Pelvic floor dysfunction can cause urinary and fecal incontinence, constipation and pelvic organ prolapse. As common as these distressing issues are, though, many patients aren't benefiting from the newest techniques and tools available to address them.
"These tend to be difficult and even taboo challenges and patients often suffer in silence,” says Christopher M. Tarnay, MD, a urogynecologist and co-director of the Center for Women's Pelvic Health at UCLA.
"They can severely impact quality of life and in some cases prevent patients from leaving the house,” adds Lisa D. Lin, MD, a gastroenterologist and health sciences assistant clinical professor at UCLA.
Dr. Lin and other specialists in UCLA's Vatche & Tamar Manoukian Division of Digestive Diseases are working with Dr. Tarnay and colleagues in the Center for Women's Pelvic Health to offer patients individualized treatment that draws upon the expertise of nationally and internationally renowned clinicians and a dedicated team that includes specially trained physical therapists.
Pelvic organ prolaspe and structural damage to the pelvic floor or anal sphincter – often the consequence of vaginal birth – may be able to be corrected by robotic or minimally invasive surgery. However, problems such as fecal incontinence and chronic constipation are frequently mutifactorial and require an approach that considers not just structural problems but functional conditions and behavioral issues.
"Our multidisciplinary team helps navigate which of the causes is predominant" in a particular patient, Dr. Tarnay says, "and come up with an individualized management plan."
Further, even if patients have undergone corrective surgery, they may continue to suffer with refractory symptoms that may benefit from other types of interventions.
GI Motility Program
The GI Motility Program in the Division of Digestive Diseases treats patients with disorders in which the nerves or muscles of the digestive tract don't function normally. These problems, Dr. Lin explains, can occur anywhere in the gut, "from mouth to anus, essentially.”
The program takes advantage of leading-edge modalities to diagnose and guide treatment. Among them is high-resolution anorectal manometry, which evaluates anorectal coordination, anal sphincter and rectal sensory function, to understand causes of constipation or fecal incontinence and to guide treatment.
If there is evidence of dyssynergic defecation or a weak anal sphincter, then patients can undergo anorectal biofeedback using a manometric biofeedback machine or by working with specialized pelvic floor physical therapists at UCLA Health. The manometric biofeedback machine also treats rectal hypo- or hypersensitivity which may also contribute to symptoms of pelvic floor dysfunction.
One of the innovative treatment modalities for fecal incontinence is sacral neuromodulation. It uses an implant akin to a pacemaker, controlled by a bluetooth-linked device, to stimulate the sacral nerves. This technique can be performed as an alternative to sphincter repair surgery, Dr. Tarnay says. "It can be a game changer and a quality of life saver. When it works it's rather miraculous."
Multidisciplinary care
Key to the success of the UCLA Health programs is a multidisciplinary approach that includes GI specialists, urogynecologists, colorectal surgeons, ultrasonographers, physical therapists, clinical nutritionists, GI health psychologists and GI motility nurses.
"Often these problems take a multipronged approach," Dr. Lin says. "Often it takes a team."
