Thursday, December 26, 2013

Pelvic Physical Therapy Distance Journal Club 2013 Summary

2013 has been another research filled year and the Pelvic PT Distance Journal club has discussed many of the year's best.  Review the year by ordering your copy of the entire year - recordings and outlines of every month. (Unfortunately I cannot include PDF of articles in this offering, another reason it is important to print or down load the articles each month.)  As a special offer this year I will include recordings and outlines for 2012 and 2011.  That's more than 38 articles outlined and discussed.  This is a great way to review research and can be used in local journal clubs or work place journal clubs. 

Cost is a very reasonable $10 (mostly the cost of shipping and supplies)
To order send your mailing address in an email to
Looking forward to a dynamic and interactive 2014. First journal club is 8, 2014 8:30 PM EST

Beth, Michelle, Trish

Sunday, December 8, 2013

McLean et al. Pelvic Floor Muscle Training in Women with Stress Urinary Incontinence Causes Hypertrophy of the Urethral Sphincters and Reduces Bladder Neck Mobility During Coughing. Neurourology and Urodynamics 32:1096-1102(2013).

Pelvic Physiotherapy Think Tank
December 4, 2013
Michelle Spicka, DPT

Objective:  To determine the effect of a 12 week pelvic floor muscle training program on urethral morphology and mobility in women with stress urinary incontinence (SUI).

Study Design/Method: 

1.       To date, there has not been investigation of the impact of pelvic floor muscle (PFM) training on urethral structure, support or mobility.

a.       Measurements of urethral trajectory and acceleration during functional tasks such as coughing have shown that women with SUI demonstrate a larger excursion of the urethra during coughing maneuvers than their continent counterparts.

b.      These results suggest that the urethra is not effectively held in place behind the pubic symphysis to ensure that it is compressed against the pelvic floor when there is an increase in intra-abdominal pressure, which in turn suggests that women with SUI have ineffective endopelvic fascia and/or PFMs that are slow or ineffective in offering support to the urethra

Quaghebeur J and Qyndaele J. Comparison of Questionnaires Used for the Evalution of Patients with Chronic Pelvic Pain. Neurology and Urodynamics. 32:1074-1079 (2013).

Pelvic Physiotherapy Think Tank
December 4, 2013
Michelle Spicka, DPT

Objective:  Comparison of questionnaires for the evaluation of symptoms and quality of life in patients with chronic pelvic pain syndrome (CPPS).

Study Design/Method: 

                Different questionnaires are used by researchers and clinicians for the evaluation of patients with CPPS but it is uncertain if their results are comparable.

The questionnaires used were:

1.       McGill pain questionnaire (MPQ)

2.       National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI)

3.       Interstitial Cystitis Symptom and Problem Questionnaire (ICSI)

4.       Pelvic Pain and Urgency/Frequency Questionnaire (PUF)

Twenty-six CPPS patients were included and each participant filled out all questionnaires during consultation and at the same sequence.

Saturday, November 30, 2013

Recent PFM articles

Ng SF, Lok MK, Pang SM, Wun YT.
J Womens Health (Larchmt). 2013 Oct 9. [Epub ahead of print]
PMID: 24106868 [PubMed - as supplied by publisher]
Hirschhorn AD, Kolt GS, Brooks AJ.
BMC Health Serv Res. 2013 Aug 13;13:305. doi: 10.1186/1472-6963-13-305.
PMID: 23938150 [PubMed - indexed for MEDLINE] Free PMC Article
Herderschee R, Hay-Smith EC, Herbison GP, Roovers JP, Heineman MJ.
Neurourol Urodyn. 2013 Apr;32(4):325-9. doi: 10.1002/nau.22329. Epub 2012 Dec 12. Review.
PMID: 23239361 [PubMed - indexed for MEDLINE]

Saturday, November 23, 2013

December 4, 2013 Pelvic Physiotherapy Distance Journal Club

Time - 8:30 PM EST for one hour

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

This month’s discussion

Comparison of questionnaires used for the evaluation of patients with chronic pelvic pain. Quaghebeur J, Wyndaele JJ. Nuerourol and Urodynam 2013;32:1074-1079

Pelvic floor muscle training in women with stress urinary incontinence causes hypertrophy of the urethral sphincters and reduces bladder neck mobility during coughing. McLean L, et al. Nuerourol and Urodynam 2013;32:1096-1102.

Saturday, November 9, 2013

Dutch guidelines for physiotherapy in patients with stress urinary incontinence: an update.

