Bridging the gap between evidence-based research and clinical practice, Physical Therapy for the Pelvic Floor has become an invaluable resource to practitioners treating patients with disorders of the pelvic floor. The second edition is now presented in a full colour, hardback format, encompassing the wealth of new research in this area which has emerged in recent years.
Kari Bø and her team focus on the evidence, from basic studies (theories or rationales for treatment) and RCTs (appraisal of effectiveness) to the implications of these for clinical practice, while also covering pelvic floor dysfunction in specific groups, including men, children, elite athletes, the elderly, pregnant women and those with neurological diseases. Crucially, recommendations on how to start, continue and progress treatment are also given with detailed treatment strategies around pelvic floor muscle training, biofeedback and electrical stimulation.
1. 5.1 Introduction - p. 44 2. Acknowledgement - p. 44 3. Classification and definitions - p. 44 4. 5.2 Visual observation and palpation - p. 47 5. Visual observation - p. 47 6. Clinical recommendations - p. 48 7. Vaginal palpation - p. 48 8. Clinical recommendations - p. 51 9. 5.3 Electromyography - p. 53 10. Introduction - p. 53 11. Muscle fibre, motor unit, muscle - p. 53 12. Kinesiological EMG - p. 54 13. EMG methods to differentiate normal from pathological muscle - p. 54 14. Usefulness of EMG in clinical practice and research - p. 57 15. Use of kinesiological EMG and CN EMG in particular patient groups - p. 58 16. Clinical recommendations - p. 59 17. 5.4 Vaginal squeeze pressure measurement - p. 61 18. Responsiveness - p. 61 19. Intra- and inter-tester reliability - p. 62 20. Validity - p. 62 21. Placement of the device - p. 62 22. Size and shapes of the device - p. 62 23. Influence from increased abdominal pressure - p. 63 24. Sensitivity and specificity - p. 63 25. Conclusion - p. 63 26. Clinical recommendations - p. 64 27. 5.5 Pelvic floor dynamometry - p. 66 28. Introduction - p. 66 29. In vitro Calibration studies - p. 68 30. Test–retest reliability studies - p. 68 31. Acceptance - p. 72 32. Validity studies - p. 72 33. Conclusion - p. 75 34. Clinical recommendations (based on the Montreal dynamometer) - p. 75 35. 5.6 Urethral pressure measurements - p. 77 36. Definitions - p. 77 37. Methods of measuring urethral pressure profilometry - p. 78 38. Factors affecting maximum urethral closure pressures - p. 79 39. Standardization of urethral pressure measurements - p. 79 40. Normal urethral pressure profiles - p. 80 41. Resting urethral pressure profiles - p. 82 42. Stress urethral pressure profiles - p. 82 43. Urethral reflectometry - p. 82 44. Conclusion - p. 82 45. Clinical recommendations - p. 82 46. 5.7 Ultrasound in the assessment of PFM and pelvic organ descent - p. 84 47. Introduction - p. 84 48. Technique - p. 84 49. Bladder neck position and mobility - p. 85 50. Levator activity - p. 86 51. Prolapse quantification - p. 86 52. 3D/4D Pelvic floor imaging - p. 87 53. Clinical research using 3D/4D pelvic floor ultrasound - p. 88 54. Outlook - p. 92 55. Conclusions - p. 93 56. Clinical recommendations - p. 94 57. 5.8 MRI of intact and injured female pelvic floor muscles - p. 97 58. Introduction - p. 97 59. Mri anatomy of the normal levator ani muscle structure - p. 97 60. Mri appearance of the levator ani muscles - p. 99 61. Birth is a major event causing pelvic floor dysfunction - p. 99 62. What are the clinical implications of levator ani muscle injury? - p. 107 63. Issues in rehabilitation - p. 108 64. Chapter 6: Pelvic floor and exercise science - p. 109 65. Chapter 7: Female pelvic floor dysfunctions and evidence-based physical therapy - p. 130 66. 