Expert consensus on multimodal assessment system for pelvic floor function_Chinese Journal of Evidence-Based Medicine

Authors：

 Multidisciplinary Expert Panel Consensus on Assessment and Intervention Techniques for Pelvic Floor Dysfunction

Corresponding author：

Multidisciplinary Expert Panel Consensus on Assessment and Intervention Techniques for Pelvic Floor Dysfunction, Email: hhb89008684@163.com

Keywords：

Female pelvic floor function evaluation; Multimodal; Stress incontinence; Pelvic organ prolapse; Fecal incontinence; Expert consensus

DOI：

10.7507/1672-2531.202405164

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Female pelvic floor dysfunction (PFD) is a common disease affecting women's quality of life, especially in older women. The establishment and application of multimodal evaluation system is the key to the accurate diagnosis and effective treatment of PFD. The purpose of this expert consensus is to provide a comprehensive, multi-layered assessment framework that includes clinical examinations, imaging examinations, biomechanical tests, and questionnaires to comprehensively assess pelvic floor function in women. By integrating different assessment methods, we aim to improve the early identification and diagnostic accuracy of PFD, so that personalized treatment can be developed to improve patient outcomes. The consensus also discusses the advantages and disadvantages of various assessment techniques and suggests directions for future research and clinical applications.

Citation： Multidisciplinary Expert Panel Consensus on Assessment and Intervention Techniques for Pelvic Floor Dysfunction. Expert consensus on multimodal assessment system for pelvic floor function. Chinese Journal of Evidence-Based Medicine, 2024, 24(8): 869-875. doi: 10.7507/1672-2531.202405164 Copy

