Top

Current Geriatrics Reports

Published in:

01-03-2018 | Physical Therapy and Rehabilitation (O. Addison, Section Editor)

Aging and the Pelvic Floor

Authors: Karla Wente, Christina Dolan

Published in: Current Geriatrics Reports | Issue 1/2018

Abstract

Purpose of Review

To define the unique effects of age on the pelvic floor muscle and to outline current treatments of pelvic floor dysfunction in the older population.

Recent Findings

Aging has muscular, hormonal, and neurological effects on the pelvic floor that may lead to pelvic floor dysfunction. Muscular changes lead to decreased force output and weakness on clinical examination. Hormonal effects exacerbate pelvic tissue changes, most notably in the postmenopausal woman. Neurological changes are less well-defined, but gradual denervation of the pelvic floor, especially noted in parous women, has been implicated as a possible cause of pelvic floor weakness and dysfunction. Medical treatments include pessaries, medications, implanted electrical stimulation, and surgery. Pelvic floor physical therapy, including strength training and coordination training, as well as pain-relieving modalities at the level of the pelvic floor muscle, is an effective conservative management option for older adults with pelvic floor dysfunction. The literature available regarding treatment of pelvic floor dysfunction is more robust for older females compared to males.

Summary

There are numerous unique considerations in the treatment of the older adult with pelvic floor dysfunction, due to muscular, hormonal, and neurological changes with age. Conservative management, including physical therapy, should be considered prior to surgical intervention. Further research is especially needed regarding the effects of age and the treatment of age-related pelvic dysfunction in the older male.

Spitznagle TM, Leong FC, Van Dillen LR. Prevalence of diastasis recti abdominis in a urogynecological patient population. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18(3):321–8. https://doi.org/10.1007/s00192-006-0143-5.CrossRefPubMed

Eickmeyer SM. Anatomy and physiology of the pelvic floor. Phys Med Rehabil Clin N Am. 2017;28(3):455–60. https://doi.org/10.1016/j.pmr.2017.03.003.CrossRefPubMed

Messelink B, Benson T, Berghmans B, Bø K, Corcos J, Fowler C, et al. Standardization of terminology of pelvic floor muscle function and dysfunction: report from the pelvic floor clinical assessment group of the international continence society. Neurourol Urodyn. 2005;24(4):374–80. https://doi.org/10.1002/nau.20144.CrossRefPubMed

Nygaard I, Barber MD, Burgio KL, Kenton K, Meikle S, Schaffer J, et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008;300(11):1311–6. https://doi.org/10.1001/jama.300.11.1311.CrossRefPubMedPubMedCentral

JM W, Vaughan CP, Goode PS, Redden DT, Burgio KL, Richter HE, et al. Prevalence and trends of symptomatic pelvic floor disorders in U.S. women. Obstet Gynecol. 2014;123(1):141–8.CrossRef

Hawkins K, Pernarelli J, Ozminkowski RJ, Bai M, Gaston SJ, Hommer C, et al. The prevalence of urinary incontinence and its burden on the quality of life among older adults with Medicare supplement insurance. Qual Life Res. 2011;20(5):723–32. https://doi.org/10.1007/s11136-010-9808-0.CrossRefPubMed

Srikrishna S, Thiagamoorthy G, Cardozo L. Pelvic organ prolapse in the older woman. In: Gordon D, Katlic M, editors. Pelvic floor dysfunction and pelvic surgery in the elderly. New York: Springer; 2017. https://doi.org/10.1007/978-1-4939-6554-0_20.

Bharucha AE, Dunivan G, Goode PS, Lukacz ES, Markland AD, Matthews CA, et al. Epidemiology, pathophysiology, and classification of fecal incontinence: state of the science summary for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) workshop. Am J Gastroenterol. 2015;110(1):127–36. https://doi.org/10.1038/ajg.2014.396.CrossRefPubMed

Norton NJ. The perspective of the patient. Gastroenterol. 2004;126(1):S175–9. https://doi.org/10.1053/j.gastro.2003.10.081.CrossRef

10.

