Pelvic Physio 101. OMA Sports Med 2019 Conference. Nelly Faghani PT. January 25,

Transcription

1 Pelvic Physio 101 OMA Sports Med 2019 Conference January 25, 2019 Nelly Faghani PT

2 CFPC CoI Templates: Slide 1 used in Faculty presentation only. Faculty/Presenter Disclosure Faculty: Nelly Faghani Relationships with financial sponsors: None

3 Learning Objectives At the completion of this presentation participants will be able to: Recognize the role and evidence of pelvic physiotherapy in the treatment of pelvic floor dysfunction Describe components of a pelvic physiotherapy assessment and treatment plan Identify when, where and how to make a pelvic floor physiotherapy referral

4 What is Pelvic Physiotherapy? PT Evidenced based treatment of pelvic floor dysfunction (incontinence, prolapse, pre-post surgical, pelvic pain, bowel dysfunction) Digital vaginal and/or rectal evaluation of the pelvic floor muscles by specially trained physiotherapists

5 Urinary Incontinence Urinary Incontinence 1 in 3 women 1 in 9 men HUGE impact on quality of life Only 1 in 12 known to health care workers because: Embarrassing Private Many thinks it s normal Pelvic floor training is the first-line treatment for stress and mixed urinary incontinence in women (Level 1, Grade A evidence) (Cochrane Collaboration 2014)

6 Pelvic Organ Prolapse 41.1% prevalence in postmenopausal women older than 60 years who have not had a hysterectomy (Women s Health Initiative Study) HUGE impact on quality of life Pelvic floor training is effective & cost-effective in reducing prolapse symptoms & should be recommended as first-line management for prolapse (Hagen, 2011) High level of bothersome

7 Subjective Evaluation Bladder Listen to their story Bowel Sexual Outcome Measures Hope Self Efficacy Pain

8 Objective Evaluation Global Contribution Global contribution Neural tension Connective tissue dysfunction Respiratory dysfunction Pelvic floor muscle (PFM) dysfunction Connective Tissue Local Contribution Objective Neural Involvement Respiratory Function

9 History of Kegels Dr. Kegel in 1940 s decided that women needed to exercise their pelvic floors Used Perineometer Used palpation (one finger) Where are we now: Verbal Stop-sign, kitchen counter Stop midstream urine

10 Current Practice Simple verbal or written instruction does not constitute adequate training for a Kegel exercise program (Bump et al 1991) In its 2008 clinical guidelines on the conservative management of UI, the Society of Obstetricians and Gynecologists of Canada recommends that proper performance of Kegel exercises should be confirmed by digital vaginal examination or biofeedback

11 Pelvic Floor Strengthening is Not Always Indicated Underactive/Hypotonicity Urinary/Feacal Incontinence Pelvic Organ Prolapse Ano-rectal Dysfunction Kegels OK to do Overactive/Hypertonicity Pelvic Pain UI/Urgency/Frequency Dyspareunia Constipation Kegels NOT ok to do

12 The Psychology of the Pelvic Floor Overactivity of the pelvic floor is not simply an isolated dysfunction, but a physical manifestation of the patients emotional state Rosenbaum, 2012 In cases of actual or imminent physical or mental pain or anxiety the pelvic floor muscles will involuntarily, and often unconsciously contract Physiotherapists are an important part of the health team in relation to chronic pelvic pain due to myofascial dysfunction Consensus Guidelines for the Management of CPP SOGC 2005

13 Layer 3 - Pelvic Floor Muscles (PFMs)

14 Pain Education Pain is an unpleasant sensory and emotional experience associated with actual and potential tissue damage, or described in terms of such damage Pain Definition by IASP Thoughts are nerve impulses, and negative thinking alone can drive the pain Moseley 2008 There is compelling evidence that pain education reduces pain, disability, catastrophization and improves physical performance Louw et al, 2012

15 Education Vulvar care Normal bladder function Normal bowel function Bladder or fibre diary Diet modification (irritants) Behavioural modification Pain education

16 What your Clients Can Expect from a Pelvic Floor Physiotherapist Biopsychosocial approach 1-1 with physiotherapists that have done post-graduate training in pelvic health Education (diet modification, vulvar care, pain education) Improved bowel and bladder routine Musculoskeletal evaluation Up-train or down-train pelvic floor, improve pelvic floor function Hope and self efficacy

17 When and How to Refer? Incontinence, prolapse or pelvic pain Plateaued progress and you suspect poor pelvic floor proprioception/strength or an overactive pelvic floor

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