Pelvic floor dysfunction

Constipation can be due to primary and secondary causes (Table 18-1). Primary or idiopathic constipation is typified by normal-transit constipation, slow-transit constipation, and dyssynergic defecation. In the normal-transit type, colonic motility is unchanged and patients tend to experience hard stools despite normal movements. In the slow-transit type, motility is decreased leading to infrequent harder, drier stools. In dyssynergic defecation (also known as pelvic floor dysfunction), patients have lost the ability to relax the anal sphincter while coordinating muscle contractions of the pelvic floor. Some causes of secondary constipation are listed in Table 18-1. 

Constipation may be caused by slow intestinal transition, pelvic floor dysfunction, bowel dysfunction like irritable Bowel syndrome and tumours, but can also be secondary to other diseases and life conditions. Many medicines cause constipation, for example opiates, calcium channel blockers and drugs with anticholinergic effects, e.g. antidepressants. 

Rufford J, Hextall A, Cardozo L, Khullar V. A doubleblind placebo-controlled trial on the effects of 25 mg estradiol implants on the urge syndrome in postmenopausal women. Int Urogynecol J Pelvic Floor Dysfunct 2003 14 78-83. 

Echols KT, Chesson RR, Breaux EF, Shobeiri SA. Persistence of delayed hypersensitivity following transurethral collagen injection for recurrent urinary stress incontinence. Int Urogynecol J Pelvic Floor Dysfunct 2002 13(l) 52-4. 

Drutz HP, Appell RA, Gleason D, Klimberg I, Radomski S. Clinical efficacy and safety of tolterodine compared to oxybutynin and placebo in patients with overactive bladder. Int Urogynecol J Pelvic Floor Dysfunct 1999 10(5) 283-9. 

The majority of patients with constipation related to pelvic floor dysfunction can benefit from electromyogram-guided biofeedback therapy. The value of biofeedback in children with chronic constipation has not been well demonstrated. ... 

Approximately 90%-95% of cases of childhood constipation are likely to represent functional constipation. Rectal distention is present in nearly all cases and failure of the external anal sphincter and/or pub-orectalis muscle to relax during defaecation attempts has been found in the majority of these children. Whilst delayed colonic transit time may be part of the problem, pelvic floor dysfunction seems to be the dominating factor (Loening-Baucke 1993). 

Bump RC, Mattiasson A, Bo K, et al. (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol... 

C.D. Anthony Herndon, Marvalyn Decambre, Patrick H. Mckenna (2001) Interactive computer games for treatment of pelvic floor dysfunction, J Urolo, vol.166, pp.1893-1898... 

McKenna, P.H., Herndon, C.D., Connery, S., and Ferrer, F.A. (1999) Pelvic floor muscle retraining for pediatric voiding dysfunction using interactive computer games. / Urol 162 1056—1062 discussion 1062—1063. 

The pelvic floor constitutes the caudal border of the human s visceral cavity. It is characterized by a complex morphology because different functional systems join here. A clear understanding of the pelvic anatomy is crucial for the diagnosis of female pelvic diseases, for female pelvic surgery as well as for fundamental mechanisms of urogenital dysfunction and treatment... 

Osteopathic treatment can begin with the initial physical examination and should include treatment of the primary somatic dysfunctions. Treatment of the uterus and pelvic floor during bimanual examination is most appropriate. 

Plister C, Dacher JN, Gaucher S et al (1999) The usefulness of minimal urodynamic evaluation and pelvic floor hio-feedback in children with chronic voiding dysfunction. Br J Urol 84 1054-1057... 

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