7.1 Female stress urinary incontinence - p. 132 67. Prevalence, causes and pathophysiology - p. 132 68. Prevalence of SUI - p. 133 69. Causes and pathophysiology of SUI - p. 133 70. Conclusion - p. 135 71. Lifestyle interventions - p. 136 72. Modifiable factors associated with urinary incontinence - p. 136 73. Evidence to support the impact of lifestyle changes on symptoms of pelvic floor dysfunction - p. 136 74. Motivating lifestyle changes - p. 146 75. How might lifestyle changes be encouraged in clinical practice? - p. 149 76. Is there evidence of the use of behaviour models within continence promotion? - p. 150 77. Clinical recommendations - p. 150 78. Bladder training - p. 153 79. Introduction - p. 153 80. Bladder training protocols - p. 153 81. Prevention - p. 153 82. Treatment - p. 154 83. Conclusion - p. 160 84. Clinical recommendations - p. 160 85. Pelvic floor muscle training for SUI - p. 162 86. Introduction - p. 162 87. Rationale for PFMT for SUI - p. 162 88. Methods - p. 164 89. Evidence for PFMT to treat SUI - p. 164 90. Conclusion - p. 174 91. Clinical recommendations - p. 174 92. Electrical stimulation for SUI - p. 178 93. Introduction - p. 178 94. Methods - p. 185 95. Evidence for electrical stimulation to treat SUI symptoms - p. 186 96. Conclusion - p. 190 97. Clinical recommendations - p. 190 98. 7.2 Female overactive bladder - p. 192 99. Pelvic floor muscle training for overactive bladder - p. 192 100. Introduction - p. 192 101. Rationale for effect of PFMT for OAB - p. 192 102. Methods - p. 193 103. Evidence for PFMT to treat OAB symptoms - p. 193 104. Conclusion - p. 194 105. Clinical recommendations - p. 195 106. Electrical stimulation for overactive bladder - p. 196 107. Introduction - p. 196 108. Rationale for electrical stimulation for OAB - p. 197 109. Evidence for electrical stimulation to treat OAB (symptoms) - p. 197 110. Conclusion - p. 206 111. Clinical recommendations - p. 206 112. 7.3 Urinary incontinence related to the peripartum period - p. 208 113. Introduction - p. 208 114. Research methods - p. 209 115. Results - p. 209 116. Discussion - p. 219 117. Conclusion - p. 223 118. Acknowledgment - p. 223 119. 7.4 Pelvic organ prolapse - p. 226 120. Clinical assessment of pelvic organ prolapse - p. 226 121. Background - p. 226 122. History - p. 226 123. Questionnaires - p. 227 124. Physical examination - p. 227 125. Conclusion - p. 229 126. Use of pessaries to prevent and treat pelvic organ prolapse - p. 226 127. Introduction - p. 230 128. Evidence for the use of pessaries to manage POP - p. 232 129. Rationale for the role of PTs in pessary fitting - p. 233 130. Clinical recommendations - p. 233 131. Pelvic floor muscle training in prevention and treatment of pelvic organ prolapse - p. 226 132. Introduction - p. 234 133. Rationale for PFMT in prevention and treatment of POP - p. 241 134. Evidence for PFMT in the prevention and treatment of POP - p. 236 135. Conclusion - p. 240 136. Clinical recommendations - p. 240 137. 7.5 Female sexual dysfunction - p. 243 138. Assessment - p. 243 139. Introduction - p. 243 140. The complexity of women’s sexuality - p. 244 141. Classification of FSD - p. 245 142. Women’s sexual desire/interest disorder - p. 248 143. Arousal disorders - p. 249 144. Orgasmic disorders - p. 251 145. Sexual pain disorders - p. 252 146. Ethical, legal and counselling related considerations - p. 253 147. Conclusion - p. 254 148. Treatment - p. 258 149. Introduction - p. 258 150. Principles of FSD therapy - p. 259 151. When the physical therapist counts - p. 265 152. Conclusion - p. 265 153. Chapter 8: Male pelvic floor dysfunctions and evidence-based physical therapy - p. 270 154. Chapter 9: Evidence-based physical therapy for pelvic floor dysfunctions affecting both women and men - p. 309 155. Chapter 10: Evidence for pelvic floor physical therapy in children - p. 353 156. Chapter 11: Pelvic floor physical therapy in the elderly: where’s the evidence? - p. 367 157. Chapter 12: Evidence for pelvic floor physical therapy for neurological diseases - p. 385 158. Chapter 13: Pelvic floor dysfunction, prevention and treatment in elite athletes - p. 396 159. Chapter 14: The development of clinical practice guidelines - p. 407 160. Index - p. 419
Bridging the gap between evidence-based research and clinical practice, Physical Therapy for the Pelvic Floor has become an invaluable resource to practitioners treating patients with disorders of the pelvic floor. The second edition is now presented in a full colour, hardback format, encompassing the wealth of new research in this area which has emerged in recent years.
