The Pelvic Floor E-Book

Beate Carrière

• Herausgeber: Thieme
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 1272

Veröffentlichungsjahr: 2006

Beschreibung

The remarkably complex pelvic floor and its disorders comprise one of the most interesting -- and challenging -- areas of physical therapy. And recently, common problems once considered taboo, such as incontinence, have become mainstream issues. More than ever before, a solid understanding of the structure and function of the manifold problems of the pelvic floor is vital to successful treatment. This groundbreaking work brings together an international team of world-renowned experts in the treatment of urinary and fecal incontinence, as well as sexual dysfunction, to provide a comprehensive guide to the structure and function of the muscles of the pelvic floor. Using concise text and clear illustrations and helpful photographs, the authors present all phenomena associated with pelvic floor dysfunction. The authors begin with a detailed overview of the anatomy and physiology of the pelvic floor, and then discuss all state-of-the-art diagnostic and treatment strategies, from biofeedback and manual therapy to the causes of different types of pain and psychosocial problems. Detailed discussions of the specific issues associated with children, women, and men, as well as with rectal and anal dysfunction, follow. With its thorough coverage, this highly practical text is essential reading for all health care professionals who wish to provide their patients suffering from disorders of the pelvic floor with the best care available.

Leseprobe

Library of Congress Cataloging-in-Publication Data is available from the publisher.

This book is an authorized and revised translation of the German edition published and copyrighted 2003 by Georg Thieme Verlag, Stuttgart, Germany. Title of the German edition: Beckenboden

Translator: Oliver French, M.D., Brooktondal, N.Y., U.S.A.

Illustrator: Helmut Holtermann, Dannenberg, Germany

© 2006 Georg Thieme Verlag

Rüdigerstrasse 14, 70469 Stuttgart, Germany

http://www.thieme.de

Thieme New York, 333 Seventh Avenue, New York,

NY 10001 USA

http://www.thieme.com

Typesetting by Hagedorn Kommunikation, Viernheim Printed in Germany by Gotz, Ludwigsburg

ISBN 3-13-139211-8 (GTV)

ISBN 1-58890-325-7 (TNY)

12 3 4 5 6

Important note: Medicine is an ever-changing science undergoing continual development. Research and clinical experience are continually expanding our knowledge, in particular our knowledge of proper treatment and drug therapy. Insofar as this book mentions any dosage or application, readers may rest assured that the authors, editors, and publishers have made every effort to ensure that such references are in accordance with the state of knowledge at the time of production of the book.

Nevertheless, this does not involve, imply, or express any guarantee or responsibility on the part of the publishers in respect to any dosage instructions and forms of applications stated in the book. Every user is requested to examine carefully the manufacturers' leaflets accompanying each drug and to check, if necessary in consultation with a physician or specialist, whether the dosage schedules mentioned therein or the contraindications stated by the manufacturers differ from the statements made in the present book. Such examination is particularly important with drugs that are either rarely used or have been newly released on the market. Every dosage schedule or every form of application used is entirely at the user's own risk and responsibility. The authors and publishers request every user to report to the publishers any discrepancies or inaccuracies noticed. If errors in this work are found after publication, errata will be posted at www.thieme.com on the product description page.

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This book, including all parts thereof, is legally protected by copyright. Any use, exploitation, or commercialization outside the narrow limits set by copyright legislation, without the publisher's consent, is illegal and liable to prosecution. This applies in particular to photostat reproduction, copying, mimeographing, preparation of microfilms, and electronic data processing and storage.

List of Contributors

Kari Bø, Ph. D., P. T. Professor Norwegian University of Sport and Physical Education Oslo, Norway

Claudia Brown, B. Sc, P.T. Physiotherapist Physiotherapy Polyclinique Ste Zotique Montreal, Quebec, Canada

Beate Carrière, P.T., C. I. F. K., C. L.T. Physical Therapist Hollywood Physical Associates Hollywood California, U.S.A.

Pauline Chiarelli, Senior Lecturer, Discipline of Physiotherapy School of Health Sciences University of Newcastle Callaghan New South Wales, Australia

Grace Dorey, Ph. D., M.Sc, F. C. S. P. Professor Consultant Physiotherapist The Somerset Nuffield Hospital Taunton, Somerset Visiting Professor University of the West of England Bristol, U. K.

