The pelvic floor check is a preventive examination that was developed especially for women by the scientific society and the professional association of gynecologists (Berufsverband der Frauenärzte e. V.). The content of this preventive measure is, among other things, the evaluation of risk factors that can lead to incontinence (bladder weakness) in the course of life. In addition to assessing the individual risk, the pelvic floor check includes comprehensive information and medical guidance on the treatment and prevention of incontinence. Incontinence describes the inability to retain urine (urinary incontinence or bladder incontinence) or stool (fecal incontinence). There are many causes of incontinence. Because of the special role of the pelvic floor during childbirth, many of these causes are found in the specialty of obstetrics or gynecology. The most common is a failure of the closure mechanism, the most important part of which is the pelvic floor muscles. Usually, the failure of the closure mechanism consists in a loss of function of the sphincter muscles (closure muscles) and results in a condition called stress incontinence. Stress incontinence is an unintentional loss of urine during physical exertion as a result of a bladder closure problem, during which the pressure in the bladder increases and exceeds the urethral pressure. In this process, the pelvic floor represents a weak point, which can already be found even in healthy young women. Risk factors include obesity (overweight), general connective tissue weakness or chronic bronchitis. Above all, however, birth traumatic changes (birth-related injuries) and the natural aging process are responsible for the development of incontinence. The pelvic floor check is designed to answer the following questions:
- How do pregnancy and childbirth affect the closing function of the pelvic floor?
- What are the preventive measures regarding vaginal prolapse and/or uterine prolapse (descensus vaginae/vaginal prolapse and/or prolapse, descensus uteri) and fecal incontinence (bowel weakness)?
Indications (areas of application)
Female incontinence
- Clarification
- Prevention
- Therapy
Procedure
The pelvic floor check consists of a number of different elements that together form a comprehensive screening examination. The routine basic elements can be supplemented with additional specialized examinations. The examination is performed by the attending gynecologist, as is the consultation. The basic elements are as follows:
- Targeted anamnesis discussion regarding risks for incontinence and lowering of the pelvic floor.
- Drinking and micturition log (toilet diary) for three days.
- Targeted gynecological examination of the pelvic floor, i.e., vaginal and rectal examination for sagging of the anterior and posterior vaginal walls (cystocele and rectocele, location of the portio (“vaginal part of the uterus“) or the suspension of the vaginal stump (suspension of the vaginal stump in the case of condition after uterine extirpation / hysterectomy), as well as possible obstetric traumatic lesions (obstetric injuries) to the perineum (perineal region) and anal sphincter (anal sphincter) and functionality of the pelvic floor muscles.
- Pelvic floor sonography – ultrasound examination of the urinary bladder and pelvic floor.
- Consultation regarding risks and prevention
Optionally, the following special examinations can complement the pelvic floor check:
- Urodynamics:
- Filling cystometry (urinary bladder pressure measurement during filling) with EMG (electromyography; electrophysiological method in neurological diagnostics measuring electrical muscle activity).
- Urethra occlusion pressure profile (difference of bladder and urethra pressure profile).
- Miktiometry (measurement of bladder emptying).
- Uroflow (measurement of urine flow during bladder emptying for objective determination of bladder emptying disorders or anorectal function tests (anal closure pressure profile, anorectal inhibitory reflex, sensitivity and capacity determination).
- Smear examination (cytological smear) – if hormone deficiency is suspected.
- Urinalysis
Since the pelvic floor check is not part of the benefits catalog of the statutory health insurance, the cost of the examination must be borne by the patient.
Possible complications
No complications are expected when performing the pelvic floor check, as it is a noninvasive diagnostic procedure.
