Pelvic Floor Muscle Strengthening Research Articles

Pleasurable and problematic receptive anal intercourse and diseases of the colon, rectum and anus.

The ability to experience pleasurable sexual activity is important for human health. Receptive anal intercourse (RAI) is a common, though frequently stigmatized, pleasurable sexual activity. Little is known about how diseases of the colon, rectum, and anus and their treatments affect RAI. Engaging in RAI with gastrointestinal disease can be difficult due to the unpredictability of symptoms and treatment-related toxic effects. Patients might experience sphincter hypertonicity, gastrointestinal symptom-specific anxiety, altered pelvic blood flow from structural disorders, decreased sensation from cancer-directed therapies or body image issues from stoma creation. These can result in problematic RAI - encompassing anodyspareunia (painful RAI), arousal dysfunction, orgasm dysfunction and decreased sexual desire. Therapeutic strategies for problematic RAI in patients living with gastrointestinal diseases and/or treatment-related dysfunction include pelvic floor muscle strengthening and stretching, psychological interventions, and restorative devices. Providing health-care professionals with a framework to discuss pleasurable RAI and diagnose problematic RAI can help improve patient outcomes. Normalizing RAI, affirming pleasure from RAI and acknowledging that the gastrointestinal system is involved in sexual pleasure, sexual function and sexual health will help transform the scientific paradigm of sexual health to one that is more just and equitable.

Comparative Evaluation of Effectiveness of Pelvic Floor Strengthening and Myokinetic Active Release of Trigger Points in Reducing Dysmenorrhea

Background and Aim Dysmenorrhea is a dull abdominal pain that may radiate to lower back and thigh beginning approximately two days before menstruation. Pelvic floor strengthening is favorable in reducing dysmenorrhea. Alteration in muscle function due to hormonal imbalance can also cause dysmenorrhea. Lower rectus abdominis trigger points TrPs deactivation relieves dysmenorrhea. Restoring correct spine mobility by deactivating quadratus lumborum trigger points may improve dysmenorrhea. Gluteus medius commonly develops satellite triggers in response to active quadratus lumborum triggers. Myokinetic active release technique can be effectively used to treat TrPs. This study aimed to find if myokinetic active release of TrPs of rectus abdominis gluteus medius and quadratus lumborum is better than pelvic floor muscle strengthening in reducing dysmenorrhea.Methods This experimental trial was done in research lab of Department of Physiotherapy SBSPGI Dehradun. This experimental study comprised of 40 subjects randomly divided into two groups namely Group 1 and Group 2. Each group consisted of 20 subjects. Subjects in Group 1 were prescribed pelvic floor muscle strengthening and those in Group 2 were prescribed myokinetic active release of triggers points. Pre-and post-treatment visual analogue scale VAS scores were recorded and analyzed. Paired t test was used for within the group and unpaired t test was used for between the group comparisons.Results The results showed both the treatment protocols to be significantly effective p lt0.0001 but on comparison of data between the groups Group 2 was found to be better.Conclusion Both the techniques were found to be effective in treating dysmenorrhea however myokinetic active release was observed to be superior.

Pelvic Floor Dysfunction In Rural Postpartum Mothers In The Usa: Prevalence, Severity And Psychosocial Correlates

PURPOSE: The purpose of this study was to characterize pelvic floor dysfunction (PFD) among postpartum women residing in rural communities (<50,000 residents) in the United States and explore the demographic, knowledge level, and psychosocial correlates of PFD. METHODS: A cross-sectional survey utilizing a convenience sample of rural postpartum women in the United States was employed. A survey packet comprised of the Pelvic Floor Disability Index (PFDI-20) and Prolapse and Incontinence Knowledge Questionnaire (PIKQ) as well as the Edinburgh Perinatal Depression Screening (EPDS), items from the Canadian Sexual Health Indicator (CSHI) survey, and demographic questions were distributed via electronic link via social media recruitment. Descriptive statistics were calculated and multivariate logistic regression was used to assess the factors associated with PFDI-20 score. RESULTS: : A total of 383 participant responses were analyzed. The majority of postpartum women have limited knowledge of the pelvic floor despite experiencing moderate symptoms of dysfunction. Most women report symptoms primarily related to urinary and colorectal/anal distress. Women report being moderately confident in their ability to utilize sex protection. Over half of women scored ≥14 on the EPDS indicating probable depression. Women with high scores on the EPDS and low scores on the PIKQ have significantly greater odds of reporting moderate to severe PFD. Women who reported not breastfeeding or who were engaging in hard exercise on a regular basis had significantly greater odds of reporting moderate to severe PFD. CONCLUSIONS: Rural women with low pelvic health knowledge and probable depression are at increased risk of suffering from greater severity of PFD. Increased opportunities for education on how to engage in pelvic floor muscle strengthening during the perinatal period are needed. In addition, future research should continue to explore the relationship between PFD and psychosocial correlates like confidence in contraception use and postpartum depression.

