Which condition is a common pelvic floor disorder, and what is included in the initial evaluation?

• A. Pelvic organ prolapse
• B. Ovarian torsion
• C. Fecal incontinence
• D. Urinary incontinence; evaluation with history, physical, bladder diary, urinalysis

Answer: (D)

Pelvic floor disorders include urinary incontinence, fecal incontinence, and pelvic organ prolapse, with urinary incontinence being the most common presentation. It results from weakness or dysfunction of the pelvic floor muscles, urethral sphincter, or detrusor activity, and it becomes more prevalent with factors like pregnancy, childbirth, aging, and obesity. Because it’s so common, the first evaluation focuses on identifying the type and impact of leakage and ruling out other issues.

The initial evaluation typically includes taking a detailed history to classify the incontinence (for example, stress versus urge) and understand its effect on daily life; a careful physical exam, including a pelvic examination; a bladder diary to quantify voiding patterns, fluid intake, and leakage episodes; and a urinalysis to screen for infection or other urinary abnormalities. These steps help tailor treatment, from pelvic floor strengthening and lifestyle changes to medications or further testing if needed.

Ovarian torsion is not a pelvic floor disorder and represents an acute gynecologic emergency, while pelvic organ prolapse and fecal incontinence are other pelvic floor disorders but urinary incontinence remains the most common and is specifically aligned with the described initial workup.