Dr. Tyas - Pelvic Floor Dysfunction Prevention and Early Detection

Curriculum Vitae
Name : dr. Tyas Priya/ni, Sp. OG, Subsp. Urogin RE

Educa/on :
• 1995 Faculty of Medicine Universitas Indonesia
• 2005 OBGYN Faculty of Medicine Universitas Indonesia
• 2009 Urogyne Consultant Faculty of Medicine Universitas Indonesia
• 2009 Fellowship at Urogynecology Unit KK Women’s and Children’s
Hospital, Singapore
Current posi/on:
• Secretary of Subspecialist programme, Department of Obstetric and
Gynecology FKUI-RSCM
• Medical staff Department of Obstetrics and Gynecology FKUI-RSCM
Organiza/on: IUGA, PERKINA, HUGI, POGI, IDI, ICS, AAVIS
Supported by:
Pelvic Floor Dysfunc/on
Tips on Preven/on and
Early Detec/on
Tyas PriyaVni
Divisi Uroginekologi Reconstruksi
Departmen of Obstetri dan Ginekologi FKUI – RSCM
DefiniVon
• Pelvic Floor DysfuncVon (PFD) refers to a

broad constellaVon of symptoms and
anatomic changes related to abnormal
funcVon of the pelvic floor support
system.
Supported by: Supported by:
Memon HU, Handa VL. Vaginal childbirth and pelvic floor disorders. Womens Health. 2014;9(3). hbps://doi.org/10.2217/whe.13.17.
NHS. What are pelvic floor exercises? [Internet]. NaVonal Health Services. 2020 Apr 14 [cited 2022 Sept 12]. p. 1. Available from: hbps://www.nhs.uk/common-health-quesVons/womens-health/what-are-pelvic-floor-exercises/
Memon HU, Handa VL. Vaginal childbirth and pelvic floor disorders. Womens Health. 2014;9(3). hbps://doi.org/10.2217/whe.13.17.
NHS. What are pelvic floor exercises? [Internet]. NaVonal Health Services. 2020 Apr 14 [cited 2022 Sept 12]. p. 1. Available from: hbps://www.nhs.uk/common-health-quesVons/womens-health/what-are-pelvic-floor-exercises/
Risk Factors of PFD
Most pronounce Hormonal changes:
risk factors are pregnancy and
pregnancy and menopause
vaginal delivery
High intraabdominal Aging

pressure: obesity,
consVpaVon, chronic
cough, heavy lijing
Hysterectomy
GeneVc factor
and familly Diabetes
history
P A T H O P H Y S I O L O G Y
1. Decrease pelvic
3. Hormonal
organ support
PFD
2. Increase
intraabdominal 4. Degenaration
preassure
It should be noted that pathophysiology of PFD is still undergoing research as it is not

yet fully understood (Grimes WR, et al. 2022)
Supported by:
Pathophysiology
Degree of pelvic
• Decreased floor Injury
Mechanical strength and
NORMAL
Injury : support from
levator ani and the pelvic
fascia neuromuscular
unit HEALING
• Increase
Nerve or muscle levator hiatal PFD
related disrupVons area NutriVon
Intrinsic factors:
(disrupVon of its • Pelvic organ hormonal
anatomical and descent imbalance,
funcVonal integrity) increased intra-
Supported by:
abdominal pressure Supported by:
Grimes WR, Strabon M. Pelvic floor dysfuncVon. StatPearls. Treasure Island: StatPearls Publishing; 2022
Butrick CW. Pathophysiology of pelvic floor hypertonic disorders. Obstet Gynecol Clin North Am. 2009;36(3):699-7705, hbps://doi.org/10.1016/j.ogc.2009.08.006.
Early Detec/on
• IdenVfy and • Assessment in • Educa/on and • Providing early

