13.9: Urinary Incontinence And Prolapse
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Urinary incontinence and POP are separate clinical entities that may or may not coexist. Significant protrusion of the vagina may obstruct voiding and defecation. Surgical repair of one pelvic support defect without repair of concurrent asymptomatic pelvic support defects appears to predispose to accentuation of unrepaired defects and new symptoms. Women with POP may have to digitally reduce their prolapse in order to void or defecate. Although pelvic anatomy can now easily be measured accurately and reliably, the relationship of these anatomic findings with functional abnormalities is not well understood. Support abnormalities of the anterior vaginal wall are common in vaginally parous women; but stress incontinence is not consistently associated with this finding. Distal posterior vaginal wall support abnormalities may exist with or without defecation abnormalities. The relationship between anatomy and function is one of the most pressing research priorities in the domain of physical examination of women with POP.