1.	Bayrambey R, Akkuş Y. Evaluation of thirst severity, death anxiety, and complementary and supportive therapy use as predictors of urinary incontinence-related quality of life in older adults. Eur Geriatr Med, 2024, 15(1): 269-277.
2.	Schulten SFM, Claas-Quax MJ, Weemhoff M, et al. Risk factors for primary pelvic organ prolapse and prolapse recurrence: an updated systematic review and meta-analysis. Am J Obstet Gynecol, 2022, 227(2): 192-208.
3.	董凌燕, 陶茜, 龚成, 等. 女性盆底功能障碍性疾病的发病机制和康复治疗的研究进展. 中外医学研究, 2023, 21(36): 180-184.
4.	Hagovska M, Dudic R, Dudicova V, et al. Prevalence of diastasis m. rectus abdominis and pelvic floor muscle dysfunction in postpartum women. Bratisl Lek Listy, 2024, 125(1): 12-16.
5.	Molina-Barea R, Slim M, Calandre EP. Health-related quality of life and psychosocial variables in women with colorectal pelvic floor dysfunction: a cross-sectional study. Healthcare (Basel), 2024, 12(6): 668.
6.	Guo M, Zbar AP, Wu Y. Imaging the levator ani and the puborectalis muscle: implications in understanding regional anatomy, physiology and pathology. Scand J Gastroenterol, 2023, 58(11): 1295-1308.
7.	Flusberg M, Kobi M, Bahrami S, et al. Multimodality imaging of pelvic floor anatomy. Abdom Radiol (NY), 2021, 46(4): 1302-1311.
8.	陈永康, 陆薇丹, 韩劲松, 等. 动态磁共振成像在女性盆腔器官脱垂诊断中的应用价值. 中国实用妇科与产科杂志, 2015, 31(7): 653-656.
9.	朱兰, 娄文佳. 中国女性盆底康复现状. 中国计划生育和妇产科, 2020, 12(10): 3-4, 8.
10.	Aparecida Salbego Lançanova A, Chaida Sonda F, Cristine da Silva Gomes D, et al. Is there correlation between perineometry and Modified Oxford Scale in women. Systematic review with meta-analysis and grade recommendations. Eur J Obstet Gynecol Reprod Biol, 2023, 288: 160-169.
11.	Da Roza T, Mascarenhas T, Araujo M, et al. Oxford Grading Scale vs manometer for assessment of pelvic floor strength in nulliparous sports students. Physiotherapy, 2013, 99(3): 207-211.
12.	Zhang M, Wu J, Lin X, et al. Quality assessment of transperineal ultrasound in Chinese tertiary medical centers: a multicenter study. Quant Imaging Med Surg, 2023, 13(10): 6952-6964.
13.	Dietz HP, Shek C, De Leon J, et al. Ballooning of the levator hiatus. Ultrasound Obstet Gynecol, 2008, 31(6): 676-680.
14.	李多, 鲁蓉. 盆底超声评估女性肛提肌形态及功能的研究进展. 中南大学学报(医学版), 2023, 48(8): 1267-1273.
15.	张萌, 司晓霖, 张广英. 女性盆底功能障碍性便秘病人耻骨直肠肌功能的盆底超声研究进展. 国际医学放射学杂志, 2022, 45(5): 582-587.
16.	Fitzgerald J, Richter LA. The role of MRI in the diagnosis of pelvic floor disorders. Curr Urol Rep, 2020, 21(7): 26.
17.	金之涵, 崔璨, 崔大伟, 等. MRI测量肛提肌裂孔前后径和面积对产后盆底肌收缩力低下的诊断价值. 浙江医学, 2023, 45(21): 2278-2282, 2288.
18.	Comiter CV, Vasavada SP, Barbaric ZL, et al. Grading pelvic prolapse and pelvic floor relaxation using dynamic magnetic resonance imaging. Urology, 1999, 54(3): 454-457.
19.	Stania M, Chmielewska D, Kwaśna K, et al. Bioelectrical activity of the pelvic floor muscles during synchronous whole-body vibration−a randomized controlled study. BMC Urol, 2015, 15: 107.
20.	de Oliveira Ferro JK, Lemos A, de Santana Chagas AC, et al. Techniques for registration of myoelectric activity of women's pelvic floor muscles: a scoping review. Int Urogynecol J, 2024, 35(5): 947-954.
21.	Duarte NS, Azevedo YS, Furtado ECS, et al. Electromyographic activity of pelvic floor muscles in different positions during the use an innovative vaginal educator: cross-sectional study. PLoS One, 2024, 19(3): e0291588.
22.	Avery K, Donovan J, Peters TJ, et al. ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn, 2004, 23(4): 322-330.
