Introduction 13 Fig. 3. POP-Q examination (From Bump RC et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 1996;175:10) Reproduced with permission of the publisher. Urinary incontinence (UI) is defined as the complaint of involuntary loss of urine, or the observations of involuntary loss of urine on examination. The three most common types of urinary incontinence are stress urinary incontinence (SUI), urge urinary incontinence (UUI) and mixed urinary incontinence (MUI). SUI is a condition of involuntary loss of urine on effort or physical exertion including sporting activities, or on sneezing or coughing. UUI is a condition where the involuntary loss of urine is associated with a feeling of urgency. Urgency is characterized by the sensation of a sudden, compelling desire to void which is difficult to defer. When both UUI and SUI are present, the term mixed urinary incontinence is used.4 A close association between prolapse and urinary incontinence has been reported.10 Prolapse repair may also result in the resolution of UI symptoms.11,12 The Integral Theory suggests that lax ligaments may lead to apical prolapse and urinary incontinence.13 Overall, treatment for prolapse and urinary incontinence is only indicated if the patient has symptoms for which she seeks therapy. In rare cases, advanced prolapse may compromise renal function due to ureteral obstruction, necessitating intervention to preserve renal function, or lead to vaginal bleeding due to erosive lesions. Apart from these cases, there are no absolute indications for intervention. Therefore, watchful waiting is a reasonable option for women with mild symptoms. Active treatment options include conservative and surgical approaches. An informed choice of treatment depends on the patient’s preferences.
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