Cynthia Markel Feldt, M. T. P., A. T. C. Physical Therapist and Owner Rehab Initiatives Jacksonville Florida, U.S.A

Jane Drooker Frahm, B.S., P.T. Coordinator, Women's Rehabilitation Services Rehabilitation Institute of Michigan Detroit, U.S.A.

Helga Fritsch, M. D. Professor of Anatomy Head of the Department of Anatomy, Histology and Embryology Head of the Division Clinical and Functional Anatomy Medical University of Innsbruck Innsbruck, Austria

Barbara Goedl-Purrer, Dip. T. P., C. I. F. K. Physiotherapist Graz, Austria

Angela Heller, P. T. Physiotherapist and Training Instructor Mannheim, Germany

Ulla Henscher, P. T. Physiotherapist and Training Instructor Hannover, Germany

Paul W. Hodges, Ph.D., Med.Dr., B.Phty.??? Professor and N.H.M.R.C. Principal Research Fellow The University of Queensland Division of Physiotherapy Brisbane, Australia

Elizabeth Ann Holey, M. A., M. C. S. P., Cert. Ed., Dip. TP. Chartered Physiotherapist Deputy Dean School of Health and Social Care University of Teesside Tees Valley, U. K.

Randall S. Kusunose, P. T., O. C. S., J. S. C. C.I. Director of the Jones Institute Carlsbad California, U. S. A.

Rik H.W. van Lunsen, M.D., Ph. D. Head Department of Sexology and Psychosomatic Divison of Obstetrics and Gynecology Academic Medical Centre University of Amsterdam Amsterdam, The NetherlandsVeronika Ospelt Physiotherapist Vaduz, Liechtenstein

Mieke Raadgers, P. T., M. H. S. Center for Physical Therapy Westerpark Coordinator Pelvic Floor Training Amsterdam, The Netherlands

Marjo J. Ramakers, M.D. Sexologist CenSeRe, Center of Sexual and Relational Health Voorschoten Erasmus MC University Medical Center Department of Obstetrics and Gynecology Rotterdam, The Netherlands

Carmen-Manuela Rock, M.A., Cand. M. P. T. Sc., P. T. Independent Physiotherapist Zurich, Switzerland

Mary Klemer Rosenberg, P. T., C. L. T.-L. A. N. A. Hollywood Physical Therapy Associates Hollywood California, U. S. A.

Theresa Monaco Spitznagle, P.T., M.H.S. Instructor Program in Physical Therapy Washington University School of Medicine St. Louis Missouri, U. S.A.

Darcy Umphred, Ph. D., P. T., F. A. P.T. A. Professor and Head Department of Physiotherapy University of the Pacific Stockton California, U. S. A.

Myriam Vleminckx, D.O. Master in Motor Revalidation and Physiotherapy Master in Physical Education Sint-Genesius-Rode, Belgium

A.T.C.

Certified Athletic Trainer

C. I. F. K.

Certified Instructor Functional Kinetics

C.L.T.–L.A. N.A.

Certified Lymphedema Therapist – Lymphedema Association of North America

Dip. TP.

Diploma in Therapeutics

D.O.

Diploma in Osteopathy

M.H.S.

Master of Health Science

F. A.P. T.A.

Fellow American Physical Therapy Association

F.C.S.P.

Fellow of Chartered Society of Physiotherapy

J. S. C. C. I.

Jones Strain Counterstrain Certified Instructor

M.P.T.

Master of Physiotherapy

Foreword

The functional significance of the pelvic floor is often underestimated or misunderstood. A malfunctioning pelvic floor can cause various types of urinary and fecal incontinence, as well as sexual dysfunction, often leading to considerable social difficulties for those affected. This book successfully undertakes a multispecialty description of the structure and functions of the pelvic floor. It establishes pathophysiological interconnections and details diagnostic measures, particularly in the field of physiotherapy. The task facing the editor was to present as far as possible all of the phenomena associated with pelvic floor dysfunction, ranging from anatomy through the causes of pain to psychosocial problems—a task requiring a highly specialized team of authors. The editor has not only been able to gather together an internationally renowned team of this type, covering many specialties, but has also arranged the chapters in such a way that the information and critical clarifying illustrations run side by side as a clear thread leading through the whole work.

