Pelvic - floor muscle rehabilitation in erectile dysfunction and premature ejaculation. Lavoisier P, et al. PTJ (2014)94:1731-1743.

This French research group has set out to objectively measure the increased pressure generated by the ischiocavernosus (IC) muscle during erection. Several papers have proposed that PFM exercises can improve erectile dysfunction (ED) through the following mechanism - stronger PFM, specifically the IC muscle, provides pressure at the base of the penis so that blood is maintained in the penis and erection is maintained.  This paper has a much more scientific explanation.  Study was observational - no control group or variations in treatment groups.  Patients were seen weekly (up to 20 sessions) and received

·         Penile injection of prostaglandin E1 to induce erection
·         Electrical stimulation to the dorsal penis 80 Hz, 30 minutes
·         Isolated, voluntary IC muscle exercises - they are not specific as to how they are sure it is an isolated contraction or the instructions given to achieve an isolated contraction. Results state there were a median of 318 to 312 "pressure peaks per session".  Not sure if this means they did over three hundred IC contractions?

Results show increase in pressure as a result of training over 80% with a conclusion that "pelvic floor muscle rehabilitation was found to be beneficial in erectile dysfunction". 

 Hoping for a little stimulating Holiday discussion:

Firstly I think it is wrong to make this conclusion when penile injections where also given.  Do we know if weekly penile injections will improve penile pressures?

 Secondly, how do you isolate the IC muscle and how many PTs are recommending over 300 contractions in their training programs?

 Also wonder if anyone is doing electrical stimulation on the penis for ED?

 Please post comments. 

Free IUGA Journal Articles

Free access to the IUGA Journal top 5 downloaded articles of 2014
Now through December 31st, read the top 5 downloaded articles of 2014 for free.
http://www.springer.com/medicine/gynecology/journal/192
 scroll down to "Popular content within this publication", then click the title of the article you wish to read.

December Pelvic PT Distance Journal Club recording link

http://rs2386.freeconferencecall.com:80/fcc/cgi-bin/play.mp3/2096471000-436790-49.mp3

 

Next call January 7, 2015

Happy Holiday

Myofascial Trigger Points of the Pelvic Floor: Associations with Urological Pain Syndromes and Treatment Strategies Including Injection therapy

Moldwin and Fariello
Curr Urol Rep (2013) 14:409-417

Journal Club 12/10/14 Jane O’Brien Franczak, PT, MSPT

MTrP: Knots in taut muscle bands that produce pain, local or referred. Twitch response when palpated; active or Latent,

Trigger points of the pelvic floor are almost always accompanied by “high tone”  pelvic floor muscular dysfunction (HTPDF)

Pain with MTrP attributed to high local concentrations of inflammatory mediators, neuropeptides and neurotransmitters.

Stimulation of local nocioceptors elicits pain- local and referred.

Shah study: n=12, 3 groups- no pain, no TrP (normal)

                                                no pain, TrP present (latent)

                                                pain, TrP present (active)

Effect of Abdominal and Pelvic floor Activation on Urine Flow in Women

Sapsford and Hodges

Jane O. Franczak

12/10/14

 

Purpose:

to see the effect of muscle contraction of abdominals on urine flow versus the effect of PFM contraction

Background

Urine stop test (stopping the flow of urine midstream) used to test the ability to activate PFM and indication of strength

Argument: Don’t use it for training due to the possibility of retention of urine(post void residual) and interfere with normal reflexative action of micturition or bladder’s ability to fully empty.

Abdominal drawing in ( activation of TrA) in association with increased mid urethral pressure. (Due to co-activation of PFM)

Managing Female Stress Urinary Incontinence

	American Medical Systems (AMS) is proud to be a sponsor of a new public television episode about SUI titled Managing Female Stress Urinary Incontinence. It will air on the National Public Television Network (PBS) as part of the popular Healthy Body, Healthy Mind series. This 30-minute program is sure to make a connection with your patients who may be concerned about SUI. Three women with SUI share inspiring personal stories of symptoms, struggles and successful treatment. You and your patients can also view the episode online at www.livelifedry.com. Contact your local AMS representative for more information about this program. We are committed to women’s pelvic health and value your partnership in bringing forward a topic that many of those affected feel too embarrassed to discuss.