Pelvic Floor Muscles and Continence

A resource to assist health professionals access information about pelvic floor muscle exercises for continence

Developed by the Home and Community Care (HACC)/

Medical Aids Subsidy Scheme (MASS) Continence Project

August 2010

ISBN: 9781921707018

Copyright

© The State of Queensland, Queensland Health, 2010

The Queensland Government supports and encourages the dissemination and exchange of information. However, copyright protects this document. The State of Queensland has no objection to this material being reproduced, made available online or electronically, but only if it is recognised as the owner and this material remains unaltered.

Disclaimer:

Queensland Health has made every effort to ensure this information is accurate. However Queensland Health accepts no responsibility for any errors, omissions or inaccuracies in respect of the information contained in the material provided by the Home and Community Care (HACC)/Medical Aids Subsidy Scheme (MASS) Continence Project, nor is the provision of this material by the HACC/MASS Continence Project to be construed as any representation that there are no other materials or information available in relation to the information provided. Further, Queensland Health accepts no responsibility to persons who may rely upon this information for whatever purpose.

HACC/MASS Continence Project Medical Aids Subsidy Scheme PO Box 281 CANNON HILL QLD 4170 Phone (07) 3136 3631 Email: contpro@health.qld.gov.au

HACC/MASS Continence Project Team 2010 Christine Leech, OT, Senior Project Officer Audrey Burgin, Continence Nurse Advisor, Project Officer Lesley Osbourne, Executive Support Officer Review of Journal Articles: Alyssa Tait, Physiotherapist

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Table of Contents

Introduction ........................................................................................................ Page 2 Websites ............................................................................................................ Page 3 Books ................................................................................................................. Page 6 Education Resources ......................................................................................... Page 11 Journal Articles .................................................................................................. Page 13

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Introduction

This resource has been developed to support health professionals to access resources and information about pelvic floor muscles and continence. The document does not purport to be a complete list, and readers requiring more information are encouraged to undertake their own data base search. In particular, there have been innumerable journal articles and books written about the pelvic floor. We are grateful for the input of physiotherapists for their assistance in limiting the journal articles and other resources listed in this document to those that are particularly useful.

The information in this resource is specifically for health professionals. Readers are referred to the Continence Foundation of Australia for client resources on pelvic floor muscle education, which can be accessed via www.continence.org.au or the National Continence Helpline on 1800 33 00 66.

Private publications and websites available on this topic have not been listed in this resource, but may be relevant for health professionals.

If you identify a resource which may be suitable for inclusion in a future edition of this “Pelvic Floor Muscles and Continence” resource, please provide the details to the HACC/MASS Continence Project team at contpro@health.qld.gov.au

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Websites

1. Australian Department of Health and Aged Care: HealthInsite

This Australian Government website aims to improve the health of Australians by providing easy access to quality information. The website has an A-Z of health topics with an extensive data base of direct links. It also contains information on conditions and diseases, health and wellbeing, life stages and events, and Australian health services. There is a link to information on pelvic floor muscles. The website provides access through HealthInsite to public summaries of the Cochrane Collaboration’s reviews of the evidence.

www.healthinsite.gov.au/topics/Pelvic_Floor_Muscles

2. Australian Government Department of Health and Ageing

This website provides links to government and other websites for both the public and health professionals. Enter “pelvic floor” in the key words box for information, fact sheets, publications and contacts.

www.health.gov.au

3. Australian Government Department of Health and Ageing: National Continence Management Strategy

The National Continence Management Strategy is an initiative of the Australian Government Department of Health and Ageing. This website provides information for health professionals, service providers and researchers on bladder and bowel problems. There are numerous links to other continence related websites, including sites providing support and help. The website includes the contact details for the National Continence Helpline, and has a link to pelvic floor information. There are brochures for English and non English speaking people, and Aboriginal and Torres Strait Islander people. Information is provided on incontinence with links to fact sheets, publications, contacts, support and help. Go to health professionals/service providers/researchers headings in the web site.

www.bladderbowel.gov.au

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4. Australian Physiotherapy Association (APA)

