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Pelvic floor, prolapse, fecal incontinence, constipation

Mariya Kobi, Milana Flusberg, Viktoriya Paroder, Victoria Chernyak
Pelvic floor dysfunction encompasses a spectrum of functional disorders that result from impairment of the ligaments, fasciae, and muscles supporting the pelvic organs. It is a prevalent disorder that carries a lifetime risk over 10% for undergoing a surgical repair. Pelvic floor weakness presents as a wide range of symptoms, including pain, pelvic pressure or bulging, urinary and fecal incontinence, constipation, and sexual dysfunction. A correct diagnosis by clinical examination alone can be challenging, particularly in cases involving multiple compartments...
May 2018: Journal of Magnetic Resonance Imaging: JMRI
Luciana P Chamié, Duarte Miguel Ferreira Rodrigues Ribeiro, Angela H M Caiado, Gisele Warmbrand, Paulo C Serafini
Pelvic floor dysfunction (PFD) is a common condition that typically affects women older than 50 years and decreases the quality of life. Weakening of support structures can involve all three pelvic compartments and cause a combination of symptoms, including constipation, urinary and fecal incontinence, obstructed defecation, pelvic pain, perineal bulging, and sexual dysfunction. The causes of PFD are complex and multifactorial; however, vaginal delivery is considered a major predisposing factor. Physical examination alone is limited in the evaluation of PFD; it frequently leads to an underestimation of the involved compartments...
January 2018: Radiographics: a Review Publication of the Radiological Society of North America, Inc
Shuqing Ding
Pelvic floor biofeedback therapy is safe and effective in chronic constipation, urinary incontinence, fecal incontinence and pelvic floor pain whereas the heterogeneous indication affects the efficacy evaluation and technical communication. The best indications are as follows: (1) Pelvic floor myogenic dysfunction without severe pelvic organ prolapse and severe neurogenic defect; (2) Patients have good mental cognition and treatment adherence who fulfill the training with the therapist. The training protocol is conducted at hospital or at home, and is as follows: (1) To help patients to target the pelvic floor muscles; (2) To improve the type I( muscle tonic contraction variability; (3) To improve the pelvic floor type I( and type II( muscles activity coordination; (4) To enhance the pelvic floor muscle strength and rectum defecation awareness...
December 25, 2017: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
Adil E Bharucha, Satish S C Rao, Andrea S Shin
The purpose of this clinical practice update expert review is to describe the key principles in the use of surgical interventions and device-aided therapy for managing fecal incontinence (FI) and defecatory disorders. The best practices outlined in this review are based on relevant publications, including systematic reviews and expert opinion (when applicable). Best Practice Advice 1: A stepwise approach should be followed for management of FI. Conservative therapies (diet, fluids, techniques to improve evacuation, a bowel training program, management of diarrhea and constipation with diet and medications if necessary) will benefit approximately 25% of patients and should be tried first...
December 2017: Clinical Gastroenterology and Hepatology
Cheryl B Iglesia, Katelyn R Smithling
Pelvic organ prolapse is the descent of one or more of the anterior vaginal wall, posterior vaginal wall, the uterus (cervix), or the apex of the vagina (vaginal vault or cuff scar after hysterectomy). Prevalence increases with age. The cause of prolapse is multifactorial but is primarily associated with pregnancy and vaginal delivery, which lead to direct pelvic floor muscle and connective tissue injury. Hysterectomy, pelvic surgery, and conditions associated with sustained episodes of increased intra-abdominal pressure, including obesity, chronic cough, constipation, and repeated heavy lifting, also contribute to prolapse...
August 1, 2017: American Family Physician
F Ris, K J Gorissen, J Ragg, M P Gosselink, N C Buchs, R Hompes, C Cunningham, O Jones, A Slater, I Lindsey
BACKGROUND: Laparoscopic ventral mesh rectopexy (LVMR) has become a well-established treatment for symptomatic high-grade internal rectal prolapse. The aim of this study was to identify proctographic criteria predictive of a successful outcome. METHODS: One hundred and twenty consecutive patients were evaluated from a prospectively maintained pelvic floor database. Pre- and post-operative functional results were assessed with the Wexner constipation score (WCS) and Fecal Incontinence Severity Index (FISI)...
August 2017: Techniques in Coloproctology
Alex Arnouk, Elise De, Alexandra Rehfuss, Carin Cappadocia, Samantha Dickson, Fei Lian
PURPOSE OF REVIEW: The purpose of the study was to catalog the most recent available literature regarding the use of conservative measures in treatment of pelvic floor disorders. RECENT FINDINGS: Pelvic floor disorders encompass abnormalities of urination, defecation, sexual function, pelvic organ prolapse, and chronic pain, and can have significant quality of life implications for patients. Current guidelines recommend behavioral modifications and conservative treatments as first-line therapy for pelvic floor disorders...
