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Hépato-Gastro & Oncologie Digestive

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La périnéologie : une médecine multidisciplinaire centrée sur le patient Volume 18, issue 1, Janvier-Février 2011

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Authors
Clinique Protestante, 1-3, chemin du Penthod, 69300 Caluire-et-Cuire, France, Hôpital Édouard-Herriot, 69437 Lyon, France, CHU Bichat, unité de proctologie médicochirurgicale, 75018 Paris, France, Clinique Blomet, 75015 Paris, France, CHU Marseille, hôpital Nord, Service de gastroentérologie, 13915 Marseille,France

Perineology is a medical discipline taking into account all the functional perineal diseases. It includes three axes of benign affections: gynaecological, urological and proctological. Functional perineal pathologies are a public health problem because of their frequency, their cost, and because of their impact on quality of life. However, the tight link between the different perineal functions induces the need for a multidisciplinary approach. The assessment of perineal functions is first clinical with a complete examination. This clinical approach also helps to assess the impact of the symptoms on the quality of life. Functional and morphological evaluation (anorectal manometry, dynamic MRI…) will help to precise the symptom's mechanism but are not systematically at first time. The therapeutic approach of perineal pathologies includes three steps. The first step includes diet advices and medical treatment. The second step is represented by biofeedback therapy. The third step is surgical (prolapsus correction, anal sphincter repair…). Functional and morphological investigations are usually proposed only if symptoms persist after the two first steps of treatment and when a surgical approach is evoked. In this case, it will be important to program a complete evaluation (functional and morphological) and the decision of a surgical treatment should be discussed in a multidisciplinary team including gastroenterologist, gynaecologist, physiotherapist and radiologist. Therefore, the aim of this multidisciplinary approach is to improve quality of life and to allow a personalised treatment for each patient.