Saturday, 11th July 2020
BEAUTY Article
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This Month's Magazine
Functional disorders of the pelvic floor.

Functional disorders of the pelvic floor.

The pelvis holds and contains the pelvic organs.

The so-called pelvic floor is made of the anatomical structures, especially muscles and supporting tissues that hold the pelvic organs: bladder, uterus, ovaries and rectum in women, and bladder, prostate and rectum in men. These organs can be affected by organic diseases (infections, tumours, inflammatory diseases), as well as by functional disorders, which means alteration of their function: urinary incontinence or voiding difficulties, faecal incontinence or constipation, and sexual dysfunction: erection troubles in men, dyspareunia (sexual intercourse painful or impossible) in women, among other problems.
Therefore, there are different specialists involved in the assessment and treatment of these complaints (urologists, gynaecologists, colorectal surgeons, physiologists, psychologists), which are much more frequent than one could expect: even doctors may have difficulties to diagnose and treat such common disorders due the reluctance of patient to tell about their problems.
These problems can often be linked: continence problems, especially in women, can be urinary and faecal, constipation due to evacuation disorders can coexist with dyspareunia. Sometimes, assessment and treatment by the different specialists involved is difficult, unless they work in a coordinated fashion in a Pelvic Floor Unit.


Can functional disorders of the pelvic floor be treated?
The answer is yes: there is a wide range of treatments available for the different problems: there are dietary, pharmacological (drugs), behavioural (retraining, biofeedback), psychotherapic and different surgical solutions that can be used, depending on the case. Latest techniques include sacral nerve stimulation, artificial urinary and bowel sphincters, muscle transpositions, and the convenience of their use will be properly assessed by the specialists of a Pelvic Floor Unit.

Pelvic floor dysfunctions:
(as an example, I shall only include those that relate to anorectal functional disorders)

Defaecation disorders:

  • Constipation (outlet obstruction):
    -Paradoxical contraction of the sphincters.
    -Solitary rectal ulcer syndrome.
    -Descending perineum syndrome.
    -Rectal prolapse (external or internal).
  • Faecal incontinence:
    -Traumatic (deliveries with lesions of sphincters muscles or nerves, surgery of the sphincters  for anal fistulas or fissures).
    -Neurogenic (lesions of the nerves supplying rectum and sphincter muscles).
    -Idiopathic (unknown origin, although this is less frequent each time due to the improvement in  diagnostic procedures).

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