1. Women’s Health Kate Brocklehurst 17/07/2013

2. 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

3. 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

4. Female Uroanatomy

5. The Bladder

6. The Pelvic floor

9. PF and Bladder

10. How it all works

11. To be Dry you need…

12. Storage and Emptying Phase 99.999999999% 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

13. What goes wrong?

14. The Bladder neck must be: HIGH and DRY

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

16. 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)

17. Outcome measures Bladder Diary Queensland female pelvic floor questionnaire Subjective improvement

18. 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

19. 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)

20. 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),