Pelvic Floor Program

Non-surgical and minimally invasive therapies resolve symptoms, restore quality of life for the majority of patients.

Pelvic floor disorders affect the lives of over 28 million Americans, yet relatively few seek and receive adequate treatment for these treatable conditions. NYP/Columbia aims to reverse this trend by letting patients know that effective help is available – often without surgery – and patients need not continue to suffer with embarrassing symptoms.

What is the pelvic floor?

Both men and women have a pelvic floor. The pelvic floor includes the muscles, ligaments, connective tissues and nerves that support the bladder, rectum and other pelvic organs.

The pelvic floor muscles stretch like a muscular trampoline from the tailbone (coccyx) to the pubic bone and from one sitting bone to the other sitting bone (side to side). These muscles are normally firm and thick.

What are pelvic floor disorders?

Pelvic floor disorders occur when the “trampoline” that supports the pelvic organs becomes weak or damaged. 

Common symptoms of pelvic floor disorders include:

  • Constipation
  • Difficulty controlling wind or bowel motions
  • Fecal leakage with coughing, sneezing, laughing or exercising (fecal incontinence)
  • Rushing to the toilet for fear of fecal leaking or leaking before you can get there (fecal urgency)
  • Having part or all of the wall of the rectum slide out of place, sometimes sticking out of the anus (rectal prolapse).

The Division of Colorectal Surgery is unique among medical centers in that it offers a comprehensive, multidisciplinary program to diagnose and treat pelvic floor problems with both non-surgical and surgical approaches. Directed by Emmanouil (Manny) Pappou, MD, PhD, the Pelvic Floor Program includes the full range of services to properly evaluate and treat patients in-house. They use non-invasive as well as novel minimally invasive and robotic surgical therapies, and these are effective in resolving the majority of people’s conditions.

According to Dr. Pappou, “Most centers send patients to other locations for testing, and it can be difficult to interpret results from external tests. We perform a full physical exam and all testing right here, ourselves, which gives us a better idea of what is going on. We have highly accurate instruments to evaluate the pelvic anatomy and muscle function, including anorectal manometry to determine how fit the pelvic muscles are, and endoanal ultrasound to tell us if the anal muscle is intact.” Because all testing, evaluation, and treatment is done by a unified team, the specialists collaborate together and communicate easily, which improves the quality of care in comparison to settings where patients must visit separate specialists for each test or consultation.

Fecal incontinence

Fecal incontinence is one of the most common problems treated at the Pelvic Floor Program. As Dr. Pappou explains, the incidence increases with age, obesity, and in women, in proportion to the number of times she has given birth. People often avoid reporting symptoms of incontinence even to their physicians because of feelings of shame and embarrassment, but Dr. Pappou encourages people to seek help. “Many patients and physicians are under the impression that there are no good treatments for incontinence, but that simply is not true,” says Dr. Pappou.

Fecal incontinence: nonsurgical approaches

Many patients with fecal incontinence can be helped with a step-wise approach including dietary modifications, medications to bulk up the stool, and biofeedback. Biofeedback is a non-invasive, painless, and highly effective method of using visual signals on a computer monitor to train the brain to consciously relax and contract the pelvic muscles. The signals come from a tiny electronic probe placed in the anus. The program has a dedicated biofeedback expert, who works closely with many patients in the program and is able to help over half of patients (60-80%) to resolve their problems in just six sessions of biofeedback.

Fecal incontinence: minimally invasive approaches

If the problem persists despite these therapies, a minimally invasive surgical approach called sacral nerve stimulation may be tried. Sacral nerve stimulation (SNS) is an extremely effective method of retraining the brain to feel the anal area. The first step in SNS is to surgically place tiny electrodes in the tissue around the anus. This is performed in the operating room. Once in place, the electrodes stimulate the nerves that enervate the muscles in the anus. “SNS helps patients to better feel the sensation of the anal muscles when they contract, and it rejuvenates the action of the nerves on the muscles so that the action of subconscious muscles becomes more active,” explains Dr. Pappou. The success rate in helping patients regain continence is very high, curing approximately 80% of patients of fecal incontinence. The program offers other non-surgical therapies as well, including injections of botox, Solesta™, and others.

Other pelvic floor disorders

Other conditions treated at the pelvic floor program include pelvic pain, constipation, rectal prolapse, and internal prolapse. Just as a stepwise approach is used for fecal incontinence, non-surgical therapies are effective in the majority of patients with other pelvic floor disorders. Only if non-surgical options fail does the team then consider surgical treatment.

Steven Lee-Kong, MD, at the console of the surgical robot.
For patients who require surgery to correct anatomical problems or damage due to trauma or other causes, the program uses minimally invasive, laparoscopic and robotic techniques. Dr. Steven Lee-Kong, an expert in the use of the surgical robot for colorectal surgery, says, “Use of the surgical robot in pelvic surgery helps with ease of performing the surgery, flexibility, and access. It gives excellent magnification and a stable view because the camera is not hand-held as in other laparoscopic surgeries. The robotic instrumentation gives us more degrees of freedom than straight instruments, which lets us target an area more precisely.” Dr. Lee-Kong and Dr. Pappou use robotic techniques routinely in their daily surgical practice.

In short, the Pelvic Floor Program uses minimally invasive methods to resolve patients’ symptoms. Dr. Pappou concludes, “These therapies work, and they can completely change a person’s quality of life.”

Learn more at columbiasurgery.org/conditions-and-treatments/pelvic-floor-disorders.