Pelvic Floor - Science topic

This study could be helpful: https://logixsjournals.com/articles/13

Thank you for this. Please note that photobiomodulation is not laser per se . In urology the use of the neodymium YAG , holmium YAG and Thulium YAG together with the side fire and green light laser which have well defined and extraordinary use. Photomodulation is well described in dermatological use. To ask about pelvic floor which anatomically is also a rather complex anatomy with a number of target from neural tissue , muscular and then the fibrotic bands and tendineous portions must be clarified. Therapy is designed to increase vascularity to generate neovascularisation , destroy nerve fibres etc . The correct descriptors of what the therapy entails remains central to the understanding of the postulation being explored.

The life style affect the maintanance of muscle bulck and power, the less active female the more liable for weakness of pelvic floor. The farm worker female in the past was less affected by pelvic muscle weakness, though she had more number of pregnancy and labour.

I had another look, as I expected to find something but haven't, yet.

Prof Kari Bø is on Researchgate - it might be worth asking her:

. . or this is her base at Norwegian School of Sport Sciences, Oslo, Norway:

 http://www.nih.no/en/about/employees/bo-kari/

I was also wondering if it might be worth contacting these authors, also on ResearchGate:

Apte, G., Nelson, P., Brismée, J. M., Dedrick, G., Justiz, R., & Sizer, P. S. (2012). Chronic female pelvic pain—part 1: clinical pathoanatomy and examination of the pelvic region. Pain Practice, 12(2), 88-110.

Thompson, J. A., O'Sullivan, P. B., Briffa, N. K., & Neumann, P. (2006). Differences in muscle activation patterns during pelvic floor muscle contraction and valsalva manouevre. Neurourology and urodynamics, 25(2), 148-155.

Looking forward to seeing the suggestions from other members,

Mary

Child anusmus which means spastic contractions of the external anal sphincter can be due to organic, functional or psychological causes. Organic causes are causes of painful defecation. These include abrasions in the skin around the anus, and irritations of the anal skin like in Oxyuriraius (Pin-worm infestation). Also, infection of the anal skin e.g. fungal infection.

Anal fissure and anal fistula are important painful lesions which may lead to anusmus.

Lacerations in the anal sphincters (internal anal sphincter IAS, and external anal sphincter EAS) can lead painful conditions and subsequently anusmus.

Functional conditions like changes in the bowel habits e.g. constipation &/or diarrhea.

Psychological conditions as in conditions of fecal incontinence, leads, fear of embarrassment will lead to anusmus.     

Maybe in book by Kari, Bo et al 2015 Evidence based physiotherapy for pelvic floor muscles. Although I don't  see the connection because in horseback riding important muscle groups are thigh adductors, gluteals, guadriceps, core muscles...just my oppinion.

The urinary bladder is like a water tank, closed by a valve. In human being the closing valve is the internal urethra sphincter (IUS). The IUS is a collagen-muscle tissue cylinder that extends from the bladder neck downwards to the perineal membrane in both men and women. The collagen, the stronges tissue in our body, forms the chassis of the IUS, and gives its high wall tension. The muscle, plain muscle fibers, that lie on, and intermingle with the collagen fibers have its nerve supply from the thoraco-lumbar alpha-sympathetic nerves (T1-L2). Toilet training in early childhood will result in gaining high alpha-sympathetic tone at the IUS that keeps the sphincter contracted and the urethra empty and closed all the time. The IUS, in women, is lying intimately on the anterior vaginal wall. Vaginal delivery ,will stretch the vagina markedly, it causes lacerations in the vaginal chassis and the intimately related IUS. The torn weak IUS will not stand against sudden rise of abdominal pressure, so urine will leak. Feeling wet, embarssement will induce sympathetic reaction, which will increase the present high alpha-sympathetic tone to prevent further leak of urine. I hope I could explain the case. Please read the above mentioned references.

Dear Niamh,

Our specialism, besides chronic backpain is pelvic girdle pain. We treat about 600 chronic pain patients annualy, Among which a vast amount of pelvic girdle pain. It is our experience that if there are pelvic floor problems (predominantly incontinence) it almost always concerns hypertone pelvic floors. 

When control of the pelvic girdle improves, the pelvic floor can relax and the problems diminish in most cases. So from our perspective these hypertone pelvic floors may be considered compensating muscle activity to control and support the pelvis. 

