Pelvic Floor Therapy

Pelvic Floor Therapy at Texas Oncology

At Texas Colon & Rectal Specialists, our physicians treat patients at our Pelvic Floor Center to improve pelvic-related health issues. The pelvic floor consists of muscles, nerves and connective tissue that support the structures of the pelvis, including the rectum, bladder and female reproductive organs. Over time, or with acute injury, these supportive tissues may weaken, causing incontinence of urine and/or feces as well as vaginal prolapse.

At Texas Colon & Rectal Specialists, our physicians treat patients at our Pelvic Floor Center to improve pelvic-related health issues.

Conditions treated

We offer an individualized, multi-disciplinary approach to overcome symptoms of pelvic floor disorders. Our pelvic floor therapy offers innovative solutions for the following:

• Accidental bowel leakage
• Chronic constipation
• Pelvic organ prolapse
• Rectal cancer

Diagnostic testing

• Anal manometry measures the strength of the internal and external sphincters, coordination of pelvic floor muscles and assesses sensations in the rectum.
• EMG recruitment assesses the patient’s ability to voluntarily contract and relax the pelvic floor muscles.
• Pudendal nerve EMG assesses conduction of the pudendal nerve and is primarily used in the diagnosis and cause of accidental bowel leakage, rectal prolapse and enterocele.
• Anal ultrasound creates images of sphincters and surrounding tissue, and is used to assess accidental bowel leakage, fistula, abscess, sphincter injury (post-delivery/surgery), and pain. This in-office procedure may cause slight discomfort, but it is largely pain-free and provides our surgeons with a clear understanding of each patient’s pelvic floor.
• Cine or MRI Defecography is a test using fluoroscopy to evaluate rectal emptying and relaxation of the pelvic floor and identify rectocele, enterocele, and rectal prolapse.
• Peripheral nerve evaluation (PNE) determines whether sacral nerve stimulation, control of accidental bowel leakage or lower urinary tract dysfunction is appropriate for a given patient. A temporary device is used, and if successful, surgical implantation of the device follows.

Types of pelvic floor therapies

The providers at Texas Colon & Rectal Specialists will recommend the appropriate pelvic floor therapy based on the patient’s individual needs:

In-office treatments

Lifestyle changes
Our providers strive to provide simple, non-surgical options before proceeding to invasive measures. Our first recommendations to patients experiencing fecal incontinence include non-intrusive lifestyle changes including fiber supplements, diet changes and sitz baths.

Biofeedback Training
In addition to lifestyle changes, physical therapy with biofeedback training represents an alternative non-invasive method used to treat incontinence. The experts at Texas Colon & Rectal Specialists work closely with physical therapy to coordinate pelvic floor therapy combining traditional physical therapy with anorectal manometry.

Outpatient procedures

Sacral Nerve Neuromodulation
If the cause of fecal or urinary incontinence is a miscommunication between the brain and the muscles of the pelvic floor, sacral nerve neuromodulation is an appropriate option. The small neuromodulation system uses mild electrical stimulation to encourage a balancing of nerve signals back to the muscles in the pelvic floor. As the nerve signals and muscles gain strength and control, many patients experience a significant improvement in their symptoms.

Sacral neuromodulation is a two-part procedure. During phase one, the patient undergoes a testing phase where a temporary wire is placed under the skin near the tailbone and connected to an external trial stimulator. This evaluation phase may last one-two weeks, and allows the patient and physician to determine if the long-term device is an effective treatment option for incontinence. If sacral neuromodulation is chosen for long-term therapy, the second stage begins, and a surgeon will place a small long-lived pacemaker under the skin in the outpatient setting.

Inpatient procedure

Sphincteroplasty
When fecal incontinence is caused by physical disruption (tearing) of the anal sphincter, surgical sphincteroplasty may be an appropriate treatment. During this inpatient operation, the patient is given general anesthesia before the physician exposes and repairs the anal sphincter. This procedure is particularly helpful for women who develop incontinence as a result of childbirth via vaginal delivery.