Female Pelvic Floor Dysfunction

Urinary Incontinence May Be Classified in:

Stress (urinary) incontinence: complaint of involuntary loss of urine on effort or physical exertion (e.g. sporting activities), or on sneezing or coughing. “activity-related incontinence” might be preferred in some languages to avoid confusion with psychological stress.

Increased daytime urinary frequency: complaint that micturition occurs more frequently during waking hours (more than 7 times a day).

Nocturia is defined as being awakened at night more than 2 times in order to pass urine.

Urgency: complaint of a sudden, compelling desire to pass urine which is difficult to defer.

Urgency (urinary) incontinence: complaint of involuntary loss of urine associated with urgency.

Nocturnal enuresis: complaint of involuntary urinary loss of urine which occurs during sleep.

Overactive bladder (OAB) syndrome: urinary urgency, usually accompanied by frequency and nocturia, with or without urgency urinary incontinence.

Voiding and postmicturition symptoms.

Hesitancy: complaint of a delay in initiating micturition.

Slow stream: complaint of a urinary stream perceived as slower compared to previous performance or in comparison with others.

Intermittency: complaint of urine flow that stops and starts on one or more occasions during voiding.

Straining to void: complaint of the need to make an intensive effort by abdominal straining, to either initiate, or improve the urinary stream.

Feeling of incomplete (bladder) emptying: complaint that the bladder does not feel empty after micturition.

Post-micturition leakage: complaint of a further involuntary passage of urine following the completion of micturition.

Dysuria: complaint of burning or other discomfort during micturition.

Retention: complaint of the inability to pass urine despite persistent effort.

Overactive Bladder O.AB.

Pelvic Organ Prolapse (POP).

Symptoms are generally worse at the times when gravity might make the prolapse worse (e.g. after long periods of standing or exercise) and better when gravity is not a factor, e.g., lying supine. Prolapse may be more prominent at times of abdominal straining, e.g., defecation.

Vaginal bulging: complaint of a “bulge” or “something coming down” towards or through the vaginal introitus. The woman may state she can either feel the bulge by direct palpation.

Pelvic pressure: complaint of increased heaviness or dragging in the suprapubic area and/or pelvis.

Splinting/digitation: complaint of the need to digitally replace the prolapse or to otherwise apply manual pressure, e.g. to the vagina or perineum or to the vagina or rectum to assist voiding or defecation.

Low backache: complaint of low, sacral backache associated temporally with (POP).

Symptoms of Anorectal Dysfunction.

Anal incontinence (symptom): complaint of involuntary loss of feces or flatus.

Fecal incontinence: complaint of involuntary loss of feces (a) Solid (b) Liquid (c) Passive fecal incontinence: such as soiling without sensation or warning.

Flatal incontinence: complaint of involuntary loss of flatus

Fecal (rectal) urgency: sudden, compelling desire to defecate that is difficult to defer.

Straining to defecate: complaint of the need to make an intensive effort by abdominal straining to either initiate, maintain or improve defecation

Feeling of incomplete (bowel) evacuation: complaint that the rectum does not feel empty after defecation.

Constipation: complaint that bowel movements are infrequent and/or incomplete and/or there is a need for frequent straining or manual assistance to defecate.

Symptoms of Sexual Dysfunction.

Female sexual dysfunction including (1) decreased sexual desire, (2) decreased sexual arousal, (3) decreased orgasm, and abstention, are less specific for female pelvic floor dysfunction and will not be defined here.

Dyspareunia: complaint of persistent or recurrent pain or discomfort associated with attempted or complete vaginal penetration.

Superficial (introital) dyspareunia: complaint of pain or discomfort on vaginal entry or at the vaginal introitus.

Deep dyspareunia: complaint of pain or discomfort on deeper penetration (mid or upper vagina)

Vaginal laxity: complaint of excessive vaginal laxity.