Application of Comprehensive Pelvic Floor Rehabilitation Therapy in Congestion Syndrome with Pelvic Oblique: A Case Report.

Background: Pelvic congestion syndrome (PCS), also known as ovarian vein syndrome, is one of the key causes of chronic pelvic pain. The present study combined pelvic floor myofascial manipulation, uterine conditioning, and improved Kegel exercise for the treatment of a PCS patient with pelvic inclination to provide a reference for clinical therapy. Case description: A 29-year-old female was admitted to our hospital on 20th April 2023, with the main complaint being repeated lower abdominal and lumbosacral pain with frequent urination (urine volume < 200 ml/time), external genital itching accompanied by increased secretion for more than 5 years. The patient was treated with pelvic floor myofascial manipulation, uterine conditioning, and improved Kegel exercise 6 times. Pelvic magnetic resonance imaging (MRI) examination, pelvic X-ray examination, overall posture assessment, and related functional status were observed and evaluated. Conclusions: After comprehensive pelvic floor rehabilitation treatment containing pelvic floor myofascial manipulation, uterine conditioning, and improved Kegel training, the symptoms and signs of the patient were significantly improved, and the effect was obvious.

[Effectiveness of multimodal rehabilitation (biofeedback plus capacitive-resistive radiofrequency) on chronic pelvic pain and dyspareunia: prospective study and literature review]. / Efectividad de la rehabilitación multimodal (biofeedback más radiofrecuencia capacitiva-resistiva) sobre el dolor pélvico crónico y la dispareunia: estudio prospectivo y revisión de la bibliografía.

OBJECTIVE: To determine whether a multimodal rehabilitation protocol (Biofeedback [BFB] plus capacitive-resistive [INDIBA®] radiofrequency [RF]) reduces pain and increases muscular strength in patients with chronic pelvic pain (CPP) and dyspareunia. MATERIAL AND METHODS: We performed a prospective, quasi-experimental, before-after study in 37 patients with CPP and/or dyspareunia referred to the Rehabilitation Department of Hospital Universitario Santa Cristina (January 2016 to December 2018). The protocol consisted of 8 sessions of pelvic floor exercises assisted by manometric BFB (15min of tonic/phasic exercises each) supervised by a physiotherapist, followed by suprapubic and perineovaginal bipolar RF [capacitive(5 min)/resistive(10 min)]. The variables evaluated were pain (VAS 0-10) and strength (mmHg) of the pelvic floor musculature and the start/end of the treatment. RESULTS: The mean age was 41.5±12.65 years. The prevalence was higher among women aged 21-40 years (n=20, 54%) and those aged 41-60 years (n=12; 32.4%). Dyspareunia was present in 34 patients (91.8%), and non-specific CPP in 3 (8.2%). The protocol improved pain (from 7.27±1.34 to 3.75±2.21 points), maximal muscular strength (from 25.56±15.9mmHg to 35.35±20.4mmHg) and mean muscular strength (from 4.86±3.53mmHg to 7.18±4.46mmHg) respectively (p<0.0001). CONCLUSION: CPP and dyspareunia are a diagnostic challenge that requires multidisciplinary management. Treatment should be started early and should consist of distinct therapeutic modalities. The protocol of multimodal rehabilitation including BFB and capacitive-resistive RF reduces pain and improves strength in patients with CPP and dyspareunia.

The Effect of Stabilization Exercises on Pain, Disability, and Pelvic Floor Muscle Function in Postpartum Lumbopelvic Pain: A Randomized Controlled Trial.

OBJECTIVE: The effect of stabilization exercises on pain, disability, and pelvic floor muscle function in postpartum lumbopelvic pain. DESIGN: This is a single-blind, randomized controlled trial. SETTING: This study was performed at the physiotherapy clinic, Zahedan University of Medical Science, from January to November 2017. PARTICIPANTS: Thirty-six multiparous women with persistent postpartum lumbopelvic pain were recruited at least 3 mos after delivery. INTERVENTIONS: Subjects in the training group (n = 18) received electrotherapy modalities and specific stabilizing exercises. The control group (n = 18) received only electrotherapy modalities. MAIN OUTCOME MEASURES: Pain, disability, and bladder base displacement (at rest and pelvic floor muscles contraction) were measured through visual analog scale, Oswestry Disability Index questionnaires, and transabdominal ultrasound imaging respectively at baseline and after 6 wks of intervention. RESULTS: Between-groups comparison showed significant improvement in pain, disability, and bladder base displacement in the training group (P < 0.05). In within-group comparison, training group had significant difference for all variables (P < 0.05). In the control group, pain and disability had significant difference (P < 0.05), whereas bladder base displacement had no significant change (P < 0.05). CONCLUSIONS: The stabilizing exercises can remarkably improve pain, disability, and pelvic floor muscles function in postpartum lumbopelvic pain (Clinical Trial Registry: NCT03030846).

