Pelvic Floor Conditions

I am the lead colorectal surgeon for pelvic floor conditions at Frimley, & work closely with Helen Walker, a urogynaecologist, and Harry Naegar, a urologist. There is often an overlap with urological, gynaecological, and bowel pelvic floor disorders, and so a multidisciplinary team approach is essential. We meet regularly for a pelvic floor MDT (multidisciplinary team meeting), and have excellent radiological support from Dr Alison Keightley.

Physiotherapy is very important in managing these conditions, and we are fortunate to have excellent physiotherapists at Frimley (Catherine Ross, who also sees private patients, and Helen Smith), and also at Clare Park (Nicola Markham). We also have gynaecological and colorectal nurse specialists at Frimley who help to support our patients. There is also a regional pelvic floor group, which meets regularly to share best practice, undertake research, & discuss difficult cases.

There are a range of bowel conditions that can occur due to pelvic floor problems. These include:

Faecal incontinence:

Faecal incontinence is a very distressing symptom, and not surprisingly patients are often reluctant to discuss this problem. I try to put patients at ease as far as possible, but am very aware it is difficult and distressing condition to discuss. However, there are a range of treatments available, and often simple measures such as firming up the stool, pelvic floor exercises and physiotherapy, will make a significant difference. Various investigations such as anorectal physiotherapy, and an endoanal ultrasound may be recommended. Other treatments include bulking injections, percutaneous tibial nerve stimulation (PTNS), and sacral nerve stimulation which is performed at St Peter's Hospital.

For more information: uploads/2016/06/CORE-PATIENT-INFORMATION-FAECAL -INCONTINENCE.pdf

Obstructive defaecation:

This is condition where patients find it difficult to open their bowels. Whilst this can be due to constipation, there are a range of anatomical conditions affecting the rectum which can lead to these problems. Other symptoms include tenesmus (the sensation of needing to go), urgency, and incomplete evacuation. Investigations will often include a flexible sigmoidoscopy, and defaecating proctogram, and a range of treatments are available, depending on the underlying cause. Often physiotherapy is recommended in the first instance.


A common condition, but can be challenging to treat. A range of investigations and therapeutic options are available.

For more information: uploads/2016/06/CORE-PATIENT-INFORMATION -CONSTIPATION.pdf


Rectal prolapse can affect patients of any age, and usually treated with surgery. Operations via the perineum or laparoscopically are available. includes/kcfinder/upload/files/LapVMR%20 -%20patient%20info%202.pdf

The pelvic floor society website has a lot of information for patients on pelvic floor conditions, investigations, and treatments: pages.php?t=Patient-Information&s=Patient -Information&id=92

And there is an App that can help you with those critical pelvic floor exercises!

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