Urinary incontinence in women - the overview of pharmacological and surgical methods

Introduction and purpose of the work:&#x0D; Urinary incontinence (UI) is a common problem among women and the incidence increases with age. It is estimated that about 50% of women will be affected by this problem. There are 5 types of urinary incontinence: exercise, pressure, mixed, overflow and functional. Stress UI is the most common cause among young women, while stress UI is the second most common cause among older women. The widespread use of this phenomenon makes it a significant economic burden.&#x0D; State of knowledge (brief description):&#x0D; Due to the different types of UI and its many causes, treating this disorder becomes a significant challenge. It is important to use combination therapy, starting with pelvic floor muscle strengthening exercise, lifestyle modification, weight loss, and smoking cessation, followed by drug therapy and surgery as necessary.&#x0D; Summary:&#x0D; Currently, many drugs are used in the treatment of urinary incontinence, with different mechanisms of action, which allow the treatment of various types of UI, but pharmacotherapy often does not bring the expected benefits. Surgical treatment appears to be a promising form of treatment, but more research is needed on the long-term effects.

Evidence for the Appropriate Use of Telemedicine in Female Pelvic Medicine and Reconstructive Surgery.

Purpose of ReviewTo summarize the available literature regarding telehealth interventions in the management of pelvic floor disorders.Recent FindingsMost Female Pelvic Medicine and Reconstructive Surgery (FPMRS) patients own and feel comfortable operating the technology required to participate in telehealth interventions and would be willing to interact remotely with their providers. Telehealth may be an appropriate and effective tool for patient education about bladder and pelvic physiology and pathophysiology, remote pelvic floor muscle strengthening when in-person physical therapy is not accessible, overactive bladder follow-up and medication management, and for postoperative care following uncomplicated incontinence and prolapse surgery.SummaryThere is a growing body of literature specific to FPMRS supporting various telehealth interventions that could reasonably be expected to improve access to sub-specialty care while maintaining or improving healthcare quality and reducing costs to the patient and the healthcare system.

23. Functional Impact of Pelvic Floor Physical Therapy on Adolescents with Biopsy Confirmed Endometriosis at a Tertiary Children's Hospital: A Case Series

