Pelvic floor dysfunction can cause symptoms like incontinence and organ prolapse. Risk factors include age, pregnancy, obesity, and smoking. Evaluation involves examination, testing like anorectal manometry, and imaging. Treatment options range from lifestyle changes and medications to biofeedback, surgery, and sacral nerve stimulation. Prevention focuses on exercises during and after pregnancy. Future research aims to better understand causes and most effective therapies.
How to Build Muscle with Red Light Therapy | BodybuildingMarkSloan21
If you want to pack on 10 to 20 pounds of muscle but don’t want to have to go through the trouble or pain of injecting yourself with testosterone and other anabolic steroids, then this presentation is for you. This presentation is also for you if you’re a professional bodybuilder who is looking for a secret weapon that will give you the edge over your competition.
In this presentation we’re going to find out if red light therapy can help you build bigger muscles and the body you want - whether it’s to help you win that upcoming bodybuilding competition or to boost your confidence and overall health.
For the show notes visit:
https://endalldisease.com/episode15
All of my videos, podcasts and articles are and will always be free. If you enjoyed this video and want to support my work, you can do so by donating, buying one of my bestselling books or red light therapy devices below.
Check out our red light therapy store:
https://endalldisease.com/store
Read my books:
https://endalldisease.com/books
Donate :
►Paypal:
https://www.paypal.me/endalldisease
La terapia medica e chirurgica della malattia perianale di Crohn - Gastrolear...Gastrolearning
Gastrolearning II modulo/21a lezione
La terapia medica e chirurgica della malattia perianale di Crohn
Relatore: Prof. Paolo Gionchetti (Università di Bologna)
How to Build Muscle with Red Light Therapy | BodybuildingMarkSloan21
If you want to pack on 10 to 20 pounds of muscle but don’t want to have to go through the trouble or pain of injecting yourself with testosterone and other anabolic steroids, then this presentation is for you. This presentation is also for you if you’re a professional bodybuilder who is looking for a secret weapon that will give you the edge over your competition.
In this presentation we’re going to find out if red light therapy can help you build bigger muscles and the body you want - whether it’s to help you win that upcoming bodybuilding competition or to boost your confidence and overall health.
For the show notes visit:
https://endalldisease.com/episode15
All of my videos, podcasts and articles are and will always be free. If you enjoyed this video and want to support my work, you can do so by donating, buying one of my bestselling books or red light therapy devices below.
Check out our red light therapy store:
https://endalldisease.com/store
Read my books:
https://endalldisease.com/books
Donate :
►Paypal:
https://www.paypal.me/endalldisease
La terapia medica e chirurgica della malattia perianale di Crohn - Gastrolear...Gastrolearning
Gastrolearning II modulo/21a lezione
La terapia medica e chirurgica della malattia perianale di Crohn
Relatore: Prof. Paolo Gionchetti (Università di Bologna)
2018 Popular Endometriosis Treatment Options Introduction !singletons li
Endometriosis Treatment Options can be divided into two types : Endometriosis Surgery Treatment and Home Remedies For Endometriosis like Endometriosis Herbal Treatment and here,the article presents 2018 Popular Endometriosis Alternative Treatment ,check it to get more informations.
ENDOMETRIOSIS UPDATEFocus on Dienogest Dr Sharda jain dr Jyoti Agarwal Lifecare Centre
ENDOMETRIOSIS UPDATEFocus on Dienogest
AGENDA
Background
What’s New in Endometriosis
Clinical Discussions in Managing Endometriosis
Newer Evidences on Dienogest
Myths Surrounding Preparation for I-131 Evaluation and TreatmentMark Tulchinsky
CE51: Myths in Radioiodine Theranostics of Differentiated Thyroid Cancer.
Presented at the Annual Meeting of the Society of Nuclear Medicine and Molecular Imaging, held in Denver, CO on Monday, June 12, 23017 4:45 PM–6:15 PM
Location: Mile High 1D-F (Colorado Convention Center)
Education: CE Session
Sponsored by: General Clinical Nuclear Medicine Council, Therapy Center of Excellence
This presentation was delivered during a webinar held by the association of anaesthetists in association with RA-UK entitled "New Blocks - Friend or Foe?".
