Pelvic Floor Rehabilitation for Incontinence and Pelvic Pain
Presenter: Linda Nett-Duesterhoeft OTR <ul><li>Registered Occupational Therapist </li></ul><ul><li>2004 Past President of ...
Prevalence of Incontinence <ul><li>25 million people </li></ul><ul><li>8% of population </li></ul><ul><li>People wait an a...
Urinary Incontinence <ul><li>Is a major factor for nursing home placement </li></ul>
Types of urinary incontinence <ul><li>Stress: Urine leakage with physical exertion (cough, sneeze, lift…) </li></ul><ul><l...
<ul><li>Dyspareunia-pain with intercourse </li></ul><ul><ul><li>Vestibulitis </li></ul></ul><ul><ul><li>Vulvadynia </li></...
Treatment <ul><li>Definitive diagnosis necessary </li></ul><ul><li>Medication treatments </li></ul><ul><li>Diet and fluid ...
<ul><li>Neuromuscular re-education to improve functional use of pelvic floor muscles  </li></ul><ul><li>Biofeedback for mu...
Biofeedback Training <ul><li>Trains in: “Finding the PFM;” correct, effortless technique for performing Kegels without als...
<ul><li>Requires non-invasive placement of small sensor into patient’s rectum </li></ul><ul><li>Patient can observe the mu...
Treatment Effectiveness <ul><li>Biofeedback treatment and pelvic floor strengthening meet high efficacy levels in the trea...
<ul><ul><li>Co-morbidity with other conditions: pelvic prolapses, cognition, sensation, history of sexual abuse… </li></ul...
Typical treatment duration <ul><li>Usually 6-8 treatments </li></ul><ul><li>Often 2 weeks between to allow patient to prac...
Medicare Coverage for Biofeedback for UI <ul><li>If a four-week course of pelvic floor muscle strengthening is not success...
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Pelvic Floor Rehabilitation for Incontinence and Pelvic Pain

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Pelvic Floor Rehabilitation for Incontinence and Pelvic Pain

  1. 1. Pelvic Floor Rehabilitation for Incontinence and Pelvic Pain
  2. 2. Presenter: Linda Nett-Duesterhoeft OTR <ul><li>Registered Occupational Therapist </li></ul><ul><li>2004 Past President of the Biofeedback Society of Wisconsin </li></ul><ul><li>Contact information: 920-831-1410 </li></ul><ul><li>[email_address] </li></ul><ul><li>Affinity Health Systems Outpatient Rehabilitation Program, Appleton </li></ul>
  3. 3. Prevalence of Incontinence <ul><li>25 million people </li></ul><ul><li>8% of population </li></ul><ul><li>People wait an average of 8 years before they mention this problem </li></ul>
  4. 4. Urinary Incontinence <ul><li>Is a major factor for nursing home placement </li></ul>
  5. 5. Types of urinary incontinence <ul><li>Stress: Urine leakage with physical exertion (cough, sneeze, lift…) </li></ul><ul><li>Urge: Inability to hold urine once urge sensation begins </li></ul><ul><li>Mixed: Combination of stress and urge </li></ul><ul><li>Over-flow: Difficulty in completely emptying the bladder </li></ul>
  6. 6. <ul><li>Dyspareunia-pain with intercourse </li></ul><ul><ul><li>Vestibulitis </li></ul></ul><ul><ul><li>Vulvadynia </li></ul></ul><ul><li>Vaginismus-difficulty allowing vaginal penetration </li></ul><ul><li>Prostatitis and prostatodynia-similar to dyspareunia in women </li></ul><ul><li>Pelvic floor and anal pain </li></ul>Types of pelvic pain
  7. 7. Treatment <ul><li>Definitive diagnosis necessary </li></ul><ul><li>Medication treatments </li></ul><ul><li>Diet and fluid effects on the bladder </li></ul><ul><li>Behavior modification of voiding habits </li></ul><ul><li>Therapeutic exercise for pelvic floor muscles </li></ul>
  8. 8. <ul><li>Neuromuscular re-education to improve functional use of pelvic floor muscles </li></ul><ul><li>Biofeedback for muscle retraining and physiological quieting </li></ul><ul><li>Manual therapy if appropriate for scar mobility, desensitization, trigger point release, coccyx release, myofascial release techniques and instruction in self-massage </li></ul>Treatment (continued)
  9. 9. Biofeedback Training <ul><li>Trains in: “Finding the PFM;” correct, effortless technique for performing Kegels without also contracting abdominals </li></ul><ul><li>Once trained, individuals are proficient in continuing PFM strengthening with daily exercises </li></ul>
  10. 10. <ul><li>Requires non-invasive placement of small sensor into patient’s rectum </li></ul><ul><li>Patient can observe the muscle activity (on computer screen) of the abdominals and pelvic floor muscles while performing quick Kegels, in maintaining endurance Kegels and training PFM to come back to low resting levels </li></ul>Surfacing EMG of PFMs
  11. 11. Treatment Effectiveness <ul><li>Biofeedback treatment and pelvic floor strengthening meet high efficacy levels in the treatment of urinary incontinence </li></ul>
  12. 12. <ul><ul><li>Co-morbidity with other conditions: pelvic prolapses, cognition, sensation, history of sexual abuse… </li></ul></ul><ul><ul><li>Severity of condition </li></ul></ul><ul><ul><li>Willingness of patient to modify habits </li></ul></ul>Treatment Effectiveness Factors
  13. 13. Typical treatment duration <ul><li>Usually 6-8 treatments </li></ul><ul><li>Often 2 weeks between to allow patient to practice and integrate exercises </li></ul><ul><li>Patient is asked to complete daily diaries of voiding, dietary habits and incontinent episodes to gauge progress </li></ul>
  14. 14. Medicare Coverage for Biofeedback for UI <ul><li>If a four-week course of pelvic floor muscle strengthening is not successful in resolving the urinary incontinence </li></ul><ul><li>Biofeedback will then be covered as a treatment of urinary incontinence </li></ul>

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