<h3>Background</h3> Chronic pelvic pain is a hallmark sign of endometriosis in adolescents and can persist in the form of musculoskeletal pain despite medical management. There is limited evidence to support that pelvic floor physical therapy (PT) is an effective intervention in treating chronic pelvic pain secondary to endometriosis in adolescents. The purpose of this case series is to describe the change in functional ability in adolescent females following pelvic floor PT management of chronic pelvic pain as part of a multidisciplinary approach. <h3>Case</h3> Participants included twenty adolescent females median age 16.5 years (IQR 3). Retrospectively, participants were included if they were referred to pelvic floor PT for chronic pelvic pain by Pediatric and Adolescent Gynecology between April 2018 and August 2019. All participants included had diagnostic laparoscopy performed with biopsy confirmed endometriosis. Fifteen participants had surgery before referral to PT and 5 participants had surgery after starting PT. The median duration of symptoms prior to referral to PT was 2 years (IQR 1.75). Pelvic floor PT included patient education, relaxation techniques to decrease pelvic floor muscle tone, manual therapy, breathing and postural retraining, and therapeutic exercise including pelvic floor muscle strengthening. Due to the adolescent age of the participants, all pelvic floor PT techniques were only performed externally. The Patient Specific Functional Scale (PSFS) assesses patient reported function and was utilized to determine functional improvements in participants referred to pelvic floor PT. The PSFS is a 0 to 10 point scale with 0 representing maximal disability and 10 representing no disability. Participants were able to self-report between one and three functional impairments with this outcome measure. In this case series, the PSFS score was represented as a percentage rather than a raw number to account for the variable number of impairments patients could report. Functional status was captured at initial evaluation and participants demonstrated a baseline score of 45.1% (IQR 16.66) on the PSFS. Functional status was captured throughout their course of PT care with the PSFS. Participants self-reported a clinically significant functional median improvement of 23.3% (IQR 41.66) over a median number of 12 visits (IQR 10.50) (p<0.001). <h3>Comments</h3> Participants in this case series reported significant functional improvement on the PSFS over the course of pelvic floor PT. This case series suggests that PT may be a helpful treatment option in the multidisciplinary approach to improve patient function in adolescents with endometriosis. Additional prospective controlled trials are warranted to assess the benefits of PT in this population.

Effectiveness of Pelvic Floor Muscle Exercise to reduce Urinary Incontinence among Postnatal Mothers

Urinary incontinence can be characterised as 'the protest of any automatic spillage of urine. Under this more extensive definition, there are various indications, similar to Stress urinary incontinence, Urge urinary incontinence and mixed urinary incontinence. Postpartum urinary incontinence is here and there an unavoidable inconvenience of vaginal conveyance, particularly in the event that it happens to be a woman's first vaginal conveyance. Weaker pelvic muscle has reduced inability to stop the flow of urine among postnatal mothers. The study supports the need for nurses to educate the postnatal mothers about methods to reduce urinary incontinence by using the first line of treatment, i.e., pelvic floor muscle strengthening exercise. The present study aims to assess the effectiveness of pelvic floor muscle exercise to reduce urinary incontinence among postnatal mothers. A quantitative pre-experimental, one group pretest and post test research design were chosen to conduct the investigation among 60 postnatal mothers. Convenience sampling technique was used to select the postnatal mothers. Modified Sandviketal Severity Index tool was chosen to assess the pretest and post test level of urinary incontinence. The assessment includes on frequency (involuntary loss of urine occurs), incontinence with daily living and amount of urine leaks. The study results show most of the postnatal mothers had severe urinary incontinence and after the administration, pelvic floor muscle exercises most of the postnatal mothers had moderate urinary incontinence and this emphasizes the need to educate the postnatal mothers and promote them to perform PMRT so that they come through the postnatal period and for the betterment of life.

The Use of HIFEM Technology in the Treatment of Pelvic Floor Muscles as a Cause of Female Sexual Dysfunction: A Multi-Center Pilot Study

Introduction: Pelvic Floor Muscles (PFM) supports the pelvic floor organs, control continence and is crucial for adequate genital arousal and attainment of an orgasm. Due to the aging process, post-delivery condition or menopause, the PFM weaken. Therefore, they do not provide sufficient support to pelvic organs, bladder control, and they may negatively affect intimate satisfaction. Aim: We aimed to investigate the High-Intensity Focused Electromagnetic (HIFEM) technology for strengthening of PFM in women with impeded sexual functioning. Methods: 30 women (average age 36.41 ± 5.62) with limited arousal, ability to achieve orgasm and painful intercourse participated in the study. Patients underwent 6 treatments (28 minutes each) scheduled twice a week. Standardized Female Sexual Function Index (FSFI) questionnaire was used pre-, post-treatment, and at the 3- month follow-up visit. FSFI scores were statistically evaluated through student´s t-test (ɑ=0.05). Subsequently, Pearson correlation coefficient was calculated for sections arousal/lubrication, lubrication/orgasm, orgasm/ satisfaction, and pain/desire. Results: The average total FSFI score significantly (p<0.001) increased from 20.06 ± 6.55 to 30.69 ± 7.55 posttreatment and to 30.29 ± 7.37 during the 3-month follow-up. A significant improvement was observed in all FSFI sections. The most significant change at the 3-month follow-up was observed in desire (76%), satisfaction (76%) and orgasm (60%) items. The overall FSFI score was improved in 93% (n=28) of patients post-treatment. All patients (n=30; 100%) showed improvement during the 3-month follow-up. Conclusion: Our initial experience shows that HIFEM technology is a promising method in addressing women’s decreased sexual satisfaction through the strengthening of PFM.

