A specialized perineum clinic at the CHL
The Centre Hospitalier de Luxembourg (CHL) has just launched its Pelvic Floor Clinic, specialized in the management of pelvic floor disorders. The first consultations took place on Wednesday.
Pelvic floor disorders such as urinary or fecal incontinence, overactive bladder, constipation, pelvic organ prolapse (commonly known as “prolapse”), pain, and sexual dysfunction can occur when the muscles of the pelvic floor weaken due to factors such as age or multiple vaginal childbirths, particularly with large babies.
These disorders are relatively common, affecting women more than men, especially from the age of 55 onwards. It is estimated that one in three women may be affected. “It is rare for a young woman to have a pelvic floor problem unless she has experienced trauma during childbirth, such as an episiotomy,” says Dr. Martine Goergen, Medical Director of the Centre Hospitalier de Luxembourg and a specialist in general, visceral, vascular, and thoracic surgery.
However, despite the prevalence of these conditions, they remain largely taboo, and patients often delay seeking help. Nevertheless, “dysfunctions of the pelvic floor can lead to short, medium, and long-term complications with significant impact on personal, social, and professional life,” reminds the CHL.
In order to optimize patient care and encourage early intervention for this issue, the CHL has launched its Pelvic Floor Clinic on the first floor of the maternity ward. This clinic is entirely specialized in the management of pelvic floor disorders in women and men of all ages. It already has five specialist doctors and various other professionals, including specialized physiotherapists in urogenital assessment and rehabilitation, a specialized nurse in perinéology, a sophrologist, a sexologist, an algologist, and a dietitian.
The approach here is multidisciplinary and comprehensive, personalized to each patient. Patients will undergo a comprehensive assessment within six weeks of the initial consultation to determine the most appropriate treatment. “It’s not just one person working on one part,” explains Dr. Goergen. The pelvic floor consists of three compartments: the anterior compartment, which involves the bladder; the middle compartment, which involves the vagina and uterus; and the posterior compartment, which involves the rectum. If only one area is addressed without a comprehensive assessment, it could potentially worsen another compartment. Hence the importance of a multidisciplinary approach.”
Patients may undergo evaluations of their pelvic floor strength and capacity by physiotherapists, gynecological examinations, urology consultations, urodynamic testing, proctology consultations, dynamic radiological examinations to assess organ position, and transit time measurements using radiological examinations.
“Based on the patient’s symptoms, they will see the most competent specialist in the respective field during their first appointment. Once all the issues are identified following this medical consultation (and the medical history assessment), the patient will be scheduled for appointments with other specialists,” explains Dr. Virginie Poulain, a specialist in general, digestive, and vascular surgery at the CHL and a proctologist.
Treatment will initially involve non-invasive solutions, such as lifestyle modifications, the use of assistive devices, such as electrotherapy for localized muscle pain, pelvic floor rehabilitation, or medication. If these measures prove ineffective, surgery may be considered, including the placement of slings to support the bladder or rectum.
The Centre Hospitalier de Luxembourg (CHL) has recently launched its Pelvic Floor Clinic, specializing in the management of pelvic floor disorders. The clinic offers comprehensive care and treatment for conditions such as urinary and fecal incontinence, overactive bladder, constipation, genitourinary prolapse (commonly known as “organ prolapse”), as well as sexual pain and dysfunction related to the pelvic floor.
Pelvic floor disorders occur when the muscles in the pelvic region, which extend from the pubic bone to the tailbone and provide support to the abdomen, weaken due to various factors such as age or multiple vaginal childbirths, particularly with larger babies. These disorders are relatively common, affecting more women than men, and tend to be more prevalent in women over the age of 55. It is estimated that one in three women may experience pelvic floor issues. However, despite their prevalence, pelvic floor disorders often remain a taboo subject, causing patients to delay seeking medical attention.
In response to this need for specialized care, the CHL has established the Pelvic Floor Clinic on the first floor of its maternity unit. The clinic comprises a team of five specialized physicians and a range of healthcare professionals, including physiotherapists specializing in urogenital assessment and rehabilitation, a perineology nurse, a sophrologist, a sexologist, a pain management physician, and a dietician. The clinic adopts a multidisciplinary and comprehensive approach, providing individualized care for each patient.
The patient journey begins with a thorough assessment within six weeks of the initial consultation, aiming to determine the most appropriate treatment plan for each individual. This assessment may include evaluations of pelvic floor strength and capacity conducted by physiotherapists, gynecological examinations, urological consultations, urodynamic testing, proctology evaluations, dynamic radiological imaging to assess organ position, and transit time measurements using radiographic imaging.
Based on the patient’s specific symptoms and conditions, they will be referred to the most appropriate specialist for their initial consultation. Following this initial consultation and comprehensive assessment, the patient will follow a planned schedule of appointments with various specialists to address their specific needs. The treatment approach initially focuses on non-invasive solutions, such as lifestyle modifications, the use of assistive devices (e.g., electrotherapy for localized muscle pain), pelvic floor rehabilitation, or medication. If these conservative measures prove ineffective, surgical options, such as the placement of slings to support the bladder or rectum, may be considered.
The CHL’s Pelvic Floor Clinic aims to provide early and comprehensive management of pelvic floor disorders through a multidisciplinary approach. By addressing the physical, functional, and emotional aspects of pelvic floor health, the clinic strives to improve patients’ quality of life and alleviate the short, medium, and long-term complications associated with these conditions.