The team associated with what was formerly called "The Stanford Protocol" for pelvic pain has evaluated the use of an internal wand by patients. This trigger point wand was designed to help the patient apply appropriate amounts of pressure as it has in its design an algometer for measuring pressure. 113 of 157 enrolled (mostly male) patients completed 6 months of wand use, the authors point out that those who dropped out of the study did not withdraw due to adverse affects from using the wand. Patients were instructed in use of the wand and carefully supervised prior to using the device on their own. They were instructed to use the wand several times per week. Visual analog scale measurements were taken at baseline and at 6 months. The baseline median sensitivity was 7.5 and decreased to 4 at 6 months. Over 95% of the patients reported that the wand was very or moderately effective in relieving pain.

This pilot study addresses some very important concerns. Although it is a pilot study, this work addresses the need for research to support aspects of pelvic pain therapy programs. Very importantly, it addresses the issue of how much pressure patients are using when applying self-trigger point releases with a device. We have all met patients who, despite our best coaching, apply so much pressure with any self-treatment that the symptoms meant to be alleviated are worsened, usually accompanied by the phrase, "I don't know what you did last time, but..."

Until such a device used in this study is available to clinicians, it will be difficult to gauge how much pressure a patient is applying with a device such as a wand. As in this study, patients who wish to use a trigger point tool should be carefully instructed in safe techniques for use of such a device. These trigger point tools may continue to be helpful in self-care and home program participation by the patient.

As reported in Female Pelvic Medicine & Reconstructive Surgery, women who were successfully treated for stress urinary incontinence also noted improvements in sexual function. Women in the study were treated with a pessary, with behavioral therapy for incontinence,  or with a combination of these treatments. Behavioral therapy included pelvic muscle strengthening and continence strategies. At 3 months, sexual function was assessed using short forms of both the Pelvic Organ Prolapse-Urinary Incontinence Sexual Function Questionnaire (PISQ-12) and the Personal Experiences Questionnaire (SPEQ).

The researchers found that in those women who experienced improved urinary continence, sexual activity was one of the activities in which a reduction of urinary leakage occurred. Patients also reported less restricted sexual function due to fear of leakage.

Interestingly, patients who experienced both urge incontinence and stress incontinence (versus stress incontinence alone) reported a lower level of sexual function at baseline.

It is well documented in the literature that urinary incontinence impairs quality of life in women, and this includes sexual health. The American Urological Association (AUA) recommends that medical providers ask questions about urinary incontinence and about level of bother of symptoms. The AUA also recommends that providers use validated surveys to assess a patient's function. As physical therapists, we can include screening questions on our intake forms, provide more detailed continence questionnaires, and discuss these sensitive issues with our patients to ensure that we are getting the best information about our patient's function.

Behavioral modification training for patients who have urinary issues commonly involves education about dietary triggers. The IC-Network lists green tea as "probably problematic" for triggering increased symptoms. Researchers in Japan, however, have reported an inverse relationship between urinary incontinence and drinking green tea.

Researchers at Curtin University in Western Australia and at the University of Tokyo completed dietary intake questionnaires for 300 Japanese community dwelling women aged 40-75 years. A urinary continence questionnaire was also completed (International Consultation on Incontinence Questionnaire- Short Form).

In the 27.5% of women who experienced urinary incontinence, less green tea was consumed on a daily basis versus those who did not leak. Average consumption of green tea for those who did not report incontinence was over 3 cups (757 ml). This relationship was not identified to be in effect for coffee, black or oolong tea.

Perhaps an important message to take from this research is that in our clinical experiences patients rarely respond equally to the same dietary factors. Some of our patients cannot, despite vigorous logging of food and beverage intake, find a consistent association between certain foods or fluids and their bladder symptoms. Even though some of our patients may benefit from reducing coffee and teas, we can appreciate that at least in Japan, where this information was gathered, a diet that includes green tea may not necessarily contribute to bladder issues.