This website has information for health professionals and the general public and on incontinence and pelvic floor muscle exercises.

www.physiotherapy.asn.au/index.php/groups/continence-and-womens-health

5. Bladder and Bowel Foundation (B&BF) United Kingdom

This website has information on continence symptoms, treatment and pelvic floor muscle exercises for women and men. It discusses doing the exercises as part of the daily routine. Follow the web site prompts of bladder, healthy bladder and pelvic floor exercises to access information.

www.bladderandbowelfoundation.org

6. Continence Foundation of Australia (CFA)

The Continence Foundation of Australia raises awareness of, and advocates on behalf of, people with bladder and bowel problems and their carers. The website provides information on available resources, links to other websites and a phone contact for the National Continence Helpline. The helpline is a nation-wide free service staffed by a team of continence advisors, who provide confidential advice regarding bladder and bowel control. For specific information on pelvic muscles, go to “continence information” and select “living with incontinence” and “pelvic floor muscle exercise” for links to information and resources for health professionals.

www.continence.org.au/site/index.cfm?display=112842

7. Queensland Government Queensland Health

This website has information for health professionals and the general public on pelvic floor muscle exercises. Type in the search words “pelvic floor muscle exercises” in the search engine to link to the information available.

www.health.qld.gov.au

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8. The Royal Women’s Hospital Melbourne

This website provides general women’s health information and includes urogynaecology and gynaecology fact sheets from A - Z. The Physiotherapy Department has information about pelvic floor anatomy and exercises and includes a step by step guide to pelvic floor muscle exercises.

www.thewomens.org.au/PelvicFloorExercises

9. West Australian Government Department of Health Population Health Unit

This website has information on a range of health topics. Go to ‘Health topics A - Z’, select ‘W’ then ‘women’s health’ to find a brochure on pelvic floor muscle exercises for women, which includes clear, easy to read information on the pelvic muscles at work, signs and symptoms of weak muscles, self help, exercises and maintaining strong pelvic floor muscles.

www.population.health.wa.gov.au

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Books

Abrams, P., Cardozo, L., Khoury S., & Wein, A. (Eds.). (2009). Incontinence: 4th International consultation on incontinence (4th ed): Health Publication Ltd.

This book contains comprehensive information on incontinence and pelvic floor dysfunction, and is compiled by multidisciplinary experts in clinical practice from international locations.

Bent, A., Cundiff, G., & Swift, W. (2007). Ostegard’s urogynecology and pelvic floor dysfunction (6 ed.). Philadelphia: London: Lippincott Williams & Wilkins. Chapter 1 - 3, 9.

This book provides information on female pelvic floor dysfunctions, including urinary incontinence, other lower urinary tract conditions, disorders of the anus and rectum, and disorders of pelvic support. The book reviews relevant anatomy, describes clinical examination and diagnostic tests, and provides current information on the diagnosis, physiology, and medical and surgical treatment of specific disorders.

Bø, K., Berghmans, B., Van Kampen, M., Morkved, S., & Artibani W (Eds.). (2007). Evidence-based physical therapy for the pelvic floor: Edinburgh: London et al: Churchill Livingstone.

This book has a focus on bridging science and clinical practice. The conservative treatment of physical therapy is discussed with evidence based background information supporting practice.

Bourcier, A., McGuire, E., & Abrams, P. (Eds.). (2004). Pelvic floor disorders: Michigan: Elsevier Saunders.

This book offers multidisciplinary guidance on the diagnosis and management of the full spectrum of pelvic floor disorders. It covers conservative management of the lower urinary tract including pelvic floor muscle exercises

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Carrière, B. (2002). Fitness for the pelvic floor: New York: Thieme.

This book highlights that, while it is common to exercise many parts of the body to stay fit, very little attention is paid to exercising the pelvic floor. The book provides treatment ideas and options, including pelvic floor muscle exercises.

Carrière, B., & Feldt, C. (Eds.). (2006). The pelvic floor: Stuttgart: New York: Thieme.

