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Objective: To compare the incidence of joint hypermobility and prolapse in incontinent and continent women with Ehlers-Danlos syndrome (EDS)., Methods: Forty-six patients with EDS were evaluated by history and physical examination. The degree of joint mobility of shoulder, elbow, wrist, hip, knee, and ankle was evaluated by orthopedic surgeons and physical therapists. Joint range of motion measurements were obtained using an orthopedic goniometer., Results: The two EDS groups, incontinent (n = 28) and continent (n = 18) women, had a statistically similar mean age, weight, and parity (p = NS). In the EDS population overall joint hypermobility averaged 34.3%. Individuals with EDS type 3 had significantly more joint hypermobility than those with type 1 and 2 EDS. However, logistic regression analysis demonstrated no significant relationship between prolapse and joint hypermobility. Wrist dorsiflexion (p < 0.05) and palmar flexion (p = 0.05) were the only variables related to incontinence., Conclusion: It has previously been reported that hypermobility was correlated with pelvic floor prolapse. Of 18 joint measures per patient, hypermobility of both wrist dorsiflexion and palmar flexion was associated with symptoms of incontinence. We were unable to document an association between joint hypermobility and prolapse in the EDS population.

Objective: We characterized the population with Ehlers-Danlos syndrome with regard to genital prolapse, urinary incontinence, and other gynecologic disorders., Methods: Forty-one adult women who had registered for a first-ever Ehlers-Danlos multidisciplinary clinic participated in the study. Each had a comprehensive standardized evaluation, including gynecologic history, physical examination, urodynamic testing, and physical therapy evaluation. Qualitative and quantitative data were analyzed to determine means for various gynecologic disorders of Ehlers-Danlos syndrome., Results: The frequencies of incontinence complaints (59%), endometriosis (27%), dyspareunia (57%), and previous hysterectomy (44%) were higher than expected for a population with a mean age of 41 years. Incontinence could not be demonstrated objectively. Prolapse was diagnosed in 12 (29.3%)., Conclusions: Careful attention should be paid to women with Ehlers-Danlos syndrome because of an association with many gynecologic complaints. Women with Ehlers-Danlos syndrome should be questioned regarding incontinence, genital prolapse, endometriosis, and dyspareunia.

The key to successful management of urinary incontinence in the older woman is accurate diagnosis of the underlying condition. A simple 30-minute in-office evaluation answers the important questions that increase the likelihood of reaching the correct diagnosis. This core evaluation includes a history and physical exam, urinalysis and other basic lab tests, assessment of urethral angulation, and a simple cystometrogram. A patient voiding diary may also help to pinpoint the severity of incontinence. Further testing is required if symptoms fail to resolve after empiric therapy.

This study assessed the effectiveness of a pelvic floor rehabilitation program in a clinical practice. A retrospective convenience sample of 48 women was evaluated pretreatment and posttreatment with follow-up interviews from six months to three years. This group consisted of 81% with stress urinary incontinence, 6% with unstable bladder and 10% with mixed incontinence. Fecal incontinence was present as well in 35% of the subjects. The patients were taught pelvic floor muscle exercises and instruction reinforced with electromyographic biofeedback. Neuromuscular electrical stimulation was used when clinically indicated. Two women did not continue the program beyond the first visit and were excluded. Sixty-two percent of patients with two or more visits demonstrated an improvement. Thirteen percent were completely dry, and 49% demonstrated a significant improvement. Patients with genuine stress urinary incontinence, unstable bladder and mixed incontinence showed a 66%, 33% and 50% improvement rate, respectively. Fecal incontinence was improved in 63% of women trained in pelvic floor muscle exercises. A significant decrease (P < .001) was found in the frequency of self-reported leakage at the six-month to three-year follow-up. The strength and duration of a pelvic muscle contraction was significantly greater between the first and last visit in all patients, regardless of the subjective improvement. A pelvic floor rehabilitation program was an effective alternative to surgical intervention in reducing the frequency of urinary leakage. Further studies are needed to identify factors predicting success and to determine the most cost-effective method of achieving pelvic floor rehabilitation.

History and physical examination do not always correlate with final urodynamic diagnoses in incontinent women. A large number of diagnostic procedures are available to help the clinician establish the correct diagnosis. The importance of urine culture, Q-tip test, ultrasound, pessary test for potential incontinence, neurophysiologic testing, endoscopy, urethral pressure profiles, stress/pad tests, uroflowmetry, and cystometry are discussed. The physician should understand the importance and limitations of each of the different investigative procedures.

The management of urinary incontinence is frequently ineffective. Inappropriate surgical intervention can convert medically treatable incontinence into a more serious and less remediable condition. To allow a more scientific approach to management, we have developed a scoring system for female incontinence based on three primary controlling factors: (1) the direction of the urethra, (2) the urethral vesical angle and (3) the urethral pressure profile. For each factor a score of 1 to 3 was assigned according to the deviation from normal anatomy or function. Scores ranged from 3 to 9. Patients scoring 6 to 9 were treated surgically, by ventral suspension of the bladder neck and urethra. Patients scoring 3 to 5 were treated medically and underwent surgery only if indicated for other pathology. Thirty-three patients were evaluated and treated with this approach, with a one- to two-year follow-up. This system appears to provide an objective method of choosing between surgical and medical therapy for urinary incontinence.