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The Pelvic Floor: Its Function and Disorders
  1. P Denis

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In my clinical practice, I have felt for a long time that the knowledge acquired in coloproctology should be more frequently shared with specialists in obstetrics, gynaecology, urology, neurology, etc. Therefore, I enjoyed receiving this book where the contributors range between at least 10 specialities which concern pelvic floor disorders. Each chapter is written by a leading figure or a group expert in this field. The book is a valuable starting point for gastroenterologists who wish to become up to date with data concerning the clinical problems of the pelvic floor, associating the anterior and posterior components, including physiology, anatomy, diagnostic imaging, surgery, nursing, and psychology.

The previously published book by these authors was entitled Coloproctology and the Pelvic Floor—coloproctology has disappeared from the title of their new book, indicating that it is no longer possible to approach the posterior pelvic floor disorders without studying the pelvic floor as a whole. In this way, this new title by itself is a very strong message. However, the reader might be a little disappointed if he looks for how to treat, for example, a patient suffering from both anal and urinary incontinence, or a patient complaining of urinary stress incontinence and posterior pelvic floor dysfunction inducing straining at stools. The book contains a number of excellent algorithms concerning pathogenesis, investigations, and treatment of the pelvic floor disorders. However, these algorithms have been constructed to treat either the anterior pelvic floor or the posterior pelvic floor, but not to treat a patient who complains simultaneously of the two parts of the pelvic floor. It was perhaps because the book was initially so promising and the subsequent chapters so interesting that I was hoping for a little more specific detail from the authors!

Nevertheless, the psychological characteristics of the pelvic floor disorders are very well described, suggesting that the impact of social factors, such as sexual abuse for example and psychological distress, on the expression of pelvic floor symptoms should be taken into account. To date it has not been very easy to suggest guidelines indicating how to achieve a balance between identifying the pathophysiology of pelvic floor disorders and understanding psychological factors. There is no doubt that the algorithms given at the beginning of the book will be very useful for the reader. However, they would have been even more useful if the experts had suggested at which step(s) of their algorithms they felt the need to investigate the psychological profile of their patients.

As C Norton wrote in the book, “there is a small but growing movement to create multidisciplinary pelvic floor clinics, where urogynecologists, colorectal surgeons, specialist nurses, physiotherapists, neurologists, psychiatrists . . . work together to improve the management of pelvic floor disorders”. While we are waiting for these future multidisciplinary clinics of “perineology”, it was probably not the time to furnish algorithms in this particular edition of The Pelvic Floor concerning investigations and management of associated symptoms of the anterior and posterior pelvic floor, integrating the psychological profiles of the patients. JH Pemberton, M Swash, and MM Henry must be acknowledged and congratulated for bringing together the knowledge of all the specialties involved in the pelvic floor.