Pelvic Floor Disorders Evaluation and Treatment

Maher A. Abbas, MD
Compassion, Excellence, Integrity

Diplomate, American Board of Surgery

Diplomate, American Board of Colon and Rectal Surgery

Fellow, American College of Surgeons

Fellow, American Society of Colon and Rectal Surgeons

“The best interest of the patient is the only interest to be considered…”W.J. Mayo, MD (Founder of the Mayo Clinic)

Dr. Maher Abbas is an American Board Certified Colon and Rectal Surgeon who performs the latest and most advanced procedures to treat conditions affecting the small intestine, colon, rectum, and anus.  He is a leader in minimally invasive and endoscopic surgery. With over 14,000 operations and procedures experience, he provides state of the art treatment to his patients.

What are pelvic floor disorders?

Pelvic floor disorders are conditions that affect the structures of the pelvis including the internal organs such as the anus, rectum, bladder, prostate, uterus, vagina, and the supporting muscles of the pelvis.  Both men and women are affected.  Risk factors that contribute to the development of pelvic floor disorders include childbirth injuries, trauma, previous surgery such as hysterectomy (removal of the uterus), neurologic disorders, cancer, previous radiation therapy, inflammatory bowel disease, diverticulitis, and constipation.  The following is a list of pelvic floor disorders:

    • Anal incontinence
      • Childbirth injuries
      • Prior anal surgery
      • Trauma injuries
    • Chronic pelvic and rectal pain
      • Endometriosis
    • Constipation
      • Difficulty with evacuation
      • Incomplete evacuation with self-digitation
      • Incomplete relaxation of the pelvic floor muscles (anismus, paradoxical puborectalis contraction)
    • Fistula conditions (communication between 2 organs)
    • Radiation proctitis (inflammation of the rectum)
    • Rectocele (internal protrusion of the rectum into vagina)
    • Weakness of the pelvic floor
      • Bulge or descent
      • Perineal hernia

 

What are the symptoms of pelvic floor disorders?

Because pelvic floor disorders affect the various pelvic organs, their symptoms can vary and include the following:

  • Anal or rectal protrusion
  • Bladder infection
  • Constipation
  • Diarrhea
  • Difficulty with evacuation
  • Gas or stool passage into the urine
  • Gas, pus, or stool passage into the vagina
  • Heaviness or pressure in the vagina
  • Lack of stool control
  • Pain during sexual intercourse
  • Pelvic or rectal pain
  • Rectal bleeding
  • Vaginal drainage
  • Vaginal yeast infections
  • Wetness of anus

 

How are pelvic floor disorders evaluated?

The most important part of the evaluation is the history provided by the patient and the office-based examination performed by Dr. Maher Abbas.   In addition, several tests can be very helpful in making the proper diagnosis. They include:

  • Blood tests: thyroid hormones, calcium level, hormones level.

  • Imaging studies: colonic transit study to check for colon function and motility.  In this procedure, the patient swallows a capsule that contains small ring markers which travel through the intestine.  XRAY films are obtained 3 and 5 days later to assess how fast these markers travel through the colon.

Dynamic MRI (magnetic resonance imaging) defecography to check for pelvic floor function.  During this procedure, gel material is inserted into the rectum and in some cases the vagina.  MRI pictures are obtained at rest and while the patient tries to defecate.  This test provides the opportunity to visualize the internal pelvic organs in action.  MRI can be helpful in diagnosing other disorders such as endometriosis.

Gastrografin or barium enema, vaginogram, and cystogram are XRAY studies that entail injecting contrast into the various orifices to check for a fistula communication between the pelvic organs.

Ultrasound of the anus visualizes the sphincter muscles and along with MRI can be used to assess patients with anal incontinence.

Anorectal Manometry test to evaluate the anal sphincter muscle function and relaxation. Pudendal nerve testing and anal EMG (electromyography) can evaluate the function of the nerve supply to the anus. Patients with disorders affecting the bladder or gynecologic organs may benefit from additional tests like cystoscopy (looking inside the bladder) and vaginoscopy (looking inside the vagina).  A multispecialty evaluation with a urologist and a gynecologist specializing in the management of pelvic floor disorders is sometimes necessary for a complete assessment.

 

What treatment options do patients have?

Medical Treatment

 

The most important step in managing pelvic floor disorders is making the correct diagnosis in order to make the proper treatment recommendations.  Many patients with pelvic floor disorders can be managed with a combination of medications, dietary modifications, and physical therapy.  Several medications and supplements can be helpful depending on the patient’s symptoms.  They include anti-diarrheal medications, Fiber Supplements, and Laxatives and Stool Softeners.  Rectal Irrigation is useful in patients with difficulty emptyingA High Fiber Diet is recommended in some patients. Depending on your condition, Dr. Maher Abbas may recommend Biofeedback and refer you to a physical therapist. 

Surgical Treatment

 

Some pelvic floor disorders are best treated by a surgical intervention.  When a surgical procedure is indicated, the expertise of the surgeon can make a huge difference for the patient.  Choosing the appropriate intervention based on the patient’s symptoms and findings is of paramount importance.

 

Dr. Maher Abbas is an American board-certified colorectal surgeon with special interest in pelvic floor disorders.  He provides the entire spectrum of operations including Minimally Invasive Laparoscopic Surgery (camera keyhole surgery) and the latest technologies such as Implantable Devices for Incontinence.  In addition, he has extensive expertise in performing Complex Pelvic Surgery in patients with complex disorders, especially those who have been previously operated.

If you would like to schedule a consultation with Dr. Maher Abbas to discuss and evaluate your condition, click here. If you have previously undergone any operation or tests related to your condition, kindly bring all outside reports for Dr. Maher Abbas to review the day of your consultation.

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