Combination of Otago Exercises and Pelvic Floor Muscle Strengthening Exercise AID in avoiding Urinary Incontinence and Fall Risk among Women

Aim - This study intends to compare the combination of Pelvic Floor Muscle Strengthening Exercise (PFMSE) with OTAGO exercise and Stay Active and Independent for Life (SAIL) exercises separately for managing UI and fall risk among women. Background of the study - Urinary incontinence (UI) is the unintentional passing of the urine and is defined by the International Incontinence Society as an “Involuntary loss of urine which is objectively a demonstrable, Social and Hygienic Problem”. It is a disorder of the reservoir function of the lower urinary tract, comprising the bladder, urethra, and sphincter muscles (1). Urinary incontinence is not just a medical problem but affects the emotional, psychological and social life of the individuals. This problem is observed both in men and women, but tends to be more common among the latter. The prevalence of falls in Indian older adults ranges from 14% to 53%. The risk factor for falls include: older age, gait deficit, malnutrition, visual impairment, muscle weakness, impaired balance and the risk of fall increases as the age. Procedure – After obtaining the approval from the institutional review board, this experimental study was conducted at the outpatient physiotherapy department. 30 females who fulfilled the inclusion and exclusion criteria were selected and they were grouped into Group A and GroupB. The outcome measures used were Berg Balance scale, The Urogenital Distress Inventory (UDI)-6 and Incontinence Impact Questionnaire (IIQ)-7. GroupA received Otago exercises and Group B received SAIL exercises. Both groups received pelvic floor muscle exercises. Result – on comparing the data’s obtained it was evident that GroupA showed significant improvement than GroupB, which states that Otago exercises along with pelvic floor muscle strengthening exercises are effective in reducing urinary incontinence and fall risk

Knowledge, attitude, and perception about antenatal physiotherapy among pregnant women in Ahmedabad

Background: Antenatal physiotherapy plays a key role in the health of the fetus and the pregnant woman. Awareness regarding the same is very important to motivate women to attend antenatal classes. Objectives: The aim of this study is to assess the knowledge of antenatal physiotherapy as well as an insight into the attitude and perception of the same among pregnant women of Ahmedabad. Materials and Methods: A descriptive cross-sectional study was conducted in a semi-government hospital. A total of 100 pregnant women, in any trimester were approached with a self-administered multiple choice questionnaire. Questions regarding their knowledge, attitude, and perception regarding antenatal physiotherapy were asked. Descriptive analysis of data obtained was done. Results: Knowledge regarding antenatal exercises was fairly low. A large number of subject population (91%, n = 91) was aware of the role of physiotherapy in general health and well-being. A sufficient number of subjects (59%, n = 59) were informed regarding the uses of physiotherapy in backache. However, only 2% of the population was familiar with the role of pelvic floor muscle strengthening in urinary incontinence. The attitude of the patients toward antenatal physiotherapy was favorable (72%, n = 72), whereas the attitude toward postnatal physiotherapy was comparatively less favorable (39%, n = 39). The perception of physiotherapy was restricted to exercises (88%, n = 88), massage (63%, n = 63), and hot water fomentation (18%, n = 18). Conclusion: Knowledge and perception regarding antenatal physiotherapy were fairly low, but the attitude of the patients was favorable.

Activation of Pelvic Floor Muscle During Ankle Posture Change on the Basis of a Three-Dimensional Motion Analysis System.

