The chat on 7th July at 8pm BST being co-hosted by Teresa Costello or @teresa_costello who is a Physiotherapist specialising in Pelvic Health from Ireland – thank you Teresa! As usual during a #physiotalk chat we hope to cover the topic in a way that makes it interesting for those who specialise in the area and also those who don’t!
Pelvic floor dysfunction may have many different presentations which can include urinary and faecal incontinence and pelvic organ prolapse. The muscles of the pelvic floor can also become tight and tense and this overactivity can result in pelvic pain and conditions such as dyspareunia and vulvadynia. The pelvic floor muscle is also an important component of the core stabilising system and dysfunction can lead to deficits in trunk and pelvic stability. Factors that can contribute to pelvic floor dysfunction include obesity, pregnancy and delivery, menopause, heavy lifting / manual work, poor posture, constipation and pelvic surgery.
Wall and DeLancey (1991) stated that ‘Pelvic floor dysfunction, particularly as manifested by genital prolapse and urinary or faecal incontinence remains one of the largest unaddressed issues in women’s health care.’ A 2006 survey found that 45.7% of women attending GP surgeries in the UK had urinary incontinence, yet only 15% of these women had sought help for their symptoms (Shaw et al, 2006). In a more recent survey of a pre and post natal population, 72% of Australian mothers aged 25-45 years reported symptoms of urinary incontinence (Continence Foundation of Australia, 2014). However, 81% of these hadn’t sought treatment for their symptoms and 98% did not do the recommended level of pelvic floor muscle training.
Physiotherapy, including pelvic floor muscle training, is recommended as first line treatment for urinary incontinence (Dumoulin and Hay-Smith, 2008). There is strong evidence to support the effectiveness of pelvic floor muscle training, either alone or with adjunctive physiotherapy treatments, for women with stress urinary incontinence, with expected rates of cure up to 73% and of cure/improvement up to 97% (Neumann et al, 2006). A recent RCT by Hagan et al (2014) has also demonstrated improvement in pelvic organ prolapse symptoms in patients undergoing a 16 week pelvic floor muscle training programme compared to controls.
The questions we hope to cover during the chat are:
- Identifying pelvic floor dysfunction in MSK / neurology / respiratory patients
- Access to specialist women’s health and continence physiotherapy services
- Undergraduate training in women’s health and continence
- Promoting awareness of pelvic health
- Discussing extended scope roles
Post chat information:
The chat on Pelvic dysfunction was a very busy chat with a significant number of particpants coming from outside of the UK – great to see so much interest in #physiotalk and Pelvic dysfunction
The analystics up to half an hour post chat were:
And for those who missed the chat or struggled to keep up at times the transcript is here
Useful Resources (updated post chat):
- A who to follow on twitter for world continence week
- NICE Guidelines Urinary Incontinence http://guidance.nice.org.uk/CG171
- NICE Quality standard for Faecal Incontinence http://www.nice.org.uk/guidance/QS54 and NICE pathway for faecal incontinence
- CPWHC Infographic WH Infographic
- International consultation on continence modular questionnaire
- Modified National Institutes of Health Chronic Prostatitis Symptom Index paper
- NIH Chronic Prostatitis Symptom Index
- CSP Physioworks on Continence
- CSP / Royal College Midwives joint position statement
Continence Foundation of Australia (2014) Keeping Mum About Incontinence, [online]. Australia: Available from: http://www.continence.org.au/news.php/228/keeping-mum-about-incontinence[accessed 26th June 2014].
Dumoulin, C. and Hay-Smith, J. (2008) Pelvic floor muscle training versus no treatment for urinary incontinence in women. A Cochrane systematic review. European Journal of Physical and Rehabilitation Medicine, 44, pp. 47-63.
Hagen, S., Stark, D., Glazener, C., Dickson, S., Barry, S., Elders, A., Frawley, H., Galea, M. P., Logan, J., McDonald, A., McPherson, G., Moore, K., Norrie, J., Walker, A. and Wilson, D. (2014) Individualised pelvic floor muscle training in women with pelvic organ prolapse (POPPY): a multicentre randomised controlled trial. The Lancet, 383, pp. 796-806.
Neumann, P., Grimmer, K.A., & Deenadayalan, Y. (2006) Pelvic floor muscle training and adjunctive therapies for the treatment of stress urinary incontinence in women: a systematic review. BMC Women’s Health, 6, 11.
Shaw, C,. Gupta, R.D., Bushnell, D.M., Assassa, R.P., Abrams, P., Wagg, A., Mayne, C., Hardwick, C., Martin, M. (2006) The extent and severity of urinary incontinence amongst women in UK GP waiting rooms. Family Practice, 23, pp. 497-503.
Wall, L. and DeLancey, J. (1991) The politics of prolapse: a revisionist approach to disorders of the pelvic ﬂoor in women. Perspectives of Biological Medicine, 34(4), pp. 486–496.