Pelvic PT Blog 2011

Saturday February 5, 2011 the first post was placed on this blog.  It has been a busy year in research and I hope this blog has helped you stay on top.  Joining this blog will help as alerts on new posts will be sent to your email.  Look forward to more updates and summaries this year. 

72 posts

14 members

4,372 page views

10 countries

·         US – 2,393

·         Germany – 212

·         UK - 164

·         India – 149

·         Russia – 139

·         Australia – 114

·         Netherlands – 68

·         South Korea – 49

·         France – 47

·         Canada - 44

The Pelvic Physiotherapy Distance Journal club has been very successful and we have a busy year ahead.  Check out the year end summary  http://pelvicpt.blogspot.com/2011/12/2011-pelvic-physiotherapy-distance.html#more  Email me at beth@bethshelly.com if you would like to join.

There is also a LinkedIn group associated with the journal club.   http://www.linkedin.com/groups?gid=3997188&trk=hb_side_g

Also remember the IOPTWH list serv.  As a member of the SOWH you can join any (or all) of the IOPTWH list servs.  There you can post patient questions or comment on others.  Check out the members only section of the web site http://www.womenshealthapta.org/

   

Keep in touch and post comments or share new info.  Keep the journal going and always be joyful.  God Bless to you and yours.

Beth

Radical prostatectomy versus watchful waiting in early prostate cancer

Might be a game changer for urologists. - Longest-Running Trial of Watchful Waiting -

The study shows that, at 15 years, the cumulative incidence of death from prostate cancer was 14.6% among 347 men randomized to prostatectomy and 20.7% among 348 men being observed without treatment.

However, the survival benefit was confined to men younger than 65 years of age.  For men older than 65 years, survival was highly similar in the 2 groups. The new data from the ongoing Scandinavian Prostate Cancer Group Study Number 4 (SPCG-4) appear in the May 5 issue of the New England Journal of Medicine. It has been conducted in men with predominantly symptom-detected early prostate cancer. All the men had clinical stage T1 or T2 disease, well or moderately well differentiated histologic findings, and a prostate-specific antigen (PSA) level of below 50 ng/mL.  Worth reading.

Hung H, Hsiao S, Chih S, Lin H, Tsauo J. Effect of Pelvic-Floor Muscle Strengthening on Bladder Neck Mobility: A Clinic al Trial

Pelvic Physiotherapy Think Tank

December 7, 2011

Michelle Spicka

Objective:  The aim of the study was to investigate the effect of PFM strengthening on bladder neck mobility for women with stress UI or mixed UI.

Subjects: 23 patients between 18 and 65 who had at least one episode of SUI or MUI during the previous month.  .

Study Design/Method:  Each participant underwent a PFM strengthening program for 4 months.  Participants were asked to perform 3-5 sets of 6 near-maximal contractions daily (hold for 10 seconds and relax for at least 10 seconds).  Fast contractions (1 second contraction with 1 second relaxation) were added after the sustained contractions, with a target of 10 reps in every set.  Bladder neck position at rest and during a cough, the Valsalva maneuver, and a PFM contraction was assessed by transperineal ultrasonography before and after the intervention.  There was no blinding of subjects or evaluators in this study.

Oxford Levels of Evidence: This study was a single-group pretest-posttest design - Level 3

Adibi P, Mazdak H, Derakhshandeh A, Toghiani A. Change in functional bowel symptoms after prostatectomy: a case-control study. J Res Med Sci. 2011 February; 16(2):130-135.

Pelvic Physiotherapy Think Tank

December 7, 2011

Michelle Spicka

Objective:  The goal of this study was to compare the relative frequency changes in IBS symptoms in the patients who underwent prostate surgery.

Subjects: 126 patients (66 in a case group and 66 in a control group) were involved.  66 patients (33 with a TURP and 33 with an open prostatectomy) were interviewed from 3-12 months postop.  66 patients (a control group who had the same prostate symptoms but were waiting for surgery in that time period) were interviewed also.  Both case and control groups were selected using convenience time-based sequential sampling from a single academic center under treatment by one urologic surgeon.

