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Harley Pelvic Care Center

What is a Pelvic Care Center?

It is a highly specialized facility where different specialists work together to offer multidisciplinary care to patients complaining of various diseases or conditions affecting the pelvic organs. The pelvis is the anatomical area where different organs, such urinary bladder/urinary structures, reproductive organs, rectum and anus are localized which are usually treated by a single specialist according to the most prevalent type of symptoms that the patient is complaining of. In many circumstances pelvic organs belonging to different systems such as Intestinal, Urinary and Reproductive organs may be affected at the same time and therefore in order to achieve better and more comprehensive care, a multidisciplinary approach is the only solution in order to effectively improve a patient’s condition.

Which specialists work in the Pelvic Care Center?

Urologists with neuro-urology skills, Gynecologists, Gastroenterologists and Colorectal surgeons are the core competences that should be present in any Pelvic Care Center. In addition to these specialists, specialized personnel in charge of rehabilitation treatments are usually present to complement the activity of the center.

Which pathologies/conditions do we treat at the Pelvic Care Center?

We provide initial consultation assessment diagnosis and innovative care option for:

  • Chronic constipation
  • Complex colonic and rectal polyps
  • Common anorectal conditions
  • Anal and fecal incontinence
  • Outlet type constipation and obstructed defecation syndromes
  • Urinary incontinence
  • Urinary retention and other voiding dysfunctions
  • Chronic pelvic pain
  • Sexual dysfunctions age and non-age related in both sexes
  • Pelvic organs prolapse
  • Advanced Gynecologic screening modalities and disease prevention
  • Obstetric services and delivery assistance

Most of these conditions, although may not be life-threatening, constitute a burden for the patient greatly affecting the quality of life.

Which diagnostic tests do we routinely perform at the Pelvic Care Center?

  • Dynamic MRI proctogram to identify defecation disorders and pelvic organs prolapse
  • Endoanal Ultrasound to assess anal sphincters and perianal tissues by Consultant Gastroenterologist
  • Lactulose breath test to identify various conditions such as slow transit constipation and bloating by Consultant Gastroenterologist
  • Abdominal, Pelvic, Duplex US scan by Consultant Gastroenterologist
  • Obstetric and Gynecology US scan by Consultant Obstetric and Gynecologist
  • Pelvic US scan by Consultant Urologyst
  • Anal manometry and balloon expulsion test to assess anal sphincter function by Consultant Colorectal surgeon
  • Advanced Urodynamic assessment for chronic urinary dysfunction and impaired voiding conditions
  • Endoanal and superficial non-needle electromyography recruitment to assess electrical activity of anal sphincter, coordination of muscle of the pelvic floor and recruitment of antagonist muscles by Consultant Colorectal surgeon
  • Endovaginal and superficial non-needle electromyography recruitment to assess electrical activity of vaginal muscle, coordination of muscle of the pelvic floor and recruitment of antagonist muscles by Consultant Urologist
  • Pelvic Neurophysiology electromyography end evoked potentials tests to assess electrical conductivity of Pudendal nerve by Consultant Urologist
  • Complete Urodynamic tests to assess urinary conditions including incontinence urgency and voiding problems
  • Peripheral Nerve Evaluation (PNE) to assess whether sacral nerve neuro modulation is effective and appropriate for certain condition such as anal incontinence and other lower urinary tract dysfunctions

Which treatments do we provide at the Pelvic Care Center?

At Harley Pelvic Care Centre we offer a step-wise approach for the common to the most complicated pelvic conditions. All treatments are based on the evidence of diagnostic tests and no treatment is offered on empirical basis. We have a vast array of most advanced diagnostic treatment modalities which are effective and proven to resolve or improve most of these troubling conditions. Most of these diagnostic tests and treatment modalities are unknown to the UAE and Harley Pelvic Care Center is the only institution in the entire country where these services are offered in an organized and multidisciplinary setting.

