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Monday, July 30, 2012

Predictors of care seeking in women with urinary incontinence. Minassian VA, et al. Neurourol and Urodyanm 2012;31:470-474.

Researchers at Brigham and Women’s hospital surveyed 4,064 women and found 40% self reported UI.  Of those women only 25% had received the official diagnosis of UI according to the medical records.  In other words 75% of women with symptoms of UI do not receive the official diagnosis – did not tell MD, told MD and did not receive the dx????  After several calculation factors associated with receiving the dx were noted.  Does not seem to be too much surprise, those with higher bother, impact on behavior and urgency type UI are more likely to receive the dx.  Also those who seek more care overall, older women, and women with one or more deliveries.  The take home message for me is the people who do not receive the dx – presumably younger women with more mild symptoms, especially those who have not had a child.  The key is to develop strategies on how to reach these women.  Please post your ideas.  How do you reach women who might otherwise not seek care for UI?

Friday, July 20, 2012

Short-term hormone replacement therapy


Short-term hormone replacement therapy (HRT) is acceptable and relatively safe for healthy, symptomatic, recently postmenopausal women, according to a new consensus statement endorsed by 15 leading medical organizations involved in women's health.


Specific recommendations in the consensus statement include the following;

  • The decision to use HRT must be individualized based on specific patient factors and anticipated risks and benefits. These include quality-of-life priorities, age, time since menopause, and risk for blood clots, heart disease, stroke, and breast cancer.
  • For healthy, relatively young women (younger than 59 years or within 10 years of menopause) with moderate to severe menopausal symptoms, systemic HRT is an acceptable option and is the most effective treatment.
  • Low-dose vaginal estrogen is the preferred treatment for women who have only vaginal dryness or discomfort with intercourse.
  • To prevent uterine cancer in women who still have a uterus, HRT should include progesterone or a similar progestogen, as well as estrogen. Women who have undergone hysterectomy can be given only estrogen.
  • Estrogen-only and estrogen-progestogen HRT are associated with increased risk for stroke and of venous thromboembolism (deep venous thrombosis and pulmonary embolus), as are hormone-based contraceptives. However, the risk is rare in women aged 50 to 59 years.
  • Use of continuous estrogen with progestogen therapy for at least 5 years, and possibly even for shorter duration, is associated with an increased risk for breast cancer. When HRT is discontinued, this risk decreases.


Friday, July 13, 2012

Pelvic Physiotherapy Distance Journal club July 11, 2012.

We had a small group this month (7 on the call).  Expect many are away on vacation or enjoying the nice weather.  Still the discussion was rich with clinical application and ideas.  Outlines are available on the blog http://pelvicpt.blogspot.com/2012/07/relationship-between-urinary-bladder.html and http://pelvicpt.blogspot.com/2012/07/addressing-anxiety-in-vivo-in.html  Recording is also available

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. 
Looking forward to next month August 8th.  

The Relationship between urinary bladder control and gait in women

Booth J, Paul L, Rafferty D, MacInnes C. Neurourology and Urodynamics 2012, Article first published online: 12 JUN 2012 | DOI: 10.1002/nau.22272

Pelvic Physiotherapy Distance Journal Club July 11, 2012
Beth Shelly PT, DPT, WCS, BCB PMD

What question did the study ask?
Is there a difference in temporal gait parameters during a strong desire to void?

Addressing anxiety in vivo in physiotherapy treatment of women with severe vaginismus: a clinical approach.

Rosenbaum T, J of Sex and Marital Ther 2011;37:89-93.

 Pelvic Physiotherapy Distance Journal Club July 11,2012.
Beth Shelly PT, DPT, WCS, BCB PMD

Progress in cases of sever anxiety
At each step the patient is asked to rate their anxiety on a scale of 0 (none) to 5 (sever). Then she is asked what needs to happen to get her anxiety to a 0 or 1 (possibly reverting to an earlier stage or using “lower anxiety” tools such as breathing).  She can always go back to a stage where she feels safe.  Progress when anxiety is 0 to 1.
·         Step one – lying on the table with cloths on covered with a sheet
·         Step two – as above with legs bent and knees apart
·         Step three  – as above without sheet
·         Step four – as above with shorts on first with sheet and then without sheet
·         Step five – as above with underwear only, with and without sheet
·         Step six – as above without underwear, with and without sheet

Friday, July 6, 2012

July 11, 2012 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
Addressing anxiety in vivo in physiotherapy treatment of women with severe vaginismus: a clinical approach. Rosenbaum T, J of Sex and Marital Ther 2011;37:89-93.

The Relationship between urinary bladder control and gait in women. Booth J, Paul L, Rafferty D, MacInnes C. Neurourology and Urodynamics 2012, Article first published online: 12 JUN 2012 | DOI: 10.1002/nau.22272