Ano-Rectal Procedures And Operations
Treatment of Incontinence
There are many different treatment options available for patients with urinary incontinence, depending on the severity of their condition. Conservative treatments are often effective, and may include the following:
- Bladder training
- Avoiding alcohol and caffeine
- Medication to control pelvic muscle spasms.
- Kegel exercises to strengthen the pelvic floor muscles and prevent urine leakage
For more severe cases of incontinence, a medical device or surgery may be used to relieve symptoms. One option includes the insertion of a pessary or urethral insert to prevent urine leakage. Surgery may also be recommended to provide support to the bladder neck. It may be performed through the abdomen or vagina, or using minimally invasive techniques.
Sacral Nerve Stimulation
Sacral nerve stimulation is an advanced electrical stimulation procedure performed to treat urinary incontinence and other bladder control problems in patients who have not responded to more conservative treatment options. A neurotransmitter device placed under the skin of the upper buttocks will send electrical impulses to the sacral nerve, which controls the bladder, sphincter and pelvic floor muscles.
Benefits of Sacral Nerve Stimulation
The sacral nerve stimulation procedure is effective in treating the following symptoms of bladder and urinary difficulties:
While sacral nerve stimulation cannot cure these conditions, they can help to treat embarrassing and uncomfortable symptoms, which can help to improve the patient's quality of life.
Sacral Nerve Stimulation Procedure
The neurotransmitter used for sacral nerve stimulation is implanted during an outpatient procedure that takes about 45 minutes to perform. There is usually a trial period of one to two weeks before implantation of the actual device to determine the effectiveness of stimulation. Patients may experience pain at the incision site for a few weeks, and may need to limit activity as the area heals. Follow-up appointments may be required throughout the first six months to fine-tune stimulation settings. The battery of the neurotransmitter will need to be replaced every three to five years.
Risks/Complications of Sacral Nerve Stimulation
This treatment is considered safe for most patients, although there are some possible risks, which may include:
- Pain at the implant site
- Movement and technical problems with the device
Biofeedback Treatment for Urinary Incontinence
Biofeedback is an alternative treatment method that is effective in treating many common conditions, including urinary incontinence. Urinary incontinence involves an inability to control the bladder, resulting in leakage of urine. This treatment trains patients to let their thoughts control their body processes, including those that are normally involuntary, and is often effective in treating conditions caused by stress.
People suffering from urinary incontinence should first be seen by a urologist to rule out any physical abnormalities that may be causing the condition. After ruling out any physical problems, most patients are referred to a behavioral therapist for potential treatment, such as biofeedback.
The Biofeedback Procedure
During the biofeedback procedure, electrodes are attached to the skin to first monitor the brain's physiologic responses, and then translate them into results that can be interpreted by a doctor. The doctor then leads a series of exercises to modify patient's response to certain activities, gradually allowing patient's to control their response. Through biofeedback, special instruments also monitor the muscles that control urine output. The goal is to control urine leakage with active practicing of certain muscles and mental control. Each session lasts for about an hour.
Most patients require at least eight to ten treatment sessions before results are noticeable. Patients can also perform mental exercises and relaxation techniques at home for ten minutes each day in order to improve or maintain the results of treatment.
Biofeedback is considered a safe and effective procedure for most patients. There are no negative side effects associated with this procedure, unlike many other incontinence treatments. While not all patients achieve successful relief from this treatment, most report a significant decrease in the severity and frequency of symptoms.
Obstruction defecation is a difficulty emptying the bowel and can be a common symptom of pelvic organ prolapse. Pelvic organ prolapse involves a pelvic organ moving from its normal position to push against the vaginal walls, causing pressure, stretching, pain and difficult or obstructed defecation. Because the organs are moved out of place and can put pressure on the rectal area, patients may find it difficult and painful to defecate.
Pelvic organ prolapse is most often caused by the strain placed on the pelvic muscles during childbirth, which commonly stretches or weakens the pelvic muscles. Other factors that put pressure on the pelvis and may lead to pelvic prolapse include:
- Chronic cough
- Frequent straining for bowel movements
- Pelvic floor dysfunction
- Weakness in the area due to aging
Types of pelvic organ prolapse include
Rectocele - A rectocele is the prolapse of the rectum. Rectal prolapse is a condition where a section of the wall of the rectum falls or descends from its normal position and in some cases, may protrude out of the anus.
Compressive Enterocele - A compressed enterocele is a herniated small bowel. An enterocele occurs when the front and back walls of the vagina separate and the intestines push against the vaginal opening.
Treatment for this condition may vary depending on the location and severity of the prolapsed organ. Patients with mild symptoms can often treat their condition at home through kegel exercises that strengthen the pelvic muscles and by losing weight. Cases of pelvic prolapse that do not respond to home treatments may require the insertion of a pessary, a small device inserted into the vagina to relieve pain and pressure and hold the organs in place. More severe cases may benefit from surgery to repair damaged tissue, close the vagina or remove the uterus. In some cases, rectal prolapse surgery may be performed.
It is important for pelvic prolapse to be thoroughly treated in order to reduce the risk of recurrence. If left untreated, pelvic prolapse can get worse over time.
Rectal surgery may be recommended to treat a variety of problems affecting the anus, rectum and/or colon (large intestine). These include cancer, diverticular disease, inflammatory bowel disease, incontinence (loss of bowel control), prolapse (sagging of organs), hemorrhoids, fissures, fistulas and Cloaca like repair, which Â is done for the most rare and complex anorectal injury sustained after a traumatic childbirth that has healed poorly. We specialize in repairing this injury without fecal diversion. Â Our surgeons aim to preserve the anus and rectum whenever possible.