Introduction

For health care providers, patients with pelvic floor problems can be one of the most complex and frustrating groups of patients we treat. There are many factors that must function in harmony for acceptable evacuation to occur at the correct moment. Minute changes in 1 aspect of the pelvis can lead to life altering results. Both ends of the spectrum can make patients miserable. I cannot imagine being afraid to leave my home and do daily activities for fear of having an uncontrolled spontaneous evacuation of stool. Likewise, sitting on the commode for hours daily, attempting to evacuate, and getting up only to feel you need to return to empty your rectum must be extremely frustrating. The degree patients go to alter their diet, activities, and schedule in an attempt to gain some control over their bowel problem amazes me.

I find many health care providers have suboptimal knowledge and understanding of the current information dealing with the pelvic floor. To this end when asked to be a guest editor for the Seminars in Colon and Rectal Surgery topic of pelvic floor evaluation, I felt this provided an excellent opportunity to ask some of the leading experts to review the literature and provide their opinions on several topics.

I started with the overall scope of the problem. As we look more closely and ask more questions, it becomes apparent that problems dealing with the pelvic floor affect more patients than we previously thought. Amy Halverson and Anne-Marie Boller have done an excellent job of setting the stage for the other chapters.

Carolynne Vaizey and Thomas Dudding have published extensively on many issues dealing with the posterior pelvis. Their chapter on evaluation and testing provides a comprehensive overview that can be used as a reference for those unfamiliar with these tests.

The chapter by Jennifer Wang and Medhulika Varma is a marvelous overview of all the tools currently in use to objectively evaluate fecal incontinence, constipation, and quality of life. I am not sure I have ever read a chapter like this, which points out the particular aspects of each tool and their use, in any published report. It truly pulls many existing information together in a clear and concise format.

The University of Minnesota has been a leader for many years in the treatment of fecal incontinence. They have extensively published on their treatment results. I have asked Anders Mellgran from that unit to report the results of traditional therapy for fecal incontinence including sphincter repair, posterior repair, dynamic graciloplsty, and artificial bowel sphincter.

There are new therapies constantly on the horizon for treating fecal incontinence. The Cleveland Clinic, Florida has been a leader at testing these new treatments and reporting the results. Sherief Shawki and Steven Wexner from that unit have written an excellent chapter covering injectable therapy and sacral nerve stimulation and the current status of each.

Because there is reportedly over 100 operations for rectal prolapse, deciding which one is the correct one for your patient can be perplexing. Myles Joyce and I have attempted to review the options and provide advice on how to tailor the choice for each particular patient.

In my practice, evacuation disturbances that originate in the pelvis remain one of the most difficult problems to assess and treat. Brooke Gurland and Massarat Zutshi have extensive experience evaluating and treating patients with this problem. They have reviewed the literature and written an overview about pelvic evacuation dysfunction and the current theories and treatments.

I congratulate the authors of each chapter for they have done an exceptional job. I appreciate all the work and effort put forth to provide this outstanding update.