PELVIC FLOOR DISORDERS CENTER
Pelvic floor disorders are a very important health problem that is quite common at global scale and has negative effects on quality of life. Although pelvic floor disorders are such prevalent in population, this group of disorders have been ignored by doctors and patients due to difficulties to talk about complaints, insufficiencies of diagnostic phases and lack of required attention.
People with pelvic floor disorders face limitations in terms of daily social life. Negative effects on work, family and social lives may lead to social isolation in these people. Regarding pelvic floor disorders as a matter of fate and resultant reluctance to find a solution is a very common public fallacy.
Since pelvic floor and its disorders are complex, it is appropriate to have these disorders examine by more than one medical department (multidisciplinary approach). Pelvic Floor Disorders Center of American Hospital primarily aims to evaluate patients with pelvic floor disorders from a multidisciplinary point of view and follow up them through personalized diagnosis, treatment and care.
‘Pelvic area’ is located inside the pelvic bones at lowest part of the body. Pelvic organs that take role in urination (urinary bladder, urethra and prostate gland), reproduction (uterus, ovaries and vagina) and defecation (rectum and anus) are present in this cavity.
Pelvic floor is a structure that is suspended between the anterior part of pubis and inferior part of the spinal column (sacrococcygeal bone) just like a hammock, forms a part of pelvic bone’s floor and consists of muscles, connective tissue and nerves.
- Pelvic floor creates a lever effect on pelvic organs (urinary bladder, uterus and rectum) through muscle tone and thus, it ensures that pelvic organs stay at normal anatomic position. Thus, prolapse of organs is prevented.
- It also helps urinary and fecal continence by surrounding anus and external orifice of the urinary tract. It prevents excretion through contractions, if required, and it ensures prevention of uncontrolled gas, stool or urine leaks (incontinence).
- When it is appropriate to meet the urination and defecation need, it relaxes and allows urination and defecation.
- Strength of pelvic floor muscles is also important in sexual intercourse. Strong pelvic floor muscles increase quality of sexual intercourse.
Pelvic floor muscles are skeletal ones that we can contract or relax voluntarily. The smooth muscles of urinary bladder and colon function autonomously, but function of pelvic floor muscles is under our control. There should be a harmony between smooth and skeletal muscles for voluntary passage of urine and stool.
We can control urination and defecation by contracting or relaxing our pelvic muscles. When a person does not need to urinate or pass stool or when it is not appropriate to pass urine or stool, failure of contraction in pelvic floor muscles will lead to urine, gas or stool leakage. On the other hand, when the muscles that do not sufficiently relax for urination and defecation, it will be quite difficult to pass urine and stool.
In addition, pelvic floor muscles may not support pelvic organs and hold them at normal anatomic position due to various reasons. This condition causes various diseases, called ‘pelvic organ prolapse’, as pelvic floor muscles lose recovery strength due to abnormally strong contraction or relaxation.
Weakness of pelvic floor muscles cause development of various diseases. Some of the conditions that cause weakness of pelvic floor muscles are as follows:
- Advanced age
- Childbirth (severity of the condition is proportional to the number and difficulty level of deliveries).
- History of surgery (uterus, bowel and urinary tract surgeries)
- Conditions that increase pressure in abdominal cavity, such as constipation, overstraining, chronic cough and lifting heavy objects.
- Overweight/obesity.
- Diabetes mellitus
- Radiotherapy
- Collagen tissue disease
- Psychiatric diseases
- Gas or stool incontinence
- Urinary incontinence
- Long-standing constipation
- Need of passing stool at frequent intervals
- Lack of relief after defecation, feeling of failure to empty stool completely, need to pass stool manually.
