Skip to main content Accessibility help
Hostname: page-component-6c8bd87754-fppf4 Total loading time: 1.06 Render date: 2022-01-19T09:02:32.587Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": true, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true, "newUsageEvents": true }

Book contents

Chapter 12 - Pelvic Floor, Urinary Problems and the Menopause

Published online by Cambridge University Press:  18 June 2020

Nicholas Panay
Queen Charlotte's & Chelsea Hospital, London
Paula Briggs
Liverpool Women's NHS Foundation Trust
Gabor T. Kovacs
Monash University, Victoria
Get access


The female pelvic floor undergoes a large numbers of adaptive changes, related to life and endocrine events. The injuries and functional modifications of female pelvic floor due to pregnancy, life events and aging are associated to several changes that may predispose to pelvic floor dysfunctions (PFD). PFD globally affects micturition, defecation and sexual activity and their incidence increases dramatically with age and menopause.

Managing the Menopause , pp. 112 - 123
Publisher: Cambridge University Press
Print publication year: 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Tinelli, A, Malvasi, A, Rahimi, S, Negro, R, Vergara, D, Martignago, R, et al. Age-related pelvic floor modifications and prolapse risk factors in postmenopausal women. Menopause 2010;17(1):204–12.Google ScholarPubMed
Gebhart, JB, Rickard, DJ, Barrett, TJ, Lesnick, TG, Webb, MJ, Podratz, KC, et al. Expression of estrogen receptor isoforms alpha and beta messenger RNA in vaginal tissue of premenopausal and postmenopausal women. Am J Obstet Gynecol 2001;185(6):1325–30; discussion 30–1.CrossRefGoogle ScholarPubMed
Xie, Z, Shi, H, Zhou, C, Dong, M, Hong, L, Jin, H. Alterations of estrogen receptor-alpha and -beta in the anterior vaginal wall of women with urinary incontinence. Eur J Obstet Gynecol Reprod Biol 2007;134(2):254–8.CrossRefGoogle ScholarPubMed
Robinson, D, Cardozo, L. Estrogens and the lower urinary tract. Neurol Urodyn 2011;30(5):754–7.CrossRefGoogle ScholarPubMed
Robinson, D, Toozs-Hobson, P, Cardozo, L. The effect of hormones on the lower urinary tract. Menopause Int 2013;19(4):155–62.CrossRefGoogle ScholarPubMed
Zoubina, EV, Mize, AL, Alper, RH, Smith, PG. Acute and chronic estrogen supplementation decreases uterine sympathetic innervation in ovariectomized adult virgin rats. Histol Histopathol 2001;16(4):989–96.Google ScholarPubMed
Portman, DJ, Gass, ML. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and the North American Menopause Society. Climacteric 2014;17(5):557–63.CrossRefGoogle Scholar
Andersson, KE, Boedtkjer, DB, Forman, A. The link between vascular dysfunction, bladder ischemia, and aging bladder dysfunction. Thera Adv Urol 2017;9(1):1127.CrossRefGoogle ScholarPubMed
Camoes, J, Coelho, A, Castro-Diaz, D, Cruz, F. Lower urinary tract symptoms and aging: the impact of chronic bladder ischemia on overactive bladder syndrome. Urol Int 2015;95(4):373–9.Google ScholarPubMed
Tyagi, P, Tyagi, V, Qu, X, Lin, HT, Kuo, HC, Chuang, YC, et al. Association of inflammaging (inflammation + aging) with higher prevalence of OAB in elderly population. Int Urol Nephrol 2014;46(5):871–7.CrossRefGoogle ScholarPubMed
Ghoniem, G, Faruqui, N, Elmissiry, M, Mahdy, A, Abdelwahab, H, Oommen, M, et al. Differential profile analysis of urinary cytokines in patients with overactive bladder. Int Urogynecol J 2011;22(8):953–61.Google ScholarPubMed
