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Nov 05, 2013

Can patients successfully perform a pelvic muscle contraction following verbal instruction? This question was asked by Bump and colleagues in the often-cited research article published in 1991. Urethral pressure profiles were assessed in forty-seven women at rest and during a pelvic muscle contraction following brief, standardized verbal instruction. In the article, the authors found that nearly half of the women performed with "an ideal effort" leading to urethral closure without a Valsalva effort. 25% of the women, unfortunately, demonstrated an effort at muscular contraction that could promote incontinence. The authors' conclusion is that simple verbal or written instruction is not the best approach for a patient engaging in a pelvic floor muscle training program.

 

The limitations of the above study (small number of subjects, arbitrary definition of "effective Kegel," and inability to predict patient outcomes based on urethral profile) are made very clear throughout the article, yet how do we see this apply to our patient population? How often do we complete a perineal observation during an examination and identify that the patient is not generating any perineal movement, demonstrating a bearing down maneuver rather than a shortening, protective contraction, or creating such force through the abdomen that even a well-contracted pelvic floor would struggle against the strain from above? The value of the Bump study reminds us that not all patients respond positively to verbal or written instruction only. 

 

What about men? A recent study aimed to assess the ability of 52 healthy men (mean age of 22.6 years with a standard deviation of 4.42 years) to complete a pelvic muscle contraction in standing or crook lying following brief, standardized instruction. Real-time transabdominal ultrasound was used to measure bladder base elevation. 6 participants were unable to contract the pelvic floor muscles in either position, 17 were unable to contract the muscles in crook lying, and 14 could not contract the muscles in standing. While many of the men we instruct in pelvic muscle rehabilitation strategies are significantly older than the men in this study, the major point matches that of the Bump article: it is not safe to assume that a patient (even a young, healthy patient) can contract the pelvic floor muscles following verbal instruction. The authors suggest that transabdominal ultrasound may be a useful clinical tool for measuring bladder base elevation and therefore pelvic muscle activity. 


Jun 28, 2013

Although exercise is critical for pregnant women (just as it is for everyone), few receive the appropriate amount of exercise.  This may seem intuitive, but physical symptoms of pregnancy often are a barrier to physical activity for women.

 

A recent Research Report article published in The Journal of Women's Health - Physical Therapy, titled “The Impact of Symptom Type and Frequency on Activity Level During Pregnancy,” studying the daily records of physical activity for “sedentary women with a history of preeclampsia,” discusses how maternal weight and gestational age affect activity levels.  For example, women who are already over-weight have lower activity levels during pregnancy.  Similarly, the further along the baby is, the less likely the mother is to be physically active.  Women, after week 28, have the greatest reduction in physical activity.

 

This is problematic because a healthy mom is crucial for both the health of the mother and the health of the baby.  Furthermore, symptoms like fatigue and backache decrease among more active moms.  Gestational diabetes and cardiovascular disease are less likely among active moms as well.  Over-exercise can be detrimental as well; however, the numbers of women over-exercising during pregnancy is negligible compared to the majority, who are under-active during pregnancy.  Often, these physiological problems persist after pregnancy.


May 13, 2011

In a study from the Center for Aging at the University of Alabama, Birmingham and the Birmingham/Atlanta Veterans Affairs Geriatric Research, Education, and Clinical Center, researchers determine that physical therapy, bladder control strategies, and biofeedback significantly reduced the incidence of urinary incontinence in post-radical prostatectomy males when compared to a control group.

Check out the abstract of the study here.


Apr 19, 2011

On April 18th, a group of German and Italian researchers published this article on the impact of episiotomy on pelvic floor dysfunction. The paper found that "Episiotomy appears to be a protective factor for women's wellness. Women who had episiotomy and who experienced perineal symptoms have a better psycho-physical health status in the 12.79 months follow-up."

Available for download is a 15 page PDF of "Impact of episiotomy on pelvic floor disorders and their influence on women's wellness after the sixth month postpartum: a retrospective study". The PDF contains research highlights (including Abstract, Background, Methods, Results and Conclusion)


Upcoming Continuing Education Courses

Pelvic Floor Level 1 - Durham, NC (SOLD OUT)
Apr 25, 2014 - Apr 27, 2014
Location: Duke University Medical Center

Myofascial Release for Pelvic Dysfunction - Portland, OR
Apr 25, 2014 - Apr 27, 2014
Location: Legacy Meridian Park Medical Center

Finding the Driver in Pelvic Pain - Milwaukee, WI
May 01, 2014 - May 03, 2014
Location: Marquette University

Visceral Mobilization of the Urologic System - Winfield, IL
May 02, 2014 - May 04, 2014
Location: Central DuPage Hospital Conference Room

Rehabilitative Ultrasound Imaging: Women's Health and Orthopedic Topics - Seattle, WA
May 03, 2014 - May 05, 2014
Location: Swedish Hospital - Issaquah campus

Rehabilitative Ultrasound Imaging Orthopedic Topics - Seattle, WA
May 03, 2014 - May 04, 2014
Location: Swedish Hospital - Issaquah campus

Pelvic Floor Level 1 - Scottsdale, AZ (SOLD OUT)
May 16, 2014 - May 18, 2014
Location: Womens Center for Wellness and Rehabilitation

Pelvic Floor Level 2A - Maywood, IL (SOLD OUT!)
May 16, 2014 - May 18, 2014
Location: Loyola University Stritch School of Medicine

Pelvic Floor Level 3 - San Diego, CA
May 30, 2014 - Jun 01, 2014
Location: FunctionSmart Physical Therapy

Pelvic Floor Level 1 - Arlington, VA (SOLD OUT)
Jun 06, 2014 - Jun 08, 2014
Location: Virginia Hospital Center

Care of the Postpartum Patient - Houston, TX
Jun 07, 2014 - Jun 08, 2014
Location: Texas Children’s Hospital

Bowel Pathology and Function - Minneapolis, MN
Jun 07, 2014 - Jun 08, 2014
Location: Park Nicollet Clinic--St. Louis Park

Oncology and the Female Pelvic Floor - Orlando, FL
Jun 21, 2014 - Jun 22, 2014
Location: Florida Hospital Sports Medicine and Rehabilitation

Myofascial Release for Pelvic Dysfunction - Dayton, OH
Jun 22, 2014 - Jun 23, 2014
Location: Southview Hospital

Pelvic Floor Level 2A - Derby, CT
Jun 27, 2014 - Jun 29, 2014
Location: Griffin Hospital