Study Design/Method:  A structured interview was designed for data gathering and patients were interviewed during follow up in the clinic.

Oxford Levels of Evidence: case-control study design - Level 4

2011 Pelvic Physiotherapy Distance Journal Club Summary

The Pelvic Physiotherapy Distance Journal Club started meeting this year with the intent to share research and information on the rehabilitation of patients with disorders of the pelvis, urogenital, and colorectal systems.  We have had 10 meetings with the first meeting March.  Meetings have covered a wide variety of topics.  Outlines of December meeting will be posted soon.

I now have 91 PTs on the journal club email list.  In addition, I have heard from many PTs that they have listened to the meeting on pod cast at a later time.  All meeting are still available for download or you can listen right from the computer (September meeting was not recorded due to technical issues).  I have collected all outlines and pod casts on one CD. Please email me at beth@bethshelly.com if you are interested in the back issues of the meetings.

A Randomized, Double Blind, Placebo Controlled Trial of Pelvic Floor Exercises in the Treatment of Genuine Stress Incontinence.

This was one of the articles that was cited in the last Pelvic Physiotherapy Distance Journal club discussion on Optimizing pelvic floor muscle exercises.  This article randomized 44 patients to perform home exercises of 4 second PFM exercises or 4 second hip abductor exercises. 

·         Both groups had 64% of patients reporting improvement (no formal outcome measure, no specifics of how much change). 

·         No difference in 2 groups perineometry scores – both got better – no numbers given

·         Pad test better in abductor group, worse in PFM exercise group – WOW

·         The really interesting point is the adherence to exercises.  – on average participants did 52 exercises per week – 7 or 8 per day.  I think we can all agree (including the authors) this is not enough.

Overall I would say the study design was poor and though the results are intriguing, I would have to see a better study to believe that hip abductor exercises are as effective as PFM exercises in decreasing SUI.   Read for yourself.

November 9, 2011 Pelvic Physiotherapy Distance Journal Club

Discussion centered on PFM exercise routines.  Still more questions than answers.  Check out the outlines posted on this blog.  Also make sure to answer the survey about the journal club if you received the link.  Next month’s meeting is December 7^th.  Already planning for next year.  2012 schedule is below. 

This month’s discussion

Dumoulin C, Bourbonnais D, Morin M, Gravel D, Lemieux MC. Predictors of success for physiotherapy treatment in women with persistent postpartum stress urinary incontinence. Arch Phys Med Rehabil 2010;91:1059-1063.

Dumoulin C, Glazner, C, Jenkinson D. Determining the optimal pelvic floor muscle training regimen for women with stress urinary incontinence. Neurourol and Urodynam 2011;30:746-753.

Listening / downloading recordings

• Meetings will be recorded so they can be shared with others who were not able to attend
• https://www.freeconferencecall.com
• Top right corner – “log in”
• Access code – 436790

Dial-in number – (209) 647-1000

Subscriber PIN – 883352

• Choose the date you want to access – you can playback or download in several formats.  If you want to save it to your computer you click “wav” and choose “save” – name the file and choose the location to save it. 

2012 schedule

January 11 – Cindy Neville

February 8 - No journal club this month

March 7 – Beth Shelly

April 4 – Jane O’Brien

May  9 – Ann Dunbar

June  6 – Michelle Spicka

July 11 –

August 8 –

September 5 -Ann Dunbar

October 10 – MJ Strauhal

November 7 – Beth Shelly

December 5 – Michelle Spicka

Determining the optimal pelvic floor muscle training regimen for women with stress urinary incontinence.

Dumoulin C, Glazner, C, Jenkinson D. Neurourol and Urodynam 2011;30:746-753.

Beth Shelly November 9, 2011

Second International Consultation on Incontinence Research Society Bristol June 2010 – experts in the field chosen to present and debate and eventually summarize selected topics. 

