Therapeutic Management of Incontinence and Pelvic Pain

Therapeutic Management of Incontinence and Pelvic Pain

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$115.00

Overview

This title provides a clear, concise and practical clinical introduction to the assessment and conservative treatment of pelvic floor disorders in both men and women. It is the first practical textbook on this topic to enable clinicians to learn about the practicalities of assessment and treatment. Many different specialists have contributed to the text, critically reviewing the literature and recommending evidence-based practice and possible further research. The book is written primarily for physical therapists working in this specialist field. However, it will also be a useful reference and practical guide for all health professionals dealing with incontinence and pelvic floor disorders, i.e. students of alternative therapies, osteopaths, urologists, gynecologists and general practitioners. This title will complement undergraduate and post-graduate formal lectures and practical sessions, with references supporting the proposed clinical guidelines.

Product Details

ISBN-13: 9781852332242
Publisher: Springer-Verlag New York, LLC
Publication date: 07/28/2002
Pages: 292
Product dimensions: 7.60(w) x 10.70(h) x 0.60(d)

Table of Contents

List of Contributorsxix
List of Abbreviationsxxi
Section IUrinary Incontinence
1Prevalence of Urinary Incontinence: A Review of the Literature3
2Anatomy7
2.1Female Pelvic Anatomy7
2.2Vagina and Uterus9
2.3Pelvic Floor Muscles10
2.4Anatomic Basis of Urinary Continence12
2.5Pelvic Organ Support13
2.6Male Pelvic Anatomy14
2.7Neurogenic Basis of Continence and Micturition14
3Aetiology and Classification of Urinary Incontinence17
3.1International Continence Society Standards17
3.2Risk Factors for Urinary Incontinence17
3.3Classification of Urinary Tract Dysfunction20
3.4Urinary Incontinence20
3.5Conclusion21
4Assessment and Treatment of Urinary Incontinence in Neurologically Impaired Patients23
4.1Prevalence23
4.2Aetiology and Pathophysiology of the Neural Control of Bladder Function25
4.3Bladder Dysfunction in Multiple Sclerosis26
4.4Bladder Dysfunction in Idiopathic Parkinson's Disease28
4.5Multiple System Atrophy28
4.6Cerebrovascular Accident29
4.7Urinary Retention in Premenopausal Women30
4.8Evaluation of Urinary Symptoms in Patients with Neurological Disease30
4.9History and Examination30
4.10Treatment of Bladder Dysfunction in Neurological Disease33
4.11Therapy for Detrusor Hyperreflexia34
4.12Summary35
5The Ageing Lower Urinary Tract39
5.1Basic Architecture39
5.2Functional Studies40
5.3Urethral Function42
5.4Nocturia42
5.5Conclusion42
6Patient Assessment45
6.1Lower Urinary Tract Dysfunction45
6.2Frequency/Volume Chart45
6.3Assessment Forms46
6.4Investigations48
6.5Observations49
6.6Internal Palpation Results50
6.7Muscle Bulk, Symmetry and Contractility51
6.8Quality of Life54
7Investigations55
7.1Pad Test55
7.2Uroflowmetry55
7.3Cystometry56
7.4Videocystourethrography56
7.5Ambulatory Urodynamics56
7.6Urethral Pressure Profilometry57
7.7Radiology of the Lower Urinary Tract57
7.8Ultrasound57
7.9Magnetic Resonance Imaging57
7.10Electromyography57
7.11Conclusion58
7.12Urinalysis58
Section IITreatment of Urinary Incontinence
8Pelvic Floor Muscle Exercise in the Treatment of Urinary Incontinence63
8.1Specific Pelvic Floor Muscle Re-education63
8.2Pelvic Floor Stability and Trunk Muscle Co-Activation66
9Improving Patient's Adherence73
9.1How Can Patients Be Encouraged To Adhere To Treatment Protocols?73
9.2Strategies to Increase Patient Motivation74
9.3Conclusion74
10Biofeedback for the Assessment and Re-education of the Pelvic Floor Musculature75
10.1Digital Biofeedback75
10.2Use of Biofeedback Equipment75
10.3Manometric Biofeedback75
10.4Electromyography Biofeedback78
10.5Other Methods of Biofeedback80
10.6Other Uses of Biofeedback80
11Vaginal Cones83
11.1Function and Mode of Action of Cones83
11.2Cone Therapy83
12Electrical Stimulation85
12.1Electrodes85
12.2Electrical Parameters85
12.3Transcutaneous Electrical Nerve Stimulation88
12.4Prolonged Effects of Electrical Stimulation88
12.5Adverse Effects88
12.6Contraindications and Precautions88
12.7Conclusions88
13Prosthetic Devices, Inserts and Plugs for the Management of Stress Incontinence91
13.1Prosthetic Devices91
13.2Intraurethral Plugs91
13.3Intravaginal Tampons and Pessaries92
13.4Extraurethral Devices93
13.5General Considerations93
13.6Areas for Future Research93
14Surgery for Genuine Stress Incontinence95
14.1Anterior Colporrhaphy95
14.2Burch Colposuspension95
14.3Slings95
14.4Bladder Neck Suspension96
14.5Injectables96
14.6Laparoscopic Colposuspension97
14.7Conclusion97
