Pelvic floor disorders are known to effect up to 42% of adult women. These disorders include urinary incontinence, fecal incontinence, pelvic organ prolapse, and obstructed defecation. Risk factors include increasing age, increasing parity, and more recently, obesity. It is estimated that by 2030 more than one-fifth of the US female population will be over 65 years of age. As the age of this population increases, the national burden of healthcare costs, lost productivity, and decreased quality of life will be substantial. This chapter discusses the more common disorders of defecation, including constipation and fecal incontinence. It describes the etiology of constipation, and its evaluation and various treatment methods. The initial evaluation of a patient presenting with either longstanding or new-onset constipation is a detailed history. Current medical conditions and prescribed and over-the-counter medication use should be reviewed. Information regarding bowel habits at a young age may provide useful information into causation. Furthermore, a careful physical exam particularly of the anorectum, is essential to rule out any anorectal disorders that may exacerbate the patient's symptoms. Digital exam should be performed while having the patient squeeze the anal sphincter muscles, relax, and then attempt to evacuate. All patients, and especially those who are of the age of 50 years or have had a recent change in bowel habits, need to be evaluated with colonoscopy as part of the initial work-up of constipation. The chapter describes the treatment of constipation related to pelvic floor dysfunction and slow transit.
|Original language||English (US)|
|Title of host publication||Principles of Gender-Specific Medicine|
|Number of pages||8|
|State||Published - Dec 1 2010|
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