Urinary incontinence and pelvic organ prolapse

Urinary incontinence and pelvic organ prolapse commonly coexist. Up to 60% of women presenting with pelvic organ prolapse are also diagnosed with urinary incontinence, and close to 40% of women presenting with urinary incontinence, in turn, are found to have some degree of pelvic organ prolapse. In addition, other disorders of the lower urinary tract, such as voiding dysfunction, are in women frequently associated with pelvic organ prolapse. All women with lower urinary tract symptoms should be screened for pelvic organ prolapse. This is important as pelvic organ prolapse beyond the hymen may either cause or mask lower urinary tract dysfunction. Further, lower urinary tract symptoms do not correlate well with clinical diagnoses of lower urinary tract dysfunction in women with advanced prolapse. Therefore, evaluation and treatment of women with lower urinary tract dysfunction and coexisting pelvic organ prolapse require special considerations. It is important to understand how prolapse may affect lower urinary tract function prior to initiating treatment for either prolapse or urinary symptoms. This is essential when weighing risks against benefits of prolapse correction in a patient who is not bothered by the prolapse itself. Conservative and surgical treatment options are available to address lower urinary tract disorders and prolapse. Treatment plans are generally individualized and determined not just by clinical diagnoses, but also by treatment goals, a patient's age, her level of activity and overall medical condition as well as her preference for treatment. Physicians providing care for women with complex pelvic floor disorders should be familiar with an array of treatment options.