Kari Bø and her team focus on the evidence, from basic studies (theories or rationales for treatment) and RCTs (appraisal of effectiveness) to the implications of these for clinical practice, while also covering pelvic floor dysfunction in specific groups, including men, children, elite athletes, the elderly, pregnant women and those with neurological diseases. Crucially, recommendations on how to start, continue and progress treatment are also given with detailed treatment strategies around pelvic floor muscle training, biofeedback and electrical stimulation.
1. 5.1 Introduction - p. 44 2. Acknowledgement - p. 44 3. Classification and definitions - p. 44 4. 5.2 Visual observation and palpation - p. 47 5. Visual observation - p. 47 6. Clinical recommendations - p. 48 7. Vaginal palpation - p. 48 8. Clinical recommendations - p. 51 9. 5.3 Electromyography - p. 53 10. Introduction - p. 53 11. Muscle fibre, motor unit, muscle - p. 53 12. Kinesiological EMG - p. 54 13. EMG methods to differentiate normal from pathological muscle - p. 54 14. Usefulness of EMG in clinical practice and research - p. 57 15. Use of kinesiological EMG and CN EMG in particular patient groups - p. 58 16. Clinical recommendations - p. 59 17. 5.4 Vaginal squeeze pressure measurement - p. 61 18. Responsiveness - p. 61 19. Intra- and inter-tester reliability - p. 62 20. Validity - p. 62 21. Placement of the device - p. 62 22. Size and shapes of the device - p. 62 23. Influence from increased abdominal pressure - p. 63 24. Sensitivity and specificity - p. 63 25. Conclusion - p. 63 26. Clinical recommendations - p. 64 27. 5.5 Pelvic floor dynamometry - p. 66 28. Introduction - p. 66 29. In vitro Calibration studies - p. 68 30. Test–retest reliability studies - p. 68 31. Acceptance - p. 72 32. Validity studies - p. 72 33. Conclusion - p. 75 34. Clinical recommendations (based on the Montreal dynamometer) - p. 75 35. 5.6 Urethral pressure measurements - p. 77 36. Definitions - p. 77 37. Methods of measuring urethral pressure profilometry - p. 78 38. Factors affecting maximum urethral closure pressures - p. 79 39. Standardization of urethral pressure measurements - p. 79 40. Normal urethral pressure profiles - p. 80 41. Resting urethral pressure profiles - p. 82 42. Stress urethral pressure profiles - p. 82 43. Urethral reflectometry - p. 82 44. Conclusion - p. 82 45. Clinical recommendations - p. 82 46. 5.7 Ultrasound in the assessment of PFM and pelvic organ descent - p. 84 47. Introduction - p. 84 48. Technique - p. 84 49. Bladder neck position and mobility - p. 85 50. Levator activity - p. 86 51. Prolapse quantification - p. 86 52. 3D/4D Pelvic floor imaging - p. 87 53. Clinical research using 3D/4D pelvic floor ultrasound - p. 88 54. Outlook - p. 92 55. Conclusions - p. 93 56. Clinical recommendations - p. 94 57. 5.8 MRI of intact and injured female pelvic floor muscles - p. 97 58. Introduction - p. 97 59. Mri anatomy of the normal levator ani muscle structure - p. 97 60. Mri appearance of the levator ani muscles - p. 99 61. Birth is a major event causing pelvic floor dysfunction - p. 99 62. What are the clinical implications of levator ani muscle injury? - p. 107 63. Issues in rehabilitation - p. 108 64. Chapter 6: Pelvic floor and exercise science - p. 109 65. Chapter 7: Female pelvic floor dysfunctions and evidence-based physical therapy - p. 130 66. 