Dec Pelvic PT Distance Journal Club recording

Listen to experts in the field discuss conservative POP treatment and anatomy of pelvic support.
https://fccdl.in/hkOGPec5z
Next call Jan 6 - post prostatectomy UI treatment

Postpartum pelvic floor muscle training and pelvic organ prolapse- a randomized trial of primiparous women

Kari Bo, et al. Am J Obstet Gynecol. 2015; 212: 38.e1-7
MJ Strauhal, PT, DPT, BCB-PMD

Pelvic Physiotherapy Distance Journal Club   December 9, 2015

Primary Aim:  evaluate the effectiveness of a 4 month postpartum PFMT program on stage of pelvic organ prolapse (POP), bladder neck position, and POP symptoms in primiparous women following vaginal delivery

Background: 

• POP is common and distressing
• Prevalence of POP differs when based on clinical exam (>30%) versus symptom “bother” (5-10%)
• When symptomatic, POP causes discomfort, reduced QOL, limitation of ADL’s
• Lifetime cumulative risk for POP surgery is 7-11%,  reoperation is common, and complications associated with mesh can be severe, warranting early nonsurgical prevention and treatment
• 3-6 months postpartum occurrence rate of POP > stage II is 18-56%
• 15-40% of primip wm have a mj. LA defectà when detected by US imaging, postpartum wm with LA defect were 2x as likely to have POP stage II or > than those with intact LA
• RCT’s have shown that PFMT is effective in reducing POP symptoms and/or stage in middle-aged wm
• Systematic review concluded Level 1, grade A evidence for PFMT in treatment of POP
• Assessor blind RCT found that PFMT improved PFM strength and thickness, lifted the bladder neck (BN) and rectal ampulla, narrowed the UGH and reduced mm length in wm with POP

Three-Dimensional Modeling of the Pelvic Floor Support Systems of Subjects with and without Pelvic Organ Prolapse.

 Ren S, Xie B, Wang J, Rong Q.  BioMed Research International. 2015; Article ID 845985: 1-9.
http://dx.doi.org/10.1155/2015/845985
Pelvic PT Distance Journal Club December 9, 2015 MJ Strauhal

Purpose and Background:

·         Develop three-dimensional finite element models of the whole pelvic support systems of subjects with and without pelvic organ prolapse (POP) that can be used to simulate anterior and posterior wall prolapses

o    Prevalence of POP by symptoms report and “bother” is 3-6%; by clinical exam is 50% (different reference than Bo et al, but similar #’s)

o    Subtle injuries of the pelvic floor support system may lead to POP

o    Numerical simulations provide a tool to study pelvic function and the effect of support defects

o    Previous studies did not take into account the vaginal cavity which is of “great significance” when evaluating the mechanical behavior of POP

§  Previous studies oversimplified the structure of the ligaments and the vagina