Four Interesting Articles

Staying on top of the research is a daunting task these days.  Here are a few good articles I have come across lately.  Will post more as I can. 
Anyone wanting to help with article review email me at beth@bethshelly.com.  Not looking for a long review, just a sentence - those interested are expected to read the article.

 Low back pain does not improve with surgical treatment of pelvic organ prolapse. Lau T, et al. Int Urogynecol J (2013) 24:147-153.

 

"statically significant but not clinically significant improvement of LBP after repair of prolapse " (measured by Oswestry).   Makes sense to me.  Need to fully investigate MSK origin of LBP including the role of the inner core (PFM, TrA, Resp diaphragm and mulifidi).  Good marketing for pre op PT to resolve these issues (and maybe avoid surgery).

 Across-sectional survey of the relationship between fecal incontinence and constipation.  Sze EHM, et al.  Int Urogynecol J (2013) 24:61-65. 

"constipation is an important risk factor for fecal incontinence".  It may seem contradictory to "clean out" the rectum with FI but I have seen its success many times.   Being white and being in menopause where also factors.

Clinical examination remains more important than arorectal function tests to identify treatable conditions in women with constipation. Lam TJ, Felt-Bersma RJF, Int Urogynecol J (2013) 24:67-72.

 

"Potentially treatable conditions, such as rectocele and pelvic floor hypertonia, are found on clinical examination in 40% of women with idiopathic constipation.  Anorectal function tests (anal manometry) contributes little and should be reserved for selected cases."  Sometimes I feel my techniques of examination are inadequate in comparison to the expensive, seemingly precise instrumented exams.  Good to see a study that confirms we have a lot to offer. 

Does regular exercise including pelvic floor muscle training prevent urinary and anal incontinence during pregnancy" A randomized controlled trial.  Stafne  SN, et al. BJOG. 2012 Sep;119(10):1270-80.

"fewer women in the intervention group reported any weekly UI (p= 0.004)"  Change in FI is insignificant (and probably more related to delivery according to other research).   This is a very well done study and follows several other studies which have similar results.  All prenatal exercise programs should include a health does of PFM exercises.  We can make an impact here.