June 2017: Current Urology Reports
José Ananias Vasconcelos Neto, Camila Teixeira Moreira Vasconcelos, Sthela Maria Murad Regadas, Leonardo Robson Pinheiro Sobreira Bezerra, Kathiane Augusto Lustosa, Sara Arcanjo Lino Karbage
INTRODUCTION AND HYPOTHESIS: The aim of this study was to evaluate the correlations between the POP-Q Bp point and the perineal body (Pb) and genital hiatus (Gh) measurements and constipation, anal incontinence, severity of symptoms and quality of life. METHODS: The patients were distributed into two groups according to the posterior vaginal wall Bp point: one group with Bp ≤-1 (without posterior vaginal wall prolapse, control group) and the other group with Bp ≥0 (with posterior vaginal wall prolapse, case group)...
September 2017: International Urogynecology Journal
Kyla Joubert, Jonathan A Laryea
Rectal prolapse is a debilitating condition with a complex etiology. Symptoms are most commonly prolapse of the rectum and pain with bowel movements or straining, with worsening fecal incontinence over time due to progressive stretching of the anal sphincters. Physical findings are fairly consistent from patient to patient-most notably diastasis of the levator ani muscles, deep pouch of Douglas, redundant sigmoid colon, a mobile mesorectum, and occasionally a solitary rectal ulcer. Evaluation includes a physical exam or imaging demonstrating the prolapse, and evaluating for other causes of pelvic floor dysfunction...
February 2017: Clinics in Colon and Rectal Surgery
Jan J van Iersel, Chris J de Witte, Paul M Verheijen, Ivo A M J Broeders, Egbert Lenters, Esther C J Consten, Steven E Schraffordt Koops
BACKGROUND: Pelvic floor disorders are a major public health issue. For female genital prolapse, sacrocolpopexy is the gold standard. Laparoscopic ventral mesh rectopexy is a relatively new and promising technique correcting rectal prolapse. There is no literature combining the 2 robotically assisted techniques. OBJECTIVE: This study was designed to evaluate the safety, quality of life, and functional and sexual outcomes of robot-assisted sacrocolporectopexy for multicompartment prolapse of the pelvic floor...
October 2016: Diseases of the Colon and Rectum
Thomas Frieling
Fecal incontinence is defined by the unintentional loss of solid or liquid stool, and anal incontinence includes leakage of gas and / or fecal incontinence. Anal-fecal incontinence is not a diagnosis but a symptom. Many patients hide the problem from their families, friends, and even their doctors. Epidemiologic studies indicate a prevalence between 7-15 %, up to 30 % in hospitals and up to 70 % in longterm care settings. Anal-fecal incontinence causes a significant socio-economic burden. There is no widely accepted approach for classifying anal-fecal incontinence available...
August 2016: Deutsche Medizinische Wochenschrift
Sumerova Natalia, Neuman Menahem, Krissi Haim, Pushkar Dmitri
OBJECTIVES: To evaluate the feasibility, safety and surgical results of skeletonized mesh implants to form a pelvic harness for pelvic floor reconstruction surgery. STUDY DESIGN: Patients with advanced pelvic floor prolapse were enrolled to this study. Study model was a kit mesh, reduced to 75% of the original surface area by cutting out mesh material from the central mesh body. Patients were evaluated at the end of the 1st and 6th post-operative months and interviewed at the study conclusion...
May 2016: International Braz J Urol: Official Journal of the Brazilian Society of Urology
Uduak U Andy, Heidi S Harvie, Avita P Pahwa, Alayne Markland, Lily A Arya
AIMS: To determine if fecal incontinence (FI) is associated with constipation and defecatory symptoms in women with urinary incontinence, fecal incontinence, and pelvic organ prolapse. METHODS: Cross-sectional study of women seeking care for urinary incontinence, fecal incontinence, and pelvic organ prolapse. FI was defined as a positive response to the question, "During the last 4 weeks how often have you leaked or soiled yourself with stool?" Constipation and defecatory symptoms, including straining, sensation of incomplete emptying, and splinting, were measured using the Birmingham Bowel Symptom Questionnaire and the Colorectal Anal Distress Inventory...
February 2017: Neurourology and Urodynamics
Liliana Bordeianou, Caitlin W Hicks, Adriana Olariu, Lieba Savitt, Samantha J Pulliam, Milena Weinstein, Todd Rockwood, Patricia Sylla, James Kuo, May Wakamatsu
BACKGROUND: The association between an objective measure of fecal incontinence severity and patient-reported quality of life is poorly understood. OBJECTIVE: The purpose of this study was to evaluate patients with various degrees of fecal incontinence to determine whether their quality of life as measured by the Fecal Incontinence Quality of Life Scale is affected by coexisting pelvic floor disorders. DESIGN: This was a prospective, survey-based study...
