Pelvic Floor Conditions

I am the lead colorectal surgeon for pelvic floor conditions at Frimley, & work closely with the urogynaecology team (Helen Walker and Vijaya Gopalan) and the urologists. 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).

Physiotherapy is critical in managing these conditions, and we are fortunate to have excellent physiotherapists at Frimley Park Hospital. We also have gynaecological and colorectal nurse specialists who help to support our patients.

A private physiotherapist I recommend is Vanesha Patel at Physica Health in Bagshot.

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

Faecal Incontinence Obstructive Defaecation Constipation Prolapse

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 including 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:

gutscharity.org.uk/advice-and-information/conditions/faecal-incontinence
bladderandbowelfoundation.org/bowel/bowel-problems

Obstructive Defaecation

This is a 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. Physiotherapy is often recommended in the first instance.

Constipation

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

For more information:

gutscharity.org.uk/advice-and-information/symptoms/constipation

Prolapse

Rectal prolapse can affect patients of any age, and is usually treated with surgery. Operations can be performed via the perineum or laparoscopically.

The pelvic floor society website has a lot of information for patients on pelvic floor conditions, investigations, and treatments:

thepelvicfloorsociety.co.uk/patients

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

squeezyapp.co.uk