How to prevent and address pelvic floor disorders

The pelvic floor disorders has different symptoms or related to the function of muscles or ligaments diseases whose mission is to support the abdominal viscera and, at the same time, give way to structures such as the rectum, vagina or urethra, and control evacuatorias and sexual functions. Many of these processes are more common in women because childbirth may be among their causal factors.

Disorders related to pelvic floor disorders

The pelvic floor disorders may be related to problems such as:- Anal or urinary incontinence- Rectocele and Enterocele- Rectal Prolapse- Chronic anal or pelvic pain- Difficulty voidingIn certain pelvic floor disorders patients can not properly relax the sphincters contract or even more, so that evacuation is very difficult (anism) or pain syndromes can appear. By contrast, in other cases, the patient is unable to hold stool or urine (anal and urinary incontinence) and finally lumps called "celes" (cystocele, histerocele, colpocele, rectocele, enterocele ...) may also appear in perineum, respectively result of herniation of viscera such as the bladder, uterus, vagina, rectum or small intestine, through defects in the floor of the pelvis.

Main symptoms of pelvic floor disorders

The symptoms of pelvic floor disorders depends on the specific problem and specific. Thus, manifested in the patient's need to constantly go to the toilet, leakage of stool or urine or having to urinate or defecate urgently to prevent escape or, conversely, difficulty urinating or defecating, and the a lump on the genitals exertion, the output of the rectum through the anus or pain in the pelvic area, reasons that should motivate a medical consultation with expert surgery and coloproctology .

How to diagnose pelvic floor disorders

Apart from a directed medical history and careful examination, as regards the assessment from the point of view of coloproctólogo, various tests may be performed, such as:

- Anorectal manometry: Measures the pressures of both anal sphincters, rectal sensitivity and coordination of the pelvic floor muscles. Rate mainly anal incontinence and constipation.- Test balloon expulsion: Analyzes the ability to eject a balloon filled with 50ml of liquid placed in the rectum to rule alterations evacuation.- Endoanal-endorectal ultrasound: It allows to assess the integrity of the anal sphincters and pelvic floor muscles and structures around the anus and rectum.- Video-Defecagram: A radiological examination used to investigate possible disturbances during evacuation (prolapse, rectocele, enterocele) and the state of the pelvic muscles.- Dynamic pelvic MRI: Rate the same as the video-defecography, with the added advantage of not irradiate and analyze, while the behavior of the pelvic organs.- Percutaneous nerve evaluation (PNE): It is performed under local anesthesia and reveals whether stimulation of the sacral nerve roots improves urinary incontinence or stool, certain types of constipation, or chronic pelvic pain.- Intestinal transit time: After taking capsules that carry a small visible rings by X - rays, x - rays are performed in order to see its distribution in the intestine and evacuation in cases of severe chronic constipation.

And sometimes are accurate other examinations, and an evaluation by different specialists, given the diversity of clinical presentations of pelvic floor problems. 

Treatment of pelvic floor disorders

It is essential the multidisciplinary management by different specialists, if the case requires. As regards the processes affecting the rectum and anus, therapies are basically:

- Medical and hygienic-dietetic treatment. Correcting abnormal defecation habits, making fiber, liquids, and control of certain medications, either beneficial or harmful, it is important as a first step.- Exercises pelvic floor muscles Kegel type, to strengthen the anal sphincter and urethral and other muscles of the perineum. These exercises consist basically perform contraction and elevated pelvic muscles for a few seconds, followed by relaxation of it, being in a sitting position.- Biofeedback (sphincter and pelvic floor rehabilitation), to treat both anal incontinence, and constipation by difficulty expulsion. It is to teach the patient to improve the contraction or relaxation of the sphincters and coordinate the time they reach the rectum stool or gas, by observing your muscle activity. This allows a reference to overcome, making the right to contract or relax the sphincter muscles properly and no other maneuvers.- Sacral root neuromodulation: This involves the implementation of a close to a sacral nerve root electrode, connecting to a battery test if the percutaneous nerve evaluation (PNE) was satisfactory.- Surgery: pelvic floor disorders often require surgery to treat rectal prolapse, rectocele, enterocele, cystocele, uterine prolapse, vaginal vault eversion, or certain cases of anal incontinence or urinary. Some of them can be performed laparoscopically. Due to the existence of a wide variety of problems and specific surgical techniques, specifically analyze each case.

They can be prevented pelvic floor problems?

Prolonged labor, those requiring significant implementation or multiparity are themselves important risk factors. The same applies to the usual evacuatorios efforts for years. Pregnancy itself, chronic cough, removal of the uterus, prostate cancer surgery, a history of back pain or obesity are also relevant in the occurrence of these problems pelvic floor.    Thus, careful attention to childbirth and reducing evacuatorios efforts and correction of constipation throughout life, will help to reduce the incidence of these problems occur more frequently in women after the onset of menopause, decreasing hormonal activity and muscle tone.    Those at risk for pelvic floor problems should avoid high - intensity exercise or exert pressure on the pelvis, such as jumping rope, lifting weights or playing sports that include sprints, among others. However, certain sports are healthy, such as swimming, cycling or walking. In addition, to do gymnastics can protect the pelvic floor, for example, lifting heavy weights not in sitting position, keeping legs together to do gymnastics, adopting a relaxed position or trying to be gentle with squatting exercises. Regardless, there are specific exercises for the pelvic floor as Kegel, already discussed.

Edited by Patricia Crespo Pujante