Pelvic relaxatio


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Pelvic relaxatio

  1. 1. Its painful
  2. 2. DON’TPANIC
  3. 3. Pelvic Floor Relaxation or Animus(uterovaginal prolapse )
  4. 4. Introduction : Up to half of the normal female population will developed uterovaginal prolapse or (PFR) during their lifetime. Twenty percent of these women will be symptomatic and need treatment. As the population of the world continues to increase in age, the prevalence of pelvic floor dysfunction is likely to increase.
  5. 5. Pelvic Floor Anatomy 1. Connective Tissue 2. Muscles 3. Neural Structures
  6. 6. Definition•"Absence of normal relaxation of pelvic floor muscles duringdefecation, resulting in rectal outlet obstruction".•"Malfunction (a focal dystonia) of the external analsphincter and puborectalis muscle during defecation".• failure of [the external anal sphincter and puborectalis]muscle[s] to relax, resulting in maintenance of the anorectalangle and the difficulty with initiating and completing bowelmovements".• failure of relaxation (or paradoxic contraction) of thepuborectalis muscle sling during defaecation, attempteddefaecation or straining.
  7. 7. factors have a significant influence onpelvic floor support:1.CONGENITAL.2.AGE3.CHILDBIRTH INJURY.4.ENDOCRINE.
  8. 8. •Congenital differences in collagen behaviour are clinicallyevident in women who have increased joint elasticity.•Age :The fascia of the pelvic floor will provide weakersupport with advancing years.•Childrenbirth:Most women recognize that their pelvic flooris different after vaginal delivery.•Endocrine: The menstrual cycle, pregnancy and themenopause are the most significant endocrine events whichmay influence pelvic floor fascia. be secondary to higherprogesterone levels increasing fascial elasticity.
  9. 9. Symptoms:•Straining to pass fecal material•Tenesmus (a feeling of incomplete evacuation)•Feeling of anorectal obstruction/blockage•Digital maneuvers needed to aid defecation•Difficulty initiating and completing bowelmovements
  10. 10. Complications fecal impaction encopresis fecal leakage megarectum
  11. 11. Classification:Type I: paradoxical contraction of the pelvic floor musclesduring attempted defecation Dislocation of the urethra—theurethra is displaceddownwards and backwards off the pubis. It may be alsodilated becoming an urethrocoele•Type II: inadequate propulsive forces during attempteddefecation (inadequate defecatory propulsion) Cystocoele—hernia of the bladder trigone•Type III: impaired relaxation with adequate propulsionUterine prolapse—descent of the uterus and cervix.
  12. 12. Type III: 3rd degree vaginalprolapse (procidentia)
  13. 13. Diagnosis•Examination(video)•Digital rectal examination(video)•Anorectal manometry•Rectal cooling test•MRI defecography•Balloon expulsion test•Evacuation proctography
  14. 14. Balloon expulsion test
  15. 15. Rectal cooling test
  16. 16. Anorectal manometry
  17. 17. Treatment:•Lifestyle modifications• Medications{Antidiarrheals, HormoneReplacement Therapy,Analgesic}• Kegel Exercises• Biofeedback• Surgery(Sphincteroplasty, Postanal repair)• Sacral Nerve Stimulation• Artificial sphincte
  18. 18. Postanal repair
  19. 19. Resources^ Voderholzer, W A; Neuhaus, D A; Klauser, A G; Tzavella, K; Muller-Lissner, S A; Schindlbeck, N E(1 August 1997). "Paradoxical sphincter contraction is rarely indicative of anismus". Gut 41 (2):258–262. doi:10.1136/gut.41.2.258. PMC 1891465.PMID 9301508.^ Preston, DM; Lennard-Jones, JE (1985 May). "Anismus in chronic constipation".Digestivediseases and sciences 30 (5): 413–8. doi:10.1007/BF01318172.PMID 3987474.^ Rao, Satish S.C. (31 August 2008). "Dyssynergic Defecation and BiofeedbackTherapy". Gastroenterology Clinics of North America 37 (3): 569–586.doi:10.1016/j.gtc.2008.06.011. PMC 2575098. PMID 18793997.^ a b c d e Bharucha, AE; Wald, A; Enck, P; Rao, S (2006 Apr). "Functional anorectaldisorders". Gastroenterology 130 (5): 1510–8. doi:10.1053/j.gastro.2005.11.064.PMID 16678564.^ a b c d e f al.], senior editors, Bruce G. Wolff ... [et (2007). The ASCRS textbook of colon and rectalsurgery. New York: Springer. ISBN 0-387-24846-3.^ a b c Wexner, edited by Andrew P. Zbar, Steven D. (2010). Coloproctology. New York:Springer. ISBN 978-1-84882-755-4.^ a b Kairaluoma, MV (2009). "[Functional obstructed defecation syndrome]". Duodecim;laaketieteellinen aikakauskirja 125 (2): 221–5. PMID 19341037.^ Bleijenberg, G; Kuijpers, HC (1987 Feb). "Treatment of the spastic pelvic floor syndrome withbiofeedback". Diseases of the colon and rectum 30 (2): 108–11.doi:10.1007/BF02554946. PMID 3803114.
  20. 20. Presented by : Ali Fakih Fatima Ra7al Presented to :S.F. Lina AmroThe ppt found in