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Faiq Shaikh, M.D. is a dual fellowship-trained nuclear medicine physician & Informaticist, with a focus on translational research in the domains of Cancer imaging, Radiomics, Genomics, Informatics and Machine learning applications in Medicine. He has written more than 35 scientific articles and abstracts and 3 book chapters on related topics.

Introduction

Pelvic floor weakening is a common (occuring in half of women 50+) condition that leads to descent of the urinary bladder, uterovaginal vault, and rectum in the females, leading to urinary and fecal incontinence, and in extreme cases, pelvic organ prolapse.

Causes

Pelvic floor weakness is caused by a variety of factors, most of which increase the intra-abdominal pressure, such as pregnancy, multiparity, advanced age, menopause, obesity, connective tissue disorders, smoking, chronic obstructive pulmonary disease, etc. All these conditions lead to weakness of the pelvic musculature, ligaments, and fascia support result in descent of the pelvic floor organs.

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Perineal massage involves pelvic floor muscle stretching by application of an external pressure to muscle and connective tissue in the perineal region. It is performed 4 to 6 weeks before childbirth to help the soft tissue in that region to withstand stretching during labor. This helps to prevent perineum during birth by decreasing the need for an episiotomy or an instrument-assisted delivery. Lengthening of skeletal muscles is known to modify the viscoelastic properties of the muscle-tendon unit, which decreases the tension peak of the musculature and therefore, chances of injury.

Pelvic floor muscle stretching is performed via widening of the hiatus in the axial plane. Perineal massage is a simple technique has been found to be associated with a decrease in the incidence of perineal tears requiring suture or an episiotomy. It has also been reported to reduce postpartum pain.

Instrument-assisted stretching is performed with the help of an inflatable silicon balloon that can be pumped to gradually stretch the vagina and perineum. However, the evidence to support its benefit is lacking. In fact, there is some concern that pelvic floor muscle stretching may cause a decrease in muscle strength. Some have argued that such exercise neither improve or worsen pelvic function (Labrecque M, et al., Medi-dan, et al.). While a meta-analysis by Aquino, et al. concluded that perineal massage during labor significantly lowered risk of severe perineal trauma, such as third and fourth degree lacerations (Aquino, et al.).

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Erectile dysfunction (ED) is a debilitation complication of radical prostatectomy, which is a treatment for prostate cancer. ED is caused by a variety of causes, diabetic vasculopathy, smoking, high blood pressure, high cholesterol, psychological issues, peripheral vascular disease and medication; we will focus on post-prostatectomy ED and the role of penile rehabilitation in its management.

Post-prostatectomy-related Erectile dysfunction

Radical prostatectomy can result in nerve injury to the penis. Moreover, significant fibrotic changes take place in the corpus cavernosum of the penis postoperatively. It takes approximately 1-2 years for erectile function to return after radical prostatectomy. This is a period of “neuropraxia,” during which there is transient cavernosal nerve dysfunction. However, a prolonged “flaccid state” might lead to irreversible damage to the cavernous tissue 1.

Research on penile hemodynamics in these patients have shown that venous leakage is also implicated in its pathophysiology. An injury to the neurovascular bundles likely leads to smooth muscle cell death, which then leads to irreversible veno-occlusive disease.

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Upcoming Continuing Education Courses

Yoga for Pelvic Pain - Remote Course

Sep 25, 2021 - Sep 26, 2021
Location: Replacement Remote Course

Pelvic Floor Level 2B - Wallingford, CT Satellite Course

Sep 25, 2021 - Sep 26, 2021
Location: Ivy Rehab Physical Therapy

Pelvic Floor Level 2B - Charlotte, NC Satellite Course (SOLD OUT)

Sep 25, 2021 - Sep 26, 2021
Location: Ivy Rehab Physical Therapy

Pelvic Floor Level 2B - Virginia Beach, VA Satellite Course

Sep 25, 2021 - Sep 26, 2021
Location: Southeastern Physical Therapy

Pelvic Floor Level 2B - Salt Lake City, UT Satellite Course

Sep 25, 2021 - Sep 26, 2021
Location: Hand and Orthopedic Physical Therapy Specialists

Pelvic Floor Level 2B - Chamblee, GA Satellite Course

Sep 25, 2021 - Sep 26, 2021
Location: Revelle Physical Therapy Atlanta

Pelvic Floor Level 2B - Baldwin, WI Satellite Course

Sep 25, 2021 - Sep 26, 2021
Location: Western Wisconsin Health

Pelvic Floor Level 2B - Smyrna, TN Satellite Course

Sep 25, 2021 - Sep 26, 2021
Location: Benchmark Physical Therapy - Smyrna, TN

Trauma Awareness for the Pelvic Therapist - Remote Course

Sep 25, 2021 - Sep 26, 2021
Location: Replacement Remote Course

Pelvic Floor Level 2B - Las Vegas, NV Satellite Course (SOLD OUT)

Sep 25, 2021 - Sep 26, 2021
Location: Action Therapeutics LLC

Pelvic Floor Level 2B - Greenville, SC Satellite Course

Sep 25, 2021 - Sep 26, 2021
Location: His Therapy

Pelvic Floor Level 2B - Willingboro, NJ Satellite Course

Sep 25, 2021 - Sep 26, 2021
Location: Kinesis Rehabilitation

Pelvic Floor Level 2B - Self-Hosted

Sep 25, 2021 - Sep 26, 2021
Location: Self-Hosted Course

Pelvic Floor Level 2B - Saint Peters, MO Satellite Course (Canceled)

Sep 25, 2021 - Sep 26, 2021
Location: Excel Spine & Sports Rehab

Pelvic Floor Level 2B - Chicago, IL Satellite Course

Sep 25, 2021 - Sep 26, 2021
Location: Advocate Illinois Masonic Medical Center

Mobilization of Visceral Fascia 2: The Reproductive System - Medford, OR Satellite Location

Oct 1, 2021 - Oct 3, 2021
Location: Asante Rogue Valley Medical Center

Oncology of the Pelvic Floor Level 2A - Remote Course

Oct 2, 2021 - Oct 3, 2021
Location: Replacement Remote Course

Pregnancy Rehabilitation - Remote Course (SOLD OUT)

Oct 2, 2021 - Oct 3, 2021
Location: Replacement Remote Course

Pelvic Floor Level 2A - Marietta, GA Satellite Location (SOLD OUT)

Oct 9, 2021 - Oct 10, 2021
Location: Southern Pelvic Health

Pelvic Floor Level 2A - Self-Hosted

Oct 9, 2021 - Oct 10, 2021
Location: Self-Hosted Course

Pelvic Floor Level 2A - Livonia, MI Satellite Location (SOLD OUT)

Oct 9, 2021 - Oct 10, 2021
Location: Mendelson Kornblum Physical Therapy

Pelvic Floor Level 1 - Torrance, CA Satellite Location (SOLD OUT)

Oct 9, 2021 - Oct 10, 2021
Location: Women's Advantage Inc

Pelvic Floor Level 2A - Smyrna, TN Satellite Location (SOLD OUT)

Oct 9, 2021 - Oct 10, 2021
Location: Benchmark Physical Therapy - Smyrna, TN

Pelvic Floor Level 2A - Columbia, MO Satellite Location (SOLD OUT)

Oct 9, 2021 - Oct 10, 2021
Location: Mizzou Therapy Services

Pelvic Floor Level 1 - Little Rock, AR Satellite Course

Oct 9, 2021 - Oct 10, 2021
Location: Core Pelvic Physical Therapy