Pelvic floor dysfunction

Disorders of the pelvic floor are common and patients with these disorders present to clinicians from various fields including gastroenterologists, surgeons, gynecologists, and urologists. They manifest with multitudes of dysfunction that affect defecation, continence, urination, and sexual function. In this book chapter, we discuss the epidemiology, pathophysiology, diagnostic approaches, and management of four common problems notably dyssynergic defecation, fecal impaction, descending perineum syndrome, and rectocele/enterocele. Dyssynergic defecation has been well characterized with well-developed and validated diagnostic criteria, clinical features, and evidence from randomized controlled trials showing the effectiveness of biofeedback therapy, both in the short term and in the long term. For the other three conditions, there is lack of sound demographic information and optimal management approaches including randomized controlled trials. Much work needs to be done to better characterize these groups of patients and facilitate management of these disorders.