Descending Perineum Syndrome
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Descending Perineum Syndrome
Descending perineum syndrome (also known as levator plate sagging) refers to a condition where the perineum "balloons" several centimeters below the bony outlet of the pelvis during strain, although this descent may happen without straining. The syndrome was first described in 1966 by Parks ''et al''. Signs and symptoms Abnormal descent of the perineum may be asymptomatic, but otherwise the following may feature: * perineodynia (perineal pain) *Colo-proctological symptoms, e.g. obstructed defecation, dyschesia (constipation), or degrees of fecal incontinence *gynaecological symptoms, e.g. cystocele (prolapse of the bladder into the vagina) and rectocele (prolapse of the rectum into the vagina) *lower urinary tract symptoms, e.g. dysuria (painful urination), dyspareunia (pain during sexual intercourse), urinary incontinence and urgency Other researchers concluded that abnormal perineal descent did not correlate with constipation or perineal pain, and there are also conflicting re ...
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Perineum
The perineum in humans is the space between the anus and scrotum in the male, or between the anus and the vulva in the female. The perineum is the region of the body between the pubic symphysis (pubic arch) and the coccyx (tail bone), including the perineal body and surrounding structures. There is some variability in how the boundaries are defined. The perineal raphe is visible and pronounced to varying degrees. The perineum is an erogenous zone. The word perineum entered English from late Latin via Greek περίναιος ~ περίνεος ''perinaios, perineos'', itself from περίνεος, περίνεοι 'male genitals' and earlier περίς ''perís'' 'penis' through influence from πηρίς ''pērís'' 'scrotum'. The term was originally understood as a purely male body-part with the perineal raphe seen as a continuation of the scrotal septum since masculinization causes the development of a large anogenital distance in men, in comparison to the corresponding lack ...
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Dyspareunia
Dyspareunia ( ) is painful sexual intercourse due to medical or psychological causes. The term ''dyspareunia'' covers both female dyspareunia and male dyspareunia, but many discussions that use the term without further specification concern the female type, which is more common than the male type. In females, the pain can primarily be on the external surface of the genitalia, or deeper in the pelvis upon deep pressure against the cervix. Medically, dyspareunia is a pelvic floor dysfunction and is frequently underdiagnosed. It can affect a small portion of the vulva or vagina or be felt all over the surface. Understanding the duration, location, and nature of the pain is important in identifying the causes of the pain. Numerous physical, psychological, and social or relationship causes can contribute to pain during sexual encounters. Commonly, multiple underlying causes contribute to the pain. The pain can be acquired or congenital. Symptoms of dyspareunia may also occur after men ...
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Perineology
Perineology is a speciality dealing with the functional troubles of the three axes (urological, gynaecological and coloproctological) of the female perineum. The perineologist takes a holistic approach, using defect-specific and mini-invasive treatments. History of the term The word perineology represents a neologism. It was invented for the occasion of the 1st International Symposium on Perineology, held in Venice in 1990 to reflect an integrated view of the anatomy, physiology and pathology of the pelvic floor. It was popularized by the Italian journal Rivista Italiana di Colon-Proctologia. Some physicians in France and Italy prefer to use the broader term “pelviperineology”, which reflect a broader multidisciplinary approach to all the aspects of the management of the pelvic floor. In 2010, an International Society for Pelviperineology was formed. References {{reflist External links European Perineology Group - GEPUp to date information about this new speciality by th ...
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Defecography
Defecography (also known as proctography, defecating/defecation proctography, evacuating/evacuation proctography or dynamic rectal examination) is a type of medical radiological imaging in which the mechanics of a patient's defecation are visualized in real time using a fluoroscope. The anatomy and function of the anorectum and pelvic floor can be dynamically studied at various stages during defecation. History Defecating proctography was pioneered in 1945, during World War II. The procedure gained popularity at this time in the midst of an outbreak of whipworm, which is known to cause rectal prolapse. It has since become used for diagnosis of various anorectal disorders, including anismus and other causes of obstructed defecation. It has fallen out of favor due to inadequate training in the technique. It is now only performed at a few institutions. Many radiology residents refer to the procedure as the "Def Proc", "Defogram", or "Stool Finale". Indications Defecography may be i ...
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Anal Canal
The anal canal is the part that connects the rectum to the anus, located below the level of the pelvic diaphragm. It is located within the anal triangle of the perineum, between the right and left ischioanal fossa. As the final functional segment of the bowel, it functions to regulate release of excrement by two muscular sphincter complexes. The anus is the aperture at the terminal portion of the anal canal. Structure In humans, the anal canal is approximately long, from the anorectal junction to the anus. It is directed downwards and backwards. It is surrounded by inner involuntary and outer voluntary sphincters which keep the lumen closed in the form of an anteroposterior slit. The canal is differentiated from the rectum by a transition along the internal surface from endodermal to skin-like ectodermal tissue. The anal canal is traditionally divided into two segments, upper and lower, separated by the pectinate line (also known as the dentate line): * upper zone (zona col ...
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Pubic Symphysis
The pubic symphysis is a secondary cartilaginous joint between the left and right superior rami of the pubis of the hip bones. It is in front of and below the urinary bladder. In males, the suspensory ligament of the penis attaches to the pubic symphysis. In females, the pubic symphysis is close to the clitoris. In most adults it can be moved roughly 2 mm and with 1 degree rotation. This increases for women at the time of childbirth. The name comes from the Greek word ''symphysis'', meaning 'growing together'. Structure The pubic symphysis is a nonsynovial amphiarthrodial joint. The width of the pubic symphysis at the front is 3–5 mm greater than its width at the back. This joint is connected by fibrocartilage and may contain a fluid-filled cavity; the center is avascular, possibly due to the nature of the compressive forces passing through this joint, which may lead to harmful vascular disease. The ends of both pubic bones are covered by a thin layer of hyaline ...