Bernards  et al.  Int Urogynecol Journal October 2013

 Journal Club discussion November 6, 2013; Trisha Jenkyns PT, DPT, WCS, BCB-PMD

Primary Aim: To update the existing Dutch evidence-based clinical practice guidelines (CPGs) for physiotherapy management of patients with SUI and to support decision making, improve efficacy and uniformity of care.

Introduction includes: definitions of SUI (according to ICS & IUGA), SUI etiology & prognostic factors and a description of the biopsychosocial model

·         Biopsychosocial model: there is a decrease in the resilience of the PFM, which may lead to impairments of physical & mental function, restrictions in activities and participation. The model also includes consequences of SUI and prognostic factors

·         SUI etiology: intrinsic closure mechanism & extrinsic support mechanism

Surgery versus Physiotherapy for Stress Urinary Incontinence

 Labrie J et al.  New England Journal of Medicine. 2013 Sep 19; 369(12):1124-33

 Journal Club discussion November 6, 2013; Trisha Jenkyns PT, DPT, WCS, BCB-PMD

Primary Aim: To compare mid-urethral sling surgery vs. physiotherapy for the treatment of SUI

Study Design: Multicenter RCT from the Netherlands, which allowed subjects to cross-over from one treatment to the other. 

o   “If a woman was dissatisfied with the result of the assigned treatment, she was allowed to cross over to the alternative treatment, which is consistent with usual clinical practice, but data were analyzed according to the intention- to-treat principle.”  Page 1126

Study Population: For 2 years from March 2008 through May 2010, a total of 656 women with SUI or MUI in which SUI was predominant …these women were asked to participate in the study; 460 gave written informed consent and were randomly assigned to the surgery or PT group.  The treatment assignments were not concealed.

Monday, October 28, 2013

November 6, 2013 Pelvic Physiotherapy Distance Journal Club


Time - 8:30 PM EST for one hour

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

This month’s discussion

Surgery versus Physiotherapy for Stress Urinary Incontinence. Labrie J,  Berghmans BCLM, et al., N Engl J Med 2013;369:1124-33.

 Dutch guidelines for physiotherapy in patients with stress urinary incontinence: an update.  Bernards ATM, Berghmans BCM, Slieker-ten Hove MC, Staal BJ, de Bie RA, Hendriks EJM. Int Urogynecol J DOI 10.1007/s00192-013-2219-, published on line October 1, 2013.

Wednesday, October 16, 2013

Guidelines on Urinary Incontinence of the European Association of Urology

Professional association guidelines have become more common and this paper includes about 20 pages of review of the research on conservative therapy for UI. Recommendations are given for various aspects of therapy with high levels of recommendations for PFM exercises. Good marketing tool especially for urologists.

Friday, October 11, 2013

The Effect of Age on Lower Urinary Tract Function: A Study in Women

Pfisterer MDH, Griffiths DJ, Schaefer W, Resnick NM.
J Am Geriatr Soc. 2006; 54: 405-412.

MJ Strauhal, PT, BCB-PMD
October 9, 2013

Primary Aim:  To identify age-associated changes in female lower urinary tract (LUT) function across a wide age spectrum, controlling for detrusor overactivity (DO).  DO is common in old age, but may not represent normal aging.

 Subjects:  Ambulatory, nondemented, community-dwelling females with and without bladder symptoms suggestive of DO who were recruited by local advertising; efforts were made to recruit equal numbers of subjects in each age bracket who did and did not have symptoms of overactive bladder (OAB).

  • Exclusion criteria: dementia, Alzheimer’s disease, diabetes mellitus, neurological disease (such as stroke, MS, Parkinson’s), disc disease, SCI or malformations resulting in gross neuropathy, detrusor-sphincter dyssynergia, current UTI, history of pelvic irradiation or bladder cancer, history of vitamin B12 deficiency, history of ETOH abuse, radical hysterectomy, abdominoperineal resection, agents acting on cholinergic or sympathetic nervous system that were given for bladder problems that could not be stopped for 2 weeks

Effects of intravaginal estriol and pelvic floor rehabilitation on urogenital aging in postmenopausal women.

Capobianco G, Donolo E, Borghero G, Dessole F, Cherchi PL, Dessole S.
Arch Gynecol Obstet. 2012; 285: 397-403.

