The Overactive Pelvic Floor PDF
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Anna Padoa Talli Y. Rosenbaum Editors The Overactive Pelvic Floor 123 The Overactive Pelvic Floor Anna Padoa (cid:129) Talli Y. Rosenbaum Editors The Overactive Pelvic Floor Editors Anna Padoa Talli Y. Rosenbaum Urogynecology and Pelvic Floor Service Inner Stability, Ltd Assaf Harofeh Medical Center Beit Shemesh , Israel Zerifi n , Israel ISBN 978-3-319-22149-6 ISBN 978-3-319-22150-2 (eBook) DOI 10.1007/978-3-319-22150-2 Library of Congress Control Number: 2015947781 Springer Cham Heidelberg New York Dordrecht London © Springer International Publishing Switzerland 2016 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. T he publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper Springer International Publishing AG Switzerland is part of Springer Science+Business Media (www.springer.com) Pref ace T his textbook is an expression of the individual professional journeys of its coeditors. As a urogynecological surgeon and a former pelvic fl oor physiotherapist (currently an individual, couples, and sex therapist), each of us possesses expertise in the biomechanical treatment of pelvic fl oor disorders. However, our involvement in the treatment of patients with pelvic floor dysfunction inspired each of us in our own direction to expand our professional interests and skills beyond the biomedical approaches com- mon to our professions. The pelvic fl oor is complex and multidimensional, and so too, are our patients. Addressing the distress of patients who presented to us with pelvic fl oor disorders, confronted us with the need to recognize the complexities of the psychosocial, relational and sexual, as well as the physiological compo- nents related to pelvic fl oor complaints. This has included recognizing that treating the pelvic fl oor means meeting people in their most intimate and vulnerable space. The word “pudendal” is, in fact, Latin for “shame.” T he pelvic fl oor is conceptualized as an anatomical area of the body, respon- sible mainly for support of the pelvic organs and maintenance of bowel and bladder control. As such, pelvic fl oor-related texts are classically devoted to reviewing the dysfunctions and treatments of conditions related to compromised integrity of the pelvic fl oor muscles and fascial support. These conditions typi- cally include pelvic organ prolapse and urinary and/or anal incontinence. T reatment of conditions related to pelvic fl oor weakness has been widely researched and protocols have been standardized. Less recognized and not as well understood are conditions related to the overactive pelvic fl oor. Unlike pelvic fl oor weakness, which is conceptualized as a condition resulting mainly from mechanical stresses such as pregnancy, delivery, and hormonally induced tissue laxity, the presentation of pelvic fl oor overactivity, is far more complex. I n conceptualizing the OPF, practitioners must move beyond the view of the pelvic fl oor as a mere anatomical location. OPF is connected to a complex inter- action of psychological, mechanical, functional, and multi-systemic infl uences. Thus, practitioners who confront patients with symptoms and presentations con- sistent with an OPF are often faced with practical treatment challenges. C aregivers who treat the pelvic fl oor are often trained to address dysfunc- tion in a mechanical manner. Imaging techniques are used to locate the ana- tomical “fault lines” and urodynamics and manometry measure pressure units. v vi Preface Physical therapists address muscle weakness with muscle s trengthening, and surgeons use their skills much as a handyman would, to lift, tighten, and repair. I n confronting patients with OPF, these tools and skills may be insuffi - cient. While treatment of patients with pelvic fl oor weakness does require an awareness and appreciation for how symptoms such as prolapse and inconti- nence affect quality of life and sexual functioning, these variables are addressed indirectly, by providing evidence-based and standardized protocols such as pelvic fl oor muscle rehabilitation and/or surgical repair. The positive outcome of these mechanical interventions aims to improve quality of life and sexual function. T he classical approach described above may not, however, be satisfactory in addressing the complexities involved in treating patients with pelvic fl oor overactivity. Treatment requires a comprehensive