This book enhances the understanding of the structural and functional significance of the pelvic floor. It provides treatment suggestions and a multifactorial approach to the topic.

Davila, G., Ghoniem, G., & Wexner, S. (Eds.). (2006). Pelvic floor dysfunction: A multidisciplinary approach: Florida: Springer.

This book comprehensively examines aspects of evaluation and therapy of female pelvic floor dysfunction. It focuses on urinary incontinence and other voiding dysfunctions, including faecal incontinence and other distal gastroenterological problems, genital and rectal prolapse, and other recognized pelvic floor problems.

Dorey, G. (2006). Pelvic dysfunction in men. Diagnosis and treatment of male urinary incontinence and erectile dysfunction. A textbook for physiotherapists, nurses and doctors: John Wiley & Sons.

Aimed primarily at specialist continence physiotherapists, continence advisors and urology nurses, this textbook includes chapters covering the male pelvic floor, anatomy and physiology of the lower urinary tract, urinary incontinence, pelvic pain in men, conservative treatment, medication, faecal incontinence and male sexual dysfunction. It includes an extensive review of the literature up to 2005 on post-prostatectomy treatment and treatment of sexual dysfunction. The subjective and objective physiotherapy assessment is covered chronologically, to enable the clinician to conduct a meaningful investigation and arrive at a logical diagnosis.

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Dornan, P. (2003). Conquering incontinence: A new and physical approach to a freer lifestyle: Australia: Allen & Unwin.

This book takes a comprehensive approach to incontinence, and includes a thorough description of the structures of organs, muscle and tissue requiring retraining to overcome incontinence. The author uses professional practice background as a physiotherapist to develop an innovative physical program and series of exercises to improve bladder control. The author also offers useful encouragement and personal insights into broader issues of incontinence and erectile dysfunction.

Ghoniem, G., & Davila, G. (Eds.). (2006). Practical guide to female pelvic medicine: Florida: Informa Health Care. Chapter 1.

This book is a practical guide highlighting the varying forms of pelvic floor disorders. Included are chapters on the pathophysiology of the female pelvic floor, the evaluation and diagnosis of problems, the practical management of symptoms, and the complications that can arise from surgical and medical treatment.

Henry, M., & Swash, M. (1992). Coloproctology and the pelvic floor (2nd ed.): Butterworth-Heinemann Ltd: Oxford.

This is a classic textbook in the field of coloproctology that covers a range of topics from embryology to investigations to pelvic floor function. It is highly recommended for a more detailed study of the pelvic floor, especially with reference to rectal function.

Home and Community Care (HACC)/Medical Aids Subsidy Scheme (MASS) Project (2010). First steps in the management of urinary incontinence in community-dwelling older people: A clinical practice guideline for primary level clinicians (registered nurses and allied health professionals) (3rd ed.): Australia: Queensland Health. Section 11.5.5.2.

This clinical practice guideline is written for primary level nurses and allied health professionals to assist in the initial assessment and management of urinary incontinence, this is an essential reference for all clinicians working with people who have urinary incontinence. This evidence based clinical practice guideline is designed to inform health professionals about urinary incontinence.

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Home and Community Care (HACC)/Medical Aids Subsidy Scheme (MASS) Project. (2008). Second steps in the management of urinary incontinence in community-dwelling older people: A clinical practice guideline for clinicians with a special interest in incontinence (2nd ed.): Australia: Queensland Health. Sections 10 -12.

This clinical practice guideline is written for secondary level clinicians who have undergone post-graduate training in continence, or who have a special interest and experience in continence management. Section 10 provides evidence based information on pelvic floor muscle training, while section 12 covers adherence issues relating to pelvic floor muscle rehabilitation management.

Kenway, M., & Goh, J. (2009). Inside Out: The essential women’s guide to pelvic support: Brisbane Australia: Healthy Fit Solutions Pty Ltd.

This book by a Queensland based physiotherapist provides a guide for improving pelvic support, bladder control and staying active, and shows fitness exercises that will not damage the pelvic floor. It is available from www.pelvicfloorexercise.com.au

Laycock, J., & Haslam, J. (2007). Therapeutic management of incontinence and pelvic pain: Pelvic organ disorders: Springer. Chapter 8.

