Review

Current Terminology of Pelvic Floor Dysfunctions

10.14235/bas.galenos.2020.4009

  • Büşra YILMAZ
  • Ergül ASLAN

Received Date: 24.05.2020 Accepted Date: 06.01.2021 Bezmialem Science 2021;9(2):236-243

Pelvic floor disorders (PFD) affect the quality of life of millions of people worldwide. PFD, which increase in frequency with advancing age, affect not only the individual with the symptoms but also the family, caregivers and the society. Increased diagnostic methods and applications in treatment cause complexity in symptom terminology. For this reason, international organizations dealing with PFD have been working for updating definitions and/or adding new definitions for many years. Accordingly, the symptoms of PFD are; urinary, pelvic organ prolapse, sexual dysfunction, lower urinary tract pain and/or other pelvic pain and anorectal dysfunction. In the diagnosis and treatment stages of PFD and in studies, expressing the symptoms in a common language is very important for achieving standardization. Standardization in terminology will provide consensus and increase the success of treatment and prevention of PFD symptoms. The aim of this review is to examine the standardized current terminology of the symptoms of PFD in the light of the literature.

Keywords: Pelvic floor disorder, symptom, standardized terminology, female

Introduction

Urinary, genital and intestinal systems located in the pelvic floor are intricately linked with each other in terms of anatomical structure and function. The striated muscles of the pelvic floor together with their fascial connections prevent the displacement of the pelvic organs, maintain urinary and fecal control, provide dynamic support, increase satisfaction in sexual life, and create a driving force in the expulsion phase of normal birth (1). The pelvic floor, which is desired to continue its life-long functions without any problems, may be insufficient to maintain its function for some reasons. Female gender, Caucasian race, low education level, excessive caffeine and cigarette consumption, obesity, difficult and traumatic birth, advanced age and postmenopausal period are among the main factors that disrupt the pelvic floor structure. Other factors that disrupt the pelvic floor muscle structure are chronic cough, chronic constipation, multiple sclerosis, diabetes, joint problems, connective tissue weakness, previous pelvic surgery, hysterectomy and urinary tract infection. The most important features of pelvic floor disorders (PFD) are the pelvic floor muscles being loose or tense than normal, pelvic pain and increased or decreased sensitivity. In the clinic, symptoms are grouped by associating them with complaints such as urinary/fecal incontinence, defecation problems, pelvic organ prolapse (POP), sexual dysfunction, chronic pelvic pain, and vulvodynia (2). Mortality rates associated with PFD are not high, but problems such as POP, pelvic organ dysfunction, dyspareunia, back pain, sexual dysfunction and decreased sexual satisfaction cause a decrease in the quality of life of women (3). In addition, PFD treatment brings a significant financial burden for individuals and public resources. It is estimated that more than one billion dollars are spent annually on the treatment of PFDs in the United States of America (4). Although PFDs are common all over the world, they cannot be adequately addressed due to both the delay in the admission of the patient and the lack of standard criteria for diagnosis (5). Increasing and complexity of definitions, diagnosis and treatment methods related to the symptoms of PFDs increased the need for new terminologies. Lack of standardization in the diagnostic criteria of PFDs and the use of their own definitions by centers may cause ambiguity in terminology, confusion and interdisciplinary communication gaps (6). It is very important to standardize the definitions of PFD symptoms in the diagnosis and treatment process of PFD and in studies conducted. This standardization is beneficial in providing language and notion consensus, and increases the success in diagnosis, treatment, and prevention of symptoms in PFD (5). The International Continence Society  has pioneered the standardization of the definitions of PFD symptoms for many years. The terminology reports of the Standardized Terminology Committee published in 1988 and 2002 are among the first examples in this field (7,8). As a result of the joint studies of the International Urogynecological Association and the International Continence Association, a joint report on the terminology for female pelvic floor dysfunction was published in 2010 (9). As a result of the joint efforts of the International Consultation on Urological Diseases and the International Continence Association, the terminology of symptoms, diagnosis and treatment processes related to urinary incontinence and fecal incontinence were updated with the title of “incontinence” in 2017 (10).

The purpose of this review is to examine the current standardized terminology of PFD symptoms in accordance with the literature.

Standardized Terminology for Symptom Groups of Pelvic Floor Disorder

Symptom is a sign of a health problem or disease perceived by the woman as a deviation from normal in structure, function, perception or experience. Symptoms either occur spontaneously or are subjective data reported by the individual and/or the caregiver. Symptom groups are urinary symptoms, lower urinary tract pain and/or other pelvic pain, urinary tract infection, POP, sexual dysfunction, and symptoms of anorectal dysfunction (9,11). While some definitions remained the same in the updating phase of the terminology of PFD symptoms in the literature, some definitions were highlighted with the expressions “new”, “updated” or “changed”. Table 1 includes definitions regarding the current terminology of PFDs in women.


Conclusion

Increasing diagnosis and treatment methods in PFDs have caused the symptom terminology to become complex. For this reason, organizations such as the International Continence Association, the International Urogynecology Association, the European Association of Urology, the American Urology Association and the Canadian Urology Association carry out studies and publish reports on updating and standardizing the terminology of pelvic dysfunction symptoms. The use of common terminology in expressing the symptoms of PFDs is very important in terms of standardization. In this review, which deals with the current terminology of pelvic dysfunction symptoms, existing, newly added, amended and updated definitions of symptoms are included. These definitions will be added in future studies and will play a facilitating role in the understanding of the terminology to be updated.

Peer-review: Externally peer reviewed.

Authorship Contributions

Concept: B.Y., E.A., Design: B.Y., E.A., Literature Search: B.Y., E.A., Writing: B.Y., E.A.

Conflict of Interest: No conflict of interest was declared by the authors.

Financial Disclosure: The authors declared that this study received no financial support.


Images

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