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Pelvic Floor Exercise (pelvic + floor_exercise)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Neuromodulation for the treatment of urinary incontinence

INTERNATIONAL JOURNAL OF UROLOGY, Issue 8 2008
Tomonori Yamanishi
Abstract: Neuromodulation has been reported to be effective for the treatment of stress and urgency urinary incontinence. The cure and improvement rates of pelvic floor neuromodulation in urinary incontinence are 30,50% and 60,90%, respectively. In clinical practice, vaginal, anal and surface electrodes are used for external, short-term stimulation, and sacral nerve stimulation for internal, chronic (long-term) stimulation. The effectiveness of neuromodulation has been verified in a randomized, placebo-controlled study. However, the superiority to other conservative treatments, such as pelvic floor muscle training has not been confirmed. A long-term effect has also been reported. In conclusion, pelvic floor exercise with adjunctive neuromodulation is the mainstay of conservative management for the treatment of stress incontinence. For urgency and mixed stress plus urgency incontinence, neuromodulation may therefore be the treatment of choice as an alternative to drug therapy. [source]

Biofeedback therapy in fecal incontinence and constipation

NEUROGASTROENTEROLOGY & MOTILITY, Issue 11 2009
P. Enck
Abstract, We examine the collected evidence for efficacy of biofeedback therapy (BFT) in incontinence and constipation by means of meta-analysis of randomized controlled trials. PubMed search was performed to identify treatment trials that match quality criteria (adequate control groups, randomization). They were entered into meta-analyses using fixed effect models and computing odds ratio (OR) and 95% confidence interval (CI) of treatment effects. For constipation, eight BFT trials were identified. In four trials, electromyographic (EMG) BFT was compared to non-BFT treatments (laxatives, placebo, sham training and botox injection), while in the remaining four studies EMG BFT was compared to other BFT (balloon pressure, verbal feedback) modes. Meta-analyses revealed superiority of BFT to non-BFT (OR: 3.657; 95% CI: 2.127,6.290, P < 0.001) but equal efficacy of EMG BFT to other BF applications (OR: 1.436; CI: 0.692,3.089; P = 0.319). For fecal incontinence, a total of 11 trials were identified, of which six compared BFT to other treatment options (sensory training, pelvic floor exercise and electrical stimulation) and five compared one BFT option to other modalities of BFT. BFT was equal effective than non-BFT therapy (OR: 1.189, CI: 0.689,2.051, P = 0.535). No difference was found when various modes BFT were compared (OR: 1.278, CI: 0.736,2.220, P = 0.384). Included trials showed a substantial lack of quality and harmonization, e.g. variable endpoints and missing psychological assessment across studies. BFT for pelvic floor dyssynergia shows substantial specific therapeutic effect while BFT for incontinence is still lacking evidence for efficacy. However, in both conditions the mode of BFT seems to play a minor role. [source]

Involuntary detrusor contractions: Correlation of urodynamic data to clinical categories

NEUROUROLOGY AND URODYNAMICS, Issue 3 2001
Lauri J. Romanzi
Abstract Data regarding the prevalence and urodynamic characteristics of involuntary detrusor contractions (IDC) in various clinical settings, as well as in neurologically intact vs. neurologically impaired patients, are scarce. The aim of our study was to evaluate whether the urodynamic characteristics of IDC differ in various clinical categories. One hundred eleven consecutive neurologically intact patients and 21 consecutive neurologically impaired patients, referred for evaluation of persistent irritative voiding symptoms, were prospectively enrolled. All patients were presumed by history to have IDC, and underwent detailed clinical and urodynamic evaluation. Based on clinical evaluation, patients were placed into one of four categories according to the main presenting symptoms and the existence of neurological insult: 1) frequency/urgency; 2) urge incontinence; 3) mixed stress incontinence and irritative symptoms; and 4) neurogenic bladder. IDC was defined by detrusor pressure of ,,15,cm H2O whether or not the patient perceived the contraction; or <,15,cm H2O if perceived by the patient. Eight urodynamic characteristics of IDC were analyzed and compared between the four groups. IDC were observed in all of the neurologically impaired patients, compared with 76% of the neurologically intact patients (P,<,0.001). No correlation was found between amplitude of IDC and subjective report of urgency. All clinical categories demonstrated IDC at approximately 80% of cystometric capacity. Eighty-one percent of the neurologically impaired patients, compared with 97% of the neurologically intact patients, were aware of the IDC at the time of urodynamics (P,<,0.04). The ability to abort the IDC was significantly higher among continent patients with frequency/urgency (77%) compared with urge incontinent patients (46%) and neurologically impaired patients (38%). In conclusion, when evaluating detrusor overactivity, the characteristics of the IDC are not distinct enough to aid in differential diagnosis. However, the ability to abort IDC and stop incontinent flow may have prognostic implications, especially for the response to behavior modification, biofeedback, and pelvic floor exercise. Neurourol. Urodynam. 20:249,257, 2001. © 2001 Wiley-Liss, Inc. [source]

Efficacy of urinary guidelines in the management of post-stroke incontinence

INTERNATIONAL JOURNAL OF UROLOGICAL NURSING, Issue 1 2009
Stephanie Vaughn
Abstract Urinary incontinence (UI) is common occurrence among stroke survivors and impacts their recovery. This mixed method study examined the effects of implementation of evidence-based urinary guidelines by the Interdisciplinary (ID) team in the management of post-stroke UI in stroke survivors in an acute rehabilitation hospital in Southern California. Essential elements of the guidelines included assessment of the bladder pattern, the urinary WBC's, the implementation of a scheduled toileting program, pelvic floor exercises, and the administration of Vitamin C 500 mg. by mouth. Functional Independent Measure (FIM) scores and urinary white blood cells (WBC's) were used to evaluate the efficacy the guidelines. Post guideline implementation FIM scores and urinary WBC's demonstrated improvement over the pre-scores. These results indicate that positive stroke outcomes were achieved following implementation. In addition, the ID team, comprised of nurses, physical therapists, speech pathologists, and occupational therapists, was queried as to the member's knowledge and perceptions of their roles in the implementation of the guidelines. Highlighted themes from the ID focus groups were communication and structure, relating that the guidelines were useful in promoting collaborative practice among the ID team members. [source]