This book provides a practical clinical introduction to the assessment and conservative treatment of pelvic floor disorders in both men and women. It is primarily written for physiotherapists dealing with incontinence and pelvic floor disorders, but is a useful reference for all health professionals.

O’Dwyer, M. (2010). Hold It Sister: The Confident Girl’s Guide to a Leak Free Life: Australia: Redsok

This fully referenced book by a Queensland based physiotherapist covers pelvic floor topics for all life stages, including pregnancy, childbirth, activity, gym and sport, menopause, pelvic pain, prolapse and pelvic surgery. It is suitable for clinicians and their clients.

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Petros, P. (2004). The female pelvic floor: Function, dysfunction and management according to the integral theory: Australia: Springer.

This book examines the underlying theory of the function, dysfunction and management of the pelvic floor. Integral theory is an interrelated and dynamic anatomical framework for understanding pelvic floor function and dysfunction, which emphasises the role of the connective tissue of the vagina and supporting ligaments in both function and dysfunction.

Rashid, P., Doyle, A., & Hibbard, V. (2007). Bladder care: Your self help guide (2nd ed.): Australia: Uronorth Group. Pages 19 - 27, 104 - 106.

Designed to simplify the understanding and treatment of common bladder problems, this book contains a section on pelvic floor muscle strength and exercises.

Schussler, B., Laycock, J., Norton, P. & Stanton, S. (Eds.) (1994). Pelvic floor re-education: Principles and practice: London: Berlin: Springer. (3rd ed.). Chapter 4.

This book provides a detailed summary of the clinical assessment and management of pelvic floor disorders. Beginning with theories on the anatomy and possible causes of pelvic floor damage, the text describes the importance of evaluation before determining the type of treatment required.

Stephenson, R., & O’Connor, L. (2000). Obstetric and gynaecological care in physical therapy (2nd ed.): SLACK Incorporated. Chapters 2 - 4.

This book is written for physiotherapists and has topics on women’s health care in physiotherapy, anatomical considerations, maternal physiology, postpartum care, special pregnancies (including high risk and women with chronic illness and disabilities), evaluation and treatment of pelvic floor dysfunction, and the aging female’s needs.

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Education Resources

Continence Foundation of Australia (Victoria). (2008). Pelvic floor muscles: A consumer education resource for health professionals.

This resource kit includes a booklet, flipchart, manual with PowerPoint slides and a CD-ROM. The kit has been jointly developed by the CFA and the Australian Physiotherapy Association. The aim is to assist health professionals to educate the community about pelvic floor muscles and their role in bladder and bowel health. Order from the National Continence Helpline on 1800 33 00 66 or through www.continence.org.au

Continence Foundation (New Zealand). (2008). Understanding your pelvic floor

This DVD provides information for women, and discusses good bladder habits, types of incontinence, healthy bowel habits, pelvic floor in sexual function. Order through jan@continence.org.nz

Home and Community Care (HACC)/Medical Aids Subsidy Scheme (MASS) Continence Project. (2010). Pelvic floor muscle exercise instruction and best toileting position for optimal bowel function DVD

This DVD shows a specialist physiotherapist demonstrating positioning for pelvic floor muscle exercises with two older people. It also includes a section showing the best toilet position for bowel function. Running time: 25 minutes. Order through contpro@health.qld.gov.au

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Prostate Cancer Foundation of Australia (2009). Pelvic Floor Exercises for Men DVD

This DVD, presented by Associate Professor Pauline Chiarelli, provides insight into the location and structure of pelvic floor muscles, and demonstrates how to exercise them effectively. It aims to help men understand their pelvic floor muscles and to improve continence pre and post prostate cancer treatment. Included in the DVD is a visually explicit demonstration on how the penis and scrotum appear when the pelvic floor muscles are being exercised correctly. Order through www.prostate.org.au

Yates, L., & Ross, F. (2008). The core and the floor. Your complete post-pregnancy education and exercise programme DVD