“It is no longer a question of whether PFM training programs work but what components (including adjunct therapies) and combinations there of are most effective.” Page 752

Comparing PFM exercises for SUI to no treatment

·         Women who were treated were 17 times more likely to report cure or improvement

·         They experienced between 0.8 and 3 few leaks per 24 hours

·         Were 5 to 16 times more likely to be continent on pad test

Predictors of success for physiotherapy treatment in women with persistent postpartum stress urinary incontinence.

Dumoulin C, Bourbonnais D, Morin M, Gravel D, Lemieux MC. Arch Phys Med Rehabil 2010;91:1059-1063.

Beth Shelly November 9, 2011

Background

·         Women who continue with UI 3 months post-partum have a significant risk of symptoms persisting 5 years later.

·         Cochrane review – PFM exercises decrease SUI

Error in terminology

“Pelvic floor physiotherapy uses graded muscle training, either alone ….”  This sentence (written by physiotherapists) creates and contributes to the confusion other professional have about what we do and what it should be called.  Pelvic floor physiotherapy is a treatment for the pelvic floor provided by physiotherapists.  So can a nurse provide pelvic floor physiotherapy?    Certainly we would say “no” but nurse can provide “graded muscle training, either alone or ….”.  More appropriate alternative would be - “Pelvic floor physiotherapists use graded muscle training, either alone…”

Center for Evidenced Based Medicine

The Centre for Evidence-based Medicine was established in Oxford as the first of several UK centers with the aim of promoting evidence-based health care. The CEBM provides free support and resources to doctors, clinicians, teachers and others interested in learning more about EBM.

EBM Tools section has a great deal of information

·         Asking Focused Questions

·         Finding the Evidence

·         Critical Appraisal

·         Making a Decision

·         Evaluating Performance

·         Designing Research

The critical appraisal section is quite good and has documents to help you review articles and understand terminology better.  http://www.cebm.net/index.aspx?o=1157 

Also of note is the 2011 Levels of Evidence Chart.

http://www.cebm.net/mod_product/design/files/CEBM-Levels-of-Evidence-2.1.pdf 

This is a great web site. 

November 9, 2011 Pelvic Physiotherapy Distance Journal Club

November 9, 2011 Pelvic Physiotherapy Distance Journal Club

Time - 8:30 PM EST for one hour

FreeConfrenceCall.com

• 209-647-1000 access code 436790#
• Email Beth if you are having trouble accessing the call - beth@bethshelly.com
• Please keep background noise to a minimum (see below for more details)

This month’s discussion

Dumoulin C, Bourbonnais D, Morin M, Gravel D, Lemieux MC. Predictors of success for physiotherapy treatment in women with persistent postpartum stress urinary incontinence. Arch Phys Med Rehabil 2010;91:1059-1063.

Dumoulin C, Glazner, C, Jenkinson D. Determining the optimal pelvic floor muscle training regimen for women with stress urinary incontinence. Neurourol and Urodynam 2011;30:746-753.

Pelvic Physiotherapy Distance Journal Club 2011 survey

The Pelvic Physiotherapy Distance Journal Club started meeting this year with the intent to share research and information on the rehabilitation of patients with disorders of the pelvis, urogenital, and colorectal systems.  We have had 8 meetings with the first meeting March covering a wide variety of topics.

Date	Topics	# of callers
3-2-11	Prognostic indicators for success in PT with SUI patients Validity and reliability of digital PFM assessment	18
4-6-11	PFM activity in different positions Pelvic alignment altered by PFM spasm	12
5-4-11	Evidence of adding TrA training to PFM training Physical exam findings in CPP – comparing PT and MD results	10
6-8-11	How to critique a research study	9
7-6-11	PFM changes after PFM training Effect of abdominal and PFM tasks on pressure and bladder neck position	11
8-10-11	Pelvic girdle questionnaire Variation in anal resting pressure with various breathing techniques	11
9-7-11	Motor control patterns in ASLR in patients with and without PGP Levator trauma associated with POP	16
10-5-11	MFR feasibility study and case study	14

I now have 68 PTs on the journal club email list.  In addition, I have heard from many PTs that they have listened to the meeting on pod cast at a later time.  All meeting are still available for download or you can listen right from the computer (September meeting was not recorded due to technical issues). 