evaluation to determine the cause and effect dynamic between the pelvic fl oor, the symptoms related to the OPF, and the psychological contributors as well as outcomes of these multifaceted conditions. W e have, therefore, collaborated with leading researchers and practitio- ners to present the most up-to-date text that specifi cally addresses pelvic fl oor overactivity. Pelvic fl oor overactivity may be associated with musculoskeletal and neurological impairments, as well as psychological distress and sexual abuse, and is correlated with symptoms that greatly affect quality of life and sexual function. As such, this condition is relevant to several disciplines including urology, gynecology, gastroenterology, sexology, psychology and physical therapy. T his textbook is the fi rst of its kind dedicated to OPF. It provides a com- prehensive, state-of-the-art review of the OPF and is intended to serve as a valuable resource for clinicians and researchers with an interest in the pelvic fl oor. In addition, this text offers clinical tools for medical and mental health practitioners alike for recognition, assessment, treatment, and interdisciplin- ary referral of patients with OPF and OPF-related conditions. This book reviews the defi nition, etiology, and pathophysiology of non- relaxing pelvic fl oor muscle tone and discusses sexual function and past sexual experience in relation to the pelvic fl oor. Specifi c pelvic fl oor dysfunctions associated with pelvic fl oor overactivity in both men and women are reviewed in detail. Individual chapters are devoted to female genital pain and vulvodynia, female bladder pain, male chronic pelvic and genital pain, sexual dysfunction related to pelvic pain in both men and women, musculoskeletal aspects of pelvic fl oor overactivity, lower uri- nary tract symptoms, voiding dysfunction, and anorectal disorders. Assessment of the pelvic fl oor is addressed in distinct chapters describing subjective and objective assessment tools. State-of-the-art testing measures including electromyographic, urodynamic analysis, and imaging techniques are introduced. The fi nal chapters are devoted to medical, psychosocial, and physical therapy treatment interventions with an emphasis on interdisciplin- ary management. I t is our hope and belief that this textbook will serve as a very useful resource for physicians, nurses, psychotherapists, sex therapists, and physical Preface vii therapists and will help guide patient management as well as stimulate i nvestigative efforts. We are deeply indebted to the chapter authors, our col- laborators in this meaningful project, for contributing their expertise and wis- dom and for their shared commitment to improving the mental and physical health and quality of life of patients with OPF. Zerifi n, Israel Anna Padoa Beit Shemesh, Israel Talli Y. Rosenbaum Contents 1 Definitions and Basic Etiology of the Overactive Pelvic Floor .................................................................................... 1 Stéphanie Thibault-Gagnon 2 Overactive Pelvic Floor: Female Sexual Functioning ................ 17 Ellen Laan and Rik H. W. van Lunsen 3 The Pelvic Floor and Male Sexual Function ............................... 31 Deborah S. Cohen , Joshua Gonzalez , and Irwin Goldstein 4 Female Genital Pain and Penetration Disorders ........................ 43 Ahinoam Lev-Sagie 5 Bladder Pain Syndromes/Interstitial Cystitis and the Overactive Pelvic Floor ................................................... 57 Mauro Cervigni , Andrea Morciano , and Giuseppe Campagna 6 Chronic Pelvic Pain Syndromes in Males ................................... 73 Kobi Stav 7 Musculoskeletal Conditions Related to Pelvic Floor Muscle Overactivity ...................................................................... 91 Pamela Morrison 8 Female Voiding Dysfunction ........................................................ 113 Asnat Groutz 9 Overactive Pelvic Floor: Gastrointestinal Morbidities .............. 121 Marc Beer-Gabel 10 Subjective Assessment of the Overactive Pelvic Floor ............... 131 Lior Lowenstein , Moti Gulersen , and Amy Lehrner 11 Objective Assessment of the Overactive Pelvic Floor ................ 151 Mélanie Morin 12 Electromyography ......................................................................... 175 Evelyne Gentilcore-Saulnier , Cindy Auchincloss, and Linda McLean ix
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