WHAT IS A PELVIC FLOOR DYSFUNCTION?
For most people, bowel functions are automatic and regular, so they do not pose a problem. However, for some individuals, especially in females, defecation can be difficult, and the symptoms include a sense of obstructed defecation, a feeling of incomplete evacuation, and fragmented bowel movements. Patients often rely on laxatives, enemas, or manual maneuvers to facilitate bowel movements. The mechanism of defecation requires the coordination of different pelvic floor muscles. Their proper synchronization allows the rectum to empty during defecation. The relaxation of the pelvic floor muscles is accompanied by the contraction of abdominal muscles, which facilitates the passage of stool from the rectum. When there is a lack of proper coordination among these muscles, defecation becomes extremely challenging, and this is referred to as pelvic floor dysfunction.
HOW IS PELVIC FLOOR DYSFUNCTION DIAGNOSED?
A thorough medical history and the accurate analysis of symptoms reported by the patient are crucial. First and foremost, it's essential to rule out organic lesions such as polyps, tumors, or other conditions that may cause intestinal obstruction. Therefore, performing a colonoscopy (traditional or virtual) or other radiological investigations (such as CT colonography or barium enema) is important. Once organic conditions have been excluded, it is crucial to conduct a colpocystoenterodefecography or defecography-MRI (see), which not only reveal any pelvic floor muscle dysfunction but can also detect other causes of obstructed defecation, such as rectal prolapse, recto-anal intussusception, anterior rectocele, or enterocele (see).
HOW CAN PELVIC FLOOR DYSFUNCTIONS BE TREATED?
If these dysfunctions result from a failure of pelvic floor muscle relaxation, they can be treated with specialized physical therapies like biofeedback or physio-kinesiotherapy. Biofeedback involves a physiotherapist helping the patient increase rectal sensitivity and coordinate pelvic floor muscles. Various biofeedback techniques can be used: patients can be taught to expel an inflated balloon in the rectum, or special devices can be placed in the rectum and/or vagina.
Other methods use electrodes placed on the surface of the anal skin and abdominal wall. These procedures detect whether a muscle is contracted or relaxed and, through a scale of LED lights, determine the intensity of the patient's muscle action. The patient can monitor the results using the LED scales of the biofeedback devices, improving muscle coordination day by day. Biofeedback yields good results in approximately 60-70% of patients with pelvic floor muscle dysfunctions. If rectocele, rectal prolapse, and enterocele are identified as causes of obstructed defecation, the treatment can be either medical or surgical (see individual entries).
For most people, bowel functions are automatic and regular, so they do not pose a problem. However, for some individuals, especially in females, defecation can be difficult, and the symptoms include a sense of obstructed defecation, a feeling of incomplete evacuation, and fragmented bowel movements. Patients often rely on laxatives, enemas, or manual maneuvers to facilitate bowel movements. The mechanism of defecation requires the coordination of different pelvic floor muscles. Their proper synchronization allows the rectum to empty during defecation. The relaxation of the pelvic floor muscles is accompanied by the contraction of abdominal muscles, which facilitates the passage of stool from the rectum. When there is a lack of proper coordination among these muscles, defecation becomes extremely challenging, and this is referred to as pelvic floor dysfunction.
HOW IS PELVIC FLOOR DYSFUNCTION DIAGNOSED?
A thorough medical history and the accurate analysis of symptoms reported by the patient are crucial. First and foremost, it's essential to rule out organic lesions such as polyps, tumors, or other conditions that may cause intestinal obstruction. Therefore, performing a colonoscopy (traditional or virtual) or other radiological investigations (such as CT colonography or barium enema) is important. Once organic conditions have been excluded, it is crucial to conduct a colpocystoenterodefecography or defecography-MRI (see), which not only reveal any pelvic floor muscle dysfunction but can also detect other causes of obstructed defecation, such as rectal prolapse, recto-anal intussusception, anterior rectocele, or enterocele (see).
HOW CAN PELVIC FLOOR DYSFUNCTIONS BE TREATED?
If these dysfunctions result from a failure of pelvic floor muscle relaxation, they can be treated with specialized physical therapies like biofeedback or physio-kinesiotherapy. Biofeedback involves a physiotherapist helping the patient increase rectal sensitivity and coordinate pelvic floor muscles. Various biofeedback techniques can be used: patients can be taught to expel an inflated balloon in the rectum, or special devices can be placed in the rectum and/or vagina.
Other methods use electrodes placed on the surface of the anal skin and abdominal wall. These procedures detect whether a muscle is contracted or relaxed and, through a scale of LED lights, determine the intensity of the patient's muscle action. The patient can monitor the results using the LED scales of the biofeedback devices, improving muscle coordination day by day. Biofeedback yields good results in approximately 60-70% of patients with pelvic floor muscle dysfunctions. If rectocele, rectal prolapse, and enterocele are identified as causes of obstructed defecation, the treatment can be either medical or surgical (see individual entries).