Pelvic Floor Dysfunction

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What is pelvic floor dysfunction?

The pelvic floor consists of several muscles that support the rectum. During a bowel movement the pelvic floor muscles are supposed to relax in coordinated fashion allowing the rectum to empty. While the pelvic floor muscles are relaxing, muscles of the abdomen contract to help push the stool out of the rectum. If the pelvic floor does not function properly and therefore does not relax as it should then an individual must instead push bowel movements against a firm muscular wall. This can result in constipation and the sensation of incomplete emptying of the rectum after a bowel movement. Residual stool left in the rectum may slowly leak out of the rectum raising concerns of stool incontinence.

How is pelvic floor dysfunction diagnosed?

The diagnosis of pelvic floor dysfunction starts with a careful review of a patient's history followed by a thorough physical exam. A defecating proctogram (defecogram) is a study that is commonly performed in order to demonstrate any functional problem of the pelvic floor. During this study, the patient is given an enema consisting of a thick liquid that can be detected with X-ray imaging resulting in a special video recording of the movement of the pelvic floor muscles and the rectum during a bowel movement. This study will show if the pelvic floor muscles are relaxing appropriately or not. Other abnormalities can be identified during the study such as a rectocele (outpouching of the rectum) or internal or external rectal prolapse (rectum folding on itself).

What treatments are available?

Abnormalities identified with a defecating proctogram such as rectal prolapse and rectocele may be treated surgically. If no abnormalities are found, a specialized physical therapy known as biofeedback to retrain the pelvic floor has proven to be helpful in up to 75% of patients experiencing dysfunction.