Cotterill N, Norton C, Avery KN, Abrams P, Donovan JLA. Patient-centered approach to developing a comprehensive symptom and quality of life assessment of anal incontinence. Dis Colon Rectum. 2008;51(1):82–7. https://doi.org/10.1007/s10350-007-9069-3.CrossRefPubMed

11.

Lindau ST, Schumm LP, Laumann EO, Levinson W, O’Muircheartaigh CA, Waite LJA. Study of sexuality and health among older adults in the United States. N Engl J Med. 2007;357(8):762–74. https://doi.org/10.1056/NEJMoa067423.CrossRefPubMedPubMedCentral

12.

Santoro N, Komi J. Prevalence and impact of vaginal symptoms among postmenopausal women. J Sex Med. 2009;6(8):2133–42. https://doi.org/10.1111/j.1743-6109.2009.01335.x.CrossRefPubMed

13.

Nicolosi A, Laumann EO, Glasser DB, Moreira ED Jr, Paik A, Gingell C. Sexual behavior and sexual dysfunctions after age 40: the global study of sexual attitudes and behaviors. Urology. 2004;64(5):991–7. https://doi.org/10.1016/j.urology.2004.06.055.CrossRefPubMed

14.

Miljkovic N, Lim JY, Miljkovic I, Frontera WR. Aging of skeletal muscle fibers. Ann Rehabil Med. 2015;39(2):155–62. https://doi.org/10.5535/arm.2015.39.2.155.CrossRefPubMedPubMedCentral

15.

•• Wu Y, Dabhoiwala NF, Hagoort J, Tan LW, Zhang SX, Lamers WH. Architectural differences in the anterior and middle compartments of the pelvic floor of young-adult and postmenopausal females. J Anat. 2017;230(5):651–63. Recent work that provides a fundamental contribution to muscle/architectural changes to the pelvic floor muscles with aging.CrossRefPubMed

16.

•• Cook MS, Bou-Malham L, Esparza MC, Alperin M. Age-related alterations in female obturator internus muscle. Int Urogynecol J. 2017;28(5):729–34. Recent work that provides a fundamental contribution to muscle/architectural changes to the pelvic floor muscles with aging.CrossRefPubMed

17.

•• Alperin M, Cook M, Tuttle LJ, Esparza MC, Lieber RL. Impact of vaginal parity and aging on the architectural design of pelvic floor muscles. Am J Obstet Gynecol. 2016;215(3):312.e1–9. Recent work that provides a fundamental contribution to muscle/architectural changes to the pelvic floor muscles with aging.CrossRef

18.

Chantereau P, Brieu M, Kammal M, Farthmann J, Gabriel B, Cosson M. Mechanical properties of pelvic soft tissue of young women and impact of aging. Int Urogynecol J. 2014;25(11):1547–53. https://doi.org/10.1007/s00192-014-2439-1.CrossRefPubMed

19.

Varella LR, Torres VB, Angelo PH, Eugênia de Oliveira MC, Matias de Barros AC, Viana Ede S, et al. Influence of parity, type of delivery, and physical activity level on pelvic floor muscles in postmenopausal women. J Phys Ther Sci. 2016;28(3):824–30. https://doi.org/10.1589/jpts.28.824.CrossRefPubMedPubMedCentral

20.

Trowbridge ER, Wei JT, Fenner DE, Ashton-Miller JA, Delancey JO. Effects of aging on lower urinary tract and pelvic floor function in nulliparous women. Obstet Gynecol. 2007;109(3):715–20. https://doi.org/10.1097/01.AOG.0000257074.98122.69.CrossRefPubMed

21.

Pontbriand-Drolet S, Tang A, Madill SJ, Tannenbaum C, Lemieux MC, Corcos J, et al. Differences in pelvic floor morphology between continent, stress urinary incontinent, and mixed urinary incontinent elderly women: an MRI study. Neurourol Urodyn. 2016;35(4):515–21. https://doi.org/10.1002/nau.22743.CrossRefPubMed

22.

