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Abstract

Proctology for gynecologists

Proctological disturbances emerge frequently in the fe-male population. Given that these entities debut espacially during pregnancy and after child birth, treatment modalities need to be reconsidered thoroughly. The therapeutic approaches range from strictly conservative measures to surgical interventions, depending on the severity of the symptoms. In most cases diagnostic evaluation and treatment can be performed on an outpatientbasis. The treatment algorithm for hemorrhoidal disease, for fissures in ano, and abscesses and fistulas will be described in detail. Special emphasis is directed towards therapeutical options during pregnancy. Surgical procedures in coloproctology require expertise and should be performed by a specially trained colorectal surgeon, especially for hemorrhoidal disease and operative strategies for anorectal fistulas.

Pelvic floor dysfunction in women is often caused by distinctive anatomic features of female fibromuscular structures of the pelvis. Besides physiological and age-dependent degeneration of the muscular-elastics elements of the pelvis, certain biomechanical stains during pregnancy, especially following vaginal delivery, or weight bearing forces in obese women can be detrimental to the pelvic floor function. These contributing factors may result in functional and morphological changes. Based on a systematic, basically clinical examination, the diagnosis of the causative alteration will rule the proper therapeutical approach. Entities in coloproctology, based on pelvic floor dysfunctions, are best treated by skilled experts in a multimodal and interdisciplinary setting.

CME Prakt Fortbild Gynakol Geburtsmed Gynakol Endokrinol 2013; 9(3): 250–265

Keywords
Hemorrhoids, fissure, fistula, pelvic floor dysfunction, outlet obstruction

Bernhard Strittmatter, Alex Furtwängler
Praxis für Koloproktologie, Praxisklinik 2000, Freiburg i. Breisgau
Reviewer: Rainer Lange, Alzey,
und Christl Reisenauer, Tübingen

Strittmatter B. Proktologie ... Gynakol Geburtsmed Gynakol Endokrinol 2013; 9(3): 250–265 publiziert 30.11.13 www.akademos.de/gyn ©akademos Wissenschaftsverlag 2013 ISSN 1614-8533