MJ Strauhal, PT, BCB-PMD
October 9, 2013

 Primary Aim:  To assess the effects of the combination of pelvic floor rehabilitation (PFR) and intravaginal estriol administration on stress urinary incontinence (SUI), urogenital atrophy (UGA), and recurrent urinary tract infections (UTI’s) in postmenopausal women

 Subjects:  Italian women between the ages of 55-70 years old living in Sassari, Italy were recruited by issuing a leaflet explaining the aim of the study and requesting their participation

  • Inclusion criteria- symptoms and signs of SUI (loss of urine on exertion with coughing, sneezing, intercourse, etc.), vaginal atrophy (vaginal dryness and dyspareunia), and history of recurrent UTI’s, no previous estrogen replacement, patients with hysterectomy were eligible
  • Exclusion criteria- pathologies or anatomical lesions of the urogenital tract (such as grade II and II pelvic organ prolapse per Baden and Walker classification), the presence of severe systemic disorders, thromboembolic diseases, biliary lithiasis, previous breast or uterine cancer, abnormal uterine bleeding, BMI >25 kg/m2, DO, and abnormal cystometric capacity

Sunday, September 29, 2013

International Continence Society 2013 Review

No funds for international travel
No time to read the entire abstract journal issue
No worries

This one hour phone discussion will review abstracts and presentation given at the International Continence Society 2013 annual meeting in Barcelona August 28 to 30.  Abstracts most relevant to pelvic PT will be the focus.  Although we should not base clinical decision making on one abstract - these snap shots of research are the cutting edge and often foreshadow upcoming changes in practice.  So, if you want to be on the cutting edge of pelvic therapy - join us for a interactive discussion.   

Host and main speaker: Dr Beth Shelly PT, DPT, WCS, BCB PMD
Guest speakers: we will be joined  by several leaders in the field of pelvic PT
Cost - $20
Date - Wednesday October 23rd 8:30 EST

Registration for the course will include live conference call, access to conference call download (just in case you cannot attend the live version) and handout.  Instructions to access abstracts also available. 

Start by going to my web site and registering for the course. It is only necessary to complete those items with the red asterisk   

Payment for the course can be completed at my web site.   click "pay now".  You may use a PayPal account.  If you do not have a PayPal account click "don't have a PayPal account"  and it will bring up the credit card payment.

Upon receipt of registration I will send information on calling in.  Outline of course will be emailed before the course and link to conference recording will be emailed after the course.  

Please email me at if you have questions. 

Friday, September 20, 2013

Women with provoked vestibulodynia experience clinically significant reductions in pain regardless of treatment: Results from a 2-year follow-up study.

Davis SNP, Bergeron S, Binik YM, and Lambert B.
Article first published online: 12 SEP 2013 DOI: 10.1111/jsm.12309
The Journal of Sexual Medicine
Top of Form
Introduction Provoked vestibulodynia (PVD) is a prevalent genital pain syndrome that has been assumed to be chronic, with little spontaneous remission. Despite this assumption, there is a dearth of empirical evidence regarding the progression of PVD in a natural setting. Although many treatments are available, there is no single treatment that has demonstrated efficacy above others.
Aims The aims of this secondary analysis of a prospective study were to (i) assess changes over a 2-year period in pain, depressive symptoms, and sexual outcomes in women with PVD; and (ii) examine changes based on treatment(s) type.

Methods Participants completed questionnaire packages at Time 1 and a follow-up package 2 years later.

Main Outcome Measures Visual analog scale of genital pain, Global Measure of Sexual Satisfaction, Female Sexual Function Index, Beck Depression Inventory, Dyadic Adjustment Scale, and sexual intercourse attempts over the past month.

Results Two hundred thirty-nine women with PVD completed both time one and two questionnaires. For the sample as a whole, there was significant improvement over 2 years on pain ratings, sexual satisfaction, sexual function, and depressive symptoms. The most commonly received treatments were physical therapy, sex/psychotherapy, and medical treatment, although 41.0% did not undergo any treatment. Women receiving no treatment also improved significantly on pain ratings. No single treatment type predicted better outcome for any variable except depressive symptoms, in which women who underwent surgery were more likely to improve.
Discussion These results suggest that PVD may significantly reduce in severity over time. Participants demonstrated clinically significant pain improvement, even when they did not receive treatment. Furthermore, the only single treatment type predicting better outcomes was surgery, and only for depressive symptoms, accounting for only 2.3% of the variance. These data do not demonstrate the superiority of any one treatment and underscore the need to have control groups in PVD treatment trials, otherwise improvements may simply be the result of natural progression.

Sunday, September 15, 2013

Does self-motivation improve success rates in pelvic floor muscle training in women with urinary incontinence in a secondary care setting?

