Diagnosing a Pelvic Floor Disorder

Help is available Are you living with a pelvic floor disorder? Talk to your doctor about your symptoms. Or call The Christ Hospital Center for Pelvic Floor Disorders at 513-585-4800 to speak to a specialist. Aren’t sure if your symptoms are the result of a pelvic floor issue? Take Our Questionnaire

During a patient’s initial visit, we do a complete work-up to identify the underlying causes of each patient’s symptoms. Patients will receive a thorough and sensitive evaluation by members of our multidisciplinary care team. Most of the time, one or more of the following tests is needed (depending on the kinds of symptoms you have). These procedures help doctors determine the best treatment option.  

• Pelvic Examination: (click for info ...) 
  • Purpose:  This exam is used to determine how severe a enterocele or rectocele  is.
    Enterocele: the small intestine protrudes through the upper vaginal supports (especially in women who have had a hysterectomy)
    Rectocele: the rectum protrudes through the back wall of the vagina
  • Preparing for the exam:  You don’t have to do anything to prepare for this exam, however, you may want to empty your bladder prior to the exam to make it a little more comfortable.
  • During the exam: This exam takes only a few minutes. Your doctor or nurse will ask you to take off your clothes in private (you will be given a gown or other covering.) He or she may press down on areas of your lower stomach to feel the organs from the outside. He or she will also perform a vaginal exam. During the exam, a device called a speculum will be inserted into the vagina. The speculum is opened to widen the vagina so that the vagina and cervix can be seen. Your doctor will also place two fingers inside the vagina and use the other hand to gently press down on the area he or she is feeling to note the size and shape of the organs. You may be asked to bear down (as when having a bowel movement) or to cough. You may also be examined while standing. The resulting pressure in the pelvis from coughing, standing or both may make a pelvic floor disorder more obvious. A rectal exam may also be performed.

• Anorectal Manometry: (click for info ...)
  • Purpose:  This test is used to evaluate patients with constipation or fecal incontinence. It measures the pressures of the anal sphincter muscles, the sensation in the rectum, and the neural reflexes that are needed for normal bowel movements.
  • Preparing for the test:  Give yourself a Fleet® enema (available over-the-counter from your pharmacy) two hours prior to your test. You should not eat anything during the two hours prior to the test. You may take regular medications with small sips of water up until two hours prior to the test.
  • During and after the procedure:  This procedure takes approximately 30 minutes. You will be asked to change into a hospital gown. A nurse will explain the procedure to you, take a brief health history, and answer any questions you may have. You will then lie your left side. A small, flexible tube, about the size of a thermometer, with a balloon at the end will be inserted into the rectum. The catheter is connected to a machine that measures the pressure. During the test, the small balloon attached to the catheter may be inflated in the rectum to assess the normal reflex pathways. The nurse may also ask you to squeeze, relax, and push at various times. The anal sphincter muscle pressures are measured during each of these maneuvers. After the examination, you may drive yourself home and go about your normal activities.

• Colonoscopy: (click for info ...)
  • Purpose:  This procedure is used to diagnose polyps and cancers.
  • Preparing for the procedure:  Your doctor will give you instructions for cleansing your bowel. This may include a combination of laxatives, enemas and not eating solid foods for two or three days before the test. Your doctor may advise you to stop taking aspirin, ibuprofen, naproxen or other blood-thinning medications for several days before the test. You will need to drink plenty of clear liquids for several days before the test. Examples of clear liquids are fat-free bouillon or broth, water, clean coffee or tea, strained fruit juices, sports drinks and gelatin. Unless otherwise instructed, continue taking any regularly prescribed medication. Stop taking iron supplements a few weeks before the test, unless otherwise instructed by your doctor. Iron residues produce a dark black stool, which makes the view inside the bowel less clear. People with some heart valve diseases may receive antibiotics before and after the test to prevent infection.
  • During and after the procedure:  This procedure is done in the endoscopy department on the first floor of the hospital. Upon arrival, you will be asked to change into a hospital gown. A nurse will explain the procedure to you, take a brief health history, and answer any questions you may have. You will then receive a sedative and pain reliever, and be asked to lie on your left side with your knees drawn up toward your chest. A colonoscope—a small camera attached to a flexible tube—will be inserted through the anus and gently advanced to the lowest part of the small bowel. You may feel pressure as the scope moves inside. You can reduce discomfort by taking slow, deep breaths. This will also help relax the abdominal muscles. Air will also be inserted through the scope to provide a better view, and tissue samples may be taken with tiny biopsy forceps inserted through the scope. The sedative and pain medication will relax you and make you feel drowsy. Many patients do not remember having the colonoscopy. Plan to have someone take you home after the test, because you will be woozy and unable to drive. Mild abdominal cramps and considerable passing of gas may occur after the exam. Sedation should wear off in a few hours. Several hours of rest is recommended after the test. To replace fluids lost because of laxatives and fasting, drink plenty of liquids after the test.

• Defecography: (click for info ...)
  • Purpose: This test is used to (coming soon!)
  • Preparing for the test: (coming soon!)
  • During and after the test: (coming soon!)

• Electromyography Recruitment: (click for info ...)
  • Purpose: This test is used to measure the function of muscles involved when urinating or having a bowel movement.
  • Preparing for the test: (coming soon!)
  • During and after the test: (coming soon!)

• Endoanal Ultrasound: (click for info ...)
  • Purpose:  This test is used to determine the presence or absence of anal sphincter injury.
  • Preparing for the test: (coming soon!)
  • During and after the test: (coming soon!)

• Pudendal Nerve Terminal Latency Testing: (click for info ...)
  • Purpose: This test is used to (coming soon!)
  • Preparing for the test: (coming soon!)
  • During and after the test: (coming soon!)

• Transit Studies: (click for info ...)
  • Purpose: This test is used to assess the speed of contents through the bowel.
  • Preparing for the test: (coming soon!)
  • During and after the test: (coming soon!)

• Urodynamics: (click for info ...)
  • Purpose: This is a study that assesses how the bladder and urethra are performing their job of storing and releasing urine. Urodynamics testing gives your doctor information that can explain symptoms such as:

               

    • Frequent urination

    ·         Incontinence

    ·         Sudden strong urges to urinate

    ·         Painful urination

    ·         Problems starting a urine stream

    ·         Recurrent urinary tract infections

  • Preparing for the test: You do not need to change your diet or daily routine. Your doctor will provide you with an antibiotic to take prior to the test. You should drink fluids prior to coming so that your bladder is full for the test.
  • During and after the test:

    Uroflow:  For the first part of the test you will be asked to empty your bladder into a special commode. This measures the amount of urine and the flow rate.

     

    Cystometrogram:  After the bladder is emptied for the uroflow, small catheters are placed into the bladder and rectum to measure pressures. Also, several sticky patches are placed on the backside to measure muscle activity. Your nurse will drain the bladder through the catheter and measure the amount. This will tell your doctor how well your bladder empties. Next, the bladder will be filled with water through a catheter that is connected to a computer. The nurse will monitor bladder pressures and may ask you to cough to check for leaks.

     

    Video urodynamics:  Sometimes, X-rays may be taken during the test to give your doctor more detailed information.

     

    Pressure flow study:  Once the bladder feels full, you will be asked to urinate into the special commode. Pressure and flow rate will be recorded as well as the amount of urine that is left in the bladder. The test is then complete.

     

    After the test:  You may feel some burning or irritation from the catheter. It is helpful to drink plenty of water the remainder of the day. The results will be sent to your doctor and you should make a follow-up appointment.