PELVIC FLOOR ASSESSMENTS & TREATMENTS
At a private outpatient's consultation, Mr Nunoo-Mensah will carry out a full baseline assessment of patients complaining of faecal incontinence, constipation or obstructive defecation syndrome. The assessment will aim to exclude conditions such as colorectal cancer and inflammatory bowel disease.
Relevant medical/obstetric history, a general examination, an anorectal examination will be performed.
A baseline Cleveland Clinic faecal incontinence questionnaire will be required to be completed by a patient with faecal incontinence to provide a subjective assessment of their symptoms and to measure the success of various treatments.
Investigations for patients with faecal incontinence include endoscopy, anophysiology studies and 3D endoanal ultrasound.
Investigations for constipation and/or obstructive defecation syndrome include endoscopy, anophysiology studies, 3D endoanal ultrasound, defecating proctogram, and colonic transit studies and nuclear gastrointestinal scintography.
All the above tests are performed at London Bridge Hospital and Guthrie Clinic, King's College Hospital. High resolution anophysiology studies ae performed with the MMS Solar GI HRAM - High Resolution Anorectal Manometry and 3D endoanal US with the BK Medical Flex Focus system at the pelvic floor laboratory at King's College Hospital. Mr Nunoo-Mensah is the lead clinician for the pelvic floor laboratory at King's College Hospital.
Following investigations, a conservative approach is usually applied first to manage a patient's symptoms.
However specific treatments available to patients with faecal incontinence includes anal sphincter repair if there is a significant sphincter defect on 3D endoanal ultrasound with an associated poor anophysiology result and/or percutaneous tibial nerve stimulation (PTNS). We hope to also offer Secca® Procedure (radiofrequency therapy of the anal sphincter for faecal incontinence).
Specific treatments for patients with constipation with isolated slow colonic transits studies consist of laparoscopic subtotal colectomy and ileorectal anastomosis.
For patients with isolated obstructive defaecation syndrome options include visual biofeedback therapy with the MMS Solar GI HRAM.
Patients with obstructive defecation syndrome with associated rectoceles which does not empty completely on defecating proctogram and/or rectal intussusception may be offered a laparoscopic ventral mesh rectopexy or internal Delorme's procedure.
Patients with full thickness prolapse may be offered a laparoscopic rectopexy, Delorme's procedure or Altemeier's procedure.