PELVIC HEALTH PHYSIOTHERAPY WOMEN S HEALTH WHAT S WE KNOW? WHAT S NEW? WHAT WILL YOU DO TO IMPROVE PELVIC HEALTH?

Transcription

1 PELVIC HEALTH PHYSIOTHERAPY WOMEN S HEALTH WHAT S WE KNOW? WHAT S NEW? WHAT WILL YOU DO TO IMPROVE PELVIC HEALTH? MARY WOOD CURA PHYSICAL THERAPIES CURAPT@TELUS.NET

2 SESSION OUTLINE Overview of pelvic health conditions ( incontinence and pelvic pain) costs of conditions Techniques all physiotherapists can do to promote pelvic health New Information

3 I took this webinar because: I already do pelvic health physiotherapy I am interested in expanding my practice into pelvic health physiotherapy I want to learn what a general physiotherapist can do about pelvic health conditions Other:

4 WHAT WE KNOW

5 CANADA IS LEADER IN PELVIC HEALTH RESEARCH, TREATMENT AND EDUCATION -Incontinence -Sexual health -POP ( Prolapse) -International Health Lois Hole Hospital, Dianna MacDonald -Pelvic Pain -Pelvic Health Education -Diastasis Recti Abdominus Nadia Keshwani

6 6 PELVIC FLOOR MUSCULATURE CURA Physical Therapies

7 7 PELVIC FLOOR MUSCLE FUNCTION Sphincters Bladder and Bowel Supports Musculoskeletal and Visceral Stabilizers core engagement Synergists Sexual Sump-pump - lymphatics psychological Pelvic Floor Muscles are Primarily Tonic Type 1

8 FASCIA one in three women wet themselves About 50% of women over 50 have a vaginal prolapse Vaginal prolapse can be managed with physio IN SPITE OF GOOD EVICEN We are NOT Doing a good job stress incontinence has about an 80% cure rate

9 PF IS NOT A HAMMOCK 9

10 WE KNOW 30% of women have leakage problems PFMT can cure symptoms (short term) in 80% Female Athletes are leaking PFMT improves symptoms 50% of women over 50 have signs of pelvic organ prolapse Physiotherapy and PFMT improves symptoms Pelvic Pain Physiotherapy is number one recommended conservative treatment requires a biopsychosocial approach

11 WE KNOW Pregnancy and Birth 45% of women have pelvic girdle pain 30% will have leakage Physiotherapy is first line treatment to improve symptoms and function PFMT in group settings prevents incontinence

12 12 COMMON MYTHS PERSIST Bladder leakage (i.e. urinary incontinence) is a normal part of aging Only women have bladder leakage Constipation is normal Only Specialist physiotherapists can treat pelvic health symptoms.

13 PREVALENCE -ALBERTA Women Leaking? tween Women with POP? 140,000 ( 50 % of women over 65) Men 23,000 ( 10% over age 65) Women with cyclical pelvic pain ~ 400,000 Women with PGP 22,000

14 COST OF INCONTINENCE Canadian Continence Foundation (2012) $2.5 BILLION on products ( IE pads,etc) for moderate to severe incontinence Total cost for female incontinence Extropolated for Canada from Australian 2010 research ( excluding $65 BILLION per year

15 COST OF CYCLICAL PELVIC PAIN (ENDOMETRIOSUS) Australian Paper looking at costs of cyclical pelvic pain - endometriosus $ 6 Billion dollar woman - $600,000 Girl ( additional $600,000 if including parental time off, etc) Canadian Estimate $9 Million Dollar Woman - $1 million dollar girl

16 16 WHAT ARE WE MISSING? Irish Study 2014 PRE PREGNANCY status n= % had leakage symptoms 12 % had frequency and urgency 10 % bothered by bladder problems 50 % had constipation problems 30% had pain with intercourse ( 10% bothered) >5% Prolapse symptoms

17 It is indeed astonishing, that given the high prevalence of incontinence,and the physical, social and financial burdens of this problem, that so many people experiencing incontinence cannot find appropriate treatment 2001 The Canadian Continence Foundation

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19 COCCYGEAL MOVEMENT TEST PELVIC FLOOR SCREENING TOOL Sensitivity = 97%, Specificity = 77% (Stensgaard et al., 2014) Useful for assessing pt s ability to locate PFMs difficult to assess PFM relaxation post-contraction

20 COCCYGEAL MOVEMENT TEST Start Position on Sacrum And bottom of PSIS Slide hand down until you are on coccyx Index and ring finger in space below and lateral to Inferior Lateral Angle ILA of sacrum ALWAYS LOWER THAN YOU THINK

21 COCCYGEAL MOVEMENT TEST Patient - Sitting with feet support PT Standing facing patients side, posterior hand palpating Base of palpating hand on sacrum, tip of middle finger on tip of coccyx, index & ring fingers spread apart monitoring gluteals Instruct patient to pull pubic bone and tailbone together and feel a lift inside Should feel subtle coccyx flexion during contraction with middle finger. Should NOT feel large contractions with Index or ring fingers (on gluteals)

22 CALL TO ACTION After this explanation would you use the coccygeal movement test in your practice/ assessment : Yes Already use this technique No, Need more training No- not applicable to my practice

23 SACROCOCCYGEAL MOBILIZATION INDICATION Poor Coccygeal movement test Decreased Extension compared to flexion in standing and sitting. POSITION: Patient position: Prone, ~20 hip abduction, IR PT position: facing pt s side, -cranial hand thenar eminence on sacrum to stabilize, - caudal hand thenar eminence on coccyx Technique : apply gentle PA with caudal hand, continuing to stabilize sacrum using gentle counterpressure with cranial hand Test/re-test task: lumbar extension