Rociu, E, Stoker, J, Eijkemans, MJ, Lameris, JS. Normal anal sphincter anatomy and age- and sex-related variations at high-spatial-resolution endoanal MR imaging. Radiology 2000;217(2):395401.CrossRefGoogle ScholarPubMed
Digesu, GA, Khullar, V, Cardozo, L, Robinson, D, Salvatore, S. P-QOL: a validated questionnaire to assess the symptoms and quality of life of women with urogenital prolapse. Int Urogynecol J Pelvic Floor Dysfunction 2005;16(3):176–81; discussion 81.CrossRefGoogle ScholarPubMed
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):103–13.CrossRefGoogle Scholar
Abrams, P, Cardozo, L, Fall, M, Griffiths, D, Rosier, P, Ulmsten, U, et al. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology 2003;61(1):3749.CrossRefGoogle ScholarPubMed
Hunskaar, S, Lose, G, Sykes, D, Voss, S. The prevalence of urinary incontinence in women in four European countries. BJU Int 2004;93(3):324–30.CrossRefGoogle ScholarPubMed
Coyne, KS, Sexton, CC, Kopp, ZS, Luks, S, Gross, A, Irwin, D, et al. Rationale for the study methods and design of the epidemiology of lower urinary tract symptoms (EpiLUTS) study. BJU Int 2009;104(3):348–51.Google Scholar
Wallace, KM, Drake, MJ. Overactive bladder. F1000Res 2015;4.CrossRefGoogle ScholarPubMed
Irwin, DE, Milsom, I, Kopp, Z, Abrams, P, Artibani, W, Herschorn, S. Prevalence, severity, and symptom bother of lower urinary tract symptoms among men in the EPIC study: impact of overactive bladder. Eur Urol 2009;56(1):1420.CrossRefGoogle Scholar
Steers, WD. Pathophysiology of overactive bladder and urge urinary incontinence. Rev Urol 2002;4 Suppl 4:S7s18.Google ScholarPubMed
Dumoulin, C, Hunter, KF, Moore, K, Bradley, CS, Burgio, KL, Hagen, S, et al. Conservative management for female urinary incontinence and pelvic organ prolapse review 2013: summary of the 5th International Consultation on Incontinence. Neurourol Urodyn 2016;35(1):1520.CrossRefGoogle ScholarPubMed
Tadir, Y, Gaspar, A, Lev-Sagie, A, Alexiades, M, Alinsod, R, Bader, A, et al. Light and energy based therapeutics for genitourinary syndrome of menopause: consensus and controversies. Lasers Surg Med 2017;49(2):137–59.CrossRefGoogle ScholarPubMed
Gambacciani, M, Palacios, S. Laser therapy for the restoration of vaginal function. Maturitas 2017;99:10–5.CrossRefGoogle ScholarPubMed
Arunkalaivanan, A, Kaur, H, Onuma, O. Laser therapy as a treatment modality for genitourinary syndrome of menopause: a critical appraisal of evidence. Int Urogynecol J 2017;28(5):681–5.CrossRefGoogle ScholarPubMed
Gambacciani, M, Levancini, M, Russo, E, Vacca, L, Simoncini, T, Cervigni, M. Long-term effects of vaginal erbium laser in the treatment of genitourinary syndrome of menopause. Climacteric 2018;21(2):148–52.CrossRefGoogle ScholarPubMed
Gaspar, A, Brandi, H, Gomez, V, Luque, D. Efficacy of Erbium: YAG laser treatment compared to topical estriol treatment for symptoms of genitourinary syndrome of menopause. Lasers Surg Med 2017;49(2):160–8.CrossRefGoogle ScholarPubMed
Fistonic, N, Fistonic, I, Gustek, SF, Turina, IS, Marton, I, Vizintin, Z, et al. Minimally invasive, non-ablative Er: YAGlaser treatment of stress urinary incontinence in women–a pilot study. Lasers Med Sci 2016;31(4):635–43.CrossRefGoogle Scholar
Digesu, GA, Swift, S. Laser treatment in urogynaecology and the myth of the scientific evidence. Int Urogynecol J 2017;28:1443–4.CrossRefGoogle ScholarPubMed
