GPs rarely examine pelvic floor in anorectal complaints, Dutch survey finds

Most cases of haemorrhoids, chronic anal fissures and faecal incontinence improve with conservative treatment, yet a survey of Dutch healthcare professionals suggests that general practitioners rarely examine one possible contributor to persistent symptoms: pelvic floor dysfunction. In the exploratory study, published in BMC Primary Care, only 3 percent of responding GPs said they almost always or always assessed the pelvic floor muscles, and fewer than half routinely performed a digital rectal examination.

The questionnaire-based study surveyed 73 general practitioners about how they diagnose, treat and refer patients with proctological complaints, and separately asked 33 secondary care specialists, a group pooling gastrointestinal surgeons and gastroenterologists, and 56 pelvic floor physical therapists about their attitudes towards a proposed new service. The researchers also asked all three groups whether they would be willing to explore implementing a one-time consultation with a pelvic floor physical therapist, intended for selected patients with chronic, recurrent or treatment-refractory anorectal symptoms.

The results point to uneven assessment habits in primary care. Digital rectal examination was performed almost always or always by 47 percent of GPs. On the treatment side, at least 59 percent of GPs said they advised patients on lifestyle and toilet behaviour, a practice the authors noted was consistent with Dutch GP guideline recommendations for several self-reported management practices.

Support for the proposed consultation was broad across all professional groups. The proportions expressing definite willingness to explore implementation were 82 percent among GPs, 79 percent among secondary care specialists and 88 percent among pelvic floor physical therapists, with no statistically significant differences between the groups (χ² (2) = 1.26, p = 0.533; Cramér’s V = 0.09). Respondents cited time constraints, gaps in knowledge, the potential for improved care and possible cost savings as key reasons for their interest.

The authors stress that the study is exploratory and based on self-reported practice rather than observed behaviour, and that the respondents may not represent all Dutch professionals in these fields. They also note that general practitioners rarely assess pelvic floor dysfunction at present, despite its potential contribution to recurring symptoms, and that little is known about how these complaints are currently managed in general practice. Because proctological complaints are common and can substantially impair quality of life, the authors argue that a one-time consultation with a pelvic floor physical therapist could help close this gap and improve care efficiency, while reserving specialist referral for cases that persist or recur.

Before any broader implementation, the researchers call for further research to establish the feasibility, clinical effectiveness and cost-effectiveness of the proposed consultation. The survey, they conclude, establishes broad support among the professionals who would be involved, but does not itself demonstrate that the service would benefit patients.

Subject of Research: A survey of Dutch general practitioners, specialists and pelvic floor physical therapists on current management of proctological complaints and support for a one-time pelvic floor physical therapy consultation.

Article Title: Current care for proctological complaints and pelvic floor physical therapy in a one-time consultation: an exploratory survey among general practitioners, surgeons, gastroenterologists, and pelvic floor physical therapists

Article References: van Reijn-Baggen, D. A., Han-Geurts, I. J. M., Elzevier, H. W., & Bonten, T. N. (2026). Current care for proctological complaints and pelvic floor physical therapy in a one-time consultation: an exploratory survey among general practitioners, surgeons, gastroenterologists, and pelvic floor physical therapists. BMC Primary Care. https://doi.org/10.1186/s12875-026-03601-1

Image Credits: AI Generated

DOI: 10.1186/s12875-026-03601-1

Keywords: proctological complaints, haemorrhoids, anal fissure, faecal incontinence, pelvic floor physical therapy, general practitioners, primary care, digital rectal examination, survey, referral, BMC Primary Care, anorectal complaints