Table Of ContentTherapeutic Management of Incontinence and Pelvic Pain
J. Haslam and J. Laycock (Eds)
Therapeutic
Management
of Incontinence
and Pelvic Pain
Pelvic Organ Disorders
2nd Edition
J. Haslam, MPhil, MCSP J. Laycock, OBE, PhD, FCSP
Visiting Lecturer The Culgaith Clinic
Division of Rehabilitation Studies Penrith
School of Health Studies UK
University of Bradford
Bradford
UK
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Control Number: 2007920486
ISBN 978-1-84628-661-2 2nd edition e-ISBN 978-1-84628-756-5 2nd edition
ISBN 1-85233-224-2 1st edition
Printed on acid-free paper
© Springer-Verlag London Limited 2008
First published 2002
Second edition 2008
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This book is dedicated to our husbands,Bob and David,for their continued
love and support,and to our children who never fail to amaze us with
their achievements.
J. Haslam and J. Laycock
Editors
Foreword to the Ist Edition
As medical knowledge advances we tend to compartmentalise our specialties into
smaller units; but, hand in hand with this, there is a growing understanding between
the different disciplines within the caring professions. Thus we are able to share our
special skills to the benefit of patients. This book is an excellent example of the advan-
tage of interdisciplinary communication and demonstrates a refreshing holistic
approach to the problems of incontinence and pelvic pain. Written with physiothera-
pists in mind, the editors have invited contributions from many distinguished experts
in their own field. These have been compiled into a comprehensive book, which will
appeal to many healthcare professionals.
I have had great pleasure in reading this book. During the time that I have been
involved with ‘pelvic dysfunction’ there have been many exciting advances. These
are all included in a most readable sequence, some presented with a refreshing new
twist. In particular, I would like to bring to your attention the section on ‘pelvic pain’.
Because of our lack of understanding it has been a problem that is too often ignored
and here at last are some practical ideas for therapeutic management.
There is still much progress to be made in the field of incontinence and pelvic pain
and as yet, no editors can be expected to produce a definitive work. However, I would
like to recommend this book most strongly. It has a new approach to this topic, which
is still a major problem for many people.
Angela Shepherd,MD,FRCOG,MCSP
Southmead Hospital, Bristol
vii
Foreword to the 2nd Edition
It has been a pleasure to follow the development of the second edition of ‘Therapeutic
Management of Incontinence and Pelvic Pain’. This builds on the success and popular-
ity of the first with updates and new sections on all aspects of pelvic floor dysfunction,
including pelvic organ prolapse and faecal incontinence. It is most pleasing that the
emphasis remains with therapy and evidence-based recommendations.
The Editors’ extensive knowledge and experience in pelvic floor muscle training
through exercise physiology and research has resulted in many organisations, including
the National Institute for Clinical Excellence (NICE) in England, and the International
Consultation on Incontinence, recommending pelvic floor muscle training as first line
therapy, as well as prevention of urinary incontinence
This and other conservative measures can produce good outcomes and the new chap-
ters on training techniques plus recommendations for future research such as improving
compliance are welcome.
Where these treatments are unsuccessful surgery is an option and this too is
included, further enhancing the quality of the book.
Children’s problems, bowel disorders, pelvic pain, quality of life and ethical issues
are often forgotten aspects of pelvic floor dysfunction and will be of great help to those
new to this ‘disease area’ as well as experienced clinicians.
The Editors emphasise the importance of collaboration within a multi-disciplinary team
and it is particularly pleasing to see a chapter on the role of the occupational therapist. As
clinicians committed to the management of patients with pelvic floor dysfunction this col-
laboration can only improve our understanding of the conditions and our treatments.
We are indebted to the Editors for gathering such a wide range of international
experts to write about so many relevant and important aspects of the pelvic floor and
making this such a valuable reference; it is a ‘must’ for the library!
The first edition has been extremely popular and I have no doubt the second will
continue to help clinicians in their everyday practice providing further benefit for
patients with these distressing conditions.
Bob Freeman
Robert M Freeman MD FRCOG
Consultant Gynaecologist and Obstetrician
and Hon. Reader to the Peninsula
Medical School
Urogynaecology Unit
Derriford Hospital
Plymouth
Devon
UK
ix
Preface to the 1st Edition
In times past incontinence was a taboo subject, never to be mentioned in public, to
family or friends. Going to a doctor with a complaint of either urinary or faecal inconti-
nence usually resulted either in advice to use pads or being referred for surgery. Times
have now changed, men and women demand ever more of the healthcare system, and
research evidence has shown that incontinence can be well managed and in many cases
cured by the use of appropriate therapies. Likewise, other pelvic floor disorders, leading
to constipation, pelvic pain and prolapse can be treated by a variety of healthcare pro-
fessionals, each bringing different skills to ameliorate their patients’ symptoms. There
is a growing body of research evidence and consensus on which to base clinical practice,
and there are also several “alternative” therapies, which need scientific evaluation.