BackgroundWeak pelvic floor muscles (PFMs) is an important cause of stress urinary incontinence. Effective strengthening of PFMs is very helpful in improving lower urinary tract disease. The purpose of this study was to determine the activation of PFMs in accordance with movement of the pelvis and ankle.Material/MethodsFifty healthy adults who underwent PFM contraction in ankle posture change (dorsiflexion, neutral, and plantar flexion) while standing were simultaneously measured using electromyography and motion capture systems. Muscle activity at the tibialis anterior and gastrocnemius muscles was measured by surface electromyography electrodes and PFMs was measured using anal/vaginal probe. Motion analysis was captured by 3-dimensional motion trajectories of the retro-reflective markers.ResultsAt the ankle dorsiflexion, pelvic tilted anteriorly and PFMs were activated, but there was no pelvic movement in ankle plantar flexion. Significantly greater PFM activities were seen in ankle dorsiflexion.ConclusionsPFM exercises performed in active ankle dorsiflexion positions while standing may increase the effectiveness of these exercises. For an effective pelvic floor enhancement in patients with weak PFMs, we recommend a dorsiflexion of the ankle in the standing position.

The impact of acute and chronic strenuous exercise on pelvic floor muscle strength and support in nulliparous healthy women

Strenuous physical activity, which is known to increase intraabdominal pressure and theoretically places stress on the pelvic floor, may affect pelvic support in nulliparous women. The aims of this study were to: (1) examine the differences in maximal vaginal descent (MVD), vaginal resting pressure (VRP), and pelvic floor muscle strength (PFMS) between women who habitually perform strenuous exercise vs women who refrain from performing strenuous exercise; and (2) compare MVD, VRP, and PFMS before and immediately following physical activity in the strenuous and nonstrenuous groups separately. Participants were healthy nulliparous women ages 18-35 years who were habitual strenuous or nonstrenuous exercisers. Women in the strenuous group participated in CrossFit (CrossFit, Inc., Washington, DC) at least 3 days per week for at least 6 months. We assessed anthropometric and body composition values using standardized procedures. Participants completed the Pelvic Organ Prolapse Quantification examination and pelvic muscle strength assessment before and again within 15 minutes of completing exercise (CrossFit for the strenuous group and self-paced walking for the nonstrenuous). A research nurse masked to study group assignment recorded MVD, defined as the greatest value of anterior, posterior, or apical support, and VRP and PFMS using a perineometer. Maximal PFMS was recorded as the highest pressure measured in 3 vaginal contraction trials. Data were analyzed using parametric and nonparametric tests as appropriate. P < .05 was considered significant. Seventy nulliparous women participated in the study, 35 in each group. The mean age was 24.77 ± 4.3 years. Compared to the nonstrenuous group, strenuous participants were heavier (64.70 ± 7.78 kg vs 60.6 ± 8.99 kg, P= .027), had lower percent body fat (23.36 ± 5.88% vs 27.55 ± 7.07%, P= .003), and had higher handgrip strength (20.78 ± 5.97 kg vs 16.04 ± 11.04 kg, P= .001). Before exercise, there were no significant differences in VRP (P= .167), MVD (P= .49), or maximal PFMS (P= .773) between the strenuous and nonstrenuous groups. Immediately following exercise, we observed significant increases in MVD in both the strenuous (P= .008) and nonstrenuous (P= .025) groups, indicating marginal decreases in support. VRP significantly decreased in both groups after exercise. Maximal PFMS did not change significantly in either group after exercise. After an exercise bout typical for each group, vaginal support and VRP decreased slightly in both groups. Based on preexercise measures, chronic strenuous exercise demonstrated neither beneficial nor deleterious effects on pelvic floor strength or support. While strenuous women had greater grip strength than nonstrenuous women, PFMS was not significantly greater, suggesting that targeted pelvic floor muscle strengthening, rather than general muscle fitness, is needed to maximize PFMS.

