Coexistence of Pelvic Floor Dysfunction Symptoms

Various surveys have been performed to obtain a better understanding of the coexistence of symptoms of urinary, genital, and fecal dysfunction. Not surprisingly, there is a high incidence of coexistence of incontinence and support defects (Table 1-1.1). It has been reported that in patients seen with fecal incontinence, 24% to 53% also complained of urinary incontinence, and 7% to 22% complained of genital prolapse. Of patients who presented with rectal prolapse, 66% also complained of urinary incontinence and 34% complained of genital prolapse.6-8 In a survey of patients who had undergone surgery for rectal prolapse and fecal incontinence at our institution, with an included control group of clinic patients, the incidence of urinary incontinence was 53% in those who had previous surgery for fecal incontinence and 65% in those who had previous surgery for rectal prolapse. Genital prolapse was found in 18% of patients with fecal incontinence and 34% of patients with rectal prolapse. The control group had a urinary incontinence incidence of 30% and genital prolapse incidence of 12.5%; both incidence rates are consistent with a normal population.6

The frequent coexistence of symptoms of urinary and colorectal dysfunction provides further emphasis on the need for a team approach to the evaluation and management of women with any of these conditions. In addition, the fact that rectal prolapse patients have a higher incidence of urinary incontinence and genital prolapse suggests that rectal prolapse may represent a more advanced degree of pelvic floor dysfunction. Anecdotally, in patients we have followed over time with urinary incontinence or other forms of pelvic floor dysfunction who were treated either surgically or medically, the progression of pelvic floor dysfunction was seen with subsequent development of rectal prolapse not being an unusual finding. There is a great need to increase our understanding of the natural history of pelvic floor dysfunction, as its progression may not be possible to stop, but only slowed by our interventions.

Table 1-1.1. Population analysis of the coexistence of pelvic floor dysfunction symptoms

Control

Population Analyzed

Population Analyzed

UI, urinary incontinence; GP, genital prolapse; FI, fecal incontinence; RP, rectal prolapse.6

setting and postoperative physiotherapeutic pelvic floor rehabilitation may represent the most desirable means of treating asymptomatic patients. Less-severe degrees of pelvic floor dysfunction and syndromes not associated with anatomic alterations are amenable to pelvic floor rehabilitative interventions. Physiotherapeutic modalities and their indications will be discussed in Chapter 12. An emphasis must be made on the fact that pelvic floor physiotherapy will benefit both urinary and fecal continence disorders. In fact, patients with concomitant urinary and fecal incontinence, especially associated with urgency symptoms, are optimal candidates for pelvic floor physiotherapy/rehabilitation. Although current reimbursement practices in the United States may pose a barrier to accessibility to pelvic floor rehabilitation, the value of this conservative treatment modality has been demonstrated in many studies involving various types of pelvic floor dysfunction. We consider physiotherapy an integral part of our treatment plan for many patients with pelvic floor dysfunction.

If it is determined that a patient has various forms of pelvic floor dysfunction that are amenable to surgical therapy, a combined surgical approach is indicated. Our previous experience has demonstrated that morbidity is not increased by performing urogynecologic and colorec-tal surgeries in one setting. In fact, there is no significant difference in morbidity, length of stay, or recuperation phase (Table 1-1.2). The longer operative time required for

Herbal Remedies For Acid Reflux

Herbal Remedies For Acid Reflux

Gastroesophageal reflux disease is the medical term for what we know as acid reflux. Acid reflux occurs when the stomach releases its liquid back into the esophagus, causing inflammation and damage to the esophageal lining. The regurgitated acid most often consists of a few compoundsbr acid, bile, and pepsin.

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