This took place on 19th October 2021.
In this short presentation - Dr Pawa covers: a brief overview of the history of Paravertebral blocks; how he got introduced to them; some updates on our understanding on the anatomy; and whether they still have a role in modern anaesthetic practice.
Effectiveness of Empirical and Maximal Tolerated Activity in I-131 TherapyMark Tulchinsky
Session Title:
Maximal Tolerated Activity of Radioactive Iodine for Metastatic Thyroid Cancer
Presented at the Annual Meeting of the Society of Nuclear Medicine and Molecular Imaging in Denver, CO on Wednesday, June 14, 8:00AM–9:30AM
Audio and slides for this presentation are available on YouTube: http://youtu.be/dYRu8PVLU14
Cindy Tofthagen, PhD, ARNP, an assistant professor of nursing at the University of South Florida in Tampa and a post-doctoral fellow at the University of Massachusetts and Dana-Farber Cancer Institute, talks about chemotherapy-induced peripheral neuropathy (CIPN), the risk factors of CIPN, and how to manage the condition. This presentation was originally given at Dana-Farber Cancer Institute on Aug. 6, 2013 and put on by Dana-Farber's Blum Resource Center.
2018 Popular Endometriosis Treatment Options Introduction !singletons li
Endometriosis Treatment Options can be divided into two types : Endometriosis Surgery Treatment and Home Remedies For Endometriosis like Endometriosis Herbal Treatment and here,the article presents 2018 Popular Endometriosis Alternative Treatment ,check it to get more informations.
ENDOMETRIOSIS UPDATEFocus on Dienogest Dr Sharda jain dr Jyoti Agarwal Lifecare Centre
ENDOMETRIOSIS UPDATEFocus on Dienogest
AGENDA
Background
What’s New in Endometriosis
Clinical Discussions in Managing Endometriosis
Newer Evidences on Dienogest
Myths Surrounding Preparation for I-131 Evaluation and TreatmentMark Tulchinsky
CE51: Myths in Radioiodine Theranostics of Differentiated Thyroid Cancer.
Presented at the Annual Meeting of the Society of Nuclear Medicine and Molecular Imaging, held in Denver, CO on Monday, June 12, 23017 4:45 PM–6:15 PM
Location: Mile High 1D-F (Colorado Convention Center)
Education: CE Session
Sponsored by: General Clinical Nuclear Medicine Council, Therapy Center of Excellence
This presentation was delivered during a webinar held by the association of anaesthetists in association with RA-UK entitled "New Blocks - Friend or Foe?".
This took place on 19th October 2021.
In this short presentation - Dr Pawa covers: a brief overview of the history of Paravertebral blocks; how he got introduced to them; some updates on our understanding on the anatomy; and whether they still have a role in modern anaesthetic practice.
Effectiveness of Empirical and Maximal Tolerated Activity in I-131 TherapyMark Tulchinsky
Session Title:
Maximal Tolerated Activity of Radioactive Iodine for Metastatic Thyroid Cancer
Presented at the Annual Meeting of the Society of Nuclear Medicine and Molecular Imaging in Denver, CO on Wednesday, June 14, 8:00AM–9:30AM
Audio and slides for this presentation are available on YouTube: http://youtu.be/dYRu8PVLU14
Cindy Tofthagen, PhD, ARNP, an assistant professor of nursing at the University of South Florida in Tampa and a post-doctoral fellow at the University of Massachusetts and Dana-Farber Cancer Institute, talks about chemotherapy-induced peripheral neuropathy (CIPN), the risk factors of CIPN, and how to manage the condition. This presentation was originally given at Dana-Farber Cancer Institute on Aug. 6, 2013 and put on by Dana-Farber's Blum Resource Center.
Herramientas de gestión para entrenadoresNacho Negredo
Aprende a utilizar herramientas para definir la estartegia de tu negocio como el business model canvas, CMI o la matriz DAFO.
Visto desde un enfoque del sector del fitness.