Fox JC, Fletcher JG, Zinsmeister AR, Seide B, Riederer SJ, Bharucha AE. Effect of aging on anorectal and pelvic floor functions in females. Dis Colon Rectum. 2006;49(11):1726–35. https://doi.org/10.1007/s10350-006-0657-4.CrossRefPubMed

23.

Yu SW, Rao SS. Anorectal physiology and pathophysiology in the elderly. Clin Geriatr Med. 2014;30(1):95–106.CrossRefPubMedPubMedCentral

24.

Morris VC, Murray MP, DeLancey JOL, Ashton-Miller JA. A Comparison of the effect of age on levator ani and obturator internus muscle cross-sectional areas and volumes in nulliparous women. Neurourol Urodyn. 2012;31(4):481–6. https://doi.org/10.1002/nau.21208.CrossRefPubMedPubMedCentral

25.

Gilpin SA, Gosling JA, Smith AR, Warrell DW. The pathogenesis of genitourinary prolapse and stress incontinence of urine a histological and histochemical study. Brit J Obstet Gyn. 1989;96(1):15–23. https://doi.org/10.1111/j.1471-0528.1989.tb01570.x.CrossRef

26.

Helt M, Benson JT, Russell B, Brubaker L. Levator ani muscle in women with genitourinary prolapse: indirect assessment by muscle histopathology. Neurourol Urodyn. 1996;15(1):17–29. https://doi.org/10.1002/(SICI)1520-6777(1996)15:1<17::AID-NAU2>3.0.CO;2-I.CrossRefPubMed

27.

Lexell J. Human aging, muscle mass, and fiber type composition. J Gerontol A Biol Sci Med Sci. 1995;50A:11–6.CrossRef

28.

Laurberg S, Swash M. Effects of aging on the anorectal sphincters and their innervation. Dis Colon Rectum. 1989;32(9):737–42. https://doi.org/10.1007/BF02562120.CrossRefPubMed

29.

Gillies AR, Lieber RL. Structure and function of the skeletal muscle extracellular matrix. Muscle Nerve. 2011;44(3):318–31. https://doi.org/10.1002/mus.22094.PubMedPubMedCentral

30.

Purslow PP. Muscle fascia and force transmission. J Bodyw Move Ther. 2010;14(4):411–7. https://doi.org/10.1016/j.jbmt.2010.01.005.CrossRef

31.

Meyer GA, Lieber RL. Elucidation of extra-cellular matrix mechanics from muscle fibers and fiber bundles. J Biomech. 2011;44(4):771–3. https://doi.org/10.1016/j.jbiomech.2010.10.044.CrossRefPubMed

32.

Jundt K, Kiening M, Fischer P, Bergauer F, Rauch E, Janni W, et al. Is the histomorphological concept of the female pelvic floor and its changes due to age and vaginal delivery correct? Neurourol Urodyn. 2005;24(1):44–50. https://doi.org/10.1002/nau.20080.CrossRefPubMed

33.

Chen BH, Wen Y, Li H, Polan ML. Collagen metabolism and turnover in women with stress urinary incontinence and pelvic prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2002;13(2):80–7. https://doi.org/10.1007/s001920200020.CrossRefPubMed

34.

Boreham MK, Wai CY, Miller RT, Schaffer JI, Word RA. Morphometric analysis of smooth muscle in the anterior vaginal wall of women with pelvic organ prolapse. Am J Obstet Gynecol. 2002;187(1):56–63. https://doi.org/10.1067/mob.2002.124843.CrossRefPubMed

35.

DeLancey JO, Morgan DM, Fenner DE, Kearney R, Guire K, Miller JM, et al. Comparison of levator ani muscle defects and function in women with and without pelvic organ prolapse. Obstet Gynecol. 2007;109(2, Part 1):295–302. https://doi.org/10.1097/01.AOG.0000250901.57095.ba.CrossRefPubMed

36.

