Pelvic Floor Dysfunction: The Importance of a Multidisciplinary Approach

[1] [2]The frequent coexistence of dysfunction in the various compartments of the pelvic floor has led to the simultaneous treatment of pelvic floor dysfunction sufferers by multiple clinicians. As the concept of the pelvic floor as a single functional unit reaches increasing degrees of acceptance among clinicians, the team approach to pelvic floor dysfunction is increasingly accepted. Until recently, the pelvic floor was divided into compartments according to specialty training. Limiting management of the anterior compartment to urologists, the middle compartment to gynecologists, and the posterior compartment to colorectal surgeons does not benefit our patients. In fact, these divisions are primarily political and frequently lead to serial surgical procedures and inefficient treatment plans.[1]

Most clinicians who care for pelvic floor dysfunction are accustomed to the concept of a vertical orientation of their organ system (e.g., kidneys-ureters-bladder, colon-rectum-anus). In contrast, the pelvic floor is oriented in a transverse (horizontal) direction, with dysfunction typically affecting multiple organ systems. This requires a reorientation of a clinician's view of a disease process and its clinical impact. For example, vaginal childbirth may result in urinary incontinence, vaginal laxity, and anal sphincteric tears.

The clinical components of a Pelvic Floor Center include those caring for bladder, genital, and colorectal dysfunction. Recent surveys of specialists in each of these areas have revealed that similar dysfunction problems are dealt with in very different ways.[2] [3] Urologists, gynecologists and urogynecologists have achieved a greater degree of agreement in management of common anterior and middle compartment problems such as urinary incontinence and the enlarging cystocele.[2] However, management of posterior compartment dysfunction has not achieved such degrees of agreement. A significant example represents the evaluation of treatment of a posterior vaginal wall bulge, the symptomatic rectocele.[4]

The purpose of this issue is to familiarize colorectal surgeons with commonly found urologic and gynecologic conditions. As such, articles addressing female genital adnexal masses (which a colorectal surgeon may encounter during abdominal surgery) and the visual and clinical characteristics of endometriosis receive a significant amount of focus. Urologic reconstructive procedures as well as management of urologic intraoperative trauma and voiding dysfunction postoperatively are addressed in great detail. In addition, gynecologic approaches to the symptomatic rectocele are addressed with a focus on vaginal surgical techniques for rectocele repair.

It is our hope that colorectal surgeons will be able to obtain information not frequently found in colorectal surgery textbooks in this issue of Clinics in Colon and Rectal Surgery. It is also our hope that this issue will expand the team approach to pelvic floor dysfunction because this new concept has been demonstrated to have a highly positive impact on our patients' well being.

REFERENCES

• 1 Wall L L, DeLancey J OL. The politics of prolapse: a revisionist approach to disorders of the pelvic floor in women.  Perspect Biol Med . 1991;  34 486-496
• 2 Davila G W, Ghoniem G M, Kapoor D S, Contreras-Ortiz O. Pelvic floor dysfunction management practice patterns: a survey of members of the International Urogynecological Association.  Int Urogynecol J . 2002;  13 319-325
• 3 Gee W F, Holtgrewe H L, Albertsen P C. et al . Practice trends of American urologists in the treatment of impotence, incontinence and infertility.  J Urol . 1996;  156 1778-1780
• 4 Mizrahi N, Kapoor D S, Baig M K. et al . A gynecologic perspective of posterior compartment defects (abstract).  Colorectal Dis . 2002;  4 68