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PELVIC FLOOR DEFECATORY DYSFUNCTION: MANAGEMENT OR CURE?

Tuesday 18 Jul 2017 {{NI.ViewCount}} Views {{NI.ViewCount}} Views

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UNPUBLISHED SCHEDULED
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WORKSHOP 32
FRIDAY 15TH SEPTEMBER 2017
09:30 - 12:30
HALL F - limited spaces available at this workshop

This workshop will provide an overview of the pathophysiology, evaluation and both conservative (including a practical element) and surgical management of pelvic floor defecatory dysfunction (PFDD). This workshop will also cover psychological symptoms and its management in this group of patients as well as how to identify and manage them when presenting to the urogynaecology and/or urology clinics with concomitant pelvic floor symptoms. These disorders affect both women and men and necessitate a multidisciplinary team approach. It is also an opportunity to raise awareness of bowel evacuation difficulties and its relationship with urinary and sexual symptoms in a society that predominantly focuses on urinary incontinence.

The first part of this workshop will focus on the incidence, pathophysiology, clinical diagnosis and evaluation, investigations and pharmacological and surgical management of PFDD. The second part will provide the participant with an overview of the conservative of PFDD. The participants will also be able to learn when and how to use rectal irrigation in patients with PFDD and practice with the different types of anorectal irrigation systems. This part of the workshop will also present the importance of psychological assessment and treatment in this patient group as well as what to do when the patients present to the urogynaecology and/or urology clinics.Finally the chairman and the speakers will stimulate discussion in the audience and answer any final questions.

The best management of PFDD is a multidisciplinary approach. This workshop will not only evaluate the most up-to-date evidence regarding the recognition of the PFDD, the assessment and treatment of PFDD, but the importance of collaborative work amongst the multidisciplinary team.

Key learning points

  • Pelvic floor disorders that affect defecation are very common and affect women predominantly
  • PFDD needs a methodical assessment before embarking onto any treatment
  • Urologists and Urogynaecologists need to be aware of PFDD when these patients present to their clinics with urinary and/or sexual symptoms
  • Biofeedback and/or conservative measures should be first line management in patients with PFDD
  • Biofeedback is an established intervention for patients with PFDD
  • Surgery should be considered for management of PFDD but only when the underlying pathophysiological dysfunction has been corrected

Take home messages

  • PFDD is a common problem that adversely affects the quality of life for many patients
  • Many women that present to the Urogynaecology/Urology clinics with urinary symptoms will have concomitant bowel dysfunction so an understanding of investigations, treatment options and when to seek further opinion once simple measures have failed is important
  • Physiologic tests such as anorectal manometry, balloon expulsion test and imaging such as proctography and MRI play a key role in objective diagnosis
  • Occasionally there is an underlying psychological problem that needs to be addressed when treating PFDD
  • Biofeedback is an effective treatment intervention that helps 30 to 90 of patients with PFDD
  • Surgery should be the last resort and a systematic evaluation and inclusion of the multidisciplinary team is imperative when evaluating and managing this group of patients

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