Diagnosis and Treatment of Disorders of the Posterior Pelvic Compartment

The pelvic floor is an important structure, mandatory to maintain urinary and faecal continence and to prevent descent of pelvic viscera. Simultaneously it should also permit micturition, defaecation and sexual intercourse. Disorders associated with the pelvic floor are common, especially in older multiparous women, and have a significant impact on quality of life. According to the related pelvic viscera, these disorders can be separated into three groups, which are the anterior, middle, and posterior pelvic compartment disorders. This thesis will evaluate the diagnosis and treatment of disorders of the posterior pelvic compartment. It is mainly focussed on the outcome of different surgical modalities in the treatment of these posterior pelvic compartment disorders, in example the outcome of rectocele, enterocele, and rectovaginal fistula repair. In addition, the value of transperineal ultrasound in the assessment of posterior pelvic compartment prolapse is investigated. Furthermore, it is examined whether pelvic floor injury contributes to the outcome of surgery for faecal incontinence

Parturition mode recommendation and symptoms of pelvic floor disorders after obstetric anal sphincter injuries

Introduction and hypothesis: Our primary objective was to evaluate parturition mode (PM) recommendations following obstetric anal sphincter injuries (OASIs) and adherence to these recommendations and to evaluate recurrence of OASIs in women who had a subsequent vaginal delivery (VD). The hypothesis was that adherence to the PM recommendations leads to a reasonable OASI recurrence rate. Methods: This was a retrospective observational cohort study of patients with previous OASIs between 2010 and 2016. After an outpatient visit including 3D transperineal ultrasound to screen for pelvic floor and anal sphincter injuries, all patients received recommendations for a subsequent PM. Patients were invited to complete validated questionnaires 2 to 5 years post-OASIs. Results: The majority of invited patients (265/320) attended follow-up, with 264 receiving a recommendation for PM. Only 5.6% did not adhere to the received recommendation. One hundred sixty-one patients delivered again, 58% had a VD, and 42% had a cesarean section (CS). Recurrence of OASIs was observed in 4.3% of the patients that had a VD. Fecal incontinence occurred in 4.9%, however any form of anal incontinence in 48% of patients. While dyspareunia was common in patients with residual external anal sphincter (EAS) injuries and levator ani muscle (LAM) avulsions, anal pain occurred more frequently in EAS injuries and fecal incontinence in LAM avulsions. Conclusions: This study showed that the vast majority of patients followed PM recommendations, and this resulted in a low recurrence of OASIs with a high CS rate. Fecal incontinence after OASIs was correlated with the degree of OASIs