Genuinely relevant physiotherapeutic and physical procedures are described in detail and applied to problems peculiar to children, women, and men. The book provides a cornucopia of treatment suggestions on ways of dealing with obscure pain syndromes that often frustrate physicians' efforts. It includes comprehensive data that are useful not only to physiotherapists but also to physicians in a variety of specialties, and it addresses an area that often seems clouded by a haze of diagnostic and therapeutic obscurity.

No other books of this type are currently available in English. After reading just a few pages, it will be evident to any reader that this was a gap that needed to be filled. I feel certain that the book will be widely read in many specialties. It enhances our understanding of the functional significance of the pelvic floor and is sure to contribute to improved treatment of patients with conditions affecting this part of the body.

Professor Manfred Stbhrer, M. D., Ph. D.

It is indeed a great pleasure for me to have been asked to write a foreword for Beate Carrière's new book, The Pelvic Floor, which must now stand as the current definitive treatise on this subject. Nearly 15 years ago, when John DeLancey and I wrote our paper “The politics of prolapse: a revisionist approach to disorders of the pelvic floor in women,”* the idea that the pelvic floor could be considered a unique bodily organ system in its own right, worthy of sustained investigation and specialist treatment, seemed like a bizarre idea to many readers. Today, as this volume ably attests, this is an idea whose time has come. No longer constrained by the “blinders” of their individual specialties, many gynecologists, obstetricians, urologists, and colorectal surgeons are discovering that pathological processes (both intrinsic diseases as well as “functional” disorders) cross traditional specialty boundaries and require collaborative efforts among many different practitioners in order to produce the best outcome for patients. The muscles and fascia of the pelvic floor, along with their myriad (and as yet, poorly understood) neurological interconnections, form the common bond which links together all of the specialties whose clinical domain includes the pelvic floor. As practical specialists in disorders of muscular function, physical therapists have a unique and important role to play in helping each of the traditional “organ bound” medical specialties advance the welfare of their patients and in finding new and previously unsuspected interconnections among disorders of the lower urinary tract, the genital system, and the ano-rectum. All three of these pelvic compartments ultimately rest on the pelvic floor, and I am proud to acknowledge the community of physical therapists as valued partners in the quest for better outcomes in the care of patients with disorders in this area.

Those who remain skeptical of this stance would do well to read this book, which covers the current state of our knowledge of the muscular structures of the pelvic floor and their contributions to pelvic health and illness in both breadth and depth. From basic anatomy and physiology to pain and posture; through psychosocial influences on pelvic floor function; to specific treatment techniques for women, men, and children; from antenatal preparation for childbirth through labor and delivery and the post-partum state; with regard to pelvic organ prolapse and urinary, sexual, and anorectal dysfunction; this book forms a comprehensive treatise that can be consulted with profit by any and all of those whose scope of practice involves patients with pelvic disorders. More than anything else, however, I am proud to recognize the support that this book offers to a belief that I have held throughout my career, namely: if you want to be a better doctor, if you want to be a better surgeon, if you want to improve your patients' outcomes and their satisfaction with their treatment: work with a physical therapist!

L. Lewis Wall, M. D., D.Phil

______________________________

* Wall LL, Delancey JOL. The politics of prolapse: a revisionist approach to disorders of the pelvic floor in women. Perspectives in Biology and Medicine 1991; 34:486–496.

Preface

“Therapy is always something more than treatment. It begins where treatment ends.” It was this statement by my medical teacher, Ilse Schuh, that encouraged me to put together a book that would be able to serve as a basis for therapy.

In the present volume, an internationally recognized team of physicians and therapists throw light on the dark recesses of the pelvic floor, helping us understand and grasp the many connections and interfaces between the systems in the human body and helping develop a comprehensive therapy for the pelvic floor.

For a disturbance to be removed permanently, its cause has to be investigated. To do this, the therapist and physician need to be sensitive to any defect in the functioning of the various systems of the body. Does the patient need connective-tissue massage, therapeutic exercises, electrotherapy, manual visceral therapy, or treatment for trigger points?

Specific syndromes are deliberately not described systematically in this book. They appear as examples in the various chapters.

Readers should realize that in order to provide therapy, they need to acquire extensive knowledge and expertise in courses given by recognized experts. This book is designed to stimulate attendance at further education and training courses in order to extend the reader's knowledge and expertise. It should not be assumed that one can apply the methods of treatment described here simply because they appear in this book. Each country has different laws that prohibit or authorize therapists to carry out certain procedures with or without medical supervision, and readers will have to observe the locally applicable laws and refer patients to the relevant specialist when appropriate.

