Pelvic Floor Dysfunction: The Need for a Multidisciplinary Team Approach

In Brief Pelvic floor dysfunction (PFD) is a disorder predominantly affecting females. It is common and undermines the quality of lives of at least one third of women. There is little agreement on the reasons for such a high prevalence of pelvic floor disorders, the relative importance of specific risk factors that predispose to their development, or the poor outcome sequelae of treatment or subsequent prevention. Mechanical, neural, and endocrine disturbances all play a role in the development of PFD with the principal causative factors associated with childbirth and obstetric injury, previous gynecological or anorectal surgery, aging, menopause, obesity, and conditions that produce chronic pelvic floor straining. Subsequent deterioration in long-term pelvic floor support and function of the pelvic viscera is the result of either direct muscular damage (for example to the anal sphincter complex) and/or cumulative pressure that leads to weakness and injury to the pelvic muscles, ligaments, and the pudendal nerve supplying them. There is a wide range of functional problems seen with pelvic floor disorders. They are anatomically grouped together and are often assessed and managed within individual specialties rather than within a comprehensive multidisciplinary setting. It is has been found that an established team approach with fully integrated services can be more effective and offers many advantages including dynamic links between disciplines, appropriate and timely investigations and referrals, and better coordination of patient-centered care. Many disciplines may be involved in the care of women with pelvic floor dysfunction, yet evidence-based treatment strategies are still lacking and there is little consensus on a standardized treatment approach in this area. Integrating services can be problematic, especially when a degree of flexibility and understanding is required to initiate change and adopt new practices. Inherent in achieving and promoting better services for women with PFD are new approaches to care that focus on the development of combined outpatient and joint surgical procedures and introduction of evidence-based combination therapies. The aim of this paper is to discuss current practice for each of the main pelvic floor disorders and consider how assessment, management, and treatment outcomes of combined symptomatology may be improved. Pelvic floor dysfunction is a common disorder predominantly affecting females. It undermines the quality of lives of at least one third of adult women.