The core group of leaders is now planning for the 2012 journal club meetings and would like your input to make the group even more usable.  Please take just a few minutes to answer a quick questionnaire. 

http://www.zoomerang.com/Survey/WEB22DKEET9YQ2

Thanks

Four interesting articles

Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study.   The Lancet, Volume 378, Issue 9798, Pages 1244 - 1253, 1 October 2011

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2811%2960749-6/abstract?elsca1=ETOC-LANCET&elsca2=email&elsca3=segment

15 min per day or 90 min per week of moderate exercise had a 14% reduced risk of morality.  This was true across all ages, sexes, and even when cardiovascular risks were present. 

Etiological, Diagnostic and Therapeutic Consideration of the Myofascial Component in Chronic Pelvic Pain. Díaz-Mohedo E, Barón-López FJ, Pineda-Galán C.  Actas Urol Esp. 2011 Sep 12. [Epub ahead of print]  [Article in English, Spanish]

http://www.ncbi.nlm.nih.gov/pubmed?term=Etiological%2C%20Diagnostic%20and%20Therapeutic%20Consideration%20of%20the%20Myofascial%20Component%20in%20Chronic%20Pelvic%20Pain.

Too bad my Spanish is not better.  Full article is available but only the abstract is in English.  Very interesting. 

Effect of increasing doses of saw palmetto extract on lower urinary tract symptoms: a randomized trial. JAMA 2011 Sep 28;306(12):1344-1351. Barry MJ et al. http://www.ncbi.nlm.nih.gov/pubmed/21954478   

Study is not in support benefit of saw palmetto use

Management of nocturia. Faisal Rauf Khan et al. Trends in urology and men’s health. Vol 2, issue 5, 4-43, sept/ oct 2011 http://onlinelibrary.wiley.com/doi/10.1002/tre.223/pdf

Wells done summary.  Full article available free. 

October 5, 2011 Pelvic Physiotherapy Distance Journal Club

This month’s journal club lead by Jane O’Brien focused on myofascial release and the treatment of pelvic pain. The difficulties in researching this modality are highlighted in the article presented.  The case study showcases the benefits of treatment. 

 

This month’s discussion

Fitzgerald MP, et al. Randomized multicenter feasibility trial of myofascial physical therapy for the treatment of urological chronic pelvic pain syndromes.  J or Urol 2009;182:570-580.

Jane K. O’Brien , PT, MSPT.  Physical Therapy Management of a Patient with Dyspareunia and Scoliosis: A Case Report. Unpublished case report using myofascial release.

Guided imagery for relaxation and healing

Donna Carrico NP at Beaumont Hospital in Royal Oak Michigan has developed two CDs specifically for women with pelvic pain, interstitial cystitis or vulvodynia.  Ms Carrico runs the Women’s Initiative for pelvic pain, and Sexual Health program (WISH) which provides intensive treatment for women with pelvic pain.  The CDs are extremely well done and provide four different opportunities (2 on each CD).  Images of healing light, restful meadow, soothing shoreline, and breathing exercises are used to encourage relaxation.  Ms Carrico’s voice is very soothing and the choice of words is positive and supportive.  For a donation of $15 you will receive both CDs.  http://www.beaumonthospitals.com/files/imce/GuidedImageryCDOrderForm.pdf 

I would recommend every woman’s health PT look into these CDs. 

October 5, 2011 Pelvic Physiotherapy Distance Journal Club

Time - 8:30 PM EST for one hour

FreeConfrenceCall.com

• 209-647-1000 access code 436790#
• Email Beth if you are having trouble accessing the call - beth@bethshelly.com
• Please keep background noise to a minimum (see below for more details)

This month’s discussion

Fitzgerald MP, et al. Randomized multicenter feasibility trial of myofascial physical therapy for the treatment of urological chronic pelvic pain syndromes.  J or Urol 2009;182:570-580.

