9. 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.
11. Definition
•"Absence of normal relaxation of pelvic floor muscles during
defecation, resulting in rectal outlet obstruction".
•"Malfunction (a focal dystonia) of the external anal
sphincter and puborectalis muscle during defecation".
• failure of [the external anal sphincter and puborectalis]
muscle[s] to relax, resulting in maintenance of the anorectal
angle and the difficulty with initiating and completing bowel
movements".
• failure of relaxation (or paradoxic contraction) of the
puborectalis muscle sling during defaecation, attempted
defaecation or straining.
12. factors have a significant influence on
pelvic floor support:
1.CONGENITAL.
2.AGE
3.CHILDBIRTH INJURY.
4.ENDOCRINE.
13. •Congenital differences in collagen behaviour are clinically
evident in women who have increased joint elasticity.
•Age :The fascia of the pelvic floor will provide weaker
support with advancing years.
•Childrenbirth:Most women recognize that their pelvic floor
is different after vaginal delivery.
•Endocrine: The menstrual cycle, pregnancy and the
menopause are the most significant endocrine events which
may influence pelvic floor fascia. be secondary to higher
progesterone levels increasing fascial elasticity.
14. 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 bowel
movements
16. Classification:
Type I: paradoxical contraction of the pelvic floor muscles
during attempted defecation Dislocation of the urethra—the
urethra is displaced
downwards and backwards off the pubis. It may be also
dilated becoming an urethrocoele
•Type II: inadequate propulsive forces during attempted
defecation (inadequate defecatory propulsion) Cystocoele—
hernia of the bladder trigone
•Type III: impaired relaxation with adequate propulsion
Uterine prolapse—descent of the uterus and cervix.
17. Type III:
3rd degree vaginal
prolapse (procidentia)
27. 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".Digestive
diseases and sciences 30 (5): 413–8. doi:10.1007/BF01318172.PMID 3987474.
^ Rao, Satish S.C. (31 August 2008). "Dyssynergic Defecation and Biofeedback
Therapy". 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 anorectal
disorders". 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 rectal
surgery. 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 with
biofeedback". Diseases of the colon and rectum 30 (2): 108–
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http://123sonography.com/?gclid=CIfs2q7FqbQCFUxY3god5n8ANA
28. Presented by :
Ali Fakih
Fatima Ra7al
Presented to :S.F.
Lina Amro
The ppt found in www.slideshare.net
