Women’s Health Kate Brocklehurst 17/07/2013

What we will cover What we’ve got and how it works What goes wrong? Terminology Women’s health assessment Outcome measures When to refer? Research

Female and Male anatomy A closer look at – The bladder/Urethra – The pelvic floor – Bladder and the pelvic floor How it all works – Sensation – Holding on – Emptying

Female Uroanatomy

The Bladder

The Pelvic floor

PF and Bladder

How it all works

To be Dry you need…

Storage and Emptying Phase % of the time we spend holding on. 1.Bladder filling 2.First sensation to void 3.Feel the need to go/emptying 4.Bladder filling

What goes wrong?

The Bladder neck must be: HIGH and DRY

Terminology Stress incontinence Over active bladder (dry) Over active bladder (wet) Overflow incontinence Mixed incontinence Functional incontinence

Women’s Health Assessment Subjective Bladder diary (min 3 days…) Queensland continence questionnaire Objective: – Palpation colon, internal – PF lift, lift with cough, max hold, (Exercise program based on findings in internal) RTUS – PF and TrA. Treatment (based on findings)

Outcome measures Bladder Diary Queensland female pelvic floor questionnaire Subjective improvement

When to refer? We can treat: pelvic organ prolapse vaginismis vulvodynia urinary incontinence (stress incontinence and overactive bladder/detrusor instability) faecal incontinence pelvic floor hypertonicity/weakness

Research Objective: To compare the effect of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment for genuine stress incontinence. Design: Stratified, single blind, randomised controlled trial. Interventions: – Pelvic floor exercise – Electrical stimulation – Vaginal cones – Control Conclusion: Training of the pelvic floor muscles is superior to electrical stimulation and vaginal cones in the treatment of genuine stress incontinence. (Bo, Telseth & Holme, 1999)

Research cont… Aim: To compare the effectiveness of pelvic floor exercises, electrical stimulation, vaginal cones and no active treatment in women with stress urinary incontinence. Design: Single-blind, randomized, controlled trial Findings: No significant difference was found between groups in the urodynamic parameters. In the subjective evaluation 58%, 55% and 54% of women who had used pelvic floor exercises, electrical stimulation and vaginal cones, respectively reported being satisfied after treatment. Conclusion: PF exercises, electrical stim and vaginal cones are equally effective treatments and are far superior to no treatment in women with stress urinary incontinence. (Castro et al. 2008),