Pelvic floor service

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 is Mr Harnek Rai, Consultant Urogynaecologist.

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.

Mr. Rai is supported at the Fitzwilliam Hospital, by a Clinical Specialist Physiotherapist - Women's & Men's Health.

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.

 

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.

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