23.	de Figueiredo VB, Ferreira CHJ, da Silva JB, et al. Responsiveness of pelvic floor distress inventory (PFDI-20) and pelvic floor impact questionnaire (PFIQ-7) after pelvic floor muscle training in women with stress and mixed urinary incontinence. Eur J Obstet Gynecol Reprod Biol, 2020, 255: 129-133.
24.	Barber MD, Walters MD, Bump RC. Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7). Am J Obstet Gynecol, 2005, 193(1): 103-113.
25.	Oliveira MC, Oliveira M, Silva H, et al. Evaluation of satisfaction of pelvic floor muscle training isolated and associated with tibial nerve stimulation in women with mixed urinary incontinence: a randomized, single-blinded clinical trial. Eur J Obstet Gynecol Reprod Biol, 2021, 265: 60-65.
26.	Reis BM, da Silva JB, Rocha APR, et al. Intravaginal electrical stimulation associated with pelvic floor muscle training for women with stress urinary incontinence: study protocol for a randomized controlled trial with economic evaluation. Trials, 2021, 22(1): 823.
27.	Messelink B, Benson T, Berghmans B, 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): 374-380.
28.	Oelke M, Khullar V, Wijkstra H. Review on ultrasound measurement of bladder or detrusor wall thickness in women: techniques, diagnostic utility, and use in clinical trials. World J Urol, 2013, 31(5): 1093-1104.
29.	Reddy D, Zulfeen M, Pandey D. Stress incontinence combined score (SICS): a novel combined grading system to assess the severity of stress urinary incontinence in women. Eur J Obstet Gynecol Reprod Biol, 2022, 278: 57-65.
30.	Shek KL, Dietz HP. What is abnormal uterine descent on translabial ultrasound. Int Urogynecol J, 2015, 26(12): 1783-1787.
31.	Wadhwani S, Ratnaparkhi C, Dhok A. Comparison of dynamic magnetic resonance defecography with clinical examination in diagnosing pelvic floor dysfunction: an observational study. Cureus, 2023, 15(12): e51378.
32.	Gao Y, Zhao Z, Yang Y, et al. Diagnostic value of pelvic floor ultrasonography for diagnosis of pelvic organ prolapse: a systematic review. Int Urogynecol J, 2020, 31(1): 15-33.
33.	Lakeman MM, Zijta FM, Peringa J, et al. Dynamic magnetic resonance imaging to quantify pelvic organ prolapse: reliability of assessment and correlation with clinical findings and pelvic floor symptoms. Int Urogynecol J, 2012, 23(11): 1547-1554.
34.	Levin MD, Korshun Z, Mendel'son G. The method of radiographic examination anorectal area. Eksp Klin Gastroenterol, 2011, (12): 15-21.
35.	Schawkat K, Heinrich H, Parker HL, et al. How to define pathologic pelvic floor descent in MR defecography during defecation. Abdom Radiol (NY), 2018, 43(12): 3233-3240.
36.	Marcu I, Gavard JA, Vazirabadi G, et al. Cystoscopic findings in women with minimal and maximal lower urinary tract symptoms. Transl Androl Urol, 2021, 10(7): 2910-2920.
37.	Yao M, Simoes A. Urodynamic testing and interpretation. StatPearls. Treasure Island (FL) companies. Disclosure: Adrian Simoes declares no relevant financial relationships with ineligible companies. 2024.
38.	Frye J, Rao SSC. Anorectal manometry: when, how to perform and interpret, and is it useful. Am J Gastroenterol, 2024, (3): 15.
39.	中国医师协会肛肠医师分会, 中国医师协会肛肠医师分会临床指南工作委员会, 中国医师协会肛肠医师分会肛肠动力异常性疾病学组, 等. 结直肠肛门测压中国专家共识(2023版). 中华胃肠外科杂志, 2023, 26(12): 1095-1102.
40.	Gregersen H, Chen SC, Leung WW, et al. Novel fecobionics defecatory function testing. Clin Transl Gastroenterol, 2019, 10(12): e00108.