Bachmann GA, Nevadunsky NS. Diagnosis and treatment of atrophic vaginitis. Am Fam Physician. 2000;61:3090.PubMed

37.

Gebhart JB, Rickard DJ, Barrett TJ, Lesnick TG, Webb MJ, Podratz KC, et al. Expression of estrogen receptor isoforms alpha and beta messenger RNA in vaginal tissue of premenopausal and postmenopausal women. Am J Obstet Gynecol. 2001;185(6):1325–30. https://doi.org/10.1067/mob.2001.119627.CrossRefPubMed

38.

Castelo-Branco C, Cancelo MJ, Villero J, et al. Management of post-menopausal vaginal atrophy and atrophic vaginitis. Maturitas. 2005;52(Suppl 1):S46.CrossRefPubMed

39.

Gold EB, Bromberger J, Crawford S, Samuels S, Greendale GA, Harlow SD, et al. Factors associated with age at natural menopause in a multiethnic sample of midlife women. Am J Epidemiol. 2001;153(9):865–74. https://doi.org/10.1093/aje/153.9.865.CrossRefPubMed

40.

Pandit L, Ouslander JG. Postmenopausal vaginal atrophy and atrophic vaginitis. Am J Med Sci. 1997;314:228.PubMed

41.

Greendale GA, Judd HL. The menopause: health implications and clinical management. J Am Geriatr Soc. 1993;41(4):426–36. https://doi.org/10.1111/j.1532-5415.1993.tb06953.x.CrossRefPubMed

42.

Forsberg JG. A morphologist’s approach to the vagina—age-related changes and estrogen sensitivity. Maturitas. 1995;22(Suppl):S7.CrossRefPubMed

43.

Jármy-Di Bella ZI, Girão MJ, Sartori MF, Di Bella Júnior V, Lederman HM, Baracat EC, et al. Power Doppler of the urethra in continent or incontinent, pre- and postmenopausal women. Int Urogynecol J Pelvic Floor Dysfunct. 2000;11(3):148–54. https://doi.org/10.1007/s001920070042.CrossRefPubMed

44.

Rud T, Andersson KE, Asmussen M, Hunting A, Ulmsten U. Factors maintaining the intraurethral pressure in women. Investig Urol. 1980;17(4):343–7.

45.

Sartori MG, Feldner PC, Jarmy-Di Bella ZI, Aquino Castro R, Baracat EC, Rodrigues de Lima G, et al. Sexual steroids in urogynecology. Climacteric. 2011;14(1):5–14. https://doi.org/10.3109/13697137.2010.508542.CrossRefPubMed

46.

Allen RE, Warrell DW. The role of pregnancy and childbirth in partial denervation of the pelvic floor. Neurourol Urodyn. 1992;6:183–4.

47.

Aukee P, Penttinen J, Airaksinen O. The effect of aging on the electromyographic activity of pelvic floor muscles. A comparative study among stress incontinent patients and asymptomatic women. Maturitas. 2003;44(4):253–7. https://doi.org/10.1016/S0378-5122(03)00044-6.CrossRefPubMed

48.

Olsen AL, Ross M, Stansfield RB, Kreiter C. Pelvic floor nerve conduction studies: establishing clinically relevant normative data. Am J Obstet Gynecol. 2003;189(4):1114–9. https://doi.org/10.1067/S0002-9378(03)00551-9.CrossRefPubMed

49.

Roig JV, Villoslada C, Lledó S, Solana A, Buch E, Alós R, et al. Prevalence of pudendal neuropathy in fecal incontinence. Results of a prospective study. Dis Colon Rectum. 1995;38(9):952–8. https://doi.org/10.1007/BF02049731.CrossRefPubMed

50.

