Tiivistelmä

Lantionpohjan toimintahäiriöitä ovat lantion laskeumat, virtsaamiseen, ulostamiseen ja seksuaalitoimintoihin liittyvät rakenteelliset ja toiminnalliset häiriöt sekä kiputilat. Vaivat ovat yleisiä, mutta vaiettuja. Virtsaamisen ja ulostamisen ongelmista tulee aktiivisesti kysyä. Tutkimisessa ja hoidossa tulee huomioida kaikki lantionpohjan osa-alueet. Konservatiivinen hoito ja fysioterapia perusterveydenhuollossa ovat hoidon kulmakivi. Kirurgialla, botuliinitoksiini- ja sakraalineuromodulaatiohoidolla voidaan parantaa elämänlaatua.

Summary

One in three women experience at least one pelvic floor disorder (PFD). PFDs include pelvic organ prolapse, urinary and fecal incontinence, bladder and bowel storage and evacuation problems, as well as pelvic pain and sexual dysfunction. Although benign conditions, their symptoms can greatly impair the quality of life and body image and cause restrictive behaviour. Symptoms are underreported owing to embarrassment and social stigma; therefore, they should be actively sought.

Patients usually present with a variety of co-existing PFDs. The pathophysiology is multifactorial and complex, often a combination of genetic, anatomic, physiological, environmental, reproductive and life-style factors accumulating during the life-span. The most important risk factors are female gender, vaginal delivery, age and obesity.

The evaluation should cover all pelvic floor compartments. Validated questionnaires facilitate symptom screening. In referral centres, management of complex cases by multidisciplinary teams is beneficial. Pelvic floor imaging and functional tests (e.g. defecography) are used to detect those structural and functional abnormalities that are not easily recognized during clinical examination (e.g. rectal intussusception).

The management addresses all affected compartments and follows a step-wise approach. A selection of conservative measures including lifestyle and dietary modifications, bladder and bowel training programmes, medication and pelvic floor muscle training form the cornerstone of treatment. Pelvic floor surgery aims to restore anatomy and function and improve quality of life. Surgery for pelvic organ prolapse and stress urinary incontinence provides a high level of cure and patient satisfaction. However, recurrent pelvic organ prolapse remains a challenge for clinicians. Sacral neuromodulation and botulinum toxin injections are used to treat fecal incontinence and overactive bladder symptoms.