1. Bayrambey R, Akkuş Y. Evaluation of thirst severity, death anxiety, and complementary and supportive therapy use as predictors of urinary incontinence-related quality of life in older adults. Eur Geriatr Med, 2024, 15(1): 269-277.
2. Schulten SFM, Claas-Quax MJ, Weemhoff M, et al. Risk factors for primary pelvic organ prolapse and prolapse recurrence: an updated systematic review and meta-analysis. Am J Obstet Gynecol, 2022, 227(2): 192-208.
3. 董凌燕, 陶茜, 龚成, 等. 女性盆底功能障碍性疾病的发病机制和康复治疗的研究进展. 中外医学研究, 2023, 21(36): 180-184.
4. Hagovska M, Dudic R, Dudicova V, et al. Prevalence of diastasis m. rectus abdominis and pelvic floor muscle dysfunction in postpartum women. Bratisl Lek Listy, 2024, 125(1): 12-16.
5. Molina-Barea R, Slim M, Calandre EP. Health-related quality of life and psychosocial variables in women with colorectal pelvic floor dysfunction: a cross-sectional study. Healthcare (Basel), 2024, 12(6): 668.
6. Guo M, Zbar AP, Wu Y. Imaging the levator ani and the puborectalis muscle: implications in understanding regional anatomy, physiology and pathology. Scand J Gastroenterol, 2023, 58(11): 1295-1308.
7. Flusberg M, Kobi M, Bahrami S, et al. Multimodality imaging of pelvic floor anatomy. Abdom Radiol (NY), 2021, 46(4): 1302-1311.
8. 陈永康, 陆薇丹, 韩劲松, 等. 动态磁共振成像在女性盆腔器官脱垂诊断中的应用价值. 中国实用妇科与产科杂志, 2015, 31(7): 653-656.
9. 朱兰, 娄文佳. 中国女性盆底康复现状. 中国计划生育和妇产科, 2020, 12(10): 3-4, 8.
10. Aparecida Salbego Lançanova A, Chaida Sonda F, Cristine da Silva Gomes D, et al. Is there correlation between perineometry and Modified Oxford Scale in women. Systematic review with meta-analysis and grade recommendations. Eur J Obstet Gynecol Reprod Biol, 2023, 288: 160-169.
11. Da Roza T, Mascarenhas T, Araujo M, et al. Oxford Grading Scale vs manometer for assessment of pelvic floor strength in nulliparous sports students. Physiotherapy, 2013, 99(3): 207-211.
12. Zhang M, Wu J, Lin X, et al. Quality assessment of transperineal ultrasound in Chinese tertiary medical centers: a multicenter study. Quant Imaging Med Surg, 2023, 13(10): 6952-6964.
13. Dietz HP, Shek C, De Leon J, et al. Ballooning of the levator hiatus. Ultrasound Obstet Gynecol, 2008, 31(6): 676-680.
14. 李多, 鲁蓉. 盆底超声评估女性肛提肌形态及功能的研究进展. 中南大学学报(医学版), 2023, 48(8): 1267-1273.
15. 张萌, 司晓霖, 张广英. 女性盆底功能障碍性便秘病人耻骨直肠肌功能的盆底超声研究进展. 国际医学放射学杂志, 2022, 45(5): 582-587.
16. Fitzgerald J, Richter LA. The role of MRI in the diagnosis of pelvic floor disorders. Curr Urol Rep, 2020, 21(7): 26.
17. 金之涵, 崔璨, 崔大伟, 等. MRI测量肛提肌裂孔前后径和面积对产后盆底肌收缩力低下的诊断价值. 浙江医学, 2023, 45(21): 2278-2282, 2288.
18. Comiter CV, Vasavada SP, Barbaric ZL, et al. Grading pelvic prolapse and pelvic floor relaxation using dynamic magnetic resonance imaging. Urology, 1999, 54(3): 454-457.
19. Stania M, Chmielewska D, Kwaśna K, et al. Bioelectrical activity of the pelvic floor muscles during synchronous whole-body vibration−a randomized controlled study. BMC Urol, 2015, 15: 107.
20. de Oliveira Ferro JK, Lemos A, de Santana Chagas AC, et al. Techniques for registration of myoelectric activity of women's pelvic floor muscles: a scoping review. Int Urogynecol J, 2024, 35(5): 947-954.
21. Duarte NS, Azevedo YS, Furtado ECS, et al. Electromyographic activity of pelvic floor muscles in different positions during the use an innovative vaginal educator: cross-sectional study. PLoS One, 2024, 19(3): e0291588.
22. Avery K, Donovan J, Peters TJ, et al. ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn, 2004, 23(4): 322-330.
23. de Figueiredo VB, Ferreira CHJ, da Silva JB, et al. Responsiveness of pelvic floor distress inventory (PFDI-20) and pelvic floor impact questionnaire (PFIQ-7) after pelvic floor muscle training in women with stress and mixed urinary incontinence. Eur J Obstet Gynecol Reprod Biol, 2020, 255: 129-133.
24. Barber MD, Walters MD, Bump RC. Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7). Am J Obstet Gynecol, 2005, 193(1): 103-113.
25. Oliveira MC, Oliveira M, Silva H, et al. Evaluation of satisfaction of pelvic floor muscle training isolated and associated with tibial nerve stimulation in women with mixed urinary incontinence: a randomized, single-blinded clinical trial. Eur J Obstet Gynecol Reprod Biol, 2021, 265: 60-65.
26. Reis BM, da Silva JB, Rocha APR, et al. Intravaginal electrical stimulation associated with pelvic floor muscle training for women with stress urinary incontinence: study protocol for a randomized controlled trial with economic evaluation. Trials, 2021, 22(1): 823.
27. Messelink B, Benson T, Berghmans B, 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): 374-380.
28. Oelke M, Khullar V, Wijkstra H. Review on ultrasound measurement of bladder or detrusor wall thickness in women: techniques, diagnostic utility, and use in clinical trials. World J Urol, 2013, 31(5): 1093-1104.
29. Reddy D, Zulfeen M, Pandey D. Stress incontinence combined score (SICS): a novel combined grading system to assess the severity of stress urinary incontinence in women. Eur J Obstet Gynecol Reprod Biol, 2022, 278: 57-65.
30. Shek KL, Dietz HP. What is abnormal uterine descent on translabial ultrasound. Int Urogynecol J, 2015, 26(12): 1783-1787.
31. Wadhwani S, Ratnaparkhi C, Dhok A. Comparison of dynamic magnetic resonance defecography with clinical examination in diagnosing pelvic floor dysfunction: an observational study. Cureus, 2023, 15(12): e51378.
32. Gao Y, Zhao Z, Yang Y, et al. Diagnostic value of pelvic floor ultrasonography for diagnosis of pelvic organ prolapse: a systematic review. Int Urogynecol J, 2020, 31(1): 15-33.
33. Lakeman MM, Zijta FM, Peringa J, et al. Dynamic magnetic resonance imaging to quantify pelvic organ prolapse: reliability of assessment and correlation with clinical findings and pelvic floor symptoms. Int Urogynecol J, 2012, 23(11): 1547-1554.
34. Levin MD, Korshun Z, Mendel'son G. The method of radiographic examination anorectal area. Eksp Klin Gastroenterol, 2011, (12): 15-21.
35. Schawkat K, Heinrich H, Parker HL, et al. How to define pathologic pelvic floor descent in MR defecography during defecation. Abdom Radiol (NY), 2018, 43(12): 3233-3240.
36. Marcu I, Gavard JA, Vazirabadi G, et al. Cystoscopic findings in women with minimal and maximal lower urinary tract symptoms. Transl Androl Urol, 2021, 10(7): 2910-2920.
37. Yao M, Simoes A. Urodynamic testing and interpretation. StatPearls. Treasure Island (FL) companies. Disclosure: Adrian Simoes declares no relevant financial relationships with ineligible companies. 2024.
38. Frye J, Rao SSC. Anorectal manometry: when, how to perform and interpret, and is it useful. Am J Gastroenterol, 2024, (3): 15.
39. 中国医师协会肛肠医师分会, 中国医师协会肛肠医师分会临床指南工作委员会, 中国医师协会肛肠医师分会肛肠动力异常性疾病学组, 等. 结直肠肛门测压中国专家共识(2023版). 中华胃肠外科杂志, 2023, 26(12): 1095-1102.
40. Gregersen H, Chen SC, Leung WW, et al. Novel fecobionics defecatory function testing. Clin Transl Gastroenterol, 2019, 10(12): e00108.

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