November 2015: Diseases of the Colon and Rectum
Desiree M J Vrijens, Jolanda I Spakman, Gommert A van Koeveringe, Bary Berghmans
OBJECTIVES: To assess patient-reported outcome and satisfaction regarding urinary incontinence 1 year after the end of treatment in a multidisciplinary pelvic care clinic. METHODS: A total of 647 patients with urinary incontinence seen in an academic multidisciplinary pelvic care clinic were prospectively included in a specific triage system. Patient-reported improvement of urinary incontinence and patient satisfaction were assessed by telephone survey 1 year after the end of treatment...
November 2015: International Journal of Urology: Official Journal of the Japanese Urological Association
Marc Beer-Gabel, Dan Carter
INTRODUCTION: X-ray defecography is considered the gold standard for imaging pelvic floor pathology. However, it is limited by the capability to demonstrate only the posterior pelvic compartment, significant radiation exposure, and inconvenience. Dynamic transperineal ultrasound (DTP-US) can visualize all of three pelvic floor compartments, is free of radiation, and does not cause significant discomfort. The aim of this study was to evaluate the level of consistency between defecography (DEF) and DTP-US in the diagnosis of pelvic floor deformations...
June 2015: International Journal of Colorectal Disease
Bary Berghmans, Fred Nieman, C Leue, M Weemhoff, S Breukink, G van Koeveringe
AIMS: (i) To describe and analyse pelvic floor dysfunction symptoms in women referred to a Pelvic Care Centre (PCC). (ii) To describe the triage process of the same patients based on response to a first-contact interview. METHODS: Triage started with a telephone interview using previously constructed questions, asking for seven types of PF complaints during the preceding 6 months. If present, complaint severity was registered on a 0-10 scale. Next, these first-contact complaints were used to describe patient case mix profiles using cross-tabular analysis...
April 2016: Neurourology and Urodynamics
Suzanne M Mugie, D Gregory Bates, Jaya B Punati, Marc A Benninga, Carlo Di Lorenzo, Hayat M Mousa
BACKGROUND: Defecography is a study to assess anorectal function during evacuation. OBJECTIVE: To investigate the value of fluoroscopic defecography in directing diagnostic and therapeutic management in children with defecation disorders. MATERIALS AND METHODS: We reviewed all fluoroscopic defecography studies performed (2003-2009) in children with defecation problems and normal anorectal motility studies. Results were classified into three groups: (1) normal pelvic floor function; (2) pelvic floor dyssynergia, including incomplete relaxation of pelvic musculature, inconsistent change in anorectal angle and incomplete voluntary evacuation; (3) structural abnormality, including excessive pelvic floor descent with an intra-rectal intussusception, rectocele or rectal prolapse...
February 2015: Pediatric Radiology
Laura García del Salto, Jaime de Miguel Criado, Luis Felipe Aguilera del Hoyo, Leticia Gutiérrez Velasco, Patricia Fraga Rivas, Marcos Manzano Paradela, María Isabel Díez Pérez de las Vacas, Ana Gloria Marco Sanz, Eduardo Fraile Moreno
Pelvic floor weakness is a functional condition that affects the anatomic structures supporting the pelvic organs: fasciae, ligaments, and muscles. It is a prevalent disorder among people older than 50 years, especially women, and may substantially diminish their quality of life. Many complex causes of pelvic floor weakness have been described, but the greatest risk factors are aging and female sex. Pelvic floor weakness can provoke a wide range of symptoms, including pain, urinary and fecal incontinence, constipation, difficulty in voiding, a sense of pressure, and sexual dysfunction...
September 2014: Radiographics: a Review Publication of the Radiological Society of North America, Inc
Leonardo Robson Pinheiro Sobreira Bezerra, José Ananias Vasconcelos Neto, Camila Teixeira Moreira Vasconcelos, Sara Arcanjo Lino Karbage, Amene Cidrão Lima, Isabella Parente Ribeiro Frota, Adriana Bombonato de Oliveira Rocha, Sandra Rebouças Macedo, Cassia Fernandes Coelho, Marília Karla Nunes Costa, Geisele Cavalcante de Souza, Sthela Murad Regadas, Kathiane Lustosa Augusto
INTRODUCTION AND HYPOTHESIS: Little information is available on the recurrent coexistence of pelvic organ prolapse (POP), urinary (UI) and/or anal (AI) incontinence and defecatory dysfunctions and the relationship between these disorders. The purpose of this study is to report the prevalence, bother, and impact on quality of life (QoL) of unreported bowel symptoms in women presenting to a Brazilian tertiary urogynecology clinic. METHODS: The study was a cross-section survey of 172 patients with symptoms of pelvic floor disorders (PFD)...
July 2014: International Urogynecology Journal
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