Few conditions damage quality of life as quietly as pelvic floor disorders. Nearly one in four women experiences a pelvic floor problem in her lifetime — bowel incontinence, rectal prolapse, obstructed defecation — especially after childbirth and with age. Yet most sufferers never seek help, assuming nothing can be done or feeling too embarrassed to ask. Both assumptions are wrong. Effective, modern treatment exists, and it is available in Durbanville.

The pelvic unit at Mediclinic Durbanville, founded by Dr Frikkie Rademan, brings together colorectal surgery, gynaecology, pelvic floor physiotherapy and specialised imaging to treat these conditions properly — as a team.

Conditions we treat

Faecal (bowel) incontinence — leakage of gas or stool, from occasional staining to loss of control. Causes include childbirth injury to the sphincter muscles, previous anal surgery and nerve dysfunction.

Rectal prolapse — the rectum telescoping through the anus, causing a lump, mucus, bleeding and disturbed bowel control.

Obstructed defecation and rectocoele — difficulty emptying, straining, and the sensation of a blockage, often related to internal prolapse or a bulge of the rectum into the vagina.

Getting the diagnosis right

Treatment starts with understanding the mechanism, not guessing. Assessment may include 3D endoanal and pelvic floor ultrasound — the gold standard for imaging the sphincter muscles and detecting childbirth injury, and a painless, cost-effective alternative to MRI. Combined with pelvic floor imaging it can define rectocele, cystocele, enterocele, sigmoidocele and puborectalis dyssynergia — the structural causes behind obstructed defecation, prolapse and incontinence. Anorectal physiology testing and, where indicated, a defecating proctogram or MRI defecography through our radiology partners complete the picture.

Treatment: a ladder, not a leap

Conservative care first. Dietary and stool adjustments, medication, and specialist pelvic floor physiotherapy resolve or substantially improve many cases — no surgery required.

Sacral neuromodulation (InterStim). A pacemaker-like device gently stimulates the sacral nerves that control the bowel, rectum and bladder. It is one of the most effective treatments for faecal incontinence: in published series, most patients achieve at least a halving of incontinence episodes, and a substantial minority regain full continence. It may also help selected patients with severe constipation and overactive bladder. The device is removable, and a temporary trial over several days shows whether it works for you before any permanent implant.

Robotic ventral mesh rectopexy. The modern operation for rectal prolapse and selected obstructed defecation: through a few keyhole incisions under a centimetre each, the rectum is lifted and supported with a mesh secured to the sacrum. Performed robotically, the deep pelvic dissection is done with exceptional precision, helping to preserve the pelvic nerves. Most patients eat and drink the same day, spend two to three nights in hospital, are driving within about two weeks, and avoid heavy lifting for six weeks.

Sphincter repair and other procedures. Where a discrete childbirth injury to the sphincter is found on ultrasound, surgical sphincter repair may be appropriate.

Take the first step

You do not need to live with these symptoms, and you will not shock us — this is our everyday work. Ask your GP for a referral to the pelvic unit, or phone our rooms directly.

Phone +27 21 201 6582 to arrange an assessment.