Wijnand F.R.M. Koch – författare

A sound and detailed knowledge of the anatomy of the pelvic floor is of the utmost importance to gynecologists, obstetricians, surgeons, and urologists, since they all share the same responsibility in treating patients with different pathological conditions caused by pelvic floor dysfunction. The most common clinical expressions of pelvic floor dysfunction are urinary incontinence, anal incontinence, and pelvic organ prolapse. Most often these clinical expressions are found in women, and they are briefly discussed below based on the outline presented in the Third International Consultation on Incontinence, a joint effort of the International Continence Society and the World Health Organization.

Established potential risk factors are age, childbearing, and obesity. The pelvic floor plays an important role in these risk factors. There is evidence that the pelvic floor structures change with age, giving rise to dysfunction. Pregnancy, and especially vaginal delivery, may result in pelvic floor laxity as a consequence of weakening, stretching, and even laceration of the muscles and connective tissue, or due to damage to pudendal and pelvic nerves. Comparable to pregnancy, obesity causes chronic strain, stretching, and weakening of muscles, nerves, and other structures of the pelvic floor.

This book offers a critical review of the pelvic sciences—past, present and future—from an anatomical and physiological perspective and is intended for researchers, medical practitioners and paramedical therapists in the fields of urology, gynecology and obstetrics, proctology, physiotherapy, as well as for patients.

The book starts with a “construction plan” of the pelvis and shows its structural consequences. The historical background of pelvic studies proceeds from medieval and early Italian models to the definitive understanding of the pelvic anatomy in the Seventeenth century. During these eras of pelvic research, concepts and approaches developed that are illustrated with examples from comparative anatomy and from mutations, also with regard to the biomechanics of pelvic structures. Perceptions of the pelvis as an important element in sexual arousal and mating conduct are discussed, as well as attitudes to circumcision, castration and other mutilations, in its anthropological, social context.

The anatomy and physiology of the pelvic wall and its organs as well as the development of these pelvic organs are covered as a prerequisite to understanding, for example, the spread of pelvic carcinoma and male and female bladder muscle function. Connective pelvic tissue is examined in its reinforcing capacity for pelvic structures, but also as a “hiding place” for infections. Innervations and reflexes relayed through the pelvic nerves are discussed in order to explain incontinence, sphincter function and the control of smooth and striated muscles in the pelvis.

Catheters and drugs acting on pelvic function are described, and a critical review of alternative clinical methods for treating pelvic dysfunctions is provided.