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25 CALL TO ACTION After this explanation would you do sacrococcygeal mobilizations in your practice: Yes Already use this technique No, Need more training No- not applicable to my practice

26 EDUCATION PROGRAMS Dr Wagg (Glenrose Continence Program) Research on group education programs throughout Alberta Simple Information sessions about bowel and bladder habits PROGRAMS AVAILABLE: AHS Incontinence Program has Mandatory sessions for those seeking treatment for incontinence CURA opens these sessions to the public to attend AHS Teleconferences from Lois Hole

27 PFMT PELVIC FLOOR MUSCLE TRAINING BEYOND KEGELS IUGA and ICS Joint report on the terminology for the conservative management for female pelvic floor dysfunction ( 2016) strongly recommends to not use Kegel for Pelvic Floor Training PFMT Pelvic floor muscle training better terminology as exact form of exercises will vary with person and condition

28 GROUP PROGRAM AT CORBETT HALL FOR POST PROSTATE RECOVERY Group exercise program for men post prostatectomy Sponsored by Movember project

29 GROUP CLASSES FOR PFMT IN ALBERTA

30 APPS 12 Found online Which one??? Reminders for PFMT eg Pelvicfloorfirst Australia Squeezy NHS UK PFMT with Pressure apparatus (Virtual Reality Games being tested)

31 FUNCTIONAL PFMT Pelvic Floor contractions have long been part of yoga and pilates Hypopressive Low Pressure Fitness Developed by Belgian Physiotherapist Marcel Caufriez

32 CORE ENGAGEMENT Ultrasound Biofeedback for assessing

33 SUPPORTS- PESSARIES Alberta Physiotherapists being trained to fit pessaries - Red deer course 2016 Impressa poise for incontinence

34 BLADDER AND BOWEL HABITS Incontinence Products Constipation - Squatty Potty.

35 GUIDED IMAGERY Pelvic Health Solutions Imagery for Urgency

36 POSTERIOR TIBIAL NERVE STIMUMLATION MACHINE $2000 LEADS $50 EACH TIME OFFICE VISIT TENS MACHINE $ LEADS REUSABLE HOME TREATMENT

37 KTAPING FOR PELVIC AND WOMENS HEALTH Developed by Birgit Kumbrink and Ktaping Academy Germany Next Course Oct Edmonton Instructor Lois Pohlod Contact

38 BIRTH AND POSTPARTUM 45% have PGP = women per year Birth Injury 18% Instrument Birth % Caesarean Birth = women Post partum Prolapse Post Partum Dyspareunia Increased Incontinence

39 PREGNANCY REDUCE FEAR Coccygeal Movement test If leakage PFMT Focus on relaxation Check for DRA if present PF hypertonic focus on relaxation Implications??? PFMT in pregnancy

40 KTAPING

41 BIRTHING Pain education Birthing Positions _ Sidelying best for reduced trauma Perineal Massage in last 5 weeks Cochrane review 2013 Epino not superior to massage

42 42 DIASTASIS RECTUS ABDOMINUS (DRA) Separation of the rectus abdominus at the linea alba Clinical Implications: Unsure from research results CURA Physical Therapies

43 SCREENING FOR DIASTASIS RECTI 43 Patient in hook lying Physiotherapists sssessing fingers are horizontal. Check (1) superior border of the umbilicus, (2) 1 hand width above umbilicus and (3) 1 hand width below umbilicus Request head lift and check for width and depth of separation just as head lifts Palpate down midline from xiphoid to pubis Any gap greater than 2 fingers is considered clinically significant To check if functional DrA: Request gentle core contraction and retest should feel more tension at the midline (i.e. not as deep of a separation as before)

44 CALL TO ACTION After this explanation would you do DRA Screening in your practice: Yes Already use this technique No, Need more training No- not applicable to my practice

45 POST PARTUM CAESAREAN BIRTH Scar Massage with Dycem Initially with induction Ktaping or Crosstape

46 POST PARTUM Ktaping for DRA Ktaping for Breast Engorgement Ktaping Course for women Oct Edmonton Lois Pohlod

47 COLLABORATION WITH Other Physiotherapists Personal Trainers Industry

48 REFERRING TO PELIVC HEALTH PHYSIOTHERAPY I have good collaboration with pelvic health physiotherapists I don t know who to refer to Service is too expensive for patients Service is too far for patients to travel Patients report the service did not meet their needs

49 PELVIC PAIN Biopsychosocial Approach Vandyken CV Hilton S/ Physical Therapy in the Treatment of Central Pain Mechanisms for Female Sexual Pain Sexual Medicine Review Book DVD

50 50 COURSES TO BECOME A PELVIC HEALTH PHYSIOTHERAPIST Medbridge online courses Dianna MacDonald Edmonton RAH dianna.macdonald@albertahealthservices.ca Introductory courses in spring and fall Carolyn VanDyken and Nellie Faghani, Ontario and across country Introductory to advanced Marie Josee Lord and Claudia Brown Quebec and across country Introductory to advanced, French and English hermanwallace.com Leaders in PH education in USA APTA Women s Health Division Australia certificate courses available at Curtin University

51 RESOURCES Your body after Baby PABC Handout Will be in resource package

52 CALL TO ACTION After this webinar I will: Ask questions about pelvic health symptoms Use Coccygeal Movement Test Use Sacrococcygeal Mobilizations Screen for DRA Treat Pregnant women Interested in Ktaping course

53 THANK YOU Contact