A Study to Investigate the Role of Pelvic Floor Muscle in Chronic Non Responsive Back Ache in Females

Background:&nbsp;Chronic low back pain remains a major health problem. Unfortunately, the majority of treatments for this condition produce small effects because not all patients respond to each treatment. It appears that only 25–50% of patients respond to exercise. At present, however, there are no guidelines regarding the best treatment to help clinicians. As a result, time and money are wasted on treatment which ultimately fail to help the patient. A backache is described as annoying and gripping pain. It can be caused by poor posture, lack of manual handling skills, change in the center of gravity due to expanding abdomen, lack of exercise, or the weight of the baby and the stretching ligaments. Pelvic floor muscle weakness is one of the major cause of chronic backache. Weakness in the pelvic floor muscles is common in females which can lead to debilitating urinary symptoms, affect sexual function and cause chronic backache.Methods:&nbsp;In 3 months, 31 female subjects with mean age of 28 who had taken treatment for their chronic backache, were improvised with pelvic floor strength at our setup, with dramatically good results. 31 subjects with non-responsive chronic back pain who had taken conventional physiotherapy were included in the study. Both married and unmarried were included. Any sign of radiculopathy or inflammation were excluded. After assessing pain using Visual Analogue Scale, the Dr Glazer’s program and Kegel’s contractions were taught.Results: There was significant improvement by 50% on reassessment after 7 days. Then exercises for transverse abdominals were included to get a better response. On completion of the treatment sessions, reduction in pain was 92% on VAS and functional abilities increased by 89%. There was a significant improvement in the quality of life and in pelvic-floor muscle strength.Conclusion:&nbsp;Non-responsive chronic back pain in females when treated with pelvic floor muscle strengthening program showed 40% improvement. This can be implemented in routine practice for the benefit of the patients.

Effect of Individualized Bladder Rehabilitation Program in Patients with Neurogenic Lower Urinary Tract Dysfunction, a Pilot Study

Objectives: Neurogenic lower urinary tract dysfunction (NLUTD) is one of the major sequelae after spinal cord injury (SCI) and a cause of increased morbidity and mortality in SCI patients. Current treatment strategies for NLUTD include medication, non-invasive conservative management, minimally invasive therapy, and surgical intervention. However, there are no studies regarding non-invasive conservative management that combines pelvic floor muscle (PFM) exercises and electrical stimulation (ES). This study was designed to evaluate the efficacy of individualized bladder rehabilitation programs, which included education on voiding behavior, PFM exercise training combined with electromyography (EMG) biofeedback, and ES (for bladder inhibition or PFM strengthening), in SCI patients with NLUTD. Methods: Individualized bladder rehabilitation programs were provided for 2 months for patients with incomplete SCI at the suprasacral level or cauda equina syndrome. The patients were evaluated using post-voiding residual urine (PVR) amounts and the questionnaires of the International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), Urogenital Distress Inventory-6 (UDI-6), and Incontinence Impact Questionnaire-7 (IIQ-7). Results: After the individualized bladder rehabilitation programs, the post-voiding residual urine amounts; OABSS, UDI-6, and IIQ-7 scores; and subtotal incontinence score and quality of life (QOL) scores of the IPSS all decreased significantly. These results indicate an improved quality of life and fewer symptoms. However, the changes in the subtotal obstruction score and the total symptom score of the IPSS were not significant. Conclusion: Selected SCI patients with NLUTD could benefit from individualized bladder rehabilitation programs, which include education on voiding behavior, PFM exercises combined with EMG biofeedback, and ES for bladder inhibition or PFM strengthening. Patients who received bladder rehabilitation programs obtained beneficial effects on reducing PVR amounts and QOL scores related to incontinence.

Prehabilitation for men undergoing radical prostatectomy: a multi-centre, pilot randomized controlled trial.