target populaVon primary care good referral
at risk (Iden/fy communica/on
symptoms) (independent)
Faubion SS, Shuster LT, Bharucha AE. RecogniVon and management of nonrelaxing pelvic floor dysfuncVon. Mayo Clin Proc. 2012;87(2):187-193. hbps://doi.org/10.1016/j.mayocp.2011.09.004
NaVonal InsVtute for Health and Care Excellence. Pelvic floor dysfuncVon: prevenVon and non-surgical management. NICE. United Kingdom: NICE Guideline; 2021.
Early Detec+on: PopulaVon at Risk
Vaginal Delivery High BMI Elderly Popula/on
• 50% of women with A study reported BMI of <25 • Study showed that elderly
history of VD was having has an odds raVo of 1.0 are more likely to develop
POP while BMI 25.0-29.9 has 1.3 PFD compared to younger
• 20-40% SUI and ≥ 30.0 has odds ra/o of generaVon
• High Parity, Big Baby, 1.6 • (10 years increase = 1000x
instrumental delivery risk)
Kenne KA, Wendt L, Jackson JB. Prevalence of pelvic floor disorders in adult women being seen in a primary care sepng and associated risk factors. Sci Rep. 2022;12:9878. hbps://doi.org/10.1038/s41598-022-13501-w
Early Detec+on:
• A feeling of pressure or
Signs and Symptoms
fullness in the pelvic area
• A backache low in the • Urgency, frequency
back • Urinary inconVnence
• A feeling that something • Straining
is falling out of the • Hesitancy
Bladder
vagina Buldge Problem • Incomplete emptying
Signs and Problem • Urinary retenVon
Symptoms
• Pain • ConsVpaVon
• Looseness • Incomplete emptying
• Vaginal buldge during
• HSDD
Sexual Dysfunc/on
3B + S Bowel •
defecaVon
Digital evacuaVon
Problems
Educate and Communicate
Educate the paVent on basic
informa/on of PFD (signs and
symptoms, prevenVon, risks, etc.)
Communicate the need of physical

examina/on, receive consent
Be aware of cultural sensiVvity and

use common vocabulary (avoid
Supported by:
medical terms) Supported by:
Early Detec+on:
what to do if we get a Referral from
Primary care
• Take full history of the paVent symptoms

and risk factors
• Full Gynecological and urogynecological
examinaVon
• Cough test, pad test, urinalysis, bladder
diary
• ConservaVve management
When to Refer to Urogynecology Subpsecialist
• POP paVent who opt for surgery
• Refracter OAB ( fail with one medicaVon and
lifestyle modificaVon)
• Hematuria
• Moderate to severe SUI
• Urinary dysfuncVon (chronic urinary retenVon)
• Urogenital pain ( bladder pain syndrome)
• Urogenital fistula
And also:
• Urethral masses: diverVcule, skene duct cyst
• Gartner cyst
• Mullerian anomaly who need surgery
Supported by: • PaVents who need scar revision in vulva-perineum area
• Raising Awareness
• Increase independence and awareness towards
possible PFD
• Lifestyle Changes
• Healthier lifestyle in aspect of diet and physical
acVvity
How to • Modifiable Risk Factors
Prevent PFD • Lessen various risk factors that are controllable
• Psychology and Behavior

• Set a posiVve mindset and good behavior to aid
prevenVon/healing
• Pelvic Floor Muscle Training
• Keeping the pelvic floor muscle used, acVve and
Supported by: healthy Supported by:
Preven+on:
Raising Awareness
• Teach pelvic floor health in school
to young audience
• Increases chance of them taking
ac/on and develop strategies
• Healthcare professional must have
adequate understanding on PFD
• Training and exposures
(campaigns)
Preven+on:
Lifestyle Changes
Give moVvaVon and encouragement to start and keep up the change as it is a long process
Lifestyle changes is strongly correlated to modifiable risk factors
Encouraging women to Controlled/well-balanced

