Reconstructive Surgery for Pelvic Floor Disorders

Introduction

Pelvic floor disorders are a group of conditions that affect pelvic floor function. The pelvic floor includes the ligaments, muscles, nerves, and connective tissue that support the pelvic organs, specifically the bladder, vagina, uterus, bowel, and rectum. Pelvic floor disorders, including pelvic organ prolapse, urinary incontinence, and fecal incontinence, greatly affect quality of life. Risk factors for pelvic floor disorders include pregnancy and birth (especially vaginal birth), aging, chronic heavy lifting and straining, hysterectomy, and genetic factors. Pelvic floor disorders are extremely common in women. In a population-based survey, 24% of all women suffered from pelvic floor disorders, with 16% of women experiencing urinary incontinence, 3% of women experiencing prolapse symptoms, and 9% of women experiencing fecal incontinence. The results also demonstrated that the prevalence of pelvic floor disorders increases significantly with age and that many women suffer from more than one pelvic floor disorder.

Pelvic floor disorders highlight an interesting relationship between anatomy and function. Many women who suffer from pelvic floor disorders have anatomic changes visible on physical examination, and with surgical correction of the anatomic abnormality, the pelvic floor disorder functionally improves. However, some women who have pelvic floor disorders have normal-appearing anatomy, and many women who have abnormal-appearing anatomy have normal function and do not have pelvic floor symptoms.

Reconstructive Surgery for Pelvic Floor Disorders

Reconstructive surgery for pelvic floor disorders encompasses a variety of procedures, including urethral support via sutures (Burch urethropexy) or a fascial or polypropylene sling to treat stress urinary incontinence; anal sphincter reconstruction to treat fecal incontinence; and diverse procedures to treat pelvic organ prolapse. This chapter focuses on reconstructive surgery for pelvic organ prolapse. Pelvic organ prolapse occurs when the connective tissue attaching the muscles, bones, and organs is compromised, leading to inappropriate support of the pelvic organs. The result is the organs dropping toward or through the vaginal opening. Patients often can see or feel this tissue protruding at or beyond the vaginal opening ( Fig. 64.1 ). Besides feeling the sensation of bulge and pressure, patients may note pain or discomfort and have trouble emptying their bladder and bowels. Reconstructive surgery aims to restore anatomy and relieve these troubling symptoms.