There is a range of different treatments depending on the type and cause of your pelvic floor condition.
If you are experiencing evacuatory problems (constipation), your doctor will want to carry out an internal examination to see if you have a prolapse or hernia or obstructive defecation syndrome (ODS). You may be referred for a diagnostic procedure called defecation proctography, which involves inserting a contrast dye into your rectum and taking X-rays as you pass stools to see what is causing the obstruction.
Treatment for evacuatory problems includes:
- Eating a healthy balanced diet and drinking at least two litres of water a day
- Laxatives to help you to empty your bowels more easily
- Pelvic floor physiotherapy which will help you to relax your pelvic floor muscles and avoid straining on the toilet.
If these methods are unsuccessful there are a range of possible surgical treatments including:
- Repairing the damaged muscle wall
- Treating rectal prolapse.
Although many people can be embarrassed to visit their GP with faecal incontinence, you don’t need to suffer in silence, as there are treatments available that can help. These include:
- Medication – such as suppositories for constipation or loperamide for diarrhoea
- Dietary changes to help with stool consistency – increasing the amount of fibre in your diet (fruit, vegetables and wholegrain bread) and drinking plenty of fluids can help reduce constipation. If diarrhoea is the problem, cutting down on high fibre foods and avoiding caffeine and alcohol can help
- Pelvic floor exercises to strengthen the muscles that control your bowels – you may be referred to a specialist continence service where you will be shown how to do the exercises by a specialist nurse or physiotherapist
- Biofeedback – this is a small electric probe placed inside your bottom. It records the movement and pressure of muscles in your rectum and conveys this to an attached computer. You will then be asked to perform a series of exercises designed to improve your bowel function. The sensor will check that you are performing the exercises in the right way
- Enemas or rectal irrigation – these are used when incontinence is caused by faecal impaction. A small tube is placed inside your anus and a solution is used to wash out your rectum. This can be performed with adequate training in the home environment
- Bowel retraining – this may involve creating a regular routine for going to the toilet and learning how to empty your bowels more effectively. The aim is to establish a regular time for you to pass stools, to find ways of helping your bowels to empty themselves and to improve the consistency of your stool
- Continence products – such as small foam plugs you put inside your anus or continence pads can be used until your symptoms are more under control
- Access to disabled toilets using a Radar key. These are available from Disability Rights UK and gives access to around 9,000 disabled toilets around the UK
- Surgery – there are several procedures that may be suitable, depending on your investigations and the underlying problems. Surgery is generally only recommended after all other treatment options including physiotherapy and medication have been tried
- Procedures include: repairing the damaged sphincter muscles in the anus, sacral nerve stimulation which uses an electronic device to stimulate the nerves supplying the anal sphincter and injectable bulking agents
- Other possible treatments are artificial sphincter surgery, endoscopic heat therapy and tibial nerve stimulation.
Treatment will depend on whether the pain is chronic or acute and what is causing it. You may be offered a range of possible diagnostic tests are available including a pelvic examination, ultrasound scan, blood test to check for infection, CT or MRI scan.
A laparoscopic test allows your doctor to check for signs of infection including pelvic inflammatory disease and endometriosis. It involves making a small incision in your tummy and inserting a telescope attached to a small camera.
Once diagnosed, you may be offered a range of treatments, including:
- Antibiotics to treat infection
- Hormone treatments to regulate ovulation and menstruation
- Antidepressants such as amitriptyline, which can be helpful in treating chronic pain
- Neurostimulation which implants a small device to block the pain signals from your nerves to your brain
- Trigger point injections, which can be used to numb painful areas using a long-acting local anaesthetic
- Physical therapy including strategies to help you cope with pain. This may include using a TENS machine which delivers electrical impulses to nerve pathways or biofeedback which helps you to relax tight muscles
- Psychological support which may help you with coping strategies
- Laparoscopic (keyhole) surgery – this may be used to remove endometrial tissues if you have endometriosis, for example
- Hysterectomy – in complex cases you may undergo removal of your womb, fallopian tubes or ovaries
- Pain rehabilitation to help you to manage the pain you are experiencing
- Acupuncture – may also help to control some types of pelvic pain.
The treatment you are offered will depend on the type and severity of your prolapse, your age and general state of health and whether you are planning to have children in the future. Possible treatments for rectal prolapse include:
- Abdominal rectopexy – using keyhole surgery to lift and fix the rectum back in its anatomical site in the pelvis and securely attach it using sutures or a mesh
- Perineal repair – fixing the bowel using trans-anal surgery and suturing it in place. This is sometimes combined with a limited bowel resection if the prolapse is very big,
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