1.
Food, fibre, bile acids and the pelvic floor: An integrated low risk low cost approach to managing irritable bowel syndrome.
Philpott, H, Nandurkar, S, Lubel, J, Gibson, PR
World journal of gastroenterology. 2015;(40):11379-86
Abstract
Patients presenting with abdominal pain and diarrhea are often labelled as suffering from irritable bowel syndrome, and medications may be used often without success. Advances in the understanding of the causes of the symptoms (including pelvic floor weakness and incontinence, bile salt malabsorption and food intolerance) mean that effective, safe and well tolerated treatments are now available.
2.
Medical and surgical management of pelvic floor disorders affecting defecation.
Schey, R, Cromwell, J, Rao, SS
The American journal of gastroenterology. 2012;(11):1624-33; quiz p.1634
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Abstract
Pelvic floor disorders that affect stool evacuation include structural (for example, rectocele) and functional disorders (for example, dyssynergic defecation (DD)). Meticulous history, digital rectal examination (DRE), and physiological tests such as anorectal manometry, colonic transit study, balloon expulsion, and imaging studies such as anal ultrasound, defecography, and static and dynamic magnetic resonance imaging (MRI) can facilitate an objective diagnosis and optimal treatment. Management consists of education and counseling regarding bowel function, diet, laxatives, most importantly behavioral and biofeedback therapies, and finally surgery. Randomized clinical trials have established that biofeedback therapy is effective in treating DD. Because DD may coexist with conditions such as solitary rectal ulcer syndrome (SRUS) and rectocele, before considering surgery, biofeedback therapy should be tried and an accurate assessment of the entire pelvis and its function should be performed. Several surgical approaches have been advocated for the treatment of pelvic floor disorders including open, laparoscopic, and transabdominal approach, stapled transanal rectal resection, and robotic colon and rectal resections. However, there is lack of well-controlled randomized studies and the efficacy of these surgical procedures remains to be established.
3.
Ultrasound imaging of the pelvic floor. Part II: three-dimensional or volume imaging.
Dietz, HP
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2004;(6):615-25
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Abstract
In this second part of a review of pelvic floor ultrasound imaging, current three-dimensional (3D) ultrasound technology and its use for imaging pelvic floor structure and function is described. Recent technical developments enable rapid automated volume acquisition in real time, and currently available transducers designed for abdominal use are well suited for translabial/transperineal imaging. To date, such systems have been used to image the urethra, the levator ani and paravaginal supports, prolapse and implants used in pelvic floor reconstruction and anti-incontinence surgery. While 3D pelvic floor imaging is a field that is still in its infancy, it is already clear that the method has opened up entirely new opportunities for the observation of functional anatomy.