Yang JM, Yang SH, Huang WC, Tzeng CR. Factors affecting reflex pelvic floor muscle contraction patterns in women with pelvic floor disorders. Ultrasound Obstet Gynecol. 2013;42(2):224–9. https://doi.org/10.1002/uog.12457.CrossRefPubMed

51.

Rowland DL, Greenleaf WJ, Dorfman LJ, Davidson JM. Aging and sexual function in men. Arch Sex Behav. 1993;22(6):545–57. https://doi.org/10.1007/BF01543300.CrossRefPubMed

52.

Rowland DL, Greenleaf W, Mas M, Myers L, Davidson JM. Penile and finger sensory thresholds in young, aging, and diabetic men. Arch Sex Behav. 1989;18(1):1–12. https://doi.org/10.1007/BF01579287.CrossRefPubMed

53.

Finlayson E, Wang L, Landefeld CS, Dudley RA. Major abdominal surgery in nursing home residents: a national study. Ann Surg. 2011;254(6):921–6. https://doi.org/10.1097/SLA.0b013e3182383a78.CrossRefPubMedPubMedCentral

54.

Hersh L, Salzman B. Clinical management of urinary incontinence in women. Am Fam Physician. 2013;87(9):634–40.PubMed

55.

Shaw C, Wagg A. Urinary incontinence in older adults. Med Older Adults. 2016;45(1):23–7.

56.

•• Bo K, Frawley HC, Haylen BT, Abramov Y, Almeida FG, Berghmans B, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction. Int Urogynecol J. 2017;28(2):191–213. Recent work that provides extensive reference on conservative management of pelvic floor dysfunction, in addition to provide reference regarding common terminology used.CrossRefPubMed

57.

Schnelle JF, Leung FW, Rao SS, Beuscher L, Keeler E, Clift JW, et al. A controlled trial of an intervention to improve urinary and fecal incontinence and constipation. J Am Geriatr Soc. 2010;58(8):1504–11. https://doi.org/10.1111/j.1532-5415.2010.02978.x.CrossRefPubMedPubMedCentral

58.

Eustice S, Roe B, Paterson J. Prompted voiding for the management of urinary incontinence in adults. Cochrane Database Syst Rev 2000, Issue 2. Art. No.: CD002113.

59.

Cram JR, Kasman GS, Holtz J. Introduction to surface electromyography. Gaithersburg: Aspen; 1998.

60.

Schreiner L, Santos TG, Souza AB, Nygaard CC, Silva Filho IG. Electrical stimulation for urinary incontinence in women: a systematic review. Int Braz J Urol. 2013;39(4):454–64. https://doi.org/10.1590/S1677-5538.IBJU.2013.04.02.CrossRefPubMed

61.

•• Hagen S, Stark D, Glazener C, Dickson S, Barry S, Elders A, et al. Individualised pelvic floor muscle training in women with pelvic organ prolapse (POPPY): a multicentre randomised controlled trial. Lancet. 2014;383(9919):796–806. Recent reference that substantiates pelvic floor muscle training as conservative treatment of pelvic organ prolapse.CrossRefPubMed

62.

Anderson CA, Omar MI, Campbell SE, Hunter KF, Cody JD, Glazener CM. Conservative management for postprostatectomy urinary incontinence. Cochrane Database Syst Rev. 2015;1:CD001843.PubMed

63.

•• Kirages DJ, Johnson EV. Pelvic floor muscle rehabilitation to improve sexual function in geriatric men. Top Geriatr Rehabil. 2016;32(3):174–81. Recent work outlining rehabilitation treatment for male sexual health.CrossRef

64.

•• Mercier J, Morin M, Lemieux MC, Reichetzer B, Khalifé S, Dumoulin C. Pelvic floor muscles training to reduce symptoms and signs of vulvovaginal atrophy: a case study. Menopause. 2016;23(7):816–20. Recent work providing evidence for treatment of vulvovaginal atrophy with pelvic floor muscle training.CrossRefPubMed

65.

Hagen S, Stark D. Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database Syst Rev 2011, Issue 12. Art. No.: CD003882.

