Global management of pelvic floor disorders : towards pelvic perineology.

Pelvic floor disorders involve the three components of the pelvicfloor : urologic, gynaecologic and coloproctologic. They are oftenassociated because of their common embryology, anatomy and physiopathology.Pelvic floor disorders result from :- a change in the abdominal forces : increase, change in the orient ation;- an anomaly of the pelvic viscera in the morphology and/or theirlocation and relationship ;- a degradation of the supporting connective tissue.The disorders can be secondary to pregnancy, delivery, old age,hormonal deficiency or any increase in abdominal pressure such asin chronic straining during defecation, sport or cough and finallyfollowing perineal or pelvic surgery.Thus, in 18 % of patients presenting a pelvic floor disorder, all threelevels are concerned : 7 % of patients with genital prolapse andbetween 19 % and 31 % of patients presenting urinary incontinencehave fecal incontinence. Finally, 38 % of urinary incontinent patientshave associated genital prolapse.All surgeons, urologist, gynaecologist and coloprocologist dealingwith pelvic floor disorders have to take into consideration that themanagement of one of the levels will probably have an impact onanother level and that consequently a global approach to pelvicstatics disorders is necessary.For these reasons it seems logical to gather pelvis and perineum onone side, and the different levels of the pelvic floor on the otherside, in one single discipline : pelvic perineology.