Background

What is Pelvic Floor Disorder?

Pelvic floor disorder is defined by the inability to control pelvic muscles, which can result in complications in controlling otherwise voluntary actions of urination and defecation. If untreated, pelvic floor disorder leads to infection or long term colon damage. A quarter of women in the United States, approximately 32 million, suffer from pelvic floor disorder.

Symptoms

• Constipation
• Frequent and painful urination
• Fecal incontinence
• Pain in the lower back or pelvic region
• Pain for women during intercourse

Current Diagnosis Technologies

Endoanal/endorectal ultrasound

• This test uses ultrasound waves to create an anatomic picture of the anus and the anal sphincter.
• An ultrasound probe is inserted into the anus and held for a few minutes to get a complete picture.
• Although the endoanal ultrasound provides a full schematic of the anal canal, the strength of the muscles cannot be determined from this process alone, which is key to determining the necessary treatment.

Anorectal manometry testing

• Aids in determining how well the anal sphincter muscles squeeze at rest and with voluntary contractions.
• Water manometry is used to determine the length tension curve of the anal sphincter, as a catheter with pressure sensors is placed on varying sized probes. The pressure at each probe diameter is recorded to create a length-tension trend that can be used to determine the severity of pelvic floor disorder seen in the patient.
• Anorectal manometry is effective in producing a numerical trend, however it can only quantify the muscles at the anal sphincter and not the other pelvic floor muscles surrounding the anal canal, and thus, is limited.

Pudendal nerve motor latency testing

• The pudendal nerve is stimulated from inside the anus, causing a muscle contraction. The conduction through the nerve is measured to confirm the functionality of the nerve and its conduction rate.
• This process is uncomfortable for the patient, and does not give information regarding the health of the pelvic floor muscles themselves.

Video defecography

• A relatively new method, the patient is given a thickened liquid that can be seen on x-rays and MRIs. The patients muscle movement is recorded as he or she evacuates the liquid from the rectum.
• This allows for a realistic recreation of the bowel movement. However, no quantitative data is achieved, and the process is long and uncomfortable for the patient. Thus, only a few centers implement this technique.

Treatment

There are different treatments depending on the severity of the disorder².

Low Severity

• Muscle relaxants
• Self care measures:
  • Relaxation techniques
  • Stretching
  • Kegels
  • Warm baths

High Severity

• Medication
• Surgery

Editor: Michelle Caplin