66.

Anderson CA, Omar M, Campbell SE, Hunter KF, Cody JD, Glazener CMA. Conservative management for postprostatectomy urinary incontinence. Cochrane Database Syst Rev 2015, Issue 1. Art. No.: CD001843.

67.

Norton C, Cody JD. Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults. Cochrane Database Syst Rev 2012, Issue 7. Art. No.: CD002111.

68.

Dorey G, Speakman M, Feneley R, Swinkels A, Dunn C, Ewings P. Randomised controlled trial of pelvic floor muscle exercises and manometric biofeedback for erectile dysfunction. Br J Gen Pract. 2004;54(508):819–25.PubMedPubMedCentral

69.

Braekken IH, Majida M, Ellstrom Engh M, Bo K. Can pelvic floor muscle training improve sexual function in women with pelvic organ prolapse? A randomized controlled trial. J Sex Med. 2015;12(2):470–80. https://doi.org/10.1111/jsm.12746.CrossRefPubMed

70.

•• Bureau M, Carlson KV. Pelvic organ prolapse: a primer for urologists. Can Urol Assoc J. 2017;11(6Suppl2):S125. Recent literature that provides excellent review of the options for treatment of pelvic organ prolapse, including both conservative and surgical options.CrossRefPubMedPubMedCentral

71.

Atnip SD. Pessary use and management for pelvic organ prolapse. Obstet Gynecol Clin N Am. 2009;36(3):541–63. https://doi.org/10.1016/j.ogc.2009.08.010.CrossRef

72.

Constantine G, Graham S, Portman DJ, Rosen RC, Kingsberg SA. Female sexual function improved with ospemifene in postmenopausal women with vulvar and vaginal atrophy: results of a randomized, placebo-controlled trial. Climacteric. 2015;18(2):226–32. https://doi.org/10.3109/13697137.2014.954996.CrossRefPubMed

73.

•• Weber MA, Lim V, Oryszczyn J, Te West N, Souget J, Jeffery S, et al. The effect of vaginal oestriol cream on subjective and objective symptoms of stress urinary incontinence and vaginal atrophy: an International multi-centre pilot study. Gynecol Obstet Invest. 2017;82(1):15–21. Recent work substantiating the use of vaginal estrogen cream for symptoms of vaginal atrophy.CrossRefPubMed

74.

Dessie SG, Armstrong K, Modest AM, Hacker MR, Hota LS. Effect of vaginal estrogen on pessary use. Int Urogynecol J. 2016;27(9):1423–9. https://doi.org/10.1007/s00192-016-3000-1.CrossRefPubMedPubMedCentral

75.

Wasenda EJ, Kamisan Atan I, Subramaniam N, Dietz HP. Pelvic organ prolapse: does hormone therapy use matter? Menopause. 2017;24(10):1185–9. https://doi.org/10.1097/GME.0000000000000898.CrossRefPubMed

76.

Pastore EA, Katzman WB. Recognizing myofascial pelvic pain in the female patient with chronic pelvic pain. J Obstet Gynecol Neonatal Nurs. 2012;41(5):680–91. https://doi.org/10.1111/j.1552-6909.2012.01404.x.CrossRefPubMedPubMedCentral

77.

Rosenbaum T. The role of physical therapy in female sexual dysfunction. Curr Sex Health Rep. 2008;5(2):97–101. https://doi.org/10.1007/s11930-008-0017-6.CrossRef

78.

Rosenbaum TY, Owens A. The role of pelvic floor physical therapy in the treatment of pelvic and genital pain-related sexual dysfunction (CME). J Sex Med. 2008;5(3):513–23.CrossRefPubMed

79.

Sung VW, Weitzen S, Sokol ER, Rardin CR, Myers DL. Effect of patient age on increasing morbidity and mortality following urogynecologic surgery. Am J Obstet Gynecol. 2006;194(5):1411–7. https://doi.org/10.1016/j.ajog.2006.01.050.CrossRefPubMed

80.

