Trouble with bowel or bladder function? It might be time to partner with a specialist. In this episode of BackTable OBGYN, hosts Dr. Amy Park and Dr. Mark Hoffman are joined by Dr. Shannon Wallace and Dr. Anna Spivak, experts from the Cleveland Clinic specializing in pelvic floor disorders. They dive into the complex world of combined colorectal and urogynecological issues, discussing the importance of a multidisciplinary approach to treat conditions such as rectal prolapse, constipation, and incontinence.

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SYNPOSIS

The conversation covers detailed diagnostic methods like manometry and defecography, various surgical options, and the crucial role of pelvic floor physical therapy in patient recovery. They also provide insights into setting up effective multidisciplinary clinics and emphasize the need for teamwork and administrative support in delivering optimal patient care. This episode is a valuable resource for both specialists and generalists aiming to enhance their understanding and treatment of pelvic floor dysfunctions.

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TIMESTAMPS

01:05 - Introduction
05:40 - Multi-Compartment Prolapse & Second Opinions
08:14 - Pelvic Floor Compartments Explained
10:36 - When Internal Prolapse Becomes Surgical
11:56 - Incomplete Emptying, Splinting, Fragmentation & Leakage
16:55 - Fluoro vs MRI and When to Order It
23:47 - Anorectal Manometry
26:56 - Physical Therapy, Biofeedback, Meds, Injections, & Motility Workup
29:08 - Robotic Mesh Repairs vs Vaginal/Perineal Approaches
34:43 - When (and Why) to Consider Biologics
36:46 - Resection Rectopexy
38:10 - Treating Ehlers-Danlos syndromes (EDS) & Eating Disorders
42:55 - Pelvic Floor PT After Surgery and Recovery Timelines
47:29- Perineal Prolapse Repairs (Altemeier vs Delorme)
49:53 - Symptom Improvement vs Retraining the 'New Normal'
52:20 - Fecal Incontinence & Sacral Neuromodulation
57:08 - Diarrhea-Driven Incontinence
58:56 - Building a Multidisciplinary Pelvic Floor Program
01:04:04 - Conclusion

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RESOURCES

Pelvic Floor Disorders Consortium (American Society of Colon & Rectal Surgeons) https://fascrs.org/Web/Web/My-ASCRS/Education/Pelvic-Floor-Disorders-Consortium.aspx