Whenever possible, treatment should be based on available evidence. However, this requirement should not limit treatment. Clinical evidence showing measurable treatment success is particularly important when the therapist is traveling down his or her own path in the absence of relevant studies, hopefully arriving at the desired goal. Obviously, this approach requires thorough documentation. Successes in these instances serve as case studies that should stimulate scientists to confirm and illuminate the results through scientific research.

The aim of this book is to expand awareness of international scholarship and research on the topic, which in many cases may lead to therapies that can restore dignity to patients with pelvic floor disorders.

I would like to dedicate the book as a sign of respect and admiration to my teacher, Ilse Schuh, a perfect example of the type of teacher who encourages us to think for ourselves.

Writing a book requires idealism and implies the hope that the experiences recorded will be able to help others. It would be much easier to keep one's knowledge and expertise to oneself! A writer needs support from an understanding family, as well as discipline, hard work, and a willingness to sacrifice leisure time. I am particularly indebted to all of the authors who contributed to this book, and also to their families. Their collaboration has been a tremendously enriching experience for me. I am especially grateful to Cynthia Feldt, my co-author, for her valuable help in reviewing the manuscripts.

Many people are involved in the production of a book at a publishing house. I am grateful to everyone involved, and special thanks go to Cliff Bergman for his vision in publishing the book in English, Gabriele Kuhn for her helpful cooperation, and finally Oliver French for his careful translation of the German text.

Beate Carrière

Contents

1 Basics

1.1 Anatomy and Physiology of the Pelvic Floor         Helga FritschOverviewThe Bony PelvisMuscles of the Pelvic FloorMuscles Below and External to the Pelvic FloorPelvic OrgansPelvic Connective TissueInnervation Systems Related to the Pelvic FloorInteractions of the Functional Systems Related to the Pelvic FloorAging of Pelvic Floor MusclesAcknowledgment1.2 The Nervous System and Motor Learning         Darcy UmphredIntroductionMotor Control and Motor LearningNeuroplasticityConclusion1.3 Musculoskeletal Chronic Pelvic Pain          Theresa M. SpitznagleIntroductionMovement Diagnosis in Chronic Pelvic PainMovement ExaminationElements of the Kinesiopathological ModelConclusion1.4 Interdependence of Posture and the Pelvic Floor         Beate CarrièrePossible Posture Conditions Affecting the Pelvic FloorPossible Conditions in the Pelvic Region Affecting PosturePossible Conditions Affecting Posture and the Pelvic FloorIdeal Standing PostureEvaluation and Restoration of Posture1.5 Low Back Pain and the Pelvic Floor          Paul W. HodgesIntroductionContribution of the Pelvic Floor Muscles to Lumbopelvic ControlContribution of the Pelvic Floor Muscles to Control of the Lumbar SpineContribution of the Pelvic Floor Muscles to Control of the PelvisCoordination of the Multiple Functions of the Trunk MusclesTrunk Muscle Function and Low Back and Pelvic PainImplications for Rehabilitation of Back Pain and Pelvic Floor Muscle DysfunctionConclusion1.6 Reflex Incontinence Caused by Underlying Functional Disorders         Carmen-Manuela RockReflex IncontinenceUpright PostureAction of the Pelvic Floor Muscles in Prone Position During BreathingGeneration of Strength by PositioningFlexed PostureSitting Posture Specific to IncontinenceSubjective Perception of Strength in the Pelvic Floor MusclesDevelopment of Strength in the Pelvic Floor Muscles and Symptomatic Incontinence1.7 Psychosocial Influences         Marjo J. Ramakers, Rik H.W. van LunsenIntroductionChronic PainThe Pelvic Floor as a Sexual OrganThe Hyperactive Pelvic Floor SyndromeSexual and Physical Abuse1.8 Evidence-Based Physical Therapy for Stress and Urge Incontinence         Kari BøWhat Does “Evidence-Based” Mean?Physical Therapy and Urinary IncontinenceEffect of Physical Therapy for Stress and Urge IncontinenceConclusion