Gibbs CF, Johnson TM 2nd, Ouslander JG. Office management of geriatric urinary incontinence. Am J Med. 2007;120(3):211–20. https://doi.org/10.1016/j.amjmed.2006.03.044.CrossRefPubMed

81.

Sung VW, Joo K, Marques F, Myers DL. Patient-reported outcomes after combined surgery for pelvic floor disorders in older compared to younger women. Am J Obstet Gynecol. 2009;201(5):534.e1–5.CrossRef

82.

Miller KL, Baraldi CA. Geriatric gynecology: promoting health and avoiding harm. Am J Obstet Gynecol. 2012;207(5):355–67. https://doi.org/10.1016/j.ajog.2012.04.014.CrossRefPubMed

83.

Ebner F, Schulz SVW, de Gregorio A et al. Prehabilitation in gynecological surgery? What do gynecologists know and need to know? Arch Gynecol Obstet. 2017.

84.

Weidner AC, Barber MD, Markland A, et al. Perioperative behavioral therapy and pelvic muscle strengthening do not enhance quality of life after pelvic surgery: secondary report of a RCT. Phy Ther. 2017;97(11):1075–83.

85.

Chang JI, Lam V, Patel MI. Preoperative pelvic floor muscle exercise and postprostatectomy incontiennce: a systematic review and meta-analysis. Eur Urol. 2016;69(3):460–7. https://doi.org/10.1016/j.eururo.2015.11.004.CrossRefPubMed

86.

Kretschmer H, Sandhu B. Evaluation and management of postprostatectomy incontiennce: a systematic review of current literature. European Uro. 2016;2(3):245–59.

87.

Hsu LK, Liao YM, Lai FC, Tsai PS. Beneficial effects of biofeedback-assisted pelvic floor muscle training in patients with urinary incontinence after radical prostatectomy: a systematic review and metaanalysis. Int J Nurs Stud. 2016;6:99–111.CrossRef

88.

Gyang AN, Feranec JB, Patel RC, Lamvu GM. Managing chronic pelvic pain following reconstructive pelvic surgery with transvaginal mesh. Int Urogynecol J. 2014;25(3):313–8. https://doi.org/10.1007/s00192-013-2256-y.CrossRefPubMed

89.

Kiolhede P, Wahlstrom J, Wingren G. Pelvic floor dysfunction after Burch colposuspension—a comprehensive study. Part I. Acta Obstet Gynecol Scand. 2005;84(9):894–901. https://doi.org/10.1111/j.0001-6349.2005.00753.x.CrossRef

90.

Joo Yan E, Lim JY, Rah UW, Kim YB. Effect of a pelvic floor muscle training program on gynecologic cancer survivors with pelvic floor dysfunction: a randomized controlled trial. Gynecol Oncol. 2012;125:705–11.CrossRef

91.

Pauls RN, Crisp CC, Novicki K, Fellner AN, Kleeman SD. Impact of physical therapy on quality of life and function after vaginal reconstructive surgery. Female Pelvic Med Reconstr Surg. 2013;19(5):271–7. https://doi.org/10.1097/SPV.0b013e31829c64ea.CrossRefPubMed

92.

Bernard S, Moffet H, Plante M, Ouellet MP, Leblond J, Dumoulin C. Pelvic-floor properties in women reporting urinary incontinence after surgery and radiotherapy for endometrial cancer. Phys Ther. 2017 Apr 1;97(4):438–48. https://doi.org/10.1093/ptj/pzx012.CrossRefPubMed

93.

Chung E. Contemporary surgical devices for male stress urinary incontinence: a review of technological advances in current continence surgery. Transl Androl Urol. 2017;6(Suppl 2):S112–21. https://doi.org/10.21037/tau.2017.04.12.CrossRefPubMedPubMedCentral

94.