Tien, YW, Hsiao, SM, Lee, CN, Lin, HH. Effects of laser procedure for female urodynamic stress incontinence on pad weight, urodynamics, and sexual function. Int Urogynecol J 2017;28(3):469–76.CrossRefGoogle ScholarPubMed
Fistonic, I, Fistonic, N. Baseline ICIQ-UI score, body mass index, age, average birth weight, and perineometry duration as promising predictors of the short-term efficacy of Er: YAG laser treatment in stress urinary incontinent women: a prospective cohort study. Lasers Surg Med 2018;epub ahead of print.CrossRefGoogle Scholar
Gaspar, A, Brandi, H. Non-ablative erbium YAG laser for the treatment of type III stress urinary incontinence (intrinsic sphincter deficiency). Lasers Med Sci 2017;32(3):685–91.CrossRefGoogle Scholar
Cody, JD, Jacobs, ML, Richardson, K, Moehrer, B, Hextall, A. Oestrogen therapy for urinary incontinence in post-menopausal women. Cochrane Database Syst Rev 2012;10:Cd001405.Google ScholarPubMed
Ostle, Z. Vaginal oestrogen for overactive bladder in post-menopausal women. Br J Nurs 2015;24(11):582–5.CrossRefGoogle ScholarPubMed
Robinson, D, Cardozo, L, Milsom, I, Pons, ME, Kirby, M, Koelbl, H, et al. Oestrogens and overactive bladder. Neurourol Urodyn 2014;33(7):1086–91.CrossRefGoogle ScholarPubMed
Schiavi, MC, D’Oria, O, Aleksa, N, Vena, F, Prata, G, Di Tucci, C, et al. Usefulness of Ospemifene in the treatment of urgency in menopausal patients affected by mixed urinary incontinence underwent mid-urethral slings surgery. Gynecol Endocrinol 2019;35(2):155–9.CrossRefGoogle ScholarPubMed
Baber, RJ, Panay, N, Fenton, A. 2016 IMS Recommendations on women’s midlife health and menopause hormone therapy. Climacteric 2016;19(2):109–50.CrossRefGoogle ScholarPubMed
Madhuvrata, P, Cody, JD, Ellis, G, Herbison, GP, Hay-Smith, EJ. Which anticholinergic drug for overactive bladder symptoms in adults. Cochrane Database of Syst Rev 2012;1:Cd005429.Google ScholarPubMed
Warren, K, Burden, H, Abrams, P. Mirabegron in overactive bladder patients: efficacy review and update on drug safety. Thera Adv Drug Saf 2016;7(5):204–16.Google ScholarPubMed
Giarenis, I, Robinson, D, Cardozo, L. Overactive bladder and the beta3-adrenoceptor agonists: current strategy and future prospects. Drugs 2015;75(15):1707–13.CrossRefGoogle ScholarPubMed
Abrams, P, Andersson, KE, Birder, L, Brubaker, L, Cardozo, L, Chapple, C, et al. Fourth International Consultation on Incontinence Recommendations of the International Scientific Committee: evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence. Neurourol Urodyn 2010;29(1):213–40.CrossRefGoogle ScholarPubMed
Gormley, EA, Lightner, DJ, Faraday, M, Vasavada, SP. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline amendment. J Urol 2015;193(5):1572–80.CrossRefGoogle ScholarPubMed
Duthie, JB, Vincent, M, Herbison, GP, Wilson, DI, Wilson, D. Botulinum toxin injections for adults with overactive bladder syndrome. Cochrane Database Syst Rev 2011(12):Cd005493.Google ScholarPubMed
Noblett, K, Siegel, S, Mangel, J, Griebling, TL, Sutherland, SE, Bird, ET, et al. Results of a prospective, multicenter study evaluating quality of life, safety, and efficacy of sacral neuromodulation at twelve months in subjects with symptoms of overactive bladder. Neurourol Urodyn 2016;35(2):246–51.CrossRefGoogle ScholarPubMed
