Alison Hainsworth

A review of functional pelvic floor imaging modalities and their effectiveness

The anatomy of the pelvic floor is complex and clinical examination alone is often insufficient to diagnose and assess pathology. With a greater understanding of pelvic floor dysfunction and treatment options, imaging is becoming increasingly common. This review compares three imaging techniques. Ultrasound has the potential for dynamic assessment of the entire pelvic floor. Magnetic resonance imaging is able to rapidly image the entire pelvic floor but it is expensive and tends to underestimate pathology. Dynamic defaecating proctography or cystocolpoproctography is the current gold standard for posterior compartment imaging but requires opacification of the bladder to provide a global view.

Total pelvic floor ultrasound for pelvic floor defaecatory dysfunction: a pictorial review.

Total pelvic floor ultrasound is used for the dynamic assessment of pelvic floor dysfunction and allows multicompartmental anatomical and functional assessment. Pelvic floor dysfunction includes defaecatory, urinary and sexual dysfunction, pelvic organ prolapse and pain. It is common, increasingly recognized and associated with increasing age and multiparity. Other options for assessment include defaecation proctography and defaecation MRI. Total pelvic floor ultrasound is a cheap, safe, imaging tool, which may be performed as a first-line investigation in outpatients. It allows dynamic assessment of the entire pelvic floor, essential for treatment planning for females who often have multiple diagnoses where treatment should address all aspects of dysfunction to yield optimal results. Transvaginal scanning using a rotating single crystal probe provides sagittal views of bladder neck support anteriorly. Posterior transvaginal ultrasound may reveal rectocoele, enterocoele or intussusception whilst bearing down. The vaginal probe is also used to acquire a 360° cross-sectional image to allow anatomical visualization of the pelvic floor and provides information regarding levator plate integrity and pelvic organ alignment. Dynamic transperineal ultrasound using a conventional curved array probe provides a global view of the anterior, middle and posterior compartments and may show cystocoele, enterocoele, sigmoidocoele or rectocoele. This pictorial review provides an atlas of normal and pathological images required for global pelvic floor assessment in females presenting with defaecatory dysfunction. Total pelvic floor ultrasound may be used with complementary endoanal ultrasound to assess the sphincter complex, but this is beyond the scope of this review.

Integrated Total Pelvic Floor Ultrasound in Pelvic Floor Defaecatory Dysfunction

Imaging for pelvic floor defaecatory dysfunction includes defaecation proctography. Integrated total pelvic floor ultrasound (transvaginal, transperineal, endoanal) may be an alternative. This study assesses ultrasound accuracy for the detection of rectocele, intussusception, enterocele and dyssynergy compared with defaecation proctography, and determines if ultrasound can predict symptoms and findings on proctography. Treatment is examined.

The future of pelvic floor services in the UK

The study aimed to determine the current state of UK pelvic floor services and to discuss future strategies.

What was hot at ICS 2016

The 46th annual conference of the International Continence Society was held in Tokyo, Japan, between September 13th and 16th, 2016. In this article, we present selected highlights of the broad range of excellent research presented by colleagues from around the world from a variety of areas of continence research, from cellular models to population‐based epidemiological studies.

What was hot at the ICS meeting 2015: What Was Hot at the ICS Meeting 2015

Alison J. Hainsworth,* Paula Igualada-Martinez, Marianne Koch, Martha Spencer, Martin Slovak, Saladin Alloussi, Christopher Hillary, Bruna M. Couri, Nadir I. Osman, Rufus Cartwright, and Christopher R. Chapple Department of Colorectal, Pelvic Floor Unit, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom Department of Physiotherapy and Pelvic Floor Unit, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom Department of Obstetrics and Gynaecology, Medical University of Vienna, Vienna, Austria Division of Geriatric Medicine, University of British Columbia, Vancouver, Canada Department of Medical Physics and Clinical Engineering, Sheffield Teaching Hospitals, Royal Hallamshire Hospital, Sheffield, United Kingdom NIHR Devices for Dignity Healthcare Technology Co-operative, Royal Hallamshire Hospitals, Sheffield, United Kingdom Department of Urology, Academic Teaching Hospital of University of Saarland, Stadtisches Klinikum Neunkirchen, Neunkirchen, Germany Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom Department of Obstetrics and Gynaecology, Cleveland Clinic Lerner Research Institute, Cleveland Clinic, Cleveland Ohio Cleveland, Ohio Department of Biomedical Engineering, Cleveland Clinic Lerner Research Institute, Cleveland Clinic, Cleveland Ohio Cleveland, Ohio Department of Urogynaecology, Imperial College London, London, United Kingdom Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom