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Pelvic floor disorders encompass all conditions affecting the normal functioning of the pelvic organs, namely the urinary bladder, uterus and vagina (female), prostate (male) and anorectum for both sexes. These disorders arise from laxity of pelvic ligaments and weakness of the pelvic floor muscles, leading to excessive descent of the pelvic organs and problems such as urinary incontinence, vaginal prolapse and bowel incontinence.
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Pelvic floor disorders are classified into three compartments; anterior (for urinary bladder), middle (for uterus/vagina) and posterior (anorectal). A patient may suffer from dysfunction to one or more of the three compartments concurrently.
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Symptoms are dependent on which compartment and organs are affected. Common symptoms of urinary bladder dysfunction are leakage of urine when one coughs or sneezes and recurrent urinary infection. Women with vaginal prolapse also often feel a heavy dragging sensation in the pelvis and may notice a prolapse of the uterus out of the vagina.
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If the problem is in the posterior compartment, the patient may complain of leakage of bowel contents (bowel incontinence) or even difficulty evacuating their bowels (obstructed defecation). Another common symptom of pelvic floor disorders is itching around the opening of the urethra (urine passage opening), vagina or anus.
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Treatments vary from medications to pelvic floor rehabilitation physiotherapy and even surgery. For effective control of pelvic floor disorders, however, a combination of the various options is commonly utilized.
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Bowel incontinence treatment involves a detailed understanding of a patient’s daily dietary, lifestyle and bowel habit first. Patients are taught dietary and lifestyle adjustments and undergo anorectal biofeedback, a form of pelvic floor rehabilitation programme aimed at improving a person’s control over their abnormal bowel habit. Patients with bowel incontinence are taught to improve the pelvic floor and anal muscle strength while patients with obstructed defecation are taught coordination methods to relax the pelvic floor muscles during a bowel movement. Medication is also used to normalize a patient’s stool content to prevent diarrhoea or constipation.
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This treatment is then reassessed after a period of time and if the improvement is inadequate, surgery may be required. The options at surgery may involve repair of the pelvic floor and anal sphincter muscle, tightening of pelvic ligaments or using a plastic mesh to augment the pelvic ligaments, injection therapy to strengthen the anal sphincters in bowel incontinence, implantation of artificial bowel sphincters or implanting an electrode with pacemaker (sacral neuromodulation) to enhance anorectal control.
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The important thing for patients to note is that treatment for pelvic floor disorders, while very safe, involves a period of time. Not every patient requires surgery, and for those that do, the aim is to allow the patient to regain control over their pelvic organs’ function. There is no quick-fix procedure to treat pelvic floor disorders; as a person grows older, the problem may recur as the pelvic floor muscle weaken with age. If this happens, additional treatments are available and usually provide very good results.
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Most of the treatments can be performed as outpatient procedures or require a short hospital stay of only a few days. Patients usually return to their normal daily lifestyle within a week after surgery.
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Thankfully, pelvic floor disorders are not associated with cancer. However, a cancer can co-exist with the pelvic floor disorder, e.g. rectal cancer with bowel incontinence or uterine cancer with uterine prolapse. We always exclude colorectal cancer prior to treatment of bowel incontinence or obstructed defaecation.
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While pelvic floor disorders are not associated with pelvic organ cancers, they may lead to significant problems with pain, infection and bleeding if left untreated. Treatment at an earlier stage will provide better results as treatment halts the progression of the pelvic floor weakness.
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