Gaziev, G, Topazio, L, Iacovelli, V, Asimakopoulos, A, Di Santo, A, De Nunzio, C, et al. Percutaneous tibial nerve stimulation (PTNS) efficacy in the treatment of lower urinary tract dysfunctions: a systematic review. BMC Urol 2013;13:61.CrossRefGoogle ScholarPubMed
Petros, PE, Ulmsten, UI. An integral theory of female urinary incontinence. Experimental and clinical considerations. Acta Obstet Gynecol Scand Suppl 1990;153:731.CrossRefGoogle ScholarPubMed
Ogah, J, Cody, DJ, Rogerson, L. Minimally invasive synthetic suburethral sling operations for stress urinary incontinence in women: a short version Cochrane review. Neurourol Urodyn 2011;30(3):284–91.CrossRefGoogle ScholarPubMed
Haylen, BT, Maher, CF, Barber, MD, Camargo, S, Dandolu, V, Digesu, A, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic organ prolapse (POP). Neurourol Urodyn 2016;35(2):137–68.CrossRefGoogle Scholar
Maher, C, Feiner, B, Baessler, K, Schmid, C. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev 2013(4):Cd004014.Google ScholarPubMed
Nygaard, I, Barber, MD, Burgio, KL, Kenton, K, Meikle, S, Schaffer, J, et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA 2008;300(11):1311–6.CrossRefGoogle ScholarPubMed
Lince, SL, van Kempen, LC, Vierhout, ME, Kluivers, KB. A systematic review of clinical studies on hereditary factors in pelvic organ prolapse. Int Urogynecol J 2012;23(10):1327–36.CrossRefGoogle ScholarPubMed
Wu, JM, Vaughan, CP, Goode, PS, Redden, DT, Burgio, KL, Richter, HE, et al. Prevalence and trends of symptomatic pelvic floor disorders in US women. Obstetr Gynecol 2014;123(1):141–8.CrossRefGoogle Scholar
Barber, MD, Maher, C. Epidemiology and outcome assessment of pelvic organ prolapse. Int Urogynecol J 2013;24(11):1783–90.CrossRefGoogle ScholarPubMed
Gutman, RE, Ford, DE, Quiroz, LH, Shippey, SH, Handa, VL. Is there a pelvic organ prolapse threshold that predicts pelvic floor symptoms? Am J Obstet Gynecol 2008;199(6):683.e17.CrossRefGoogle Scholar
de Boer, TA, Salvatore, S, Cardozo, L, Chapple, C, Kelleher, C, van Kerrebroeck, P, et al. Pelvic organ prolapse and overactive bladder. Neurourol Urodyn 2010;29(1):30–9.CrossRefGoogle ScholarPubMed
Bo, K, Frawley, HC, Haylen, BT, Abramov, Y, Almeida, FG, Berghmans, B, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction. Int Urogynecol J 2017;28(2):191213.CrossRefGoogle ScholarPubMed
Li, C, Gong, Y, Wang, B. The efficacy of pelvic floor muscle training for pelvic organ prolapse: a systematic review and meta-analysis. Int Urogynecol J 2016;27(7):981–92.CrossRefGoogle ScholarPubMed
Barber, MD, Brubaker, L, Burgio, KL, Richter, HE, Nygaard, I, Weidner, AC, et al. Comparison of 2 transvaginal surgical approaches and perioperative behavioral therapy for apical vaginal prolapse: the OPTIMAL randomized trial. JAMA 2014;311(10):1023–34.CrossRefGoogle ScholarPubMed
Hagen, S, Stark, D. Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database Syst Rev 2011(12):Cd003882.Google ScholarPubMed
Cited by

Send book to Kindle

To send this book to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle.

Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats

Send book to Dropbox

To send content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about sending content to Dropbox.

Available formats

Send book to Google Drive

To send content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about sending content to Google Drive.

Available formats