The Overactive Pelvic Floor

350 Pages·2016·11.62 MB·English

by  Anna Padoa

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
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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