At Texas Colon & Rectal Specialists (TCRS), our physicians work with patients at our Pelvic Floor Center to improve pelvic health issues with the latest in pelvic floor therapy. We offer an individualized, multi-disciplinary approach to overcome the various symptoms of pelvic floor disorders. Our pelvic floor therapy offers innovative solutions for the following:
The pelvic floor consists of muscles, nerves and connective tissue that support the structures of the pelvis: the rectum, bladder and female reproductive organs. Over time or with acute injury these supportive tissues can weaken, causing incontinence of urine and/or feces as well as vaginal prolapse, a condition in which the pelvic organs can “fall” into the vagina causing tissue to protrude.
Anal Manometry – Measures the strength of the internal and external sphincters, coordination of the muscles of the pelvic floor, and assesses sensations in the rectum. Used to assess constipation, fecal incontinence, to rule out Hirschsprung’s and many other pelvic floor conditions.
EMG recruitment – Assess patient’s ability to voluntarily contract and relax the pelvic floor muscles. Used to assess relaxation of the pelvic floor in constipation.
Pudendal nerve EMG – Assesses conduction of the pudendal nerve. Used primarily in diagnosis of cause of accidental bowel leakage but also in rectal prolapse and enterocele.
Anal ultrasound – Images sphincters and tissues surrounding the anal canal. Used to assess accidental bowel leakage, fistula, abscess, sphincter injury (post-delivery/surgery), and pain. This in-office procedure involves placing an ultrasound probe in the anorectal canal. While this may cause slight discomfort, it is largely pain-free and provides our surgeons with an excellent understanding of the anatomy of each patient’s pelvic floor.
Cine Defecography – A test using fluoroscopy that evaluates rectal emptying and relaxation of the pelvic floor. Visualizes rectocele, enterocele, and rectal prolapse.
PNE (Peripheral Nerve Evaluation) – Determines whether sacral nerve stimulation for the control of accidental bowel leakage or lower urinary tract dysfunction is appropriate for a given patient. A temporary device is used and, if successful, surgery to implant a permanent device would be the next option.
The TCRS physicians and staff will recommend the best pelvic floor therapy based on the patient’s individual needs:
Our group prides itself in attempting simple, non-surgical options before proceeding to more involved measures. Our first recommendations to patients experiencing fecal incontinence often include non-intrusive lifestyle changes including fiber supplements, diet changes and sitz baths.
In addition to lifestyle changes, physical therapy with biofeedback training represents another non-invasive method our surgeons use to treat incontinence. Our group works closely with physical therapists to coordinate this pelvic floor therapy which combines traditional physical therapy with anorectal manometry. This allows patients to focus their efforts on very specific areas of the pelvic floor by alerting them through audible tones when they are training the correct muscles.
If the cause of fecal or urinary incontinence is a miscommunication between the brain and the muscles of the pelvic floor, this is an appropriate option. The small neuromodulation system uses mild electrical stimulation (not unlike those emitted by a pacemaker) to encourage a balancing of nerve signals back to the muscles in the pelvic floor. As the nerve signals and muscles get better, many patients experience a significant improvement in their symptoms.
Sacral Neuromodulation is a two-part procedure. First, the patient will undergo a testing phase in which a temporary wire is placed under the skin near the tailbone and connected to an external trial stimulator. This evaluation phase, which can last from 1-2 weeks, will give both the patient and the physician time to determine if the long-term device is the best option to treat the incontinence. If Sacral Neuromodulation is decided on for long-term therapy, then the surgeon will place a small long-lived pacemaker under the skin in a short outpatient procedure.
If the cause of fecal incontinence is physical disruption (tearing) of the anal sphincter, surgical sphincteroplasty may be an appropriate treatment. During this inpatient operation the patient is given general anesthesia before the physician exposes the anal sphincter and repairs it using sutures. This procedure is particularly useful for women who develop incontinence after childbirth via vaginal delivery.
For patients who do not have symptom resolution with less invasive means, our group is one of a limited number of colorectal groups across the nation with surgeons who can perform implantation of the Acticon™ Neosphincter. This device is a fluid-filled silicone-rubber ring that mimics the body’s own anal sphincter. During the surgery our physicians implant the ring into the patient’s anal canal and place a small pump in the patient’s labia or scrotum. After recovery the patient is able to defecate by using the pump to release fluid from the silicone-rubber ring; after defecation is complete the ring is re-filled using the same pump, thus closing off the anal canal preventing fecal material from leaking out.