Pelvic Floor Diseases at The Western Pennsylvania Hospital

Millions of people suffer from it, often in silence. It accounts for a significant number of physician office visits. Yet, it is commonly misunderstood and often goes untreated. It is pelvic floor disease. Contrary to popular belief, disorders of the pelvic floor such as fecal and urinary incontinence, pelvic pain, and pelvic organ prolapse are not a normal part of the aging process. Although pelvic floor diseases may be caused by neurologic conditions or metabolic disorders, most often they result from stresses to the pelvic floor muscles due to childbirth, anorectal surgery or muscular degeneration. Pelvic floor diseases can devastate a person's quality of life, creating discomfort and embarrassment. Fecal and urinary incontinence have made many people virtual captives in their own homes. However, following an initial evaluation, many conditions can be treated painlessly in an outpatient setting through the use of medications, biofeedback, pelvic floor muscle exercises and behavioral modifications. In some cases, surgery is needed to repair the muscles located between the rectum, vaginal canal and urethra, or to treat other associated conditions. At the Center for Pelvic Floor Diseases, specialists in colon and rectal surgery, urology, gastroenterology and psychiatry work together with patients to determine the cause of their problem and explore therapeutic options. Sophisticated diagnostic tests such as anorectal manometry, transanal ultrasound and defecography help the physician and patient decide the best course of treatment. The physicians of the Center are also actively involved in national, multi-center research trials of the latest therapeutic modalities for patients suffering from pelvic floor disease.

About the Center for Pelvic Floor Diseases

The Center for Pelvic Floor Diseases provides a unique multidisciplinary approach to the diagnosis and treatment of pelvic floor disorders. This program brings together the specialties of colon and rectal surgery, urology, gastroenterology and psychiatry to diagnose and treat pelvic floor disorders. The Center helps patients suffering from a variety of pelvic floor diseases, such as fecal or urinary incontinence, pelvic pain, cystocele, rectal prolapse, rectocele and enterocele as well as bladder incontinence or uterine prolapse. This state-of-the-art facility offers sophisticated evaluation unavailable at other sites including anal electromyography, transanal/transrectal ultrasound, biofeedback, anorectal manometry, pudendal nerve terminal motor latency and endoscopy. The Center combines the most technologically advanced and effective treatments for pelvic floor diseases with the utmost in compassion and care to individually improve the quality of life for each patient. Its biofeedback center is the most advanced in the region.

Services Provided

The following tests are performed to evaluate the status of a patient's anus, rectum and pelvic floor. Many different tests can be performed. An individual may be scheduled for only one test or for several tests. A physician will use the results of these tests to determine the most appropriate medical or surgical treatment for each individual. The following tests are offered at the Center for Pelvic Floor Diseases:

Anal Manometry
Anal manometry is a painless procedure that measures the overall strength of the pelvic floor muscles and rectal reflexes. The test is performed by placing a thin catheter, perfused by water, into the anus. Pressure monitors inside the catheter transmit the muscle impulses to a graph similar to an electrocardiogram. This is a painless procedure that takes approximately ten minutes to perform.

Anal Ultrasound
Anal ultrasound is a safe, painless examination that uses high frequency sound waves to create images of tissue layers beneath the surface. A small, smooth probe the size of a finger is placed into the anus, detecting lesions, tears and scarring in the sphincter muscles. This test is performed prior to surgery without the use of radiation.

Biofeedback
Biofeedback is an important component of treating pelvic floor syndromes and urinary or fecal incontinence, providing patients with specific information regarding their pelvic muscles. By placing small sensors on the muscles being monitored, biofeedback devices can detect the electrical activity of the pelvic muscles. Once the sensors are in place, they are connected to a computer which changes the electrical activity of the muscles into a signal that can been seen or heard on the computer screen. A trained physician assistant directs the biofeedback session.

Cine Defecography (Cine Defecatogram)
A cine defecatogram tests the motion of the pelvic floor, the muscles that control a bowel movement and the motion of the anus and rectum during a bowel movement. A small amount of thickened barium is placed into the rectum and a video recording is made while a patient expels the barium. Contrasts may also be placed in the vagina of female patients to better define the movement of the rectum toward the vagina.

Electromyography (EMG)
EMG allows physicians to determine whether the nerves that are within an individual's sphincter muscle are intact and if muscles relax and retract as they should. These tests are performed by inserting a small sponge into the anus or by stimulating the nerve with a small electrode. This painless procedure measures the electrical activity of the external anal sphincter and puborectalis muscle during a rest period, during a small squeeze and also during a very large squeeze.

Endoscopy or Colonoscopy
Endoscopy or colonoscopy enables a physician to examine the lining of the colon (large bowel) and rectum. During the procedure, a flexible tube is inserted into the anus. The tube is gradually placed into the rectum and lower part of the colon. Biopsies or treatments may be conducted at the initial screening.

Pelvic Exam
Pelvic exams are performed on women with complex pelvic floor problems. During the procedure, patients are examined for a rectocele, cystocele and enterocele and for urinary incontinence.

Peritoneography
Peritoneography is a very advanced test for patients who have pelvic floor problems that cannot be fully diagnosed using standard tests. These patients may have had previous surgery for a pelvic floor problem. Peritoneography combines a cine defecatogram with placement of a special fluid within a patient's abdomen. An area on the abdomen is injected with lidocaine, a numbing agent, and a small needle is then inserted into the abdomen.

Transanal/Transrectal Ultrasound
Transanal/transrectal ultrasound is a painless procedure that utilizes an ultrasound probe the size of an index finger to evaluate the sphincter muscles, or the pelvic floor. This procedure is also used to stage cancers or other lesions or to treat abscess or fistulars.

Urodynamics
This is a painless procedure that tests bladder function. Small catheters are placed into the bladder and rectum to take pressure readings. Urodynamics provides greater insight into the nature of bladder problems such as leakage, urgency and voiding problems.

Consultation and Additional Testing
An important aspect of care, a consultation between the patient and a physician from the Center for Pelvic Floor Diseases is scheduled to review test results and determine an appropriate plan of care.

Additional specific testing is available through The Western Pennsylvania Hospital. These procedures include specialized radiological testing that is performed by our expert team of board certified radiologists.

For More Information
For more information regarding The Western Pennsylvania Hospital Center for Pelvic Floor Diseases please call (412) 578-4023.