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Coccyx
The coccyx ( : coccyges or coccyxes), commonly referred to as the tailbone, is the final segment of the vertebral column in all apes, and analogous structures in certain other mammals such as horses. In tailless primates (e.g. humans and other great apes) since ''Nacholapithecus'' (a Miocene hominoid),Nakatsukasa 2004, ''Acquisition of bipedalism'' (SeFig. 5entitled ''First coccygeal/caudal vertebra in short-tailed or tailless primates.''.) the coccyx is the remnant of a vestigial tail. In animals with bony tails, it is known as ''tailhead'' or ''dock'', in bird anatomy as ''tailfan''. It comprises three to five separate or fused coccygeal vertebrae below the sacrum, attached to the sacrum by a fibrocartilaginous joint, the sacrococcygeal symphysis, which permits limited movement between the sacrum and the coccyx. Structure The coccyx is formed of three, four or five rudimentary vertebrae. It articulates superiorly with the sacrum. In each of the first three segments may ...
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Anus
The anus (Latin, 'ring' or 'circle') is an opening at the opposite end of an animal's digestive tract from the mouth. Its function is to control the expulsion of feces, the residual semi-solid waste that remains after food digestion, which, depending on the type of animal, includes: matter which the animal cannot digest, such as bones; Summary at food material after the nutrients have been extracted, for example cellulose or lignin; ingested matter which would be toxic if it remained in the digestive tract; and dead or excess gut bacteria and other endosymbionts. Amphibians, reptiles, and birds use the same orifice (known as the cloaca) for excreting liquid and solid wastes, for copulation and egg-laying. Monotreme mammals also have a cloaca, which is thought to be a feature inherited from the earliest amniotes via the therapsids. Marsupials have a single orifice for excreting both solids and liquids and, in females, a separate vagina for reproduction. Female placental mamm ...
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Rectal Examination
Digital rectal examination (DRE; la, palpatio per anum, PPA) is an internal examination of the rectum, performed by a healthcare provider. Prior to a 2018 report from the U.S. Preventive Services Task Force, the DRE was a common and "dreaded" component of annual exams for older men, as it was thought to be a reliable screening test for prostate cancer. Usage This examination may be used * for the diagnosis of prostatic disorders, benign prostatic hyperplasia and the four types of prostatitis. Chronic prostatitis/chronic pelvic pain syndrome, chronic bacterial prostatitis, acute (sudden) bacterial prostatitis, and asymptomatic inflammatory prostatitis. The DRE has a 50% specificity for benign prostatic hyperplasia. Vigorous examination of the prostate in suspected acute prostatitis can lead to seeding of septic emboli and should never be done. Its utility as a screening method for prostate cancer however is not supported by the evidence; * for the evaluation of certain clinical ...
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Urinary Incontinence
Urinary incontinence (UI), also known as involuntary urination, is any uncontrolled leakage of urine. It is a common and distressing problem, which may have a large impact on quality of life. It has been identified as an important issue in geriatric health care. The term enuresis is often used to refer to urinary incontinence primarily in children, such as nocturnal enuresis (bed wetting). UI is an example of a stigmatized medical condition, which creates barriers to successful management and makes the problem worse. People may be too embarrassed to seek medical help, and attempt to self-manage the symptom in secrecy from others. Pelvic surgery, pregnancy, childbirth, and menopause are major risk factors. Urinary incontinence is often a result of an underlying medical condition but is under-reported to medical practitioners. There are four main types of incontinence: * Urge incontinence due to an overactive bladder * Stress incontinence due to "a poorly functioning urethral sph ...
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Dysuria
Dysuria refers to painful or uncomfortable urination. It is one of a constellation of ''irritative'' bladder symptoms (also sometimes referred to as lower urinary tract symptoms), which includes nocturia and urinary frequency. Diagnosis The clinician should also look for physical findings of fever, rash, direct tenderness over the bladder area, and joint pain. Physical findings of increased temperature, increased pulse, low blood pressure in the presence of dysuria can indicate systemic infection. Urological obstruction due to stone or tumor can result in findings of hematuria, decreased urination, and bladder spasms. All these physical findings should be looked for carefully while obtaining history. History regarding recent sexual activity is crucial. Urinalysis is the most useful test to start the work up in a patient of dysuria. Urinalysis positive for nitrite carries a high predictive value of a positive urine culture. Also, urine dipstick showing leukocytes as equal predicti ...
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Pelvis
The pelvis (plural pelves or pelvises) is the lower part of the trunk, between the abdomen and the thighs (sometimes also called pelvic region), together with its embedded skeleton (sometimes also called bony pelvis, or pelvic skeleton). The pelvic region of the trunk includes the bony pelvis, the pelvic cavity (the space enclosed by the bony pelvis), the pelvic floor, below the pelvic cavity, and the perineum, below the pelvic floor. The pelvic skeleton is formed in the area of the back, by the sacrum and the coccyx and anteriorly and to the left and right sides, by a pair of hip bones. The two hip bones connect the spine with the lower limbs. They are attached to the sacrum posteriorly, connected to each other anteriorly, and joined with the two femurs at the hip joints. The gap enclosed by the bony pelvis, called the pelvic cavity, is the section of the body underneath the abdomen and mainly consists of the reproductive organs (sex organs) and the rectum, while the pelvic f ...
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