Is it Fear

?

Is it Anxiety?

It's painful

IS IT SERIO

US ?

TIM

E S

UP!!!!!!

DON’T PANIC

Don’t scream!!!!

You may have

Pelvic Floor Relaxation or Animus

(uterovaginal prolapse )

Up to half of the normal female population will developed uterovaginal prolapse or (PFR) during their lifetime.

Twenty percent of these women will be symptomatic and need treatment.

As the population of the world continues to increase in age, the prevalence of pelvic floor dysfunction is likely to increase.

Introduction :

Pelvic Floor Anatomy1. Connective

Tissue

2. Muscles

3. Neural Structures

Definition

•"Absence of normal relaxation of pelvic floor muscles during defecation, resulting in rectal outlet obstruction".•"Malfunction (a focal dystonia) of the external anal sphincter and puborectalis muscle during defecation".• failure of [the external anal sphincter and puborectalis] muscle[s] to relax, resulting in maintenance of the anorectal angle and the difficulty with initiating and completing bowel movements".• failure of relaxation (or paradoxic contraction) of the puborectalis muscle sling during defaecation, attempted defaecation or straining.

factors have a significant influence onpelvic floor support:

1.CONGENITAL.2.AGE3.CHILDBIRTH INJURY. 4.ENDOCRINE.

•Congenital differences in collagen behaviour are clinically evident in women who have increased joint elasticity.

•Age :The fascia of the pelvic floor will provide weaker support with advancing years.

•Childrenbirth:Most women recognize that their pelvic floor is different after vaginal delivery.

•Endocrine: The menstrual cycle, pregnancy and the menopause are the most significant endocrine events which may influence pelvic floor fascia. be secondary to higher progesterone levels increasing fascial elasticity.

Symptoms:

•Straining to pass fecal material •Tenesmus (a feeling of incomplete evacuation) •Feeling of anorectal obstruction/blockage •Digital maneuvers needed to aid defecation •Difficulty initiating and completing bowel movements

:Complications

fecal impaction  encopresis

fecal leakage  megarectum

Classification:

Type I: paradoxical contraction of the pelvic floor muscles during attempted defecation Dislocation of the urethra—the urethra is displaceddownwards and backwards off the pubis. It may be also dilated becoming an urethrocoele•Type II: inadequate propulsive forces during attempted defecation (inadequate defecatory propulsion) Cystocoele—hernia of the bladder trigone •Type III: impaired relaxation with adequate propulsion Uterine prolapse—descent of the uterus and cervix.

3rd degree vaginal prolapse (procidentia)

Type III:

Diagnosis

•Examination(video)•Digital rectal examination(video)•Anorectal manometry•Rectal cooling test•MRI defecography•Balloon expulsion test•Evacuation proctography

Balloon expulsion test

Rectal cooling test

Anorectal manometry

Treatment:

•Lifestyle modifications• Medications{Antidiarrheals, Hormone Replacement Therapy,Analgesic}• Kegel Exercises• Biofeedback• Surgery(Sphincteroplasty, Postanal repair)• Sacral Nerve Stimulation• Artificial sphincte

Postanal repair

Artificial sphincter:

Resources^ Voderholzer, W A; Neuhaus, D A; Klauser, A G; Tzavella, K; Muller-Lissner, S A; Schindlbeck, N E (1 August 1997). "Paradoxical sphincter contraction is rarely indicative of anismus". Gut 41 (2): 258–262. doi:10.1136/gut.41.2.258. PMC 1891465.PMID 9301508.^ Preston, DM; Lennard-Jones, JE (1985 May). "Anismus in chronic constipation".Digestive diseases and sciences 30 (5): 413–8. doi:10.1007/BF01318172.PMID 3987474.^ Rao, Satish S.C. (31 August 2008). "Dyssynergic Defecation and Biofeedback Therapy". Gastroenterology Clinics of North America 37 (3): 569–586.doi:10.1016/j.gtc.2008.06.011. PMC 2575098. PMID 18793997.^ a b c d e Bharucha, AE; Wald, A; Enck, P; Rao, S (2006 Apr). "Functional anorectal disorders". Gastroenterology 130 (5): 1510–8. doi:10.1053/j.gastro.2005.11.064.PMID 16678564.^ a b c d e f al.], senior editors, Bruce G. Wolff ... [et (2007). The ASCRS textbook of colon and rectal surgery. New York: Springer. ISBN 0-387-24846-3.^ a b c Wexner, edited by Andrew P. Zbar, Steven D. (2010). Coloproctology. New York: Springer. ISBN 978-1-84882-755-4.^ a b Kairaluoma, MV (2009). "[Functional obstructed defecation syndrome]". Duodecim; laaketieteellinen aikakauskirja 125 (2): 221–5. PMID 19341037.^ Bleijenberg, G; Kuijpers, HC (1987 Feb). "Treatment of the spastic pelvic floor syndrome with biofeedback". Diseases of the colon and rectum 30 (2): 108–11.doi:10.1007/BF02554946. PMID 3803114.http://123sonography.com/?gclid=CIfs2q7FqbQCFUxY3god5n8ANA

Presented by :Ali Fakih

Fatima Ra7al

Presented to :S.F. Lina Amro

The ppt found in www.slideshare.net