Low Pressure Fitness es un innovador sistema de entrenamiento postural basado en la técnica hipopresiva que combina el stretching miofascial, ejercicios neurodinámicos y respiratorios junto con la metodología didáctica mas avanzada en ciencias del ejercicio. Su objetivo es la práctica de una actividad física saludable, minimizando el riesgo de lesión por exceso de presión intra-abdominal.
¿Puede un programa de ejercicio postural asociado a aspiración diafragmática ...Tamara Rial (PhD)
Los ejercicios posturales realizados conjuntamente con aspiración diafragmática son popularmente denominados Ejercicios Hipopresivos (EH). A pesar de ser ampliamente utilizados en España y otros países europeos para la rehabilitación de las disfunciones de suelo pélvico y patologias de columna, no cuentan con suficiente evidencia científica sobre sus efectos en dichos ámbitos. Por ello, el objetivo principal del estudio fue valorar los efectos que un programa de EH realizados durante 12 semanas (tanto un día como dos días por semana) sobre la extenisbilidad isquiosural de mujeres adultas sanas. Metodología: Participaron en este estudio cuasiexperimental, 151 mujeres adultas sanas (M=44 años). Fueron distribuidas en tres grupos: grupo hipopresivos un día (GH1), grupo hipopresivos dos días (GH2) y grupo control (CG). El GH1 y GH2 realizaron sesiones de 30 minutos de EH durante tres meses, un día dos días a la semana respectivamente. El GC no realizó ningún ejercicio durante el tiempo de la intervención. Se ha valorado antes y después de la intervención la extensibilidad isquiosural mediante el test sit&reach. Resultados: El análisis multifactorial ANCOVA, describió qu hubo una mejora significativa de la extensibilidade isquiosural para el GH1 y GH2 al final del tratamiento (p<.001)><.001). Conclusiones: El tratamiento con EH, practicados tanto uno como dos días por semana durante três semanas puede producir efectos positivos en la extensibilidad isquiosural de mujeres adultas sanas.
Rectal prolapse: Do we really have a perfect surgical solution? pptx copyDr Amit Dangi
Ventral rectopexy has gained worldwide acceptance for surgical correction of rectal prolapse and high-grade internal rectal intussusception. The technique is based on correcting the descent of the posterior and middle compartments combined with reinforcement of the vaginal septum and elevation of the pelvic floor. anterior mobilization of the distal rectum and mesh suspension performed during VR can correct full-thickness rectal prolapse, rectoceles, and internal rec- tal prolapse and can be combined with vaginal prolapse procedures, such as sacrocolpopexy, in patients with multicompartment pelvic floor defects.
Darren M. Brenner, MD, Assistant Professor of Medicine and Surgery at Northwestern University's Feinberg School of Medicine discusses fecal incontinence in scleroderma patients including its prevalence, diagnostics, types and therapeutics.
Pancreatic cystic lesions are encountered quite commonly nowadays. How to appraoch them is important as some are bnign and some having malignant potential. EUS helps in characterising them complementing with the CT or MRI
UOG Journal Club: October 2013
Endometrial scratching performed in the non-transfer cycle and outcome of assisted reproduction: a randomized controlled trial
CO Nastri, RA Ferriani, N Raine-Fenning, WP Martins
Volume 42, Issue 4, Date: October 2013, pages 375–382
Link to free access article:
http://onlinelibrary.wiley.com/doi/10.1002/uog.12539/abstract
Fast-track surgery - the role of the anaesthesiologist in ERASscanFOAM
A presentation by Narinder Rawal at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Delivered in collaboration between scanFOAM, SSAI & SFAI.
ShearWave™ Elastography in Chronic Liver Diseases: Clinical Research Literatu...Joel Gay
By the end of 2016, SuperSonic Imagine’s proprietary ShearWave™ Elastography (SWE™) reached a track record of over 100 peer-reviewed publications focusing on the evaluation of liver fibrosis severity in patients with chronic liver diseases. Therefore, it has become the most clinically studied shear-wave based elastography technique for liver fibrosis assessment.