Professionally designed by a women’s health physiotherapist, midwife and personal trainer, this comprehensive DVD comprises two parts; an evidence based, peer reviewed education component that provides information on the pelvic floor, abdominals, posture and back care (42 minutes) and an exercise section (52 minutes). Exercises using a fit-ball specifically target both core and pelvic muscle strength, and include pilates, tai chi and yoga principles. While originally designed for post-pregnancy, the low-impact beginner, intermediate and advanced home based exercise program messages may be appropriate for women of all ages. Order through www.filifit.com

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Assessment of Pelvic Floor Muscle Function

Bø, K., and Sherburn, M. (2005): Evaluation of female pelvic floor muscle function and strength. Physical Therapy 85 (3): 269-282.

Frawley, H. (2006). Pelvic floor muscle strength testing: commentary. Australian Journal of Physiotherapy, 52, 307.

Frawley, H.C., Galea, M.P., Phillips, B.A., et al. (2006). Reliability of pelvic floor muscle strength assessment using different test positions and tools. International Urogynecology Journal and Pelvic Floor Dysfunction17(4):365-371.

Lang, J., Brown, H., & Crombie, E. (2007). Assessment of the anal sphincter muscle: Comparison of a digital and a manometric technique. Physiotherapy, 93, 121-128.

Neumann, P., Blizzard, L., Grimmer, K., et al. (2004). Expanded paper towel test: an objective test of urine loss for stress incontinence. Neurourology and Urodynamics, 23, 649-655.

Peschers, U., Gingelmaier, A., Jundt, K., et al. (2001). Evaluation of pelvic floor muscle strength using four different techniques. International Urogynaecology Journal, 12, 27-30.

Thompson, J., O’Sullivan, P., Briffa, K., & Court, S. (2004). Transabdominal and transperineal ultrasound: a study of reliability and validity. Paper presented at the Proceedings of the joint ICS/IUGA meeting. To access this paper, go to www.icsoffice.org, click on ‘meetings and courses’, ‘ICS Annual Meetings’ then ‘ICS/IUGA 2004 (Paris)’ then ‘search’. Enter the surname of the first author in the box next to ‘abstract search’ and select the desired article.

Journal Articles

This journal article list, while not comprehensive, provides health professionals with a number of pertinent articles from peer-reviewed journals about pelvic floor muscle function and exercises. Readers are encouraged to source additional literature on this topic as required.

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Tunn, R., Paris, S., Fischer, W., et al. (1998). Static magnetic resonance imaging of the pelvic floor muscle morphology in women with stress urinary incontinence and pelvic prolapse. Neurourology and Urodynamics, 17(6), 579-589.

Whittaker, J., Thompson, J., Teyhen, D., et al. (2007). Rehabilitative ultrasound imaging of pelvic floor muscle function. Journal of Orthopaedic & Sports Physical Therapy, 37(8), 487- 498.

Effects of Pelvic Floor Muscle Training: Trials

Bø K, Fleten C., & Nystad, W. (2009). Effect of antenatal pelvic floor muscle training on labour and birth. Obstetrics and Gynecology,113 (6): 1279-1284.

Choi, H., Palmer, M., & Park, J. (2007). Meta-Analysis of pelvic floor muscle training: Randomized controlled trials in incontinent women. Nursing Research, 56(4), 226-234.

Diokno, A., Sampselle, C. M., Herzog, A., et al. (2004). Prevention of urinary incontinence by behavioural modification program: A randomized, controlled trial among older women in the community. The Journal of Urology, 171, 1165-1171.

Hay-Smith, E., & Dumoulin, C. (2006). Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews (Issue 1. Art. No.: CD005654. DOI: 10.1002/14651858.CD005654).

Herbison, P., Plevnik, S., & Mantle, J. (2002). Weighted vaginal cones for urinary incontinence. Cochrane Database of Systematic Reviews (Issue 1. Art. No.: CD002114. DOI: 10.1002/14651858.CD002114).

