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

Does It Work in the Long Term?—A Systematic Review on Pelvic Floor Muscle Training for Female Stress Urinary Incontinence

BØ K and Hilde G: Neurol and Urodynam 32:215-223 (2013)

Ann Dunbar PT, DPT, MS, WCS

April 9, 2014

Primary Aim:  To present long-term results of pelvic floor muscle training (PFMT) with or without biofeedback on stress urinary incontinence (SUI) and mixed urinary incontinence (MUI) with predominant SUI symptoms (including both RCTs and pre- and post-evaluation studies)

Study Design:  Systematic Review

Methods:

• Inclusion criteria: Pre-and post-test design, non-RCT and RCT’s using PFMT with or without biofeedback to treat SUI and SUI predominant MUI
• Authors completed a computerized search on PubMed
1. Pelvic floor AND (training OR exercise OR physical  activity)AND (urinary incontinence  OR stress urinary incontinence) AND (follow-up OR long-term)
2. Limits: humans, female, clinical trial, English, only adult subjects

Proof of concept: differential effects of Valsalva and straining maneuvers on the pelvic floor

Talasz H, Kremser C, Kofler M, Kalchschmid E, Lechleitner M, Rudisch A:  Eur J Obstet Gynec and Repord Biology 164(2012) 227-233

Ann Dunbar PT, DPT, MS, WCS

April 9, 2014

Introduction: History of Valsalva Maneuver (VM): 

• Named after physician (Antonio Maria Valsalva 1666-1723) whose main interest was in studying the ear. He described use of forceful inflation of air from the oro-nasopharyngeal cavity into Eustachian tubes and then into middle ear with closed mouth and nostrils. Over time, VM became widely used  in medicine including otorhinology, internal medicine (see article for details), and OB/GYN (to assess urinary incontinence, pelvic organ prolapse, to aid diagnosis of intrinsic sphincter deficiency in urodynamic testing, to demonstrate maximum impact of IAP on pelvic organ descent.
• More recently, an article published in 2006, reported on current understanding of VM which demonstrated variance from its original definition thus presenting confusion between 2 different maneuvers.