Bandipalyam V Praveen
Southend University Hospital, UK
Title: Posterior Pelvic Floor Dysfunction : Causes, Consequences and Cures
Biography
Biography: Bandipalyam V Praveen
Abstract
Posterior Pelvic Floor Dysfunction (PFD) can be disabling with severe effects on the quality of life (QOL). The symptoms can be varied and hence increased awareness and low threshold to investigate would lead to early diagnosis and appropriate treatment. The natural course is usually towards deterioration in symptoms with gradual progression of the problem. The underlying cause for the dysfunction can be neurogenic, muscular or mechanical. A combination of these may also be present. Contributory factors such as obstetric injuries, BMI, mental stress, psychiatric states, surgical procedures, diet, medications and life style may be important. The usual symptoms are fecal incontinence, evacuatory dysfunction, rectal prolapse and pelvic pain. A combination of these may also occur. Initial assessment should include standard pro-formas, symptom scores and QOL impact questionnaires. Physiology tests to evaluate the anorectal function will help to know the underlying problem and formulate the treatment plan. Management is multi-disciplinary and involves doctors, physiotherapists, specialist nurses, dieticians, pain specialists, stoma nurses and psychologists. Initial treatment is usually non-surgical in the majority of these patients and may involve treatments such as Biofeedback, Anal irrigation and neuro-modulation. Surgery is reserved for the small group of patients who continue to have persistent symptoms which significantly affect their QOL. The expectations of the patient from the operation should be discussed pre-operatively and ensured that the goals are realistic. Cases are best discussed in Pelvic MDT pre-operatively and counseling should include success rates, the possibility of some symptoms still continuing despite surgery, specific procedure related risks and long term recurrence rates. Overall, correct identification and treatment of the pelvic floor dysfunction can lead to improvement in QOL and grateful patients while a failure to identify this can lead to unnecessary operations and a life of misery.