Norton CC, Cody JD, Hosker G. Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD002111. DOI: 10.1002/14651858.CD002111.pub2.

Stillman, B.& Chase, J. (2006). Strengthening of the pelvic floor muscles using transcutaneous magnetic nerve stimulation: A review of the literature. Australian and New Zealand Continence Journal, 12(4), 31-40.

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Effects of Pelvic Floor Muscle Training: Theory and Physiological Studies

Bø, K. (2004). Pelvic floor muscle training is effective in treatment of female stress urinary incontinence, but how does it work? International Urogynaecology Journal, 15, 76-84.

Bø, K., Kvarstein, B., & Nygaard, I. (2005). Lower urinary tract symptoms and pelvic floor muscle exercise adherence after 15 years.Obstetrics and Gynecology, 105(5), 999-1005.

Bump, R., Hurt, W., Fantl, J., et al. (1991). Assessment of Kegel pelvic muscle exercise performance after brief verbal instruction. American Journal of Obstetricians and Gynaecologists, 165(2) 322-329.

Grewar, H., & McLean, M. (2008). The integrated continence system: A manual therapy approach to the treatment of stress urinary incontinence. Manual Therapy, 13(5), 375-386.

Hulme, J. (2000). Research in geriatric urinary incontinence: Pelvic muscle force field. Topics in Geriatric Rehabilitation, 16(1), 10-21.

Kelly, M., Tan, B., Thompson, J., et al. (2007). Healthy adults can more easily elevate the pelvic floor in standing than in crook-lying: An experimental study. Australian Journal of Physiotherapy, 53, 187-191.

Miller, J.M., Sampselle, C., Ashton-Miller, J., (2008): Clarification and confirmation of the Knack maneuver: the effect of volitional pelvic floor muscle contraction to preempt expected stress incontinence. International Urogynecological Journal and Pelvic Floor Dysfunction, 19(6), 773-782.

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Interaction among Pelvic Floor Muscles, Abdominal Muscles and the Diaphragm

Bø K, Mørkved S, Frawley H, et al. (2009). Evidence for benefit of transversus abdominis training alone or in combination with pelvic floor muscle training to treat female urinary incontinence: a systematic review. Neurourology and Urodynamics Feb 3 [Epub ahead of print]

Bø, K & Borstad, E (2003). Urodynamic assessment during pelvic floor muscle and transversus abdominis contraction. Proceedings of the International Continence Society (ICS), 33rd Annual Meeting, Florence, 5-9 Oct, p 484-485.

Bø, K., Sherburn, M., & Allen, T. (2003). Transabdominal ultrasound measurement of pelvic floor muscle activity when activated directly or via a transversus abdominis muscle contraction. Neurourology and Urodynamics, 22(6), 582-588.

Bø, K., & Stein, R. (2003). Needle EMG registration of striated urethral wall and pelvic floor muscle activity when activated directly or via a transversus abdominus muscle contraction. Neurourology and Urodynamics, 22, 582-588.

Hodges, P.W., Sapsford, R., & Pengel, LHM. (2007). Postural and respiratory functions of the pelvic floor muscles. Neurourology and Urodynamics, 26, 362-371.

Neumann, P., & Gill, V. (2002). Pelvic floor and abdominal muscle interaction: EMG activity and intra-abdominal pressure. International Urogynaecology Journal, 13, 125-132.

Sapsford, R. (2004). Rehabilitation of pelvic floor muscles utilizing trunk stabilization. Manual Therapy, 9, 3-12.

Sapsford, R., & Hodges, P. (2001). Contraction of the pelvic floor muscles during abdominal maneuvers. Archives of Physical Medicine and Rehabilitation, 82, 1081-1089.

Sapsford, R., Hodges, P., Richardson, C., et al. (2001). Co-activation of the abdominal and pelvic floor muscles during voluntary exercises. Neurourology and Urodynamics, 20, 31-42.

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Sapsford, R., Richardson, CA., Maher, CF., et al. (2008). Pelvic floor muscle activity in different sitting postures in continent and incontinent women. Archives of Physical Medicine and Rehabilitation, 89, 1741-1747.

