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Friday, May 16, 2014

May Pelvic PT Distance Journal Club


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.

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