Assessment of Pelvic Floor Function

Weakness of the pelvic floor muscles is a large contributor to the occurrence of pelvic organ prolapse, urinary incontinence, and fecal incontinence. Proper dynamic assessment of muscle function is a critical component of the initial evaluation.

Numerous methods have been described to quantify dynamic pelvic floor function. The most common and simplest techniques currently in use are digital pelvic examination scales, which note the power and duration of pelvic floor muscle squeeze and perineal lift. Intra- and interobserver reliability have been shown to be good, using the digital assessment. This method's scientific usefulness is limited, however, because of its subjectivity.

Perineometry using either electromyography pads or pressure sensors on a vaginal plug are also frequently used methods. These are also limited because they are indirect assessments of muscle activity and subject to numerous sources of artifact such as contraction of the rectus abdominus and/or adductor muscles.

Weighted cones are also useful for evaluation of the pelvic floor. Pelvic floor strength is calculated by the ability of the patient to retain the progressively weighted cones. Cone retention, however, is often poorly correlated with physical findings. This is attributed to retention of the cone in the posterior pelvis of women with severe prolapse.

The Kolpexin® Pull Test, a new and recently validated dynamic pelvic floor assessment tool in use at Cleveland Clinic Florida, attempts to overcome the shortcomings of the previously described methods and give a more direct, objective measurement of pelvic floor strength.7 To perform the pull test, the patient is placed in the dorsal lithotomy position. A lightly lubricated Kolpexin® sphere with attached force-gauge is then placed in the vagina above the level of the levators. The patient is then asked to perform a maximum pelvic floor contraction and the sphere is withdrawn. The maximum force generated is recorded in pounds or kilograms to three significant digits. This test is rapid, inexpensive, and the most direct evaluation tool for pelvic floor strength currently available.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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