- Anal pain and bleeding secondary to overstraining
- Vaginal or anal fullness, feeling like pelvic organs are protruding outside or recognizing the protrusion (prolapsed)
- Urinating frequently, failure to delay urination or feeling of failure to empty urinary bladder
- Pelvic pain; severe pain in anus, groins, vagina or urinary bladder
- Sexual disorders;
- Pain during sexual intercourse or inability to have sex
- Decreased arousal or orgasm in sexual intercourse
- Sexual desire disorders
- Erectile dysfunctions
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Incontinence (involuntary passage of stool, gas or urine)
- Fecal incontinence (involuntary passage of stool)
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- Urinary incontinence (involuntary passage of urine)
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Pelvic organ prolapse (urinary bladder, colon, uterine cervix)
- Rectal prolapse (rectum protrudes from anus)
- Cystocele (urinary bladder protrudes from orifice of urethra in vulva)
- Rectocele (Rectal herniation – rectum, the terminal part of colon, prolapses or herniates from vagina)
- Enterocele (small intestine prolapse from vagina)
- Sigmoidocele (sigmoid colon prolapse from vagina)
- Uterine prolapse (uterus bulges down into vagina)
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Chronic constipation
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Defecation disorders
- Obstructive defecation syndrome
- Anismus (Dyssynergic defecation, contraction/relaxation deficit of anus)
- Mega-rectum/mega-colon (very severe dilatation of entire colon)
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Pelvic pain
- Coccydynia (pain in coccyx)
- Levator ani syndrome
- Proctalgia fugax (pain in terminal part of colon)
- Pudental neuropathy
- Endometriosis and gynecological problems
- Interstitial cystitis (bladder pain syndrome)
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Sexual dysfunctions
- Genito-pelvic pain or penetration disorder (Vaginismus, dyspareunia, vulvodynia)
- Orgasm disorder: Failure to have organs, difficult or late orgasm
- Sexual arousal and orgasmic disorder.
- Premature or late ejaculation
- Erectile Dysfunction
First, complaints of patients are carefully addressed and next, a detailed medical history is obtained and physical examination is made. Finally, certain tests and examinations are ordered.
- Anorectal manometry
- Endoanal ultrasound
- Defecography or MR defecography
- Ultrasound (examines pelvic floor and gynecological area)
- Balloon expulsion test
- Electromyography (EMG)
- Urodynamic Tests
- Cystoscopy
- Colonoscopy
Pelvic floor disorders can be caused by an isolated factor or by a combination of more than one factor. At baseline evaluation of the patient, ‘Pelvic Floor Distress Inventory’ should be used to review co-existing conditions. Next, certain scales and surveys should be employed to obtain quantitative (numerical) data about severity of disease and its effect on quality of life. Thus, it is possible to compare baseline severity and effect of the disease with post-treatment data. We use numerous surveys and scales that help us evaluate baseline severity of disorders and review the treatment response in our pelvic floor disorders center.
Treatment of pelvic floor disorders covers a wide spectrum ranging from simple non-surgical approaches to major surgeries depending on the disease, its severity and the effect on quality of life as well as age of the patient, health condition and co-existing diseases. It is rational to determine the best treatment option for a patient with a multidisciplinary approach.
- Life style modifications
- Pelvic floor exercises (Kegel exercises)
- Pelvic floor rehabilitation (Biofeedback, manual therapy, neuromuscular electric stimulation)
- Medication therapies
- Anal plug
- Pesser
- Rectal irrigation
- Tibial nerve stimulation with percutaneous or superficial probe
- Sacral nerve stimulation
- Botulinum Toxin (Botox) injection
- Gynecological platelet rich plasma (PRP) and hyaluronic acid injections
- Gynecological laser therapy
- Surgical methods
Pelvic floor disorders as much negative psychological and social effects as biological ones. Limitation of life activities decreases quality of life and chronic feeling of discomfort has negative effects on social, work and family lives, resulting with social isolation.
Particularly negative perceptions about body image and problems in adaptation to changing life style may lead to intense anxiety and depressive emotions. These conditions further complicate the adaptation to treatment and in such cases, psychological support (psychotherapy, breathing exercises and medication treatment) is offered.
Pelvic floor disorders center aims to progress diagnosis and treatment phases with a holistic and patient-centered approach, while physiological and psychosocial factors of the patient are concomitantly addressed.