Chung E, Katz DJ, Love C. Adult male stress and urge urinary incontinence—a review of pathophysiology and treatment strategies for voiding dysfunction in men. Aust Fam Physician. 2017;46(9):661–6.PubMed

95.

Salvatore S, Leone Roberti Maggiore U, Athanasiou S, Origoni M, Candiani M, Calligaro A, et al. Histological study on the effects of microablative fractional CO2 laser on atrophic vaginal tissue: an ex vivo study. Menopause. 2015;22(8):845–9. https://doi.org/10.1097/GME.0000000000000401.CrossRefPubMed

96.

Salvatore S, Nappi RE, Parma M, Chionna R, Lagona F, Zerbinati N, et al. Sexual function after fractional microablative CO₂ laser in women with vulvovaginal atrophy. Climacteric. 2015;18(2):219–25. https://doi.org/10.3109/13697137.2014.975197.CrossRefPubMed

97.

Tadir Y, Gaspar A, Lev-Sagie A, Alexiades M, Alinsod R, Bader A, et al. Light and energy based therapeutics for genitourinary syndrome of menopause: consensus and controversies. Lasers Surg Med. 2017;49(2):137–59. https://doi.org/10.1002/lsm.22637.CrossRefPubMed

98.

Roach M, Christie JA. Fecal incontinence in the elderly. Geriatrics. 2008;63(2):13–22.PubMed

99.

Van Kampen M, De Weerdt W, Claes H, Feys H, De Maeyer M, Van Poppel H. Treatment of erectile dysfunction by perineal exercise, electromyographic biofeedback, and electrical stimulation. Phys Ther. 2003;83(6):536–43.PubMed

100.

Dorey G. Conservative treatment of erectile dysfunction: literature review. Br J Nurs. 2000;9(13):859–63. https://doi.org/10.12968/bjon.2000.9.13.5514.CrossRefPubMed

101.

Strasser H, Steinlechner M, Bartsch G. Morphometric analysis of the rhabdosphincter of the male urethra. J Urol. 1997;157(Suppl 4):177–80.

102.

Kaufman JM, Vermeulen A. The decline of androgen levels in elderly men and its clinical and therapeutic implications. Endocr Rev. 2005;26(6):833–76.CrossRefPubMed

103.

Feldman HA, Longcope C, Derby CA, Johannes CB, Araujo AB, Coviello AD, et al. Age trends in the level of serum testosterone and other hormones in middle-aged men: longitudinal results from the Massachusetts male aging study. J Clin Endocrinol Metab. 2002;87(2):589–98. https://doi.org/10.1210/jcem.87.2.8201.CrossRefPubMed

104.

Harman SM, Metter EJ, Tobin JD, Pearson J, Blackman MR. Longitudinal effects of aging on serum total and free testosterone levels in healthy men. J Clin Endocrinol Metab. 2001;86(2):724–31. https://doi.org/10.1210/jcem.86.2.7219.CrossRefPubMed

Title: Aging and the Pelvic Floor
Authors: Karla Wente
Christina Dolan
Publication date: 01-03-2018
Publisher: Springer US
Published in: Current Geriatrics Reports / Issue 1/2018
Electronic ISSN: 2196-7865
DOI: https://doi.org/10.1007/s13670-018-0238-0

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Aging and the Pelvic Floor

Abstract

Purpose of Review

Recent Findings

Summary

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose of Review

Recent Findings

Summary

Please log in to get access to this content

Other articles of this Issue 1/2018

Recent Advances in Cholinergic Imaging and Cognitive Decline—Revisiting the Cholinergic Hypothesis of Dementia

Using Informant and Performance Screening Methods to Detect Mild Cognitive Impairment and Dementia

Correction to: Management of Osteoporotic and Neuropathic Ankle Fractures in the Elderly

Best Practice for Home Physical Therapy for Older Adults with Heart Failure

Special Concerns for the LGBT Aging Patient: What Rehab Professionals Should Know

Rehabilitation for Individuals with Dementia: Facilitating Success

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page