International Journal of Clinical Case Reports, 2025, Vol.15, No.1, 34-43 http://medscipublisher.com/index.php/ijccr 35 2 Understanding Pelvic Floor Dysfunction 2.1 Definition and classification of PFD Pelvic Floor Dysfunction (PFD) refers to a range of disorders that occur when the muscles and connective tissues of the pelvic floor are weakened or impaired. This can lead to issues such as urinary incontinence, fecal incontinence, and pelvic organ prolapse. PFD is often classified based on the specific type of dysfunction, such as stress urinary incontinence, urgency urinary incontinence, and fecal incontinence (Louis-Charles et al., 2019; Lakomy et al., 2022). The classification helps in tailoring specific treatment strategies and understanding the underlying pathophysiology, which involves multiple body systems including musculoskeletal, urinary, anorectal, and sexual systems (Gleason, 2021). 2.2 Common symptoms and their impact on quality of life Common symptoms of PFD include urinary incontinence, fecal incontinence, pelvic organ prolapse, and sexual dysfunction, all of which can significantly impact a patient's quality of life. These symptoms can lead to physical discomfort, emotional distress, and social embarrassment, affecting daily activities and overall well-being (Verbeek and Hayward, 2019; Brennen et al., 2020; Opławski et al., 2021). For instance, urinary incontinence and fecal incontinence can cause anxiety and depression due to the fear of accidents in public, while sexual dysfunction can strain intimate relationships and reduce sexual satisfaction (Hazewinkel et al., 2010; Huffman et al., 2016; Cyr et al., 2020). Addressing these symptoms through appropriate interventions is crucial for improving the quality of life in affected individuals. 2.3 Epidemiology and prevalence in post-surgical gynecological cancer patients PFD is highly prevalent among gynecological cancer survivors, with studies indicating a higher prevalence compared to the general female population (Rutledge et al., 2010). For example, the prevalence of stress urinary incontinence, urgency urinary incontinence, and fecal incontinence can increase significantly after treatments such as surgery and radiation therapy for gynecological cancers (Ramaseshan et al., 2017). In uterine cancer survivors, the prevalence of urinary incontinence and dyspareunia can range from 2% to 44% and 7% to 39%, respectively, post-treatment. The high prevalence of PFD in this population underscores the need for targeted interventions and comprehensive survivorship care plans to address these issues effectively (Marcu et al., 2023). 3 Pathophysiology of Pelvic Floor Dysfunction Post-Surgery 3.1 Mechanisms of pelvic floor damage during gynecological malignancy surgery Pelvic Floor Dysfunction (PFD) following gynecological malignancy surgery is primarily attributed to the mechanical and structural alterations that occur during surgical procedures. The surgical removal of pelvic organs, such as in hysterectomy, can lead to significant changes in the pelvic anatomy, resulting in weakened support structures and altered pelvic floor dynamics (Liu et al., 2022). The disruption of the pelvic floor's integrity is often due to the extensive resection of tissues, which can compromise the support provided by the pelvic muscles and connective tissues. Additionally, surgical techniques that involve extensive dissection and manipulation of pelvic structures can exacerbate these effects, leading to increased risk of PFD (Wu et al., 2023). The type of surgical procedure also plays a crucial role in the extent of pelvic floor damage. For instance, total hysterectomy has been identified as a significant risk factor for PFD, as it involves the removal of the uterus and potentially other supporting structures, which can destabilize the pelvic floor (Liu et al., 2023). Moreover, the surgical approach, whether open or minimally invasive, can influence the degree of trauma to the pelvic floor, with open surgeries often associated with greater tissue disruption. 3.2 Role of nerve injury, tissue scarring, and radiation therapy Nerve injury is a critical factor in the development of PFD post-surgery. During gynecological surgeries, the pelvic nerves, which are essential for maintaining muscle tone and function, can be inadvertently damaged, leading to impaired neuromuscular control of the pelvic floor (Dugan, 2021). This nerve damage can result in symptoms such as urinary incontinence and pelvic organ prolapse, which are common manifestations of PFD (Verbeek and Hayward, 2019).
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