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The phrase “rectal prolapse” may be easily confused with the term “rectocele” yet they may be very distinct clinical presentations. A rectocele refers to a prolapse of the posterior wall of the vagina that allows the rectum to bulge forward towards the posterior vaginal wall. This condition occurs most often in women rather than men. A rectal prolapse is a protruding of the rectum itself outside of the anal verge or opening. An overview article published in 2013 in the Journal of Gastrointestinal Surgery provides information about the condition that may assist the pelvic rehabilitation provider with valuable clinical concepts. Prior to becoming a full external prolapse, an internal intussusception may occur (and observed on defecography) and progress to include an external mucosal prolapse. Rectal prolapse may occur with or without other conditions of pelvic organ descent such as a cystocele or uterine prolapse. Although the prevalence of complete rectal prolapse is low, and occurs more often in women or in elderly patients, interference with quality of life may be significant.

 

Tagged in: Bowel Health Prolapse

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Herman & Wallace faculty member Lila Abbate instructs several courses in pelvic rehabilitation, including "Coccyx Pain, Evaluation and Treatment". Join Lila this October in Bay Shore, NY in order to learn evaluation and treatment skills for patients with coccyx conditions.

 

Varicoceles are enlarged veins that occur in the scrotum. They can be common in adolescent boys and men, with an incidence rate of approximately 15%. Because up to 1/3 of men dealing with infertility have a varicocele, a repair of this venous herniation may be a first line treatment for male fertility. Varicoceles are sometimes referred to as feeling like a "bag of worms" due to the distended veins that coil through the area (the U.S. National Library of Medicine provides a useful illustration). Although varicoceles may be painless, they are thought to be symptomatic in up to 10% of men. Symptoms can be dull, aching, throbbing, and can worsen with physical activity. Conservative care includes scrotal support, limiting physical activity, and using anti-inflammatory medications.


Vericoceles

Pelvic rehabilitation providers may work with a male patient who complains of scrotal pain, and who has a known diagnosis of a varicocele. If the patient is unsure of such a diagnosis, questioning the patient about prior discussions with his medical providers may reveal that he was told about “enlarged veins in the scrotum” or similar description. Visual inspection may reveal the tell-tale appearance of distended veins inside the scrotum, and palpation may reveal a significant difference among sides (unless both sides are involved of course.) Physical examination for a varicocele is usually completed in supine and standing positions and may be palpable with or without Valsalva maneuver. Keeping in mind that the differential diagnosis for pain in the scrotum can include medical conditions such as testicular torsion, epididymitis, inguinal hernia, testicular tumor, hydrocele, epididymal cyst, or sperm granuloma, patients who have complaints must see an appropriate medical provider to rule out such conditions. It is also possible for a patient’s condition to change or worsen if a period of time has passed, with communication with the referring provider recommended. Post-surgical complications that should also be considered are inguinal hernia repair for nerve entrapment or vasectomy.

Tagged in: Male Pelvic Floor

Guidelines for the management of 3rd and 4th degree tears were updated and published last month by The Royal College of Obstetricians & Gynaecologists. The purpose of the guidelines are to provide evidence-based guidelines on diagnosis, management and treatment of 3rd and 4th degree perineal tears. These types of tears are also referred to as obstetric anal sphincter injuries, or OASIS. The authors acknowledge an increased rate of reported anal sphincter injuries in England that may in part be due to increased awareness and detection of the issue. In terms of classification of anal sphincter injuries, the following is recommended (note the different levels at grade 3:

 

Rectum

The research on pelvic pain and specifically on sexual dysfunction has focused on heterosexual women, leaving a large gap in the clinically-based evidence. A study published last year in the Journal of Sex & Marital Therapy aimed to narrow this gap by studying the characteristics of vulvar pain in women in a variety of relationships. The associations between qualities such as love and communication were evaluated in relation to the participants' perceptions of how pain influenced their relationships. Within the research report, the authors establish that pelvic pain commonly causes pain and limitation with sexual function, and that queer women (defined in their work as women who identify as something other than heterosexual) also experience pain with sexual function.

 

"Of the 839 women, 31% reported genital pain, with 12% of the women with genital pain in a same-sex relationship, 67% in a mixed-sex relationship, and 21% being single"

Michelle Lyons is instructor of "Oncology and the Female Pelvic Floor: Female Reproductive and Gynecologic Cancers", among other Herman & Wallace courses. We thought you might like to hear her expert analysis of current research going on in the field of gynecologic oncology, and the benefits therapeutic yoga can have on patient rehabilitation. Take it away, Michelle!

 

Pelvic rehabilitation providers commonly treat a variety of conditions associated with peripartum pelvic girdle dysfunction. This list of conditions includes coccyx pain, and a recent study aimed to identify risk factors which may lead to coccyx pain in the postpartum period. Dr. Jean-Yves Maigne, who is well known for providing foundational research on the topic of coccyx pain, and colleagues completed a case series of 57 postpartum women presenting to a specialty coccydynia clinic. Dynamic x-rays were taken to assess mobility of the coccyx, and data about delivery methods were collected. (A control group of 192 women were comprised of women who also presented to the clinic but who had coccyx pain from other causes.)

 

Today we are fortunate to hear from Barbara S. Rabin MSPT ATC PYTc, owner and practitioner at Holistic Physical Therapy in Gates Mills, OH. Barbara has more than 20 years of experience in orthopedic rehabilitation. Her perspective as an athletic trainer and orthopedic therapist highlights the many approaches practitioners can take when working with pelvic rehabilitation patients.

 

"We were reminded how all the muscles of the hip are intricately integrated into the pelvic floor and one can’t ignore the influence and interaction they have on each other."

Do you have a burning question about pelvic rehabilitation? Herman & Wallace faculty member Michelle Lyons will be happy to help! The Pelvic Rehab Report will be conducting an interview with Michelle and we are inviting you to submit your questions. Head over to www.hermanwallace.com/michelle-lyons-question-and-answer if you are curious to hear about what it's like treating pelvic pain patients, some of Michelle's experiences practicing abroad, teaching courses to practitioners, or about her favorite pasta sauce! We will take the top 5 or 10 questions and put Michelle through the ringer.

 

What are you saying when giving directions to men during pelvic floor muscle training, and how do those instructions affect the effectiveness of a contraction? These questions are tackled in a study that is very interesting to therapists working in pelvic dysfunction. 15 healthy men ages 28-44 (with no prior training in pelvic floor training) were instructed to complete a submaximal effort pelvic muscle contraction. Tools utilized to acquire data in the study include those below:

Assessment tool Measuring
Transperineal ultrasound displacement of pelvic floor landmarks
Surface EMG (electromyography) abdominal, anal sphincter muscle activation
Nasogastric transducer intra-abdominal pressure (IAP)
Fine wire electromyography (3 participants only) puborectalis, bulbocavernosus muscles

 

Upcoming Continuing Education Courses

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