Jane K. O’Brien , PT, MSPT.  Physical Therapy Management of a Patient with Dyspareunia and Scoliosis: A Case Report. Unpublished case report using myofascial release.

Reviews on Pain Management

Cochrane Review Tackles Acute Postoperative Pain

This review begins a process of reevaluating the effect of pain medication.  It appears they are currently working on a similar paper on chronic pain which should be very interesting.  Even though PTs do not prescribe pain medications, it is important for us to understand the current thoughts on usage of medications.  I will be watching for more on this.

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008659.pub2/abstract 

http://www.medscape.com/viewarticle/749816?src=nl_topic 

National Coverage Analysis (NCA) Tracking Sheet for Transcutaneous Electrical Nerve Stimulation for Chronic Low Back Pain (CAG-00429N)

More review of the treatment of pain.  Unfortunately this may result in loss of coverage for TENS units. 

“CMS will review available evidence on the use of TENS for the treatment of chronic low back pain. We are particularly interested in receiving evidence speaking to the health outcomes attributable to the use of TENS in home settings.” 

Would be good for PTs to post if you have some input / evidence.

http://tinyurl.com/TENSreview

Feedback or biofeedback to augment pelvic floor muscle training for urinary incontinence in women.

Very interesting paper on biofeedback for PFM dysfunction.  Unfortunately it does point out the argument against biofeedback – increased patient contact.  Is it only the increased patient contact or does the machine add to the treatment. 

Cochrane Database Syst Rev.  2011; (7):CD009252 (ISSN: 1469-493X)

Herderschee R ; Hay-Smith EJ ; Herbison GP ; Roovers JP ; Heineman MJ
Department of Obstetrics & Gynaecology Academic Medical Centre, University of Amsterdam, Kerkstraat 379b, Amsterdam, Netherlands, 1017 HW.
BACKGROUND: Pelvic floor muscle training (PFMT) is an effective treatment for stress urinary incontinence in women. Whilst most of the PFMT trials have been done in women with stress urinary incontinence, there is also some trial evidence that PFMT is effective for urgency urinary incontinence and mixed urinary incontinence. Feedback or biofeedback are common adjuncts used along with PFMT to help teach a voluntary pelvic floor muscle contraction or to improve training performance.
OBJECTIVES: To determine whether feedback or biofeedback adds further benefit to PFMT for women with urinary incontinence.To compare the effectiveness of different forms of feedback or biofeedback.

Five Interesting Articles

I receive table to contents from a number of journals each month.  Here are a few I have found interesting in the past several months.  Hope you find them interesting also.  I would love to know what articles you are finding that are interesting.  Post on the blog or email me beth@bethshelly.com

NAFC's New Health Forum

NAFC recently partnered with Inspire.com to bring you a new online support community. NAFC and Inspire have created a community where members can discuss bladder and bowel health and offer support to each other.

More than just a forum where individuals can post discussion topics, Inspire is a community of members in which one can write journal entries, add friends, maintain a profile and contribute to the discussion. NAFC's support community serves as a safe place to exchange questions, stories and suggestions about bladder and bowel control problems and even make some new friends along the way.

Click here to access NAFC's New Online Support Community!

Bladder Health Awareness Campaign

Recently, NAFC began its nation-wide Bladder Health Awareness campaign. With the launch of the new website, last month, NAFC now has more tools to help educate the public about bladder health. Activities throughout this campaign are channeled in a countdown to National Bladder Health Week, November 14-18, 2011.

Read the blogs, articles and news bulletins to stay up-to-date with the latest treatment and management options for bladder dysfunction. Participate in the simple suggested activities to improve your bladder health and promote this campaign to others.

Specific exercises to treat pregnancy-related low back pain in a South African population. Kluge J, Hall D, Louw Q, Theron G, Grové D. Int J Gynaecol Obstet. 2011 Jun;113(3):187-91.

