Obstetrics and Gynaecology Forum - Volume 19, Issue 1, 2009
Volume 19, Issue 1, 2009
Author S.R. RamphalSource: Obstetrics and Gynaecology Forum 19, pp 1 –3 (2009)More Less
Worldwide, the prevalence of pelvic floor disorders (urinary incontinence, lower urinary tract dysfunction, pelvic organ prolapse, and faecal incontinence, defecatory and sexual dysfunction) is increasing and this is largely due to improved women's health and the population living longer. More than 50% of women will experience one or more pelvic floor disorders at some period in their lives, and one in eleven will undergo surgery for pelvic floor abnormalities by the age of 80 years. Besides the economic costs and general health care burden, pelvic floor dysfunction can result in significant psychosocial disharmony and have a profound effect on the patient's quality of life.
Source: Obstetrics and Gynaecology Forum 19, pp 7 –12 (2009)More Less
Stress urinary incontinence (SUI) is a common condition with no standardized evaluation prior to surgery. The role of urodynamic studies (UDS) in the assessment of SUI has been the subject of considerable debate over the years. The Royal College of Obstetricians and Gynaecologists recommends urodynamic testing prior to surgery for SUI. This review gives an overview and discusses the evidence of UDS prior to surgery. It is apparent from the literature that UDS provides the clinicians with a wealth of information which may be used to refine treatment decisions in complex cases. However, its use in "pure stress incontinence" continues to be a source of controversy. There is a need for improved standardization of urodynamic studies such as abdominal leak point pressures and urethral pressure profiles before any further conclusions can be drawn about their utility in predicting the success of surgery in SUI. Prospective randomized controlled trials to evaluate the clinical efficacy, cost effectiveness, and effect on quality of life issues of a full preoperative UDS compared to no UDS studies trials is urgently needed before any firm conclusion can be drawn regarding the superiority of UDS.
Source: Obstetrics and Gynaecology Forum 19, pp 15 –20 (2009)More Less
Obstetric Anal Sphincter Injuries (OASIS) are major contributory factors to the development of anal incontinence that may go unreported due to embarrassment. Anal incontinence can have a devastating effect on a woman's physical, social and emotional well-being. There is now undisputed evidence that OASIS are being missed at delivery but even when they are diagnosed and repaired about 40% of women suffer persistent anal incontinence. It is therefore paramount that midwives and doctors receive intensive focused training on the identification and repair of OASIS. Every woman who has a vaginal delivery must have a careful vaginal and rectal examination to exclude OASIS. A structured protocol of repair should be followed and special heed should be given to the recognition and repair of the internal anal sphincter. All women should be followed up and counselled regarding the mode of delivery in a subsequent pregnancy.
Author T.D. NaidooSource: Obstetrics and Gynaecology Forum 19, pp 23 –27 (2009)More Less
Constipation is usually characterized by infrequent defecation, straining, hard stools and feelings of incomplete evacuation. It is essential to distinguish between acute and chronic constipation. Primary constipation maybe classified as normal transit constipation, slow transit constipation or anorectal dysfunction, which can be either due to ansimus or abnormal perineal descent.
A detailed history and physical examination is necessary. Tests of colonic and pelvic floor function help distinguish constipation due to transit problems from that due to anorectal dysfunction. Patients can be divided into 4 main groups : Slow-transit constipation, pelvic floor dysfunction, combined (slow-transit and pelvic floor dysfunction) and normal transit constipation. A small group of patients, refractory to medical therapy should be considered for surgery. Should test results show pelvic floor dysfunction, then behavioural modifications such as biofeedback is successful in up to 76% of patients. An algorithmic approach to treatment is associated with an excellent long term outcome.
Source: Obstetrics and Gynaecology Forum 19, pp 29 –31 (2009)More Less