Pelvic Floor Service
Pelvic floor dysfunction in the general population is common.
The aetiology, functional anatomy and physiology of those
conditions which result, however, are often poorly understood, but
there has been an upsurge of interest in them amongst
urogynaecologists and coloproctologists.
It is increasingly apparent that bladder, vaginal and rectal
dysfunction frequently co-exist and are often inseparable. Where
patients previously may have had to put up with considerable
restrictions on their activities with little hope of improvement,
some very effective surgical and non-surgical management options
now exist. These may make a significant difference to a patient’s
lifestyle.
The pelvic floor service at the Fitzwilliam Hospital is aimed at
individuals with the following problems:
- Vaginal prolapse
- Urinary incontinence
- Lower urinary tract disorders
- Faecal incontinence
- Difficult or painful rectal evacuation
- Rectal prolapse
The consultants delivering and coordinating a combined service
will be Mr Richard Guy, Consultant Colorectal Surgeon and Mr Harnek
Rai, Consultant Urogynaecologist, who share an interest in these
disorders.
Mr Guy qualified as a doctor in 1987 and spent the subsequent 17
years as a Medical Officer in the Royal Navy reaching the rank of
Surgeon Commander. Higher Surgical Training was spent in Colorectal
Units in Basingstoke, John Radcliffe Hospital Oxford, St. Mark’s
Hospital and Singapore General Hospital. In addition to pelvic
floor dysfunction Mr Guy’s interests include bowel cancer,
inflammatory bowel disease, anal disorders and colonoscopy. He is
married with two young children.
Mr Rai qualified in 1989 and spent his specialist registrar
training in Leicester. He gained experience in Urogynaecology at
both Leicester and Sydney as an Urogynaecology fellow. He is a
Member of the British Society of Urogynaecology. Mr Rai offers a
wide range of options regarding vaginal prolapse as well as the
minimally invasive option of a tension free vaginal tape for stress
urinary incontinence. Mr Rai’s interests also include fibroid uteri
and effects on urinary symptoms, labial surgery and post natal
pelvic floor review and advice. He is married with two young
daughters.
Mr. Guy and Mr. Rai are supported at the Fitzwilliam
Hospital, by Jane Dixon, Clinical Specialist Physiotherapist -
Women's & Men's Health.
Referral Process
We would like patients to be referred to the “Pelvic Floor
Service” at the Fitzwilliam Hospital. Referral letters will be
reviewed by Mr Guy or Mr Rai and the most appropriate consultant
will arrange to hold the initial patient consultation which may
include vaginal, pelvic and rectal examinations including speculum
examination, rigid sigmoidoscopy and proctoscopy. Some patients may
need to be seen by both consultants but this will usually occur on
separate occasions.
Investigations
Further evaluation might include urodynamics, endoanal
ultrasound, evacuation proctography, flexible sigmoidoscopy and
cystoscopy. Other investigations may be recommended by the
clinician depending upon clinical findings.
Treatment
1) Conservative. This might include pharmacological treatment or
dietary manipulation for faecal incontinence or evacuation
difficulties. Some patients will be referred for specialist pelvic
floor assessment and treatment which might include the use of
biofeedback by a specialist physiotherapist with an interest in
pelvic floor disorders. At the Fitzwilliam, the specialist
physiotherapist is Jane Dixon.
2) Surgical. The range of operations offered, depending upon the
nature of the disorder, includes Trans-vaginal Tape (TVT) for
stress incontinence, various vaginal prolapse repairs, rectocele
repair, perineal fixation of rectal prolapse, laparoscopic
rectopexy and anal sphincter repair.
Follow-up
This will be determined by the nature of the problem or any
procedures performed.