  • Minimally invasive and advanced procedures for colo-proctology conditions such as hemorrhoids, anal fistula and non-surgical treatment for anal spasm and anal pain
  • Routine and advanced endoscopy services including polypectomies, endoscopic mucosal resection and trans-anal resection
  • Routine advanced laparoscopy for pelvic organ prolapse and other benign gynecologic and urologic conditions
  • Routine and advanced endoscopic-urologic procedure for diagnosis and treatment con urinary tract and bladder diseases including stone disease
  • Non-scalpel minimally invasive vasectomy
  • Advanced treatments of chronic constipation and irritable bowel syndrome
  • Peripheral nerve stimulation for chronic pelvic pain, functional anal and urinary conditions and some forms of anal and urinary incontinences
  • Biofeedback and pelvic muscle retraining with and without electrical stimulation for various pelvic conditions such as incontinences, obstructed defecation, pelvic dyssynergia, chronic pelvic pain, voiding dysfunctions, etc.
  • Peripheral nerve anesthetic blocks under EMG guidance for chronic pelvic pain or anal spasm
  • Peripheral nerve denervation for chronic pelvic pain with Pulsed Radiofrequency for chronic pelvic pain and other conditions
  • Sacral Nerve Neuromodulation permanent implants for chronic pelvic conditions such as fecal and urinary incontinences
  • Sexual enhancement treatments for chronic age and non-age related sexual dysfunctions both in female and male.

At Harley Pelvic Care Center we make sure that all procedures and diagnostic tests required are performed with minimal discomfort and inconvenience to the patient. Anesthesiologists are fully involved and integrated in the practice making sure that the highest quality of care is delivered with the best possible patient’s experience.

Pelvic Floor Disorders

The pelvic floor is a set of muscles that form a hammock or sling around the opening of the pelvis. The pelvic organs, including the womb (uterus), rectum and bladder, are held in position by the pelvic floor muscles and the surrounding tissues. The incidence of pelvic floor disorders increases when the muscles of the pelvic floor and connective tissue are injured or weakened. Some of the common pelvic floor disorders include pelvic organ prolapse, urinary incontinence, and anal incontinence.

One of the most common conditions that colorectal surgeon can encounter during practice are patient complaining symptoms of difficulties in emptying the rectum and passing the stool. In same circumstances the diagnosis is pretty obvious as the presence of an external abnormality can be identified based of the history given by the patient and confirmed during physical examination. This is typically the case of complete RectalProlapse. In other and most frequent circumstances no abnormalities can be detected on examination on patient reporting difficulties in emptying the rectum and therefore commonly needing to return to the toilet several time to finally achieved a satisfactory bowel motion. This condition, which is called obstructed defecation may identify different causes but the most common is certainly the one called Ano-rectal intussusception which is caused upper segment of the rectum to telescope into the lower part of the anal canal causing an obvious obstruction during the expulsion phase of the defecation. This condition can be diagnosed using special tests such as x-ray dynamic proctogram or dynamic MRI of the pelvis. More recently a tri-dimensional or 3D US of the anal canal and lower rectum and a Dynamic pelvic US have been introduced to investigate pelvic floor conditions. This type of investigation minimize the inconvenience for the patient to undergo further testing and it can be done in the office at the time of the initial consultation. This service will be very soon available at Harley Colorectal Clinic and it will definitively enhance the quality of care for the assessment of pelvis floor conditions. In addition to that we will be introducing an express modality of assessment of the function of the anal sphincter muscles called Anopress, which is done in the office during the initial consultation allowing accurate and immediate results. Depending on the results of the combined investigations, surgery may be offered to the patient in order to correct the condition which is causing the abnormality. In case of complete Rectal prolapse and anorectal intussusception surgery is performed through laparoscopy in order to fix the rectal segment which is telescoping into the lower part of the ano-rectum, preventing the blockage during defecation. This surgery is called Laparoscopic Ventral Mesh Rectopexy and it is illustrated in the Video Educational Section.

In case of defect of the sphincter muscle due to injuries or weakness demonstrated by US and Manometry, corrective surgery may be offered to the patient with different techniques that go from Sphincter augmentation, US guided implantation in the anal sphincter area of expandable beads which create additional cushions enhancing the continence, to Sacral Nerve Stimulation for the most severe cases, which consists with implantation under local anesthesia of an internal micro-wiring stimulator in the sacral bone controlled by the patient via remote control. Both procedures will be available in 2017 with the collaboration of Prof Giulio Santoro who is a world wide leading expert in the field of pelvic floor.

Clinical Assessment, Diagnostic Tests and Pelvic Floor Rehabilitation Procedures

Initial assessment consists of standard physical examination which is done fully respecting your privacy, minimizing exposure of body parts and therefore reducing the embarrassment and discomfort that this type of examination may naturally entail. According to your clinical condition, the doctor may require performing additional office tests. With the vast majority of cases, these tests may be carried out after the initial assessment. These tests are called Anoscopy, Anorectal Manometry, Anal and Pelvic Floor Electromyography and Pelvic Dynamic and Proctogram MRI. Once the diagnosis is established the doctor will be explaining the results of the investigation and what is required to fix your conditions. Whenever surgical procedure is required your doctor will provide full information about that. It is also possible as it happens is a large percentage of cases that your condition is amenable to be treated by special rehabilitation techniques which are called Biofeedback Pelvic Floor Retraining and Electrotherapy.

