Towards evidence based practice in pelvic floor physiotherapy

Abstract

The PelFIs is new practical and conceptually clear questionnaire that focus on micturition, defecation and/or sexual dysfunction, related to pelvic floor dysfunction. The use of PelFIs may provide a better and reliable insight in the patients__ experience of specific complaints of pelvic floor dysfunction. o In our opinion the interaction of a patient and clinician during the administration of a questionnaire is essential in order to gain the patients__ trust and thus acquire a true perspective of FSDs and past or prevalent sexual abuse. We believe that a questionnaire administered by a clinician should be preferred to a self-administered questionnaire. o Pelvic floor dysfunction is correlated with urinary, sexual or gastroenterological complaints. In our retrospective study we found that 77, 2 % of patients who presented to the clinic with urinary, gastro or sexual complaints had measurable pelvic floor dysfunction (69, 3 % overactive rest tone and 7, 9 % under active rest tone). In relation to the ICS terminology there is a need for a well defined normal versus elevated rest tone of the pelvic floor. o The electrodes of the probes, as we use them now during electrostimulation and biofeedback training in the treatment of pelvic floor dysfunction, are not optimal for the structures we want to stimulate or to register. o Extracorporeal Magnetic Innervation (ExMI) appeared to have no beneficial effect on pelvic floor function. o We were able to demonstrate an acute effect of one application of TENS in the combined setting on bladder function using urodynamic parameters in patients with the overactive bladder syndrome o We were able to demonstrate an acute effect of one application of intravaginal ES (8 Hz, pulse duration 1000 _seconds and no pulse to rest) on bladder function using urodynamic parameters in patients with symptoms of the OAB. 137 131 It has been established and it is my personal believe that pelvic floor physiotherapy has an important place in the treatment of micturition-, defecation problems and sexual dysfunction. Pelvic Floor Physiotherapy should be at least considered before irreversible surgery is advocated. The treatment is safe, minimal invasive and not costly. A consensus should be reached on treatment indications, patient selection and treatment protocol. Further research is necessary to determine the mechanisms of action, the efficacy and the proper placement of probes in the treatment of pelvic floor dysfunction. This thesis is an effort towards evidenced based pelvic floor physiotherapy, but more fundamental research in pelvic floor science is necessary.