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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
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