BackgroundAn emerging field of research describes the role of preoperative health behaviours, known as prehabilitation. The preoperative period may be a more physically and emotionally salient time to introduce and foster chronic adherence to health behaviours, such as exercise, in patients compared to post-treatment during recovery. Moreover, physical and psychosocial improvements during the preoperative period may translate into an enhanced recovery trajectory with reduced operative complications and postoperative adverse effects. No studies have assessed prehabilitation for men with prostate cancer undergoing radical prostatectomy.Methods/DesignThis is a multi-centre, pilot randomized control trial conducted at two Canadian urban teaching hospitals. 100 men undergoing radical prostatectomy for prostate cancer with no contraindications to exercise will be recruited and randomized to the prehabiliation program or usual care. Prehabilitation participants will engage in a preoperative, individualized exercise program including pelvic floor muscle strengthening instructions and a healthy lifestyle guide for men with prostate cancer. These participants will be asked to engage in 60 minutes of home-based, unsupervised, moderate-intensity exercise on 3–4 days per week. Usual care participants will receive the same pelvic floor muscle strengthening instructions and healthy lifestyle guide only. We will assess the feasibility of conducting an adequately powered trial of the same design via recruitment rate, programmatic adherence/contamination, attrition, and safety. Estimates of intervention efficacy will be captured through measurements at baseline (4–8 weeks preoperatively), within 1 week prior to surgery, and postoperatively at 4, 12, and 26 weeks. Efficacy outcomes include: fatigue, quality of life, urinary incontinence, physical fitness, body composition, aerobic fitness, pain, and physical activity volume.DiscussionThe primary outcome of this study is to determine the feasibility of conducting a full-scale, randomized controlled trial of prehabilitation versus usual care and to estimate effect sizes that will inform sample size determinations for subsequent trials in this field. To our knowledge, this is the first study to examine a structured presurgical exercise program for men undergoing radical prostatectomy for prostate cancer. This trial will advance our understanding of strategies to efficiently and effectively use the preoperative period to optimize postoperative recovery.Trial registrationClinicaltrials.gov Identifier: NCT02036684

New ideas in urology: 2014 update

Pharmacists practicing in a variety of settings should be aware of the most recent findings on medications used in urology. Hot topics include safety concerns about testosterone replacement therapy (TRT), novel treatments for overactive bladder, and daily dosing of phosphodiesterase-5 enzyme (PDE) inhibitors for erectile dysfunction (ED).

Pelvic-floor muscle rehabilitation in erectile dysfunction and premature ejaculation.

In men, involuntary or voluntary ischiocavernosus muscle contractions after erection lead to intracavernous blood pressures far higher than the systolic pressure, which builds and maintains penile rigidity. Thus, erectile dysfunction may be partly due to ischiocavernosus muscle atrophy and may be treated by rehabilitation interventions. The purpose of this study was to determine whether pelvic-floor muscle strengthening interventions could be associated with increases in intracavernous pressure that would increase penile rigidity. An observational study was conducted. One hundred twenty-two men with isolated erectile dysfunction and 108 men with isolated premature ejaculation participated (no neuromuscular diseases or previous perineal rehabilitation). Thirty-minute sessions of voluntary contractions coupled with electrical stimulation were designed to increase ischiocavernosus muscle strength (monitored through intracavernous pressure increase). A linear mixed-effects model per group analyzed separately, then jointly, the maximum change in pressure (ΔP) and the maximum baseline (ie, respectively, the average contraction-generated difference in intracavernous pressure and the intracavernous pressure plateau at full erection, both measured during the highest moving average of the best 2 minutes of each session). Over 20 sessions, the maximum ΔP increased in erectile dysfunction as well as in premature ejaculation (87% and 88%, respectively, in men with positive trends). The maximum baseline also increased (99% and 72%, respectively, in men with positive trends). The joint modeling indicated that the mean expected progressions of the intracavernous pressure after 5 sessions in erectile dysfunction and premature ejaculation were 62.85 and 64.15 cm H2O, respectively. Indirect measurements were obtained of intracavernous pressure and ischiocavernosus muscle force. Pelvic-floor muscle rehabilitation was found to be beneficial in erectile dysfunction. However, its effects on symptoms of premature ejaculation, despite intracavernous pressure gains, were much more difficult to assess. The definitive proof of its benefits requires rather difficult-to-design clinical trials.

Exercise Adherence to Pelvic Floor Muscle Strengthening Is Not a Significant Predictor of Symptom Reduction for Women With Urinary Incontinence

