This book on pelvic floor re-education provides a comprehensive overview of the subject, along with other aspects of the clinical assessment and management of pelvic floor disorders. It is written for all health care professionals working with women with urogynecological disorders. Practical techniques of muscle assessment and investigative methodologies are reviewed and up-to-date information on anatomy and physiology is discussed. The text is clear, practical, and is written from experience in the field. An algorithmic approach takes the reader through the options for clinical evaluation and treatment.
1. Function and dysfunction of the pelvic floor and viscera: Functional anatomy of the pelvic floor and lower urinary tract.- Neural control of pelvic floor muscles.- The effects of pregnancy and childbirth on the pelvic floor.- Muscle function and ageing.- Urinary incontinence and voiding dysfunction.- Pelvic organ prolapse.- Anal incontinence, constipation and obstructed defaecation.- Overactive pelvic floor muscles and related pain.- 2. Evaluation of the pelvic floor: Clinical evaluation of the pelvic floor muscles.- Examination of patients with pelvic organ prolapse.Urodynamics.- Applying urodynamic findings to clinical practice.- Anorectal physiology.- Ultrasound imaging.- Magnetic resonance imaging.- Introduction and technique. Static MRI: anatomy, normal variation and pathology. Dynamic MRI of the pelvis.- Electrophysiology.- Outcome measures in pelvic floor rehabilitation.- 3. Techniques of pelvic floor rehabilitation and muscle training: Concepts of neuromuscular rehabilitation and pelvic floor muscle training.- Exercise, feedback and biofeedback.- Electrical stimulation.- Extracorporal magnetic stimulation.- Devices.- Alternative methods to pelvic floor muscle awareness and training.- 4. Treatment - condition-specific assessment and approaches: Behavioural treatment.- Stress urinary incontinence.- Evidence for the effectiveness of pelvic floor muscle training in the treatment and antenatal prevention of female urinary incontinence.- Postpartum management of the pelvic .- Role of a perineal clinic.- Overactive bladder.- Sexual dysfunction and the overactive pelvic floor.- Anal incontinence and evacuation difficulties.- Incontinence during sports and fitness activities.- Pelvic organ prolapse.- 5. What to do if physiotherapy fails?: Stress urinary incontinence: choice of surgery.- Genital prolapse: surgery for failed conservative treatment.- The anal sphincter.