Because the pelvic floor mostly responds adequately, There is usually no need for internal investigation. An important consideration is that in the early phase of treatment the focus should be on relaxation (whole body, not only the pelvic floor) Retraining stabilizing activity in an already hypertone system is not effective.

Brilliant! thank you again

Hello Ponmathi

I used to do this for the majority of woman who I saw, with pelvic floor symptoms; I used the method that Jo Laycock and colleagues designed and validated. I don't know if you've seen this method - I was introduced to it by Jo, and never changed from this.

Laycock, J., & Jerwood, D. (2001). Pelvic floor muscle assessment: the PERFECT scheme. Physiotherapy, 87(12), 631-642.

Part of this is available from ResearchGate:

You might want to read a previous ResearchGate Question/Answer where other members also made suggestions:

The other paper I mentioned in this answer was:

Jeyaseelan, S. M., Haslam, J., Winstanley, J., Roe, B. H., & Oldham, J. A. (2001). Digital vaginal assessment: An inter-tester reliability study. Physiotherapy, 87(5), 243-250.

If you are unable to access the full text, I have a copy  that I could send you on ResearchGate messages, for your attention only.

Very best wishes

Mary 

Hello  Ponmathi

I used to work with patients with pelvic floor dysfunction, but as I was a nurse not a physiotherapist, this is a little beyond my knowledge level, but is an interesting topic. I hope there is something relevant here for you:

This might be useful but I have not been able to access the full text:

O’Sullivan, P. B., Beales, D. J., Beetham, J. A., Cripps, J., Graf, F., Lin, I. B., ... & Avery, A. (2002). Altered motor control strategies in subjects with sacroiliac joint pain during the active straight-leg-raise test. Spine, 27(1), E1-E8.

https://www.researchgate.net/publication/11552845_OSullivan_PB_Beales_DJ_Beetham_JA_et_al.._Altered_motor_control_strategies_in_subjects_with_sacroiliac_joint_pain_during_the_active_straight-leg-raise_test

However, this full text paper is also authored by O'Sullivan:

O’Sullivan, P. B., & Beales, D. J. (2007). Diagnosis and classification of pelvic girdle pain disorders—Part 1: A mechanism based approach within a biopsychosocial framework. Manual therapy, 12(2), 86-97.

Pool-Goudzwaard, A., van Dijke, G. H., van Gurp, M., Mulder, P., Snijders, C., & Stoeckart, R. (2004). Contribution of pelvic floor muscles to stiffness of the pelvic ring. Clinical Biomechanics, 19(6), 564-571.

 http://kinex.cl/papers/Cadenas%20Miofasciales/piso%20pelvico%20y%20sacro.pdf

Sapsford, R. (2004). Rehabilitation of pelvic floor muscles utilizing trunk stabilization. Manual therapy, 9(1), 3-12.

Chaitow, L. (2007). Chronic pelvic pain: Pelvic floor problems, sacro-iliac dysfunction and the trigger point connection. Journal of Bodywork and Movement Therapies, 11(4), 327-339.

Very best wishes

Mary

you´re wellcome, Nicola

Depends on the patient's goals, activity level and overall health.  The best surgery for long term prolapse reduction is a sacrocolpopepxy.  Otherwise, vag hyst with uterosacral suspension or sacrospinous ligament suspension are good.  For uterine sparing, hysteropexy is an option or a LaForte colpocleisis with or without a hysterectomy.  Pessary is always an option, but a gellhorn would probably be required for a complete procedentia.  These options are all dependent on your patient's desires and degree of prolapse bother.  

I hope this will help you

Hi Lori

We have used a vaginal probe 50Hz alternating 2 sec pulses in addition to squatting based PFR. We improved urge, pain nocturia symptoms >50% in half the patients

Skilling PM,·Petros PE Synergistic non-surgical management of pelvic floor dysfunction: second report. Int J Urogyne (2004)15: 106-110

See also Ch5 of my textbook "The Female Pelvic Floor" 3rd Ed SPringer Heidelberg

Agreed that depression can be from chronic illness and pain, but if treated and functional difficulties persist, a dementia would have to be considered, whether Alzehimer's or some other would still have to be considered.