7.1 Female stress urinary incontinence - p. 132 67. Prevalence, causes and pathophysiology - p. 132 68. Prevalence of SUI - p. 133 69. Causes and pathophysiology of SUI - p. 133 70. Conclusion - p. 135 71. Lifestyle interventions - p. 136 72. Modifiable factors associated with urinary incontinence - p. 136 73. Evidence to support the impact of lifestyle changes on symptoms of pelvic floor dysfunction - p. 136 74. Motivating lifestyle changes - p. 146 75. How might lifestyle changes be encouraged in clinical practice? - p. 149 76. Is there evidence of the use of behaviour models within continence promotion? - p. 150 77. Clinical recommendations - p. 150 78. Bladder training - p. 153 79. Introduction - p. 153 80. Bladder training protocols - p. 153 81. Prevention - p. 153 82. Treatment - p. 154 83. Conclusion - p. 160 84. Clinical recommendations - p. 160 85. Pelvic floor muscle training for SUI - p. 162 86. Introduction - p. 162 87. Rationale for PFMT for SUI - p. 162 88. Methods - p. 164 89. Evidence for PFMT to treat SUI - p. 164 90. Conclusion - p. 174 91. Clinical recommendations - p. 174 92. Electrical stimulation for SUI - p. 178 93. Introduction - p. 178 94. Methods - p. 185 95. Evidence for electrical stimulation to treat SUI symptoms - p. 186 96. Conclusion - p. 190 97. Clinical recommendations - p. 190 98. 7.2 Female overactive bladder - p. 192 99. Pelvic floor muscle training for overactive bladder - p. 192 100. Introduction - p. 192 101. Rationale for effect of PFMT for OAB - p. 192 102. Methods - p. 193 103. Evidence for PFMT to treat OAB symptoms - p. 193 104. Conclusion - p. 194 105. Clinical recommendations - p. 195 106. Electrical stimulation for overactive bladder - p. 196 107. Introduction - p. 196 108. Rationale for electrical stimulation for OAB - p. 197 109. Evidence for electrical stimulation to treat OAB (symptoms) - p. 197 110. Conclusion - p. 206 111. Clinical recommendations - p. 206 112. 7.3 Urinary incontinence related to the peripartum period - p. 208 113. Introduction - p. 208 114. Research methods - p. 209 115. Results - p. 209 116. Discussion - p. 219 117. Conclusion - p. 223 118. Acknowledgment - p. 223 119. 7.4 Pelvic organ prolapse - p. 226 120. Clinical assessment of pelvic organ prolapse - p. 226 121. Background - p. 226 122. History - p. 226 123. Questionnaires - p. 227 124. Physical examination - p. 227 125. Conclusion - p. 229 126. Use of pessaries to prevent and treat pelvic organ prolapse - p. 226 127. Introduction - p. 230 128. Evidence for the use of pessaries to manage POP - p. 232 129. Rationale for the role of PTs in pessary fitting - p. 233 130. Clinical recommendations - p. 233 131. Pelvic floor muscle training in prevention and treatment of pelvic organ prolapse - p. 226 132. Introduction - p. 234 133. Rationale for PFMT in prevention and treatment of POP - p. 241 134. Evidence for PFMT in the prevention and treatment of POP - p. 236 135. Conclusion - p. 240 136. Clinical recommendations - p. 240 137. 7.5 Female sexual dysfunction - p. 243 138. Assessment - p. 243 139. Introduction - p. 243 140. The complexity of women’s sexuality - p. 244 141. Classification of FSD - p. 245 142. Women’s sexual desire/interest disorder - p. 248 143. Arousal disorders - p. 249 144. Orgasmic disorders - p. 251 145. Sexual pain disorders - p. 252 146. Ethical, legal and counselling related considerations - p. 253 147. Conclusion - p. 254 148. Treatment - p. 258 149. Introduction - p. 258 150. Principles of FSD therapy - p. 259 151. When the physical therapist counts - p. 265 152. Conclusion - p. 265 153. Chapter 8: Male pelvic floor dysfunctions and evidence-based physical therapy - p. 270 154. Chapter 9: Evidence-based physical therapy for pelvic floor dysfunctions affecting both women and men - p. 309 155. Chapter 10: Evidence for pelvic floor physical therapy in children - p. 353 156. Chapter 11: Pelvic floor physical therapy in the elderly: where’s the evidence? - p. 367 157. Chapter 12: Evidence for pelvic floor physical therapy for neurological diseases - p. 385 158. Chapter 13: Pelvic floor dysfunction, prevention and treatment in elite athletes - p. 396 159. Chapter 14: The development of clinical practice guidelines - p. 407 160. Index - p. 419