2 Treatment Techniques

2.1 Manual Physiotherapy Techniques for Pelvic Floor Disorders         Claudia BrownFacilitationMobilizationStrengtheningNormalization of TonePain ModificationCombining Techniques2.2  Strain and Counterstrain for Pelvic Pain         Randall S. KusunoseIntroductionHistoryEvaluation with Tender PointsTechniquesPiriformis (PIR)Gluteus Medius (GM)Obturator Internus (OI)Levator Ani (LA)Quadratus Lumborum (QL)Posterior First Sacral (PS1)Posterior Second Sacral (PS2) and Posterior Third Sacral (PS3)Posterior Fourth Sacral (PS4)Posterior Fifth Sacral (PS5)Coccyx (CYX)2.3 Connective-Tissue Manipulations         Elizabeth A. HoleyBasicsAssessmentConnective-Tissue Reflex ZonesTechniqueIndicationsPrinciplesProgression of TreatmentPhysiological Basis of CTM2.4 Physical TherapiesElectrotherapyJane D. FrahmBiofeedback and ElectromyographyJane D. FrahmHeat Application: the Hot RollBeate Carrière2.5 Visceral Mobilization         Myriam VleminckxGeneral Guidelines for Manipulation of the Pelvic VisceraManipulation of the BladderManipulation of the ProstateManipulation of the UterusManipulation of the RectumConclusions2.6 Training and Functional Exercises for the Muscles of the Pelvic Floor         Barbara Gbdl-PurrerFunctional Significance of the Pelvic Floor MusculatureMuscle Training—Therapeutic Exercise2.7 Diagnosis, Evaluation, and Treatment of Reflex Incontinence         Carmen-Manuela RockDiagnosis and EvaluationTreatment2.8 Therapy for Lymphedema         Mary K. RosenbergDefinition of LymphedemaPrimary versus Secondary LymphedemaSecondary Causes and Contributing FactorsMechanisms for DysfunctionPsychosocial ImpactManual Lymph Drainage and Complete Decongestive Therapy

3 Pediatric Therapy

      Cynthia M. Feldt

Incidence of EnuresisIncidence of EncopresisClassification of EnuresisClassification of EncopresisNormal Continence DevelopmentEtiology of EnuresisEtiology of EncopresisSubjective ExaminationPhysical ExaminationDiagnostic Urological StudiesDiagnostic Gastrointestinal TestsMedical Interventions for EnuresisMedical Interventions for EncopresisTherapeutic InterventionsSummary

4 Therapy for Women

4.1 Swinging and Sliding—Back-to-Nature Labor: a Safer Method for Mother and Child         Angela HellerPrenatal Care: Preventive Care for the Pelvic Floor During LaborBreathing during the First Stage of LaborBreathing during the Transition Phase and the “Swinging” Respiratory Aid“Sliding” and Breathing during the Expulsion Stage4.2 Storage and Emptying Disorders of the Bladder         Ulla HenscherAnatomy and Physiology of the Lower Urinary TractDisorders of Storage and VoidingTreatment4.3 Prolapse         Veronika OspeltIntroductionTerminologyClassificationCauses of ProlapseSymptoms of Genital ProlapseBasic Principles of Physiotherapeutic ProceduresProcedure for Physical ExaminationTreatment PlanSupportive Measure: Pessary TreatmentOutcome MeasurementFinal Remarks4.4 Treatment of Sexual and Pelvic Floor Dysfunctions         Mieke Raadgers, Marjo J. Ramakers, Rik H.W. van LunsenIntroductionVulvar Vestibulitis SyndromeVaginismusHyperactive Pelvic Floor SyndromeTreatment of Women with Pelvic Floor Dysfunction and Sexual Dysfunction by a Specialist Physiotherapist

5 Therapy for Men

Grace Dorey

Male Pelvic Floor FunctionProstate ConditionsMale IncontinenceAssessment of Male IncontinenceIntervention for Male IncontinencePelvic PainErectile DysfunctionConclusions

6 Treatment for Rectal and Anal Disorders

6.1 Anal Dysfunction after Delivery         Pauline ChiarelliIntroductionThe Prevalence of Anorectal SymptomsPelvic Floor Trauma and ChildbirthObstetric Risk Factors for Anorectal DysfunctionSymptoms of Anorectal DysfunctionOther Causes of Fecal IncontinenceSummary6.2 Physiotherapy for Anorectal Disorders         Claudia BrownBasic Anatomy and Normal FunctionNormal Mechanisms of Continence and Stool EvacuationAnorectal DisordersRelated PathologiesSpecialized TestsPhysiotherapy EvaluationPhysiotherapeutic ApproachTreatment

Index