Initial assessment of a female patient with pelvic floor dysfunction
Abstract
Urogynaecology is dedicated to diagnostics and treatment of pelvic floor dysfunction. Pelvic floor dysfunction (PFD) is a common problem that affects at least half of all women. Symptoms associated with it are numerous; however, the most common are urinary incontinence and those of pelvic organ prolapse (POP).
The initial assessment of women with PFD consists of urogynaecological history with bladder diary, urine analysis and clinical examination. Focused urogynaecological history identifies the patient’s main symptoms, established their duration, characteristics, and their effect on the patient’s quality of life. The patient should be asked about the severity of their symptoms, their triggers and onset. The amount and the type of fluid consumed during the day should be established. Complete gynaecological history and information regarding concomitant medical issues, previous surgeries and any allergies should also be obtained. The bladder diary can also be analysed, as it provides important information regarding the patient’s frequency, incontinence episodes, pad use, fluid intake, and degree of urgency and incontinence.
Clinical examination consists of general assessment, abdominal examination, and vaginal examination with POP and pelvic floor muscle (PFM) assessment. We recommend that POP assessment be performed using the POP Quantification System (POP-Q system) and that digital palpation is used for PFM assessment with contraction strength assessed either according to the six-level Oxford scale or four levels of PFM strength. Because of high prevalence of urinary tract infections in women with lower urinary tract symptoms, urine analysis and urinary culture represent an indispensable part of the initial assessment of these patients.
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