May
journal club outlines are available on the blog www.pelvicpt.blogspot.com
Recordings
can be accessed with this link
https://www.freeconferencecall.com/itunes/podcast.asp?id=2096471000:436790
Next call will be June 4th.
Friday, May 16, 2014
Impact of levator trauma on pelvic floor muscle function
Rojas RG, Wong V, Shek KL, Dietz HP. Int Urogynecol J
2014;25:375-380.
Beth Shelly PT, DPT, WCS, BCB PMD
May 7, 2014 Pelvic PT Distance Journal Club
Method - 433 primips, Blinded
measurements before and after delivery
·
Questionnaires
·
MMT by Oxford
scale
·
4D translabial US
(specifics on page 377)
Macrotrauma = levator
avulsion
·
15% of parous
women
·
Defined as
puborectalis insertion of all three central segments of US were abnormal.
Microtrauma = overdistention
of levator hiatus
·
21% of vaginal deliveries
·
Defined as
increase of over 20% in hiatus during valsalva comparing pre to post delivery
·
May be related to
o
Over stretching
of connective tissue
o
Overstretching of
PFM
o
Changes in
resting tone, baseline cortical activation
o
Changes in
neuromuscular pathways
Managing chronic pelvic pain following reconstructive pelvic surgery with transvaginal mesh.
Gyang AN, Feranec JB, Patel RC, Lamvu GM. Int Urogynecol J
2014;25:313-318
Beth Shelly PT, DPT, WCS, BCB PMD
May 7, 2014 Distance Journal Club
Method - expert opinion paper on management of post mesh
pain
Post op mesh pain = 0% to 30%
Causes - PFM spasm, pudendal neuralgia, infection
PFM spasm
·
14% to 22% prevalence
·
Symptoms - dyspareunia, LBP, bowel sx
(constipation, diarrhea, excessive flatus, painful defecation), urinary sx
(frequency, urgency, nocturia)
·
Signs - PFM pain greater than 3/10, increased
PFM tone
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