OBJECTIVE:

To investigate the effect of an exercise program, including specific stabilizing exercises, on pain intensity and functional ability in women with pregnancy-related low back pain.

METHODS:

Fifty women between 16 and 24 weeks of pregnancy were recruited at Tygerberg and Paarl Hospitals, Western Cape, South Africa. Twenty-six women were randomized to a 10-week exercise program and 24 were randomized as controls.

RESULTS:

Overall, the most frequent type of back pain experienced was lumbar pain (36 [72.0%]). Pain intensity (P=0.76) and functional ability (P=0.29) were comparable between the groups on study entry. In the study group, there was a significant improvement in pain intensity (P<0.01) and an improvement in functional ability (P=0.06) at the end of the study. In the control group, there were no significant changes in pain intensity (P=0.89) or functional ability (P=0.70) at the end of the study.

CONCLUSION:

A specific exercise program decreased back pain intensity and increased functional ability during pregnancy in South African women with lumbar and pelvic girdle pain.

Article supports use of exercise in decreasing pregnancy related LBP. 

September 7, 2011 Pelvic Physiotherapy Distance Journal Club

Discussion continues on intra-abdominal pressure adding the component of levator avulsion.  Each month adds more to the picture and brings up more questions.

The group also discussed the need for more patient education on birth trauma and recovery.  It was proposed that the SOWH consider another task force to develop and disseminate such a document.     

Unfortunately I was not able to record this month’s call but will work on fixing that for next month.   See outlines below.  We will be thinking about the schedule for next year.  I would like to send out a short survey to all on the journal club list.  Please let us know what is working or not working for you.  Looking forward to next month’s call.

This month’s discussion

Dietz HP, Simpson JM. Levator trauma is associated with pelvic organ prolapse. BJOG 2008;115:979-984.

Beales DJ, O’Sullivan PB, Briffa NK. Motor control patterns during an active straight leg raise in pain-free subjects.  Spine 2008;34(1):E1-E8.

Beales DJ, O’Sullivan PB, Briffa NK. Motor control patterns during an active straight leg raise in chronic pelvic girdle pain subjects.  Spine 2009;34(9):861-870.

World Congress of Physical Therapy 2011

All of the available abstracts and PowerPoint presentations from the World Congress of Physical Therapy 2011 can now be accessed online at the link below. Notice that there is a search function at the top of the page.

http://www.wcpt.org/posters_and_ppts

Abstracts and web cast for the International Contenence Society meeting just completed are also aviable on the ICS web site.  More details and highlights coming soon. 

September 7, 2011 Pelvic Physiotherapy Distance Journal Club

Time - 8:30 PM EST for one hour

FreeConfrenceCall.com

• 209-647-1000 access code 436790#
• Email Beth if you are having trouble accessing the call - beth@bethshelly.com
• Please keep background noise to a minimum (see below for more details)

This month’s discussion

Dietz HP, Simpson JM. Levator trauma is associated with pelvic organ prolapse. BJOG 2008;115:979-984.

Beales DJ, O’Sullivan PB, Briffa NK. Motor control patterns during an active straight leg raise in pain-free subjects.  Spine 2008;34(1):E1-E8.

Beales DJ, O’Sullivan PB, Briffa NK. Motor control patterns during an active straight leg raise in chronic pelvic girdle pain subjects.  Spine 2009;34(9):861-870.

Stuge B, Garrett A, Jenssen H, Grotle M: The Pelvic Girdle Questionnaire: A Condition-Specific Instrument for Asssessing Activity Limitations and Symptoms in People with Pelvic Girdle Pain. Phys Ther. 2011;91:1-11.

August 10, 2011 Michelle Spicka

Objective:  The objective of this study was to develop a condition-specific measure, the Pelvic Girdle Questionnaire (PGQ), for sue during pregnancy and postpartum.

