Pelvic Floor Dysfunction and Continence
Pelvic Floor Dysfunction and Continence
Distinguish stress, urgency, mixed, and overflow incontinence, plus fecal incontinence and pelvic organ prolapse, by mechanism and symptom pattern. Understand urethral support and sphincteric contributions to continence, the role of intra-abdominal pressure transfer, and how levator function, connective tissue, and nerve integrity interact. Know bladder diary interpretation, fluid and caffeine effects, and typical behavioral and exercise interventions.
Recognize overactive bladder and urgency as sensory/motor urgency patterns that may respond to bladder training and urge suppression. Know that constipation and straining are modifiable contributors to prolapse and incontinence.
Traps: labeling all leakage as stress incontinence; missing overflow incontinence (which can worsen with tightening strategies and requires referral); assuming a strong pelvic floor contraction guarantees continence; ignoring bowel management as part of a continence plan; and overlooking neurologic red flags such as saddle anesthesia, new motor loss, or sudden retention.
Rule of thumb: classify by provoking circumstance and timing first, then by mechanism-treatment follows the classification.
Worked example: A patient reports constant dribbling with incomplete emptying and no cough-related leakage. This pattern suggests overflow, not stress incontinence; the correct action is referral for evaluation rather than an escalating PFMT program.