The purpose of this book is for many different specialists including doctors, nurses,
physiotherapists and researchers within various fields of work to present their work
with a critical review of the literature, and to identify and give recommendations for
both practice and possible further research.
The book provides a clear, concise and practical clinical introduction to the assess-
ment and conservative treatment of pelvic floor disorders in both men and women.
Section I looks at the prevalence, anatomy and aetiology of urinary incontinence,
including the neurological patient and the elderly. Clear guidance is given regarding
assessment and the investigations available. Section II contains chapters that look at spe-
cific therapeutic management strategies by exercise, biofeedback, vaginal cones and elec-
trical stimulation. The importance of patient compliance to therapy is discussed and the
use of plugs and devices considered, as are the appropriate types of surgery available.
The male patient receives particular consideration as does bladder training, voiding
problems and drugs acting on the lower urinary tract. Section III considers colorectal
disorders, including an overview of the possible problems and the therapies available.
Section IV is concerned with all aspects of pelvic pain and its therapeutic treatment and
management, and section V looks at the various aspects of pelvic organ prolapse. Section
VI considers osteopathy and the diversity of alternative therapies that are at present prac-
tised by clinicians with specialist knowledge and training: these include acupuncture,
reflex therapyand homeopathy relating to pelvic disorders. The final section looks at the
issues thatneed to concern health professionals including research trials, audit and infec-
tion control issues.
The book is written primarily for physiotherapists working in this specialist field.
However, it is hoped that anyone working with patients suffering with incontinence or
other pelvic disorders, such as nurse continence specialists, students of ‘alternative’
therapies, osteopaths, urologists, gynaecologists and general practitioners will increase
their knowledge and all find something of use within its covers.
xi
xii Preface to the 1st Edition
We are most grateful to Angela Shepherd for agreeing to write the foreword.
Dr Shepherd initially qualified as a physiotherapist before medical training, becoming
renowned internationally as a specialist urogynaecologist; she is the ideal person to
give words of wisdom on the subject.
Jo Laycock and Jeanette Haslam
Preface to the 2nd Edition
Due to the World Health Organisation, International Continence Society, many other
societies, and several government initiatives, patients with bowel and bladder disorders
world wide should now expect improved standards of care. These organisations have
pooled research and clinical expertise contributing to a multi-professional approach in
treating many pelvic floor disorders. Consequently, many of the contributors to this
book are international experts from various professions, who have helped to set the
standards for evidence-based ethical practice, to improve the quality of life for the mil-
lions of sufferers world-wide.
Divided into sections, this well referenced book will complement under-graduate and
post-graduate formal lectures, demonstrating the value of Integrated Continence
Services. In this way, all professions working in this specialist field of medicine will
better understand their role in promoting continence and ameliorating pelvic floor
disorders in men, women and children.
In this second edition there are updated chapters from the first edition - some with
new authors - and also the introduction of several new topics. In section 1, there are
new chapters on children’s continence problems, and also on quality of life issues.
Section 2 incorporates new chapters on pelvic floor muscle training using real-time
ultrasound biofeedback, manual therapy, exercise balls, the effects of childbirth and the
menopause on the pelvic floor muscles and related disorders. Further chapters are pre-
sented on the impact of urinary incontinence on athletic women, the value of having an
occupational therapist in the service, and the use, and misuse, of catheters in managing
urinary incontinence.
Sections 3, 4 and 5 have all been updated and include the assessment and conserva-
tive treatment of faecal incontinence and constipation, pelvic pain management, and
the evaluation, treatment and prevention of pelvic organ prolapse. Finally, Section 6
also has new chapters on ethical issues relating to research, investigations and treat-
ment, and a new chapter on UK Government Guidelines. The opinions expressed in
each chapter are those of the individual authors.
We are very grateful to Bob Freeman for writing the foreward. Mr Freeman is an
internationally renowned urogynaecologist with a wealth of experience in both the sur-
gical and conservative management of incontinence; who better to appreciate the multi-
professional concept of this book.
Jeanette Haslam and Jo Laycock
xiii
