ASGE Endoscopy Course at ACG: Everyday Endoscopy: Expertise Meets Evidence (On-demand) | October 2024-12

12_Barrett-Englert Pelvic Floor Dysfunction

Pdf Summary

The document addresses pelvic floor dysfunction and its associated anorectal complications, alongside their management via endoscopic techniques. Dr. Meghan Barrett-Englert from Rush University Medical Center outlines various symptoms patients present with, such as feeling fullness, difficulty pushing stool out, and sensations of obstruction or pain during defecation.<br /><br />Pelvic floor dysfunction encompasses multiple conditions, including dyssynergic defecation, rectal prolapse, rectocele, fecal incontinence, and pelvic pain, as well as levator ani syndrome, proctalgia fugax, and perineal descent. It may also involve complications with urination and types of pelvic organ prolapse like enterocele, cystocele, and vaginal or uterine prolapse.<br /><br />Three specific anorectal complications discussed are solitary rectal ulcer syndrome, anal fissures, and hemorrhoids. Solitary rectal ulcer syndrome presents a wide range of endoscopic appearances and is usually located on the anterior rectal wall, with treatment potentially involving argon plasma coagulation for persistently resistant ulcers. Anal fissures, typically located at the posterior midline, are treated primarily by relieving local muscle spasm, with botulinum toxin injections considered when conservative management is insufficient. Hemorrhoids involve swollen vascular cushions in the anal canal, and treatment aims at reducing vascularity and securing the anal cushions. Rubber-band ligation is one procedure that can be employed using endoscopy.<br /><br />Effective management of pelvic floor dysfunction requires thorough physical and endoscopic evaluations to diagnose and treat underlying complications, leading to improved patient outcomes. The document emphasizes the importance of a multidisciplinary approach combining anatomical understanding and functional assessments of the anorectal and pelvic regions to manage these complex conditions effectively.

Keywords

pelvic floor dysfunction

anorectal complications

endoscopic techniques

dyssynergic defecation

rectal prolapse

solitary rectal ulcer syndrome

anal fissures

hemorrhoids

multidisciplinary approach

patient outcomes