Anoscopy

This is a standard investigation which is carried out with a small, rigid, self-illuminated and disposable instrument which is inserted into the anal canal to allow visual inspection. The procedure is performed using a lubricant gel to minimize the friction and facilitate the introduction. The procedure is generally rapid, lasting on average no more than one minute and it is very well tolerated with minimal discomfort.

Anorectal Manometry

Rectal manometry is a test used to measure and assess pressure, reflex and sensation in the rectum. The test also evaluates the efficiency of the anal sphincter. The procedure will help your doctor evaluate the cause and determine the correct treatment of fecal incontinence or constipation. While lying on your left side, a thin flexible catheter with a small uninflated balloon at the tip is passed through the anus and into the rectum. The catheter is slowly withdrawn while numerous pressure measurements are recorded. You will also be asked to push and squeeze your anal muscles at certain times. You will also be asked to indicate when you experience a feeling of fullness or distension in the rectum, upon inflation of a small balloon at the end of the catheter. The test is not painful and is performed with the complete respect of patient privacy and avoiding unnecessary exposure of private parts.

  • Do not take smooth muscle relaxants (Valium, or narcotic pain medications) 24 hours prior to your appointment time.
  • Use Fleet enema when it is prescribed by your doctors and apply it one hour before coming to the hospital for your appointment.

Electromyography of Anal Canal and Pelvic Floor

The electromyography involves direct recording of muscle electrical activity at rest and during specific contractions that you will be requested to perform during the test. Registration will be performed using a small probe inserted in your back passage and superficial registration electrodes applied on your lower abdomen in order to allow simultaneous registration of the activity of your accessory muscles. During the test you will be prompted the instructions on the computer screen and you will be able to visualize the muscular activity of your contraction directly on the computer screen.

The test will consist of registration of muscle activity at rest for 60 seconds then followed by a phase where the patient is asked to perform 5 rapid contraction over the period of 10 seconds and then followed by a phase of contraction maintained for 10 seconds followed by 10 seconds of rest, repeated for 5 times. Lastly, 60 seconds of resting registration phase. The test is not painful and is performed with the complete respect of patient privacy and avoiding unnecessary exposure of private parts.

  • Do not take smooth muscle relaxants (Valium, or narcotic pain medications) 24 hours prior to your appointment time.
  • Use Fleet enema when it is prescribed by your doctors and apply it one hour before coming to the hospital for your appointment.

Pelvic Dynamic and Proctogram MRI

This is a special magnetic resonance of the pelvic floor that allow to visualize the dynamic phase of defecation in order to see how the pelvic organs interacts together during resting and dynamic phases of defecation. This is a non-radiologic test which requires one hour, and it is performed in a special radiologic suit with full respect of your privacy.

  • Do not take smooth muscle relaxants (Valium, or narcotic pain medications) 24 hours prior to your appointment time.
  • Use Fleet enema when it is prescribed by your doctors and apply it one hour before coming to the hospital for your appointment.

Biofeedback/Pelvic Floor Retraining and Electrotherapy

In case your pelvic muscle are weaker than expected or are working in a way that is not coordinated you may be required to undergo session of rehabilitation that are permed with the aid of special instruments that will allow you to visualize the results of your effort and therefore improve the way you use your pelvic and anal muscles in order to improve specific conditions you may be affected with such as fecal incontinence, weakness of pelvic muscle, difficult rectal emptying and other. In same circumstances in order to improve strength and condition of your muscles it may be necessary to provide electrical stimulation which will be able to reinforce them to work more efficiency. These types of rehabilitation works are performed is a cycle of ten over 2-week period. Each session lasts between 20 to 30 minutes. These sessions are not painful and are performed with the complete respect of patient privacy and avoiding unnecessary exposure of private parts.


To visit the password protected educational video and presentation section please click.

For every communication or further request of information please contact

Miss Hannah Giron

Miss Hannah Giron
Medical Secretary to Dr. M Cristaldi
+971 26133999
[javascript protected email address] [javascript protected email address]

Practice Location

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Marina Village
Villas A18, 19, 20, 21, 22
P.O. Box: 41475
Abu Dhabi - UAE

Phone: +971 (0)2 6133 999 +971 (0)2 6133 999
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