In this all new webinar, we will walk you through a literature review that will help you to familiarize yourself with clinical research results related to the use of ShearWave™ Elastography (SWE™) within the field of chronic liver diseases.
bladder pain syndrome is highly prevalent. it is a diagnosis of exclusion. the biggest hurdle in management is diagnosis. more often than not patients suffering with BPS move from pillar to post, from a clinician to another, often getting urethral dilatations, receiving NSAIDS and even antipsychotics (having been labelled as 'psychiatric' patient).
once diagnosis is made, treatment is multipronged and based on phenotype - the concept is called UPOINT. interstitial cystitis is a small but significant minority (moreover ulcerative type) of BPS.
Gabapentin, amitriptyline and pentosan polysulfate are cornerstone pharmacotherapeutic agents for IC/BPS
5. Prevalence
• Varies greatly in the literature
• UI 17-45%
• FI 1.9-11.3%
• Prolapse 2-25%
• Reasons for variation
– Lack of standardized definitions
– Use of surrogate markers; ie surgical history
6. NHANES 05-06 Data
• 3440 women >20 years old selected
• 2489 agreed to participate
• 528 patients excluded- 1961remaining
– UI defined using a 2 item incontinence
severity index
– FI defined as at least monthly leakage of
solid, liquid, or mucous stool
• Validated fecal incontinence severity index
– POP- experience bulging or something falling
out that you can see or feel
7. NHANES
• 23.7% (21.2-26.2) ≥ 1 PFD
• 15.7% (13.2-18.2) UI
• 9% (7.3-10.7) FI
• 2.9% (2.1-3.7) POP
Nygaard, et al. JAMA 300(11): 1311-6.
8. • 2008- 38.6 million adults > 65 years old
• 2010- 28.1 million women with 1 PFD
• 2050- projected to double to 88.5 million
– 43.8 million women with 1 PFD
• Kaiser consultation for PFD from 2000-2030
– Consultations for 2000 618,165
– Projections for 2030 954,397
Wu et al. Ob&Gyn 114(6): 1278-
83.
10. Age
Age UI (n=331) FI (n=176) POP (n=58) ≥1 PFD (n=470)
20-39 6.9(4.9-9.0) 2.9(1.9-3.9) 1.6(0.6-2.6) 9.7 (7.8-11.7)
40-59 17.2(13.9-20.5) 9.9(7.4-12.5) 3.8(2.0-5.7) 26.5(23-29.9)
60-79 23.3(17-29.7) 14.4(10.4-18.3) 3(0.9-5.1) 36.8(32-41.6)
≥80 31.7(22.3-41.2) 21.6(12.8-30.4) 4.1(1.1-7.1) 49.7(40.3-59.1)
NHANES data demonstrated age as a clinical significant risk
factor except for POP. This may be related to the small
amount of pts with POP.
11. Parity
Parity UI FI POP ≥1 PFD
0 6.5(4.2-8.9) 6.3(2.9-9.6) 0.6(0-1.5) 12.8(9-16.6)
1 9.7(6.4-13) 8.8(4.3-13.3) 2.5(0.2-4.9) 18.4(12.9-23.9)
2 16.3(12.3-20.3) 8.4(5.8-11) 3.7(1.7-5.6) 24.6(19.5-29.8)
>3 23.9(20.1-27.7) 11.5(8.7-14.3) 3.8(2.1-5.4) 32.4(27.8-37.1)
Parity was not a stastically significant risk factor for FI.
The greatest damage occurs during the first pregancy.
12. Sphincter Defects and Parity
• Anal sphincter defects are associated with
first delivery
– Primiparas: Before 0% After 35%
– Multiparas: Before 40% After 44%
Sultan et al. NEJM 325:1905.
13. Pregnancy and Childbirth
• PFD are more common among women who
have delivered @ least 1 child
• Premenopausal women- parous women have
higher prevalence of SUI and UI
• Postmenopausal women parity has little
effect on UI
– WHI: History of at least one delivery
associated with 2x risk of POP
14. • UI and FI are common during pregnancy
– UI reported by 7-60% of pregnant women
– FI 6%
– 70% UI symptoms during pregnancy resolve
postpartum
• Conflicting data regarding vaginal delivery
and increased rates on incontinence
15. Pregnancy & Childbirth:
Mechanisms of Injury
• Neural Injury
– Operative delivery
– Prolonged second stage of labor
– High birth weight
• Anal sphincter disruption
– Gross and occult injuries
– Role and risk of episiotomy
– Maternal birth position
– Epidural
16. Mode of Delivery
• Australian Cross-sectional Study
Method of Delivery Odds Ratio
Caesarean only 2.5(1.5-4.3)
Vaginal only 3.4(2.4-4.9)
At least one forceps 4.3(2.8-6.6)
Both vaginal and caesarean 4.7(2.3-9.3)
MacLennan et al. Br J
Obstet Gynae
107:1460-1470.
