Pelvic muscle strength after childbirth

Friedman S, Blomquist JL, Nugent JM, McDermott KC, Munoz A, Handa VL. Obstet Gynecol 2012;120:1021-28.

 

Laura Scheufele PT, DPT, WCS

November 7, 2012

 Primary Aim: To estimate the effect of vaginal delivery and other obstetric exposures on pelvic muscle strength measured 6-11 years after first delivery and to investigate the relationship between pelvic muscle strength and pelvic floor disorders.

Subjects: 666 parous women who were originally recruited 5-10 years after first delivery for Mothers’ Outcomes after Delivery study returned for their second annual visit (thus 6 -11 years after first delivery). Enrolled participants plan to return annually for assessment of pelvic floor disorders.

Exclusion criteria: Maternal age younger than 15 or older than 50 years, delivery at less than 37 weeks of gestation, placenta previa, multiple gestation, known fetal congenital anomaly, stillbirth, prior myomectomy, latex allergy, and abruption. Women who developed these events during subsequent pregnancies not excluded.

 Study Design: A prospective cohort study.

Can pelvic floor muscle training reverse pelvic organ prolapse and reduce prolapse symptoms? An assessor-blinded, randomized, controlled trial.

Braekken IH, Majida M, Engh ME, Bo K. Am J Obstet Gynecol 2010;203:170e1-7.

Laura Scheufele PT, DPT, WCS

November 7, 2012

Primary Aim: To evaluate whether PFMT can (1) reverse and prevent further development of POP and (2) reduce symptoms related to POP.

Subjects: 109 women at least 1 year post-partum with POP stages I, II and III as determined by POP-Q regardless of symptoms.

Exclusion criteria as follows:  POP stage 0 or IV, inability to contract the PFM, breastfeeding, previous POP surgery, radiating back pain, pelvic cancer, neurologic disorders, psychiatric disorders, untreated urinary tract infection, planning to become pregnant during the next 6 months, or to be away for more than 4 weeks during the intervention period.

 

Study Design: An assessor-blinded, randomized, controlled, parallel group trial with stratification on severity of POP.

                Stratified into 2 groups by severity of prolapse: (1) maximal vaginal descent at or above the hymen, and (2) maximal descent below the hymen. Within each strata randomization proceeded.  

Pelvic Physiotherapy Blog 2012 Summary

Views on the blog continue to increase.  Page views for January to September average 600 to 800 per month (last year it was 400 to 600 per month).  The month of October had over 2,000 page views and November is also very busy with over 1,500 page views.  Visitors to the blog come from all over the world: Israel, Netherlands, Latvia, Australia, Canada, United States, France, Russia, United Kingdom, Germany, India, Brazil, Ukraine, and South Korea. Thirty two “members” receive email notification when a blog post is loaded.  You can “join” the blog to receive email notification on the home page – scroll down under the blog archive on the right and click “join this site”. 

 There have been 62 posts this year averaging 2 per week.  Posts include announcements about the journal club, journal club outlines, reviews of current research, new clinical guidelines / position statements, and the occasional event and new product. Goal of posts is to keep busy clinicians updated on current research and other information important for clinical practice.  Till now I have created all posts however, I would like to invite one or two other PTs to join me in monitoring the literature and posting summaries.  I can email journal announcements and will help with editing posts. Must be fluent in English.  Interested PTs should email me at beth@bethshelly.com

 I would like to make this site user friendly and functional. Please email suggestions or comments also.  beth@bethshelly.com Thanks for your support.  Stay tuned for more.

 Beth Shelly

International Continence Society - October 2012 Beijing, China -Presentations by Physiotherapists

PREVALENCE OF FECAL INCONTINENCE AFTER VAGINAL DELIVERIES VERSUS CAESAREAN SECTIONS. Rømmen K, Schei B, Rydning A, Daltveit A K, Sultan A, Mørkved S (podium poster)

OSTEOPOROSIS AND URINARY INCONTINENCE IN AUSTRALIAN WOMEN: A LONGITUDINAL ANALYSIS Chiarelli P, Sibbritt D (podium poster)

RESEARCH PRIORITIES FOR ELDERLY WOMEN WITH URINARY INCONTINENCE: RESULTS OF A CITIZENS JURY. Dumoulin C, Gareau A, Morin M, Tang A, Jolivest M, Lemieux M, Liberman D, Jadin M, Élliott V, Faro-Dussault V, Pontbriand-Drolet S, Bergeron J (podium poster)

The Canadian Urological Society

The Canadian Urological Society has just released an updated guideline for adult urinary incontinence which supports the use of conservative management before medication in all patient groups.  This is a well done summary of current literature and can be an adjunct to marketing efforts of PTs. 

http://www.cua.org/userfiles/files/Incontinence%20Guidelines%201-2012(1).pdf

Therapists might also be interested in the 2011 guideline on prostatitis.  It summarizes the 4 categories, diagnosis and treatment.  It does include category 3 CPPS and recognizes the possibility of massage of trigger points.  However, it also points out that there is not enough high level research to fully support the treatment.  Keep those research projects going!

http://www.cua.org/userfiles/files/CUA%20Prostatitis%20Guidelines%20June%206%202011%20FINAL%20DRAFT%20ver.pdf

Two products you might want to check out

Stop Your Drip! An exercise program for male bladder control.  Daniel J. Kirages, PT, DPT, OCS, FAAOMPT, www.stopyourdrip.com. 2012 $49.99.

  This program includes a DVD and manual outlining a progressive exercise program for men undergoing prostate procedures, especially prostatectomy.  The created, Dr Daniel Kirages DPT, has several orthopedic credentials and has participated in research related to pelvic floor muscle exercises in the post prostatectomy population published in the Journal of Urology.   The program is written for the lay public and includes pre and post operative stages.  Pictures and video are very clear and professionally created.  Exercises incorporate isolated PFM exercises, overflow exercises, and functional PFM exercises.  There is quite a good variety and I can pick and choose which ones I use for each patient at each stage of recovery.  Good resource if you treat this patient population.

 The Pelvic Floor Therapy Pad by Babette Gray - Pelvic Pain Solutions  http://www.pelvicpainsolutions.com retails for $39.99.

Wearable, perineal heat / cold pack for patients with pelvic pain.  Created by a patient with pudendal neuralgia. All pads are made locally. Wholesale pricing possible or patients can order off the web site.  Pad covers the entire perineal area and is held on by waist strap.  Web siote has other shapes and products.  One of my patients just loves it. 

Urinary incontinence in neurological disease: Management of lower urinary tract dysfunction in neurological disease

NICE clinical guidelines Issued: August 2012 http://publications.nice.org.uk/urinary-incontinence-in-neurological-disease-cg148/introduction

 This guideline lists a comprehensive patient approach and background for the treatment of UI in patients with neurological disease. It also includes a small amount about possible treatments including bladder training and pelvic floor muscle exercises.  Several nurses sat on the panel that created these guidelines – no PT.

National Institution for Health and Clinical Excellence issues the NICE Guidelines.  They develop evidence-based guidelines on the most effective ways to diagnose, treat and prevent disease and ill health. Patient-friendly versions of the guidelines can help educate and empower patients, carers and the public to take an active role in managing their conditions. Highest evidence is used to create guidelines along with medical professional consensus.