouraged to change their lifestyles; interventions such as reducing body weight, limiting the use of stimulants, quitting smoking, limiting strenuous efforts, preventing constipation and increasing physical activity can help prevent pelvic floor dysfunction. For those that already have diagnosed pelvic floor dysfunction, symptoms can be eased by physical activity, especially abdominal exercises and pelvic floor exercises (Kegels) that strengthen the pelvic floor. Symptoms of urinary incontinence can also be reduced by making dietary changes such as limiting intake of acidic and spicy foods, alcohol and caffeine.

Though pelvic floor dysfunction is more common in individuals with ovaries, there are also proven methods to assist individuals with testes with pelvic floor rehabilitation. These interventions help improve urinary incontinence, also a common problem for many individuals with testes. In severe cases, a radical prostatectomy is a treatment option. Postoperative pelvic floor muscle therapy with a physiotherapist will aid in the recovery process, helping to control individual with testes' urinary incontinence and improve quality of life. Physical therapists are educated about techniques that focus on resolving urinary incontinence, which can have a significant positive impact on the quality of life of those affected. People who experience urinary incontinence profit from such techniques and see positive changes in the physical, social, and mental aspects of their lives.