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 urinary 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 observation in our practice are patients complaining difficulties in emptying the rectum during defecation. Most frequently no obvious abnormalities can be detected on physical examination. Therefore, additional tests are required to define the nature of these conditions. Dynamic Pelvic US and 3D Endo anal US allow anatomical and dynamic assessment of the pelvic structure and are performed in these circumstances. Both tests are available at our clinic and are performed in the clinic without requiring specific preparation and they provide detailed assessment of pelvic structures even during dynamic phases. High resolution Anorectal Manometry is also utilized in patient with pelvic dysfunctions, and it usually carried out in the same session of Dynamic Pelvic US and 3D Endo anal US. These tests altogether constitute and integrated diagnostic approach of patient with pelvic conditions.
In selected cases, Dynamic pelvic MRI can be performed to visualize the entire pelvic region during certain dynamic functions such as straining and pushing. All diagnostic tools are available at our center.
Fecal incontinence is another common condition where integrated diagnostic approach is utilized to define the pelvic anatomy and the function of the anal muscles.
The most appropriate treatment can only be offered only after precise anatomical and functional assessment.
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. These tests are usually carried out immediately after initial assessment or in some circumstance they will require a separate appointment. Anoscopy, High Resolution Anorectal Manometry, 3D Endo anal US, Dynamic Pelvic US Anal and Pelvic Floor Electromyography and Pelvic Dynamic and Proctogram MRI are the most frequently performed tests . Once the diagnosis is established the doctor will be explaining the results of the investigation and what is required to deal with your condition.
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.
High Resolution Anorectal Manometry
The test evaluates the efficiency and function of the anal sphincters assessing different aspect of ano-rectal physiology. The procedure will help your doctor evaluate the cause and determine the correct treatment of fecal incontinence, chronic constipation or other conditions. 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. This solid-state probe will provide precise measurement of anal canal and rectal pressure. The test is not painful and is performed with the complete respect of patient privacy and avoiding unnecessary exposure of private parts.
3D Endo Anal US and Dynamic Pelvic US
Dedicated pelvic endo-anal and endo-vaginal US are the cornerstones of modern coloproctology and pelvic floor care. These tests allow dynamic assessment of the pelvis and pelvic stricture with detailed 3D reconstruction of the peri-anal and pelvic region. These US can be variably combined according to the patient conditions. Test is performed in the US room in the doctor’s office. They are not painful and not require any specific preparation.
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 and you will be able to visualize the muscular activity of your contraction directly on the computer screen.
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.
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 performed 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 which may be affected in certain circumstances such as fecal incontinence, weakness of pelvic muscle, difficult rectal emptying and others. 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.