Vella M, Nellist E, Cardozo L, Mastoroudes H, Giarenis I, Duckett J.
Int Urogynecol J 2013. Published online: May 24, 2013

Ann Dunbar PT, DPT, MS, WCS
September 11, 2013

Primary Aim:  To determine the effect of women’s self-motivation to perform pelvic floor muscle training (PFMT) on outcome, assessing both pre- and post-treatment with PFMT

Subjects:  Women with stress-predominant UI were recruited from 3 urogynecology clinics.  Exclusion criteria included:  Urgency predominant mixed UI; pregnancy/breastfeeding; symptomatic prolapse; surgery for UI in past 6 months; hematuria; UTI; bladder or urethral pain; anticholinergic medication.

Study Design:  Correlational  

Too tight to give birth? Assessment of pelvic floor muscle function in 277 nulliparous pregnant women

Bo K, Hilde Gunvor, Jensen JS, Siafarikas F, Engh ME
Int Urogynecol J. 2013, June 08 published online

September 11, 2013
Ann Dunbar PT, DPT, MS, WCS

Primary Aim:  To investigate the influence of vaginal resting pressure (VRP), PFM strength (measured as maximum voluntary contraction (MVC)), and endurance at midpregnancy on delivery outcomes.

Subjects:  At week 18 of their first pregnancy, 300 women were recruited at the time of their US assessment.  Exclusion criteria:  multiple pregnancies or miscarriages after week gestational 16; premature birth before 32 weeks, stillbirth, or serious illness of child or mother.

Study Design: Prospective cohort  

Friday, September 13, 2013

New concept in biofeedback home trainers

Well here it is telemetry pressure PFM training.  This device works with your smart phone and a web based platform to provide individualized home biofeedback.  The device is a vaginal pressure biofeedback which displays contraction on the patient's phone.  It is programmed and monitored by the PT.  Very good for compliance checking or in situations where the PT is very far from the patient.  I certainly think there is a patient population for this device and it is worth a look for the treatment of simple PFM weakness.  Just to be sure I would never prescribe this without an internal exam and EMG evaluation in my clinic to identify overactive PFM.  Pressure is not useful for overactive PFM down training - need to stick with EMG, imaging or palpation for that.  Also want to monitor closely to make sure they are not bearing down and provide other treatments like bladder training and coordination of PFM during lifting and sneezing.   I would love to hear your thoughts on this device.

Sunday, September 8, 2013

Four new articles

Van Houdt S, Heyrman J, Vanhaecht K, Sermeus W, De Lepeleire J.
Qual Prim Care. 2013;21(3):149-55.
PMID: 23968264 [PubMed - in process]


Hyland G, Hay-Smith J, Treharne G.
Int Urogynecol J. 2013 Aug 17. [Epub ahead of print]
PMID: 23955582 [PubMed - as supplied by publisher]


Betschart C, Mol SE, Lütolf-Keller B, Fink D, Perucchini D, Scheiner D.
Female Pelvic Med Reconstr Surg. 2013 Jul-Aug;19(4):219-24. doi: 10.1097/SPV.0b013e31829950e5.
PMID: 23797521 [PubMed - indexed for MEDLINE]


Kashyap R, Jain V, Singh A.
Int J Gynaecol Obstet. 2013 Apr;121(1):69-73. doi: 10.1016/j.ijgo.2012.11.012. Epub 2013 Jan 17.
PMID: 23332657 [PubMed - indexed for MEDLINE]

Monday, August 19, 2013

Trunk strength and mobility changes in children with slowtransit constipation.Chase JW, Stillman BC, Gibb SM, Clarke MC, Robertson VJ, Catto-Smith AG, Hutson JM, Southwell BR. J Gastroenterol Hepatol. 2009 Dec;24(12):1876-84.

Laura Scheufele PT, DPT, WCS
August 7, 2013

Primary Aim: To determine whether children and adolescents with STC have different trunk musculoskeletal characteristics that might be related to their defecation difficulties, compared to controls. Additional aims were to determine the usual activity patterns of slow transit constipation (STC) children.

Subjects: 41 children who met the STC criteria, aged between 7-18 years, were matched for age and sex in the control group. Criteria for selection into the STC group included diagnosis by radionuclear transit studies, and at least 2-year history of medical management. The control subjects recruited by requests for volunteers fromAustralian Scouting groups, and children of colleagues. The parents of each of the control subjects were interviewed and confirmed no known relevant musculoskeletal disorders or constipation history requiring medical management. 

Concurrent Validity of Calipers and Ultrasound Imaging to Measure Interrecti Distance. Cynthia M. Chiarello, J. and Adrienne McAuley. J Orthop Sports Phys Ther 2013;43(7):495-503.