Sapsford, R., Richardson, C., & Stanton, W. (2006). Sitting posture affects pelvic floor muscle activity in parous women: An observational study. Australian Journal of Physiotherapy, 52, 219-222.

Pelvic Floor Disorders: Background

Ashton-Miller JA. & DeLancey, JO. (2007). Functional anatomy of the female pelvic floor. Annals of the New York Academy of Science 1101, 266-296.

DeLancey, J., & Ashton-Miller, J. (2004). Pathophysiology of adult urinary incontinence. Gastroenterology, 126, S23-S32.

DeLancey, JO., Kane Low, L., Miller, JM., et al. (2008). Graphic integration of causal factors of pelvic floor disorders: An integrated life span model. American Journal of Obstetrics and Gynecology 199(6), 610. e1-5.

Dietz, H. (2006). Pelvic floor trauma following vaginal delivery. Current Opinion in Obstetrics and Gynecology, 18(5), 528-537.

Dillon, L., & Fonda, D. (2000). Medical evaluation of causes of lower urinary tract symptoms and urinary incontinence in older people. Topics in Geriatric Rehabilitation, 15(4), 1-15.

Lee, D. & Lee, L. (2004). Stress urinary incontinence: A consequence of failed load transfer through the pelvis? Paper presented at the 5th Interdisciplinary World Congress on Low Back and Pelvic Pain.

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Pelvic Floor Function in Back and Pelvic Pain

Avery, A., O’Sullivan, P., & MacCallum, M. (2000). Evidence of pelvic floor muscle dysfunction in subjects with chronic sacro-iliac joint pain syndrome. Proceedings of the 7th scientific conference of the international federation of manual therapists.: International Federation of Manual Therapists.

Eliasson, K., Elfving, B., Nordgren, B., et al. (2007). Urinary incontinence in women with low back pain. Manual Therapy, 13(3), 206-212.

O’Sullivan, P., Beales, D., Beetham, et al. (2002). Altered motor control strategies in subjects with sacroiliac joint pain during the active straight-leg-raise test. Spine, 27(1), 1-8.

Stuge, B., Morkved, S., Haug Dahl, H., et al. (2006). Abdominal and pelvic floor muscle function in women with and without long lasting pelvic girdle pain. Manual Therapy, 11(4), 287-296.

Pelvic Floor Function in Sexual Dysfunction

Rosenbaum, T. (2007). Pelvic floor involvement in male and female sexual dysfunction and the role of pelvic floor rehabilitation in treatment: A literature review. Journal of Sexual Medicine, 4, 4 -13.

Pelvic Floor Muscles and Erectile Dysfunction

Dorey, G. (2000). Conservative treatment of erectile dysfunction 1: anatomy/physiology. British Journal of Nursing, 9(11), 691-694.

Dorey, G. (2000). Conservative treatment of erectile dysfunction 2: clinical trials. British Journal of Nursing, 9(12), 755-762.

Dorey, G. (2000). Conservative treatment of erectile dysfunction 3: literature review. British Journal of Nursing, 9(13), 859-863.

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Dorey, G. (2003). Pelvic floor muscle exercises for men. Nursing Times, 99(19), 46-48.

Dorey, G. (2004). Pelvic floor exercises as a treatment for men with erectile dysfunction. Nursing Times Supplement, 100(12), 65-67.

Dorey, G., Speakman, M., Feneley, R., et al. (2004). Pelvic floor exercises for treating post-micturition dribble in men with erectile dysfunction. Urological Nursing 24(6): 490-497.

Hunter KF, Moore KN, Glazener CMA. Conservative management for postprostatectomy urinary incontinence. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD001843. DOI: 10.1002/14651858.CD001843.pub3

Pelvic Floor Muscle Dysfunction in Incontinence and Prolapse (including Levator Avulsion)

Abdool, Z., Shek, K.L., & Dietz, H.P. (2009). The effect of levator avulsion on hiatal dimension and function. American Journal of Obstetrics and Gynecology May 7 [Epub ahead of print].

