Ultrasound in the investigation of pelvic floor disorders

Translabial ultrasound with systems designed for obstetric imaging is now the commonest diagnostic modality in pelvic floor medicine. This review will outline current clinical utility and introduce recent research in the investigation of pelvic floor disorders, such as urinary and anal incontinence, pelvic organ prolapse, obstructed defecation and of complications after sling and mesh surgery.There has been significant progress in standardization of imaging methods, and the International Urogynecology Association has developed an online course encouraging this standardization. Tomographic methods are increasingly used for imaging of the levator ani and anal canal. Several comparative studies have investigated concordance between tomographic translabial imaging and competing methods, and the widespread availability of equipment has facilitated interethnic comparative studies. Several meta- analyses have investigated risk factors for major pelvic floor trauma and the role of pelvic floor abnormalities in prolapse recurrence after surgery.The widespread use of imaging has the potential to change the management of pelvic floor morbidity, such as urinary and anal incontinence, pelvic organ prolapse and related conditions. Even in units and locations where the required systems are not easily accessible, the insights provided by real-time imaging will enhance diagnostic and therapeutic capabilities.