Hung H-C, Chih S-Y, Lin H-H, Tsauo J-Y. Exercise adherence to pelvic floor muscle strengthening is not a significant predictor of symptom reduction for women with urinary incontinence. ObjectiveTo explore the predictors of treatment effectiveness for women with urinary incontinence (UI) receiving pelvic floor muscle (PFM) strengthening. DesignFour-month cohort study. SettingLaboratory. ParticipantsVolunteers (N=68; mean age ± SD, 50.5±6.0y) with UI. InterventionFour-month daily PFM strengthening exercise program at home. Main Outcome MeasuresOutcome measures included self-reported improvement, Severity Index score, 3-days diary, strength of PFM, and quality of life. The participants' recall of the amount of exercise after the 4-month exercise period was used to assess the exercise adherence. ResultsFifty-one (75%) of 68 women reported that their condition improved after 4 months of exercise. There were significant reductions in Severity Index score, number of voidings per day, number of leakages per day, and impact on quality of life (P<.05). In addition, the score of PFM strength was significantly improved (P=.001). There were no significant correlations between the change score of the Severity Index and age, body mass index, parity, type of UI, duration of UI, menopausal status, and amount of exercise (all P>.10). Multiple regression analysis revealed that initial severity of symptoms and improvement of PFM strength predicted 51.3% of variance in 4-month exercise effectiveness (change score of the Severity Index). ConclusionsThe effectiveness of the 4-month PFM strengthening program was influenced by the severity of symptoms and the improvement score of PFM strength instead of exercise adherence. Women who had more significant symptoms of leakage (higher score on the Severity Index at baseline) and who had more improvement of PFM strength showed more improvement of symptoms after PFM strengthening.

Effect of Pelvic-Floor Muscle Strengthening on Bladder Neck Mobility: A Clinical Trial

Pelvic-floor muscle (PFM) strengthening has been widely used to treat people with urinary incontinence (UI). However, its effect on bladder neck position and stiffness is unknown. The aim of the study was to investigate the effect of PFM strengthening on bladder neck mobility for women with stress UI (SUI) or mixed UI (MUI). This study was conducted as a single-group pretest-posttest design. This study was conducted mainly at the Life Quality & Health Promotion Laboratory at National Taiwan University and partly in the Ultrasonography Room of the Department of Obstetrics and Gynecology at National Taiwan University Hospital. Patients Twenty-three patients (mean age=51.9 years, SD=6.1) participated in the study. Each participant underwent a PFM strengthening program for 4 months. Bladder neck position at rest and during a cough, the Valsalva maneuver, and a PFM contraction was assessed by transperineal ultrasonography before and after the intervention. Severity Index score, self-reported improvement, PFM strength (force-generating capacity), and vaginal squeeze pressure were assessed for treatment effect. The position of the bladder neck at PFM contraction and bladder neck mobility for maximal incursion from rest to PFM contraction were elevated, with effect sizes of 0.48 and 0.84, respectively. Bladder neck position and bladder neck mobility were not changed during a cough and the Valsalva maneuver. All participants reported diminution of incontinence, and PFM strength and maximal vaginal squeeze pressure were improved after the intervention. Limitations The limitations of the present trial included the pretest-posttest design and the absence of intra-abdominal pressure measuring and exercise adherence recording. Four months of daily PFM strengthening can significantly improve the ability of the PFM to elevate the bladder neck voluntarily, but may not improve its stiffness during a cough and the Valsalva maneuver for women with SUI and MUI.

Treatment of Postsurgery Bowel Dysfunction

Following surgical procedures such as partial colectomy, total colectomy with ileorectal anastomosis, restorative proctocolectomy, or low anterior anastomosis, altered bowel habits and function may have adverse long-term effects on health-related quality of life. Symptoms of postsurgery bowel dysfunction include loose stools, frequent defecation, rectal urgency, fecal incontinence, and difficult or incomplete evacuation. The Anorectal Physiology Clinic at The Townsville Hospital, Queensland, Australia, offers a treatment program for postsurgery bowel dysfunction that combines behavioral strategies and pelvic floor muscle training using biofeedback techniques. The behavioral strategies include education, support and coping measures, and advice about diet, fluid intake, medication, and exercise discussed in a previous article. This article describes biofeedback-assisted pelvic floor muscle training, including techniques for relaxation and effective bowel evacuation, and exercises for pelvic floor muscle strengthening. Biofeedback is also used to modify rectal sensitivity and assist with anorectal coordination training, in order to alleviate stool frequency and urgency. We believe that behavioral strategies and pelvic floor muscle training are complementary components of the holistic treatment program.