Introduction:

1) In general, literature does not make a clear distinction between pregnancy-related low back pain (LBP) and pelvic girdle pain (PGP) but there is growing evidence that PGP disorders comprise a distinct subgroup with a unique clinical presentation and a need for specific management.

                a. For adequate evaluation of interventions, reliable and valid outcome measures are needed

2) Outcome measures that have been validated for LBP are not necessarily the most appropriate ones for PGP

a. The Pregnancy Mobility Index (van de Pol, et al 2006) has activity items that are based on literature research and clinic experience but does not include the views of patients.

b. Current outcome measures may not adequately capture the specific problems and consequences that patients describe, and there is a discrepancy between patients’ scores and their feedback.

3) This study was designed to develop a condition-specific measure for use both during pregnancy and postpartum in research and clinical practice.  After the application of Rasch analysis, the final questionnaire was assessed for test-retest reliability and construct validity.

Benetti TH, Santos MF, Mergulhao MEA, Fagundes JJ, Ayrizono MJS, Coy CSR: Variation of the Anal Resting Pressure Induced by Postexpiratory Apnea Effort in Patients with Constipation. Arq Gastroenterol 2011; 48(1):30-5.

August 10, 2011 Michelle Spicka

Objective:  

To analyze, by manometric data, the anal pressure variation at rest, during evacuation effort by using the Valsalva maneuver and forced post-expiratory apnea in subjects with secondary constipation.

Introduction:

1.  Functional evacuation disorders that lead to constipation are not completely understood (dyskinesia of the pelvic floor) but functional change is common (though underestimated) as a cause of chronic constipation and studies report that 50% of individuals suffer from constipation.

                a. Dyskinesia of the pelvic floor is characterized by difficulty initiating the evacuation and

sensation of incomplete evacuation secondary to failure of relaxation of the puborectal and external anal sphincter or contraction of those muscles during evacuation.

b. The observation that the Valsalva, used by some patients at the end of the evacuation effort, could be an aggravating favor of constipation led to this study to compare this variable with apnea after forced expiration.

c. Patients with dyskinesia of the pelvic floor tend to have decreased rectal sensitivity and muscular incoordination during the act of evacuation, showing an unconscious paradoxical contraction, exacerbated by the Valsalva.

August 10, 2011 Pelvic Physiotherapy Distance Journal Club

We had continued discussions of the effect of intra-abdominal pressure on the PFM.  More questions, some new ideas, lots of stimulating discussion.  Check out the pod cast.  Outlines of the talks are posting in this blog with links to more articles and references.

This month’s discussion

Stuge B, Garrett A, Jenssen H, Grotle M: The Pelvic Girdle Questionnaire: A Condition-Specific Instrument for Asssessing Activity Limitations and Symptoms in People with Pelvic Girdle Pain. Phys Ther. 2011;91:1-11.

Benetti TH, Santos MF, Mergulhao MEA, Fagundes JJ, Ayrizono MJS, Coy CSR: Variation of the Anal Resting Pressure Induced by Postexpiratory Apnea Effort in Patients with Constipation. Arq Gastroenterol 2011; 48(1):30-5.

Continue the discussion on LinkedIn group - Pelvic Physical Therpay Distance Journal Club
http://www.linkedin.com/groups?gid=3997188&trk=hb_side_g

August 10, 2011 Pelvic Physiotherapy Distance Journal Club

Time - 8:30 PM EST for one hour

FreeConfrenceCall.com

• 209-647-1000 access code 436790#
• Email Beth if you are having trouble accessing the call - beth@bethshelly.com
• Please keep background noise to a minimum (see below for more details)
• Call will begin promtpy at 8:30 EST

This month’s discussion

Stuge B, Garrett A, Jenssen H, Grotle M: The Pelvic Girdle Questionnaire: A Condition-Specific Instrument for Asssessing Activity Limitations and Symptoms in People with Pelvic Girdle Pain. Phys Ther. 2011;91:1-11.

Benetti TH, Santos MF, Mergulhao MEA, Fagundes JJ, Ayrizono MJS, Coy CSR: Variation of the Anal Resting Pressure Induced by Postexpiratory Apnea Effort in Patients with Constipation. Arq Gastroenterol 2011; 48(1):30-5.