15The Importance of Fluids99
15.1The Amount to Drink99
15.2Fluid Restriction99
15.3Types of Fluid99
16The Male Patient101
16.1Assessment of the Male Pelvic Floor101
16.2Voiding Techniques102
16.3Post-Micturition Dribble102
17Bladder Training and Behavioural Therapy103
17.1Detrusor Instability and the Overactive Bladder103
17.2Normal Bladder Behaviour103
17.3Assessment103
17.4Behavioural Therapy104
17.5Bladder Training in Association with Drug Therapy105
17.6Bladder Training Versus Pelvic Floor Muscle Training105
17.7Other Therapies105
17.8Conclusions and Recommendations106
18Voiding Problems in Women109
18.1Dangers of Incomplete Emptying109
18.2Detrusor Hypoactivity and Inappropriate Relaxation of the Pelvic Floor Muscles and Urethral Sphincter109
18.3Neurogenic Bladder110
18.4Outflow Obstruction in Women110
18.5Prevention of Post-Void Residual Urine110
18.6Investigations and Treatment of Post-Void Residual Urine110
18.7Conclusions111
19Drugs Acting On the Lower Urinary Tract113
19.1Detrusor Instability: Anticholinergic Drugs113
19.2Detrusor Instability: Antidepressant Drugs113
19.3Genuine Stress Incontinence: Oestrogens114
19.4Genuine Stress Incontinence: Sympathomimetic Drugs114
19.5Sensory Disorders114
19.6Summary114
Section IIIColorectal Disorders
20An Anatomical Overview119
20.1Anatomy of the Anorectum119
20.2Aetiology and Pathophysiology of Anorectal Disorders121
20.3Assessment and Investigations122
20.4Conservative and Medical Management of Faecal Incontinence126
20.5Conservative and Medical Management of Constipation126
21Faecal Incontinence129
21.1Prevalence129
21.2Assessment130
21.3Dietary Management of Faecal Incontinence and Faecal Urgency135
21.4Treatment
136
137
22Constipation143
22.1Prevalence of Constipation and Associated Factors143
22.2Aetiology and Pathophysiology143
22.3Assessment of the Constipated Patient145
22.4Treatment Programmes for the Patient with Constipation148
22.5Abdominal Massage150
22.6Laxatives151
Section IVPelvic Pain
23Prevalence of Pelvic Pain157
23.1Definition and Management157
23.2Prevalence157
24Anatomy161
24.1Sources of Pelvic Pain161
24.2Sacroiliac Joint161
24.3Pubic Symphysis162
24.4Sacrococcygeal Joint162
24.5Muscles of the Pelvis162
24.6Vestibule162
24.7Pelvic Nerves162
24.8Pain Pathways162
25Aetiology of Pelvic Floor Muscle Pain Syndromes167
25.1Pelvic Muscle Pain and Vaginismus167
25.2Musculoskeletal Factors167
25.3Psychogenic Factors169
25.4Visceral or Systemic Factors169
25.5Iatrogenic Factors169
25.6Neurological Factors169
26Assessment of Pelvic Pain171
26.1Integrated or Holistic Approach171
26.2History - Initial Interview171
26.3Tests and Measures173
27Treatment of Pelvic Pain177
27.1Posture and Body Mechanics177
27.2Relaxation and Stress Management179
27.3Manual Therapies180
27.4Modalities for Pelvic Floor Muscle Spasms182
27.5Vulvodynia185
Section VPelvic Organ Prolapse
28Background193
28.1Definitions193
28.2Prevalence193
28.3Symptomatology194
28.4Anatomy and Physiology194
28.5Aetiology and Pathophysiology195
29Evaluation of Prolapse197
30Treatment and Prevention of Prolapse201
30.1Therapeutic Options for the Patient with Prolapse201
30.2Surgical Options204
30.3Prevention of Prolapse207
Section VIComplementary Therapies
31Osteopathy211
31.1Assessment211
31.2Treatments213
31.3Contraindications and Precautions216
31.4Conclusion217
32Acupuncture219
32.1Urinary Incontinence219
31.2Faecal Incontinence221
31.3Pelvic Pain221
32.4Prolapse223
32.5Conclusion223
33Reflex Therapy225
33.1Assessment226
33.2Treatment227
33.3Changes that May Be Found During Treatment of Pelvic Conditions227
33.4Conditions Illustrated by Case Studies229
33.5Summary230
34Homeopathy231
34.1What Is Homeopathy and How Does It Work?231
34.2How Is a Remedy Chosen?231
34.3How Can Homeopathy Help Continence?231
34.4Homeopathic Remedies for the Urinary Tract232
34.5Doses of Homeopathic Remedies233
34.6Finding and Choosing a Homeopath234
Section VIIProfessional Issues
35Research Trials in Incontinence237
35.1Randomised Controlled Trials237
35.2Study Population237
35.3Size of Trial238
35.4Randomisation and Blinding238
35.5Interventions and Controls238
35.6Assessment238
35.7Ethical Considerations239
35.8Analysis239
35.9Conclusion239
36Audit241
36.1Audit and the NHS Reforms241
36.2What Is Audit?241
36.3Conclusion242
37Infection Control Issues243
37.1Background243
37.2Universal Precautions244
37.3Hand Hygiene245
37.4Inoculation Injuries245
37.5Equipment245
37.6Decontamination245
37.7Summary247
Appendix 1Bladder Record Chart249
Appendix 2Urinary Continence Assessment Form250
Appendix 3Exercise Diary252
Appendix 4Fluid Intake and Bladder Diary253
Appendix 5Useful Addresses and Websites255
Index257

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