17. Elective Caesarean
• Cochrane Review
– 21 studies- total of 31,698 patients
Elective Caesarean
• 6028 Caesarean delivery
• 25170 Vaginal delivery
Cannot Bestudy- Term Breech Trial
• 1 randomized Recommended
• 1 Study illustrated benefit
• No difference in elective versus emergency
• Risk include adhesions(83% by third
pregnancy), infertility, bleeding
Cochrane Review 2010
21. Physiologic Testing
Clinical Utility of ARM in Fecal
• Manometry and Sensory Testing
Incontience
– Functional weakness 95%
Diagnosis Confirmed EAS and IAS
– Abnormal rectal sensation
New Information 98%
– Grade B evidence
Influenced Treatment 84%
Normal Study 2%
Not Helpful 14%
Rao et el. AJG 92:460-
75.
25. Anal Endosonography
• Assessment of integrity and thickness of
sphincters
• Sphincter thickness does not correlate with
manometry findings
• EUS vs. EMG mapping
– High concordance for identifying sphincter
defects
• Low specificity for demonstrating etiology of
Enck et al. AJG 91:2539-
fecal incontinence 43.
26. Pelvic MRI
• Endoanal MRI
– Recognition of EAS atrophy
– Possible role in preoperative evaluation
• Dynamic MRI
– Possible replacement of defecography
– Depends on radiologist’s expertise
27. Fecal Incontinence
Diarrhea Prolapse
Obstetric/Surgical
Neurological Hx
Chronic
Diarrhea Confirmed Suspect
Workup Surgery Imaging
ARM and Imaging-
Supportive Rx MRI or EUS
Adapted from Rao et al.
No improvement ACG Guidelines AJG 2004
33. Biofeedback: Effective Treatment?
• Subjective treatment 40-85% in uncontrolled
studies
• Norton et al- RCT of 171 patients
– Outcomes- Immediate and 1 year post
intervention
– 60% of patients had improvement
– No difference between treatment arms
Norton et al Gastro
125:1320-9.
34. BF and Pelvic Exercise: Equal
Efficacy?
• Heyman et al- RCT of 108 pts
– Run-in/Education Period- 21% of patients
reported adequate control
– Biofeedback group
• Greater reduction in FISI
• Fewer episodes of FI
• 44% complete continence
• 3 months- 76% reported adequate response
• Greater increase in anal squeeze pressure
Heyman et al. Dis Col
Rect 2009:1730-7.
35. Surgery
• Sphincteroplasty
– Short term
improvement
70-85%
– 5 years post op
50% failure
• Postanal repair
– Success 20-58%
38. Sacral Nerve Stimulation
• Approved for urinary incontinence
• Full restoration of continence in 37-74% @
24 months
• Objective changes
– Increase in resting and squeeze pressure
– Increase squeeze duration
– Improved perception of rectal sensation
Ganio et al. Dis Col Rectum 44:1261-7.
Jarrett et al Br J Surg 91:1559-69.
39. Prevention
• Kegel exercises
– Cochrane review- 15 trials: 6000pt
– Antenatal and Postnatal
– Decreased UI and FI
– Minimial difference
40. Future Research
• Pelvic Floor Disorder Network
– BOOST Study- behavioral therapy versus
usual care in women with anal sphincter tears
and FI
– ADAPTION Study
41. Take Home Points
• FI is common
• Unclear whether pregnancy or delivery
causative; multifactorial causes
• History, exam, and testing are
complementary in diagnosis
• Biofeedback is the mainstay of therapy in
patients who failed to respond to supportive
Rx