Building a Multidisciplinary Pelvic Floor Clinic: Why Bother?

Elsevier

Available online 10 December 2022, 100933

Seminars in Colon and Rectal SurgeryAuthor links open overlay panelAbstract

Patients attending the pelvic floor clinic may have symptoms of defaecatory, urinary and sexual dysfunction, including incontinence and prolapse. Pelvic floor dysfunction is multifactorial and multi-compartmental. A holistic approach which addresses all aspects and compartments is essential to achieve optimal assessment and outcomes. The team must be multidisciplinary and cohesive, with open channels of communication and discussion. A multidisciplinary clinic provides a platform to ensure an efficient pathway for the patient and healthcare system, all aspects of care are simultaneously addressed, and patient care is optimised. This section outlines the drivers for, and potential outcomes from, running a multidisciplinary clinic.

Section snippetsBackground

Patients presenting to the pelvic floor clinic may present with defaecatory, urinary and sexual dysfunction; including constipation/evacuatory difficulties, incontinence, prolapse and pelvic pain. Causation is multifactorial with anatomical and functional factors, psychological aspects and multiple occult contributing factors1. The pelvic floor was traditionally divided into its’ anatomical compartments; with the posterior, middle and anterior compartments treated separately but experience has

Patient Assessment

Multidisciplinary clinics allows assessment by different specialists during the same consultation. There is also the option of a one stop service whereby multiple investigations are performed on the same day. Subjective assessment with a thorough history and validated questionnaires, identifies all aspects of pelvic floor dysfunction2. This is combined with abdominal, rectal and vaginal examination for a complete clinical assessment3.

Symptom investigation draws the assessor closer to a

Conservative Treatment

Expert physiotherapists, nurses and advanced practitioners ensure appropriate conservative measures are provided. Well-functioning teams understand the standard care pathway, but pathways also need to be flexible to allow for the individualised care. Teams should have interactive reflexive discussions to aid their decision making within a multidisciplinary meeting4,6; a feasible model which contributes to a change in management for the complex patient7.

An overall assessment of the patient's

Surgical Treatment and Joint Surgeries

A weak pelvic floor may affect different compartments, with concomitant pelvic organ prolapse in 21-34% of cases14. Among women with vaginal prolapse, 40% suffer stress urinary incontinence15. Repairing prolapse affecting two compartments during a unified procedure may; reduce anaesthetic risk, ensure a single hospital stay and recovery period, reduce time off work and increase patient satisfaction. Furthermore, addressing only one of the three compartmental symptoms might deteriorate and/or

Providing multi-professional clinics

A multidisciplinary clinic can be provided in various ways. Nurses, Physiotherapists, Psychologists, Doctors, Physiologists and others may work on the same day independently in separate rooms or in the same room providing a joint consultation. Considerations for the patient's time, complexity of their condition and who needs to be involved all need to be considered to provide the optimal patient experience and the most efficient pathway to diagnosis and treatment.

It is clear from the

Summary

Pelvic floor dysfunction is often multicompartmental and multifactorial; all aspects should be addressed for optimal assessment and treatment. The multidisciplinary clinic, in conjunction with the multidisciplinary meeting, provides opportunity to deliver patient centred care and individualised treatment, which is efficient for both the patient and the healthcare provider.

Table 2.

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