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DISEASES OF THE PELVIC FLOOR
Pelvic floor diseases are a group of diseases that change people’s defecation habits and sometimes cause pelvic pain. Discussing these diseases can be embarrassing, they are difficult to diagnose and often have a negative impact on the quality of life. Symptoms vary depending on the type of disease.
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TYPES OF PELVIC FLOOR DISEASES
Obstructive Type of Defecation: Obstructive defecation is difficulty defecating. Although the stool reaches the rectum or the mouth of the breech, the patient has difficulty emptying. This usually makes them feel that they cannot ejaculate completely, such as the desire to defecate frequently, the need to constantly go to the toilet, or the stool is stuck in the breech mouth. Obstructive type defecation disorders can be caused by pelvic floor sagging, pain-induced muscle or by mismatched working muscles.
Rectocele: With the medical name of intestinal hernia with its folk name, rectocele is a herniation, decapitation of the anterior wall of the rectum towards the vagina. Normally, there is no forward herniation because there is a barrier between the rectum and the vagina, the deca comes directly up to the anus. In a patient with rectocele, there will be a feeling of hanging here with sagging and accumulation in the case of defecation, as the rectum is cut off towards the vagina, it is herniated, and there will be a feeling of inability to fully empty it. As the intestinal hernia expands, it can cause difficulty defecating or leakage of stool after defecation, contamination. Rectocele is more common in women who have given birth, especially those who have given birth normally. Muscles of the tissue between the rectum and vagina and weakening of the pelvic floor muscles often result in intestinal hernia, i.e. rectocele is formed.
The pelvic floor consists of the muscles of the pelvis and organs located there, such as the rectum, vagina, bladder. Excessive stretching of the pelvic floor, aging or collagen disorders can occur after childbirth. Straining or sagging of the intestine out of the breech mouth even at rest, sagging of the bladder, cervix into the vagina are conditions that can be seen. The bowel that comes out of the anus can remain outside, as in the case of hemorrhoids, and can be manifested by bleeding, discharge, difficulty defecating, and sometimes very severe pain. This condition, which is more common in older women, requires absolute treatment due to its possible complications. Symptoms of pelvic desensitization/sagging usually include difficulty emptying, urinary incontinence, gas-stool incontinence, or a feeling of fullness, pressure in the pelvis during urination or defecation.
Paradox Muscle Puborectal Contraction/Anismus: The puborectal muscle is part of the muscle that control defecation. The puborectal muscle is wrapped around the lower rectum like a sling. During defecation, the puborectal muscle relaxes so that the stool can be fully emptied, and thus the stool can be emptied comfortably in the act of defecation. In the case of the paradoxical puborectal condition, also called anismus, that is, pelvic dysenergy, the patient can not defecate in the toilet, despite the feeling of straining and the need to defecate. This leads to excessive pushing, prolonged time spent in the toilet, feeling that the stool is stuck, not being able to empty it completely and going to the toilet repeatedly, defecating hard / infrequently.
Levator Syndrome Muscle Levator syndrome is a condition of abnormal spasms, ie contraction, of the pelvic floor muscles. Spasms may occur after bowel movements or for no known reason. Patients often experience prolonged vague, dull, or painful pressure in the rectum. These symptoms may worsen while sitting or lying down. Levator spasm is more common in women than in men.
Coccygodynia: The coccyx, or tailbone, is the last bone of the spine. Coccygodynia is pain in the tailbone. It is a condition in which this bone, which is often immobile, moves and causes pain with trauma or by falling with conditions such as normal childbirth. The pain can usually worsen after defecation. It is usually caused by a fall or trauma involving the coccyx, although no cause is indicated in a third of patients.
Proctalgia Fugax: Proctalgia fugax is a sudden and abnormal pain in the rectum that usually wakes patients up from sleep. This pain can last up to several minutes. It is muscle that proctalgia fugax is caused by spasms in the muscles of the rectum and/or pelvic floor.
Pudendal Neuralgia: The pudendal nerves are the main sensory nerves of the pelvis. Pudendal neuralgia is chronic pain in the pelvic floor that holds the pudendal nerves. This pain may first appear after childbirth, but most often it comes for no reason and disappears.
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DIAGNOSIS
A complete medical history and a thorough physical examination are the key to assessing pelvic floor dysfunction. Your specialist should ask if there are other pain problems in the body, such as difficulty defecating, pain during urination, or sexual intercourse, among other things. It is important to undergo a complete physical examination/pelvic floor examination, including rectal and vaginal examinations. Muscle transplant of the various nerves and muscles involved in defecation/defecation is complicated, and the doctor may need additional tests to determine the cause of the problem. Tests that may be requested by your colon and rectum surgeon can help you diagnose and guide treatment.
Endoanal/Endorectal Ultrasound: Provides images of pelvic structures including anus, rectal wall and control muscle. It may also indicate rectocele, rectal prolapse, or enterocele (small bowel prolapse). This is usually done in the office.
Anor Muscle Manometry: Evaluates the ability of the control muscle and rectum to work, as well as the strength of the muscles, their pressure. This is also usually done in the office or at the endoscopy center. This test requires the patient to push and muscle so that he can accurately determine the strength of the muscles.
Colonic Transit Study: The colonic transit study is a series of X-rays that evaluate the passage of feces through the colon to determine the possible causes and locations of constipation.
MR Defecography: This is an imaging method performed by taking images of an opaque gel applied from the anal region during defecation on MRI. This test is very helpful in determining the cause of pelvic floor dysfunction. In particular, intestinal prolapse, urinary bag prolapse, intestinal hernia, and uterine prolapse can be easily detected with this examination. This graphy can also be applied conventionally in the form of defecation under scopy.
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TREATMENT
Treatment is carried out depending on the cause of the dysfunction and the severity of the symptoms. Surgical treatment for pelvic floor dysfunction is rarely needed, except for large, symptomatic rectoceles or other pelvic prolapses. Surgery in case of sagging can help restore the normal placement of the pelvic organs. This can be done open/laparoscopically / robotically from the abdomen, as well as from the horseshoe area, vagina, or perineum, depending on the specific problem. The purpose of treatment for pelvic pain syndromes is to alleviate or reduce symptoms. In some cases, a combination of treatment methods helps to reduce pain.
– Dietary changes such as increased fiber and fluid intake to facilitate bowel movements.
-Biofeedback is a special form of pelvic floor rehabilitation aimed at improving rectal sensation and pelvic floor muscle contraction. It is often performed by a pelvic floor physiotherapist. Thanks to biofeedback, the patient is provided with oral, auditory and visual effects to show how she should defecate, she should contract and relax the muscles he uses during defecation and apply them correctly. One way is to give the patient the right feedback. This may include electrical stimulation of the pelvic floor muscle, ultrasound or massage therapy. In transplantation, there are pelvic floor exercises that can be done at home that can help improve symptoms.
– Injection of local anesthetics and/or anti-inflammatory agents.
PTNS/SNS: pelvic floor muscles can be strengthened and their functions can be rehabilitated with the help of the muscletric u devices applied from the ankle or coccyx region. In this way, complaints such as gas stool incontinence, defecation disorders, constipation can be reduced.
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PROGNOSIS AFTER SURGERY IN TURKEY
The purpose of pelvic floor surgery is to return the relevant organs to their anatomical positions and thus restore their functionality. The goal is to improve the patient’s quality of life. Especially in patients with chronic constipation, complaints of constipation may persist despite pelvic floor surgery. In this case, patients should definitely be supported in terms of pelvic floor rehabilitation.
Pelvic floor diseases should be managed multidisciplinary This team should include a surgical specialist in Turkey, gastroenterologist, gynecologist, urologist, radiologist, physiotherapist, dietitian and psychiatrist who deals with the pelvic floor.
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Turkey's world-renowned organ transplant specialist. Dr. Demirbaş has 104 international publications and 102 national publications.
Physician's Resume:
Born on August 7, 1963 in Çorum, Prof. Dr. Alper Demirbaş has been continuing his work as the President of MedicalPark Antalya Hospital Organ Transplantation Center since 2008.
Prof. who performed the first tissue incompatible kidney transplant in Turkey, the first blood type incompatible kidney transplant, the first kidney-pancreas transplant program and the first cadaveric donor and live donor liver transplant in Antalya. Dr. As of August 2016, Alper Demirbaş has performed 4900 kidney transplants, 500 liver transplants and 95 pancreas transplants.
In addition to being the chairman of 6 national congresses, he has also been an invited speaker at 12 international and 65 national scientific congresses. Dr. Alper Demirbaş was married and the father of 1 girl and 1 boy.
Awards:
Eczacibasi Medical Award of 2002, Akdeniz University Service Award of 2005, Izder Medical Man of the Year Award of 2006, BÖHAK Medical Man of the Year Award of 2007, Sabah Mediterranean Newspaper Scientist of the Year Award of 2007, ANTIKAD Scientist of the Year Award of 2009, Social Ethics Association Award of 2010, Işık University Medical Man of the Year Award of 2015, VTV Antalya's Brand Value Award of 2015.
Certificates:
Doctor of Medicine Degree Hacettepe University Faculty of Medicine Ankara, General Surgeon Ministry of Health Turkey EKFMG (0-477-343-8), University of Miami School of Medicine Member of Multiple Organ Transplant, ASTS Multiorgan Transplant Scholarship. Lecturer at Kyoto University. Lecturer at University of Essen, Research assistant at the University of Cambridge .
Professional Members:
American Society of Transplant Surgeons, American Transplantation Society Nominated, Middle East and Southern Africa Council Transplantation Society 2007, International Liver Transplantation Association, Turkish Transplantation Association, Turkish Society of Surgery, Turkish Hepatobiliary Surgery Association.
Disclaimer:
Our website contents consist of articles approved by our Web and Medical Editorial Board with the contributions of our physicians. Our contents are prepared only for informational purposes for public benefit. Be sure to consult your doctor for diagnosis and treatment.