Pelvic Floor Disorders
The pelvic floor is a set of muscles that form a hammock or sling around the opening of the pelvis. The pelvic organs, including the womb (uterus), rectum and bladder, are held in position by the pelvic floor muscles and the surrounding tissues. The incidence of pelvic floor disorders increases when the muscles of the pelvic floor and connective tissue are injured or weakened. Some of the common pelvic floor disorders include pelvic organ prolapse, urinary incontinence, and anal incontinence.
One of the most common conditions that colorectal surgeon can encounter during practice are patient complaining symptoms of difficulties in emptying the rectum and passing the stool. In same circumstances the diagnosis is pretty obvious as the presence of an external abnormality can be identified based of the history given by the patient and confirmed during physical examination. This is typically the case of complete RectalProlapse. In other and most frequent circumstances no abnormalities can be detected on examination on patient reporting difficulties in emptying the rectum and therefore commonly needing to return to the toilet several time to finally achieved a satisfactory bowel motion. This condition, which is called obstructed defecation may identify different causes but the most common is certainly the one called Ano-rectal intussusception which is caused upper segment of the rectum to telescope into the lower part of the anal canal causing an obvious obstruction during the expulsion phase of the defecation. This condition can be diagnosed using special tests such as x-ray dynamic proctogram or dynamic MRI of the pelvis. More recently a tri-dimensional or 3D US of the anal canal and lower rectum and a Dynamic pelvic US have been introduced to investigate pelvic floor conditions. This type of investigation minimize the inconvenience for the patient to undergo further testing and it can be done in the office at the time of the initial consultation. This service will be very soon available at Harley Colorectal Clinic and it will definitively enhance the quality of care for the assessment of pelvis floor conditions. In addition to that we will be introducing an express modality of assessment of the function of the anal sphincter muscles called Anopress, which is done in the office during the initial consultation allowing accurate and immediate results. Depending on the results of the combined investigations, surgery may be offered to the patient in order to correct the condition which is causing the abnormality. In case of complete Rectal prolapse and anorectal intussusception surgery is performed through laparoscopy in order to fix the rectal segment which is telescoping into the lower part of the ano-rectum, preventing the blockage during defecation. This surgery is called Laparoscopic Ventral Mesh Rectopexy and it is illustrated in the Video Educational Section.
In case of defect of the sphincter muscle due to injuries or weakness demonstrated by US and Manometry, corrective surgery may be offered to the patient with different techniques that go from Sphincter augmentation, US guided implantation in the anal sphincter area of expandable beads which create additional cushions enhancing the continence, to Sacral Nerve Stimulation for the most severe cases, which consists with implantation under local anesthesia of an internal micro-wiring stimulator in the sacral bone controlled by the patient via remote control. Both procedures will be available in 2017 with the collaboration of Prof Giulio Santoro who is a world wide leading expert in the field of pelvic floor.
To visit the password protected educational video and presentation section please click.
For every communication or further request of information please contact
Miss Hannah Giron
Medical Secretary to Dr. M Cristaldi