Devreese, A., Staes, F., Janssens, L., et al. (2004). Incontinent women have altered pelvic floor muscle contraction patterns. The Journal of Urology, 178, 558-562.

Devreese, A., Staes, F., Janssens, L., et al. (2007). Clinical evaluation of pelvic floor muscle function in continent and incontinent women. Neurourology and Urodynamics 23, 190-197.

Dietz, H.P., Kirby, A., Shek, K.L., et al. (2009). Does avulsion of the puborectalis muscle affect bladder function? International Urogynecology Journal and Pelvic Floor Dysfunction Apr 28 [Epub ahead of print]

Smith, M., Coppieters, M., & Hodges, P. (2006). Postural activity of the pelvic floor muscles is delayed during rapid arm movements in women with stress urinary incontinence. International Urogynaecology Journal, 18, 901-911.

Smith, M., Coppieters, M., & Hodges, P. (2007). Postural response of the pelvic floor and abdominal muscles in women with and without incontinence. Neurourology and Urodynamics, 26, 377-385.

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Thompson, J., & O’Sullivan, P. (2003). Levator plate movement during voluntary pelvic floor muscle contraction in subjects with incontinence and prolapse: A cross-sectional study and review. International Urogynaecology Journal, 14, 84-88.

Thompson, J., O’Sullivan, P., Briffa, K., et al. (2004). Assessment of pelvic floor muscle exercises in women with incontinence and normal controls. Paper presented at the Proceedings of the Joint ICS/IUGA meeting. To access this paper, go to www.icsoffice.org, click on ‘meetings and courses’, ‘ICS Annual Meetings’ then ‘ICS/IUGA 2004 (Paris)’ then ‘search’. Enter the surname of the first author in the box next to ‘abstract search’ and select the desired article.

Thompson, J., O’Sullivan, P., Briffa, K., et al. (2004). Motor control strategies involved in pelvic floor elevation and depression: Poster presented at Proceedings of the Joint ICS/IUGA meeting. To access this paper, go to www.icsoffice.org, click on ‘meetings and courses’, ‘ICS Annual Meetings’ then ‘ICS/IUGA 2004 (Paris)’ then ‘search’. Enter the surname of the first author in the box next to ‘abstract search’ and select the desired article.

Thompson, J., O’Sullivan, P., Briffa, K., et al. (2005). Altered muscle activation patterns in symptomatic women during pelvic floor muscle contraction and valsalva manoeuvre. Neurourology and Urodynamics, 24(5/6), 517-518.

Thompson, J., O’Sullivan, P., Briffa, N., et al. (2006). Assessment of voluntary pelvic floor muscle contraction in continent and incontinent women using transperineal ultrasound, manual muscle testing and vaginal squeeze pressure measurements. International Urogynaecology Journal, 17, 624-630.

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Pelvic Floor Muscles in Association with Other Muscle Contraction and Functional Activities

Bø, K., & Stein, R. (1994). Needle EMG registration of striated urethral wall and pelvic floor muscle activity patterns during cough, valsalva, abdominal, hip adductor, and gluteal muscle contractions in nulliparous healthy females. Neurourology and Urodynamics, 13, 35-41.

Ree, ML., Nygaard I., & Bo K. (2007). Muscular fatigue in the pelvic floor muscles after strenuous physical activity. Acta Obstetricia et Gynecologica Scandinavica, 86(7), 870-876.

The Normal Pelvic Floor: MRI Studies

Bø, K., Lilleas, F., Talseth, T., et al. (2001). Dynamic MRI of the pelvic floor muscles in an upright sitting position. Neurourology and Urodynamics, 20, 167-174.

Christensen, L., Djurhuus, J., & Constantinou, C. (1995). Imaging of pelvic floor contractions using MRI. Neurourology and Urodynamics, 14, 209-216.

Mikuma, N., Tamagawa, M., Morita, K., et al. (1998). Magnetic resonance imaging of the male pelvic floor: The anatomical configuration and dynamic movement in healthy men. Neurourology and Urodynamics, 17, 591-597.