The future of pelvic floor services in the UK

Abstract

The provision of pelvic floor services includes local, regional and tertiary centres. The overall response rate was low (38%) and biased to centres with a consultant who was a member of the Pelvic Floor Society. Not all regional or tertiary centres held an MDM or a pelvic floor clinic. Given the nature of pelvic floor pathology an integrated service should be aimed at linking different centres and specialities.

Barriers to the management of obstructed defaecation according to colorectal surgeons

“…Several areas for improvement were observed, including the need for better standardization of care, greater utilization of MDT meetings and services and expansion of dedicated pelvic floor centres and training experiences. Similar issues have previously been identified in the UK concerning pelvic floor services in general, and our results are therefore likely to be informative for colorectal service provision elsewhere .…”

“…The majority of CSSANZ members did express a preference for dedicated pelvic floor units at their institution (70%), although only half expressed preference for a full multidisciplinary clinical service. The benefits of a dedicated pelvic floor unit are well established, including access to subspecialist knowledge and experience as well as to specialist radiological, nursing, biofeedback and physiotherapy services, and enhanced collaboration with affiliated medical disciplines . Many patients with pelvic floor disorders suffer concurrent dysfunction in multiple pelvic floor compartments , and multidisciplinary clinics can improve patient and clinician satisfaction, while also facilitating healthcare efficiency and cost savings .…”

“…This result may reflect a lack of awareness regarding the benefits of dedicated pelvic floor services, as well as the logistical difficulties of coordinating multidisciplinary care within the constraints of current colorectal practice , particularly in the private sector. It is evident that the wider establishment and utilization of pelvic floor services should be prioritized and promoted in Australasia, as has recently been advocated in the UK . Allied health professionals could also be trained to investigations of perform pelvic floor physiology themselves, with clinical oversight, to mitigate the time pressures facing colorectal surgeons.…”

“…Another challenge to OD care in Australasia is providing care for patients living in rural or provincial settings, which may be separated by vast geographical distances. In the UK, a rationalization of pelvic floor services has been proposed, including shared referral pathways for access to investigations, diagnostic and therapeutic services among regional centres . Adopting a planned model of this type could similarly facilitate improved pelvic floor service provision in Australasia, although the geography in some locations may be limiting.…”

“…This outcome partly reflects an incomplete scientific understanding of the complex pathophysiological and anatomical changes that contribute to OD . However, patient management may also be influenced by several clinical and health service delivery factors, including patient‐ and surgeon‐specific variables, the types of investigations that are available and applied and access to specialist pelvic floor services .…”