Article

The effect of manual physical therapy in patients diagnosed with interstitial cystitis, high-tone pelvic floor dysfunction, and sacroiliac dysfunction.

The Pelvic Floor Institute, Graduate Hospital, Philadelphia, Pennsylvania, USA.
Urology (Impact Factor: 2.13). 07/2001; 57(6 Suppl 1):121-2. DOI: 10.1016/S0090-4295(01)01074-3
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    ABSTRACT: Background: Pelvic floor (PF) hypertonic disorders are a group of conditions that present with muscular hypertonia or spasticity, resulting in a diminished capacity to isolate, contract and relax an individual muscle. Their presentation includes voiding and sexual dysfunctions, pelvic/perineal pain and constipation. Various factors are associated with these conditions, such as complicated vaginal birth, muscular injury, scar tissue formation and neuropathies. Study Design: the case of a single patient will be presented, together with the management strategies employed. Case Description: The case of a woman with hereditary spastic paraplegia/paraparesis is presented, with a history of muscle spasticity, urinary and fecal complaints since childhood. She presented to this institution seeking treatment for pelvic pain, pain during intercourse, constipation and micturition problems. A physical therapy protocol was developed, with the trial of several treatment modalities. Thiele’s perineal massage, abdominal massage and pelvic floor strengthening were first tried, followed by cryotherapy, which had low adherence, and by pelvic floor muscles stretching exercises using an insufflated vaginal probe. Outcome: after some failed attempts, perineal and pelvic floor stretching proved to be very efficacious therapies for this patient´s complaint, leading to improved pain during intercourse, constipation, pelvic pain and urinary stream.Discussion: pelvic floor spasticity can lead to severe disability and interfere with daily basic functions, such as micturition and evacuation. Physical therapy plays an essential role in the management of these patients, and can lead to significant improvement in quality of life.
    11/2014; 2014. DOI:10.1155/2014/306028
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    ABSTRACT: PurposeThe aim of this study is to explore non-steroid anti-inflammation drugs (NSAIDs) potency for pelvic floor muscle pain by measuring local concentration in a rat model.Materials and MethodsWe used nine NSAIDs, including nabumetone, naproxen, ibuprofen, meloxicam, piroxicam, diclofenac potassium, etodolac, indomethacin, and sulindac, and 9 groups of female Wister rats. Each group of rats was fed with one kind of NSAID (2 mg/mL) for three consecutive days. Thereafter, one mL of blood and one gram of pelvic floor muscle were taken to measure drug pharmacokinetics, including partition coefficient, lipophilicity, elimination of half-life (T1/2) and muscle/plasma converting ratio (Css, muscle/Css, plasma).ResultsDiclofenac potassium had the lowest T1/2 and the highest mean Css, muscle/Css, plasma (1.9 hours and 0.85±0.53, respectively). The mean Css, muscle/Css, plasma of sulindac, naproxen and ibuprofen were lower than other experimental NSAIDs.ConclusionDiclofenac potassium had the highest disposition in pelvic floor muscle in a rat model. The finding implies that diclofenac potassium might be the choice for pain relief in pelvic muscle.
    Yonsei Medical Journal 07/2014; 55(4):1095-100. DOI:10.3349/ymj.2014.55.4.1095 · 1.26 Impact Factor
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    ABSTRACT: Resumo Cistite intersticial (CI) é uma síndrome de etiologia desconhecida, multifatorial, que provoca sintomas no trato urinário inferior como aumento na frequência urinária, urgência miccional, noctúria, acompanhada de dor vesical que frequentemente é aliviada após a micção. A prevalência é maior nas mulheres, que podem apresentar dor em região suprapúbica, perineal, vaginal e, não raramente, dispareunia. A conduta terapêutica é difícil, pela baixa eficácia nos tratamentos oferecidos e pelo alto impacto da doença na qualidade de vida dos pacientes. A fisioterapia surge como um tratamento promissor e de papel fundamental na melhora sintomatológica e redução da disfunção do assoalho pélvico, que comumente acometem os portadores desta dessa síndrome. Apesar da escassez de trabalhos científicos, principalmente no Brasil, utilizando apenas técnicas fisioterapêuticas, esta revisão discutiu o papel da fisioterapia na CI, enfatizando a terapia manual para o assoalho pélvico (massagem de Thiele) e a terapia comportamental como técnicas mais empregadas para alívio dos sintomas e melhoria na qualidade de vida dos pacientes. Abstract Interstitial cystitis (IC) is a mulfactorial syndrome with unknown etiology, which causes symptoms on the lower urinary tract characterized by urinary frequency, urgency, nocturia and bladder pain that diminishes with bladder emptying. The prevalence is significantly higher in women who may have suprapubic, vaginal, perineal pains and dyspareunia. The therapeutic is difficult due to the lower efficiency of the treatments offered and the higher impact in the quality of patients' life. The physical therapy appears tobe a promising treatment and has a fundamental part on the symptoms improvement and reduction of pelvic floor dysfunction. In spite of the shortage of scientific articles using only physiotherapeutic techniques, mainly in Brazil, this review discussed the role of physical therapy on the IC, mainly manual therapy of pelvic floor (Thiele massage) and behavior therapy to relieve the symptoms and improve the quality of life.
    Femina: revista da Federação Brasileira das Sociedades de Ginecologia e Obstetrícia 07/2010; 38(7):353-358.

Kristene E Whitmore