St Mark's HospitalLondon North West Healthcare

Pelvic Floor Service

Description of Service

Pelvic floor problems are benign. The degree of anatomical abnormality does not always equate to the degree of symptoms. They can however represent a major cost to the NHS in terms of GP time, medications and depression and an often forgotten cost to the State in terms of loss of ability to work and broken homes.

At St Mark’s we try to provide a one-stop service. We also take a conservative approach to these problems when possible. We also remain on cutting edge of research, ensuring that patients do not miss out on any new therapies. Patients are investigated but not over investigated. Radiological testing is undertaken if there is a clear clinical indication and not just to accumulate research data. 

Biofeedback is the cheapest, most effective treatment for these disabling diseases when performed in a world class unit. It is not a complimentary or alternative therapy but is medically proven, giving huge, lasting relief to desperate patients.    

We have the biggest biofeedback service in the country. The team consists of:

  • 5 Specialist Nurses
  • 1 Physiotherapist
  • 1 Psychotherapist
  • 1 Dietician 

The Specialist Nurses are dedicated to the biofeedback service and are not shared with stoma care, cancer care or any of the other sub-specialities. We take on over 900 new cases a year. These include patients with incontinence, constipation and anal pain. Within this setting our operative rates are kept to a minimum. Our sacral nerve stimulation rates per patients seen with incontinence are the lowest of those in the specialist units.

In our hands 80% of patients can be successfully treated with conservative measures alone and discharged with no side effects at all.


Anorectal Physiological Testing

Over 900 anorectal physiological tests are undertaken at St Mark’s each year. All results are checked by consultant, together with any radiological testing undertaken and written management plan provided.

Endoanal ultrasound

This investigation was invented at St Marks. This is a consultant radiologist service led service.

Defaecatory proctography

This is used only in women with a history to suggest ‘obstructed’ defaecation or in those few patients who fail biofeedback.

Transit studies

The imaging here consists of only a single abdominal x-ray – it is done prior to biofeedback in patients with constipation.

Most commonly seen problems

Faecal Incontinence

This embarrassing and disabling condition is little discussed in polite circles – behind the scenes many patients are housebound. The most common causes are childbirth and surgery.

Many patients suffer in silence. The minority that seek hospital advice can mostly be successfully treated with Biofeedback techniques which include supervising the titration of Imodium Syrup, directed sphincter exercises, improving rectal capacity, dietary advice, supplying coping mechanisms, rectal irrigations, tibial nerve stimulation and, where necessary, psychological support.


Constipation is a surprisingly debilitating condition which occurs mainly in young women. The vast majority are treated in the community with over the counter preparations. A small minority are referred to specialist centres having failed multiple and ever increasing doses of laxatives. They are usually suffering not only from an inability to pass stools but also from abdominal pain and severe bloating.

Biofeedback, which consists of physical retraining, psychological support, dietary advice and rectal irrigation, is the mainstay of treatment. 

Anorectal Physiology Service