Laura Scheufele PT, DPT, WCS
August 7, 2013

Primary Aim: To determine the concurrent validity of digital nylon calipers in comparison to ultrasound imaging (USI) for the measurement of interrecti distance (IRD). Secondary purpose was to describe the IRD seen in typical adult males and females.

Subjects: A sample of convenience of 56 individuals (11 men, 45 women: 22 nulliparous and 23 parous)

Monday, July 29, 2013

August 7, 2013Pelvic Physiotherapy Distance Journal Club

Time - 8:30 PM EST for one hour

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

This month’s discussion

Chase JW, et al. Trunk strength and mobility changes in children with slow transit constipation. J of Gastroenterology and Hematology 2009;24:1876-1884. 

Chiarello CM, Mcauley JA. Concurrent validity of calipers and ultrasound imaging to measure interrecti distance. J Orthop Sports Phys Ther 2013;43(7):495-503.

Thursday, July 25, 2013

Aspects of Sexual Self-Schema in Premenopausal Women with Dyspareunia: Associations with Pain, Sexual Function, and Sexual Distress

Els Pazmany MA1,*, Sophie Bergeron PhD2, Lukas Van Oudenhove MD, PhD3, Johan Verhaeghe MD, PhD4, Paul Enzlin PhD1,5
Article first published online: 11 JUL 2013 The Journal of Sexual Medicine

Introduction Although it is known that women with dyspareunia suffer from impaired psychological and sexual functioning, the study of the various dimensions of sexual self-schema and their associations with these outcomes has been neglected.

Aim To examine whether self-image cognitions about vaginal penetration, body image, and feelings and beliefs about one's own genitals contribute to the variance in pain, sexual functioning, and sexual distress.

Saturday, July 20, 2013

New articles of intrest

Giggins OM, Persson UM, Caulfield B.
J Neuroeng Rehabil. 2013 Jun 18;10:60. doi: 10.1186/1743-0003-10-60.
PMID: 23777436 [PubMed - in process] Free PMC Article
Hou CP, Chen TY, Chang CC, Lin YH, Chang PL, Chen CL, Hsu YC, Tsui KH.
Clin Interv Aging. 2013;8:667-73. doi: 10.2147/CIA.S44321. Epub 2013 Jun 6.
PMID: 23766642 [PubMed - in process] Free PMC Article
Nilssen SR, Mørkved S, Overgård M, Lydersen S, Angelsen A.
Scand J Urol Nephrol. 2012 Dec;46(6):397-404. doi: 10.3109/00365599.2012.694117. Epub 2012 Jul 2.
PMID: 22746358 [PubMed - indexed for MEDLINE]
Pereira VS, de Melo MV, Correia GN, Driusso P.
Neurourol Urodyn. 2013 Jan;32(1):48-52. doi: 10.1002/nau.22271. Epub 2012 Jun 5.
PMID: 22674639 [PubMed - indexed for MEDLINE]

Monday, July 15, 2013

Urinary Incontinence Among Group Fitness Instructors Including Yoga and Pilates Teachers. Bo K, et al. Neurourology and Urodynamics 30:370-373 (2011).

Pelvic Physiotherapy Think Tank
July 10, 2013 Michelle Spicka, DPT

Objective:  The aim of this study was to investigate the prevalence of urinary incontinence (UI) among female group fitness instructors, including Pilates and yoga teachers. 

Study Design/Method:  This was a cross-sectional study using an online questionnaire to evaluate health issues in group fitness instructors in Norway.  847 (152 men and 685 women) Fitness instructors responded to the survey.  The questionnaire contained questions about age, education, number and types of classes taught per week, exercise history, height and weight, injuries and different health issues. 

The International Consultation on Incontinence Questionnaire- UI short form was used to assess UI which assesses frequency, severity and perceived impact of incontinence in addition to an unscored self-diagnostic item.

Sexual Function after Childbirth by the Mode of Delivery: A Prospective Study. Lurie S, Aizenberg A, et al. Arch Gynecol Obstet. 16 April 2013.

Pelvic Physiotherapy Think Tank
July 10, 2013 Michelle Spicka, DPT

Objective:  To evaluate sexual behavior longitudinally in the postpartum period by mode of delivery.

Study Design/Method: 

                Five groups were defined:

1.       Women who delivered vaginally without an episiotomy

2.       Women who delivered vaginally with an episiotomy

3.       Women who delivered by instrumental delivery

4.       Women who delivered by emergent cesarean section

5.       Women who delivered by an elective cesarean section