make the changes diet
Avoid heavy lijing

Importance of weight
management
Preven+on:
Lifestyle Details
• Encouragement • PosiVve communicaVon improves moVvaVon and adherence
• Process takes Vme
• Communicate not only negaVve aspects, provide posiVves as well
• Weight Loss • Major help for urinary inconVnence and overacVve bladder
• Decrease severity of some PFD symptoms
• Beneficial in early stages of pelvic organ prolapse
Preven+on:
Lifestyle Details
• Diet • ReducVon in caffeine intake helps with urinary
inconVnence and overacVve bladder
• Balanced diet and adequate fluid intake can reduce risk
of consVpaVon
• A study evaluated: yoga, pilates, weight training and
aerobic exercises
• Physical Ac/vity • Result though unclear, shows that involvement of pelvic
floor muscle may help
Supported by:
• Supervision is recommended Supported by:
Preven+on:
Risk Factors
Non-Modifiable Modifiable Risk
Risk Factors: Factors:
• Age • BMI > 25
• Family history • Smoking
• Cancer and its treatment • No physical acVvity
• Necessary surgical procedure • ConsVpaVon
• Fibromyalgia • Diabetes
• Chronic respiratory disease
• Pregnancy and labour
Preven+on:
Modifiable Risk Factors
• BMI > 25 • Smoking • No Exercise • Cons/pa/on • Diabetes
Prevent higher Causes chronic Some exercise AdjusVng Good nutriVon

BMI with cough and may increase appropriate management
balanced decreases pelvic floor fluid intake can generally
nutriVon and blood muscle (varies per prevent
exercise oxygenaVon strength individual) diabetes
Wieslander CK, Word RA, Schaffer JI, et al. Paper 34: smoking is a risk factor for pelvic organ prolapse. J Pelvic Med and Sur. 2005;11:S16-17, hbps://doi.org/10.1097/01.spv.0000176109.39830.72
Preven+on:
Psychology/ Behavior
• Mental health are thought to

have impact for PFD symptom
• Behavioral techniques such as
bladder re-training and
educaVon can aid prevent
PFD progression
Preven+on:
Pelvic Floor Muscle Training
• Recommended lengths of Vme for training was:
– 12- 16 weeks for prolapse
– 12 weeks for urinary inconVnence
• Group training may increase adherence
• SVll undergoing research, as inconsistent evidence was
seen in:
– Usage of addiVonal therapies
– Biofeedback
– Pessary/intravaginal device
Preven+on:
Specific to Pregnancy and Postpartum
Pregnancy Postpartum
• Manage weight gain during • Supplemen to promote

pregnancy wound healing: amino acid,
• Keep the baby’s weight less zinc, omega 3, vit C, vit D3.
than 3500g • Cell-based therapy
• Not more than 3 children
Take Home Message
• “
• Pelvic floor dysfuncVon is a highly prevalent problem in women.
PFD can affect anyone, but pregnant women and women who
delivered the baby vaginally have the highest risk.
• Early detecVon can be done through idenVfying populaVon at
risk, signs and symptom assessment, educaVon, and early
referral.
• PrevenVon of PFD generally revolves around weight
management, healthy lifestyle, balance diet and muscle
training.
Supported by:
• ”
Supported by:

Dr. Tyas - Pelvic Floor Dysfunction Prevention and Early Detection

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Dr. Tyas - Pelvic Floor Dysfunction Prevention and Early Detection

Uploaded by

Copyright:

Available Formats

Curriculum Vitae

Name : dr. Tyas Priya/ni, Sp. OG, Subsp. Urogin RE

• Pelvic Floor DysfuncVon (PFD) refers to a

Supported by: Supported by:

High intraabdominal Aging

It should be noted that pathophysiology of PFD is still undergoing research as it is not

• IdenVfy and • Assessment in • Educa/on and • Providing early

Supported by: Supported by:

Communicate the need of physical

Be aware of cultural sensiVvity and

• Take full history of the paVent symptoms

Supported by: Supported by:

• Psychology and Behavior

Encouraging women to Controlled/well-balanced

Avoid heavy lijing

Supported by: Supported by:

Supported by: Supported by:

Prevent higher Causes chronic Some exercise AdjusVng Good nutriVon

• Mental health are thought to

Supported by: Supported by:

• Manage weight gain during • Supplemen to promote

You might also like