Physical Activity and Yoga-Based Approaches for Pregnancy-Related Low Back and Pelvic Pain.

OBJECTIVE: To conduct an integrative review to evaluate current literature about nonpharmacologic, easily accessible management strategies for pregnancy-related low back and pelvic pain (PR-LBPP). DATA SOURCES: PubMed, CINAHL, Cochrane Database of Systematic Reviews. STUDY SELECTION: Original research articles were considered for review if they were full-length publications written in English and published in peer-reviewed journals from 2005 through 2015, included measures of pain and symptoms related to PR-LBPP, and evaluated treatment modalities that used a physical exercise or yoga-based approach for the described conditions. DATA EXTRACTION: Electronic database searches yielded 1,435 articles. A total of 15 articles met eligibility criteria for further review. DATA SYNTHESIS: These modalities show preliminary promise for pain relief and other related symptoms, including stress and depression. However, our findings also indicate several gaps in knowledge about these therapies for PR-LBPP and methodologic issues with the current literature. CONCLUSION: Although additional research is required, the results of this integrative review suggest that clinicians may consider recommending nonpharmacologic treatment options, such as gentle physical activity and yoga-based interventions, for PR-LBPP and related symptoms.

Prospective Outcomes of a Pelvic Floor Rehabilitation Program Including Vaginal Electrogalvanic Stimulation for Urinary, Defecatory, and Pelvic Pain Symptoms.

OBJECTIVES: This study evaluated our experience after implementing a pelvic floor rehabilitation program including behavioral modification, biofeedback, and vaginal electrogalvanic stimulation (EGS). METHODS: This prospective cohort study evaluated outcomes of patients with pelvic floor dysfunction (urinary or defecatory dysfunction, pelvic pain/dyspareunia) who underwent pelvic floor rehabilitation. Patients received 4 to 7 sessions (1 every 2 weeks) including biofeedback and concluded with 30 minutes of vaginal EGS. Surveys assessed subjective changes in symptoms; success was evaluated using a 10-point visual analog scale (VAS) at the final session (10 = most successful). Paired comparisons of responses at baseline and final treatment were evaluated. RESULTS: Ninety-four patients were followed up through therapy completion. Treatment indications included urinary (89.4%), defecatory (33.0%), and pelvic pain or dyspareunia (30.9%); 44.7% of patients had a combination of indications. Among women with urinary symptoms, the percentage reporting leakage decreased from 92.9% to 79.3% (P = 0.001), leakage at least daily decreased from 69.0% to 39.5% (P < 0.001), daily urgency with leakage decreased from 42.7% to 19.5% (P = 0.001), daily urgency without leakage decreased from 41.5% to 18.3% (P < 0.001), and median VAS rating (0 = not at all, 10 = a great deal) of daily life interference decreased from 5 to 1.5 (P < 0.001). The median success ratings were 8, 8, and 7 for treatment of urinary symptoms, pelvic pain/dyspareunia, and bowel symptoms, respectively. CONCLUSIONS: An aggressive pelvic rehabilitation program including biofeedback with vaginal EGS had a high rate of self-reported subjective success and satisfaction and should be considered a nonsurgical treatment option in patients with pelvic floor dysfunction.

Applying the RE-AIM Framework to Evaluate Integrative Medicine Group Visits Among Diverse Women with Chronic Pelvic Pain.

The purpose of this study was to evaluate group medical visits using an integrative health approach for underserved women with chronic pelvic pain (CPP). We implemented an integrative medicine program to improve quality of life among women with CPP using Centering, a group-based model that combines healthcare assessment, education, and social support. Patients were from university-affiliated and public hospital-affiliated clinics. We evaluated the program with qualitative and quantitative data to address components of the RE-AIM framework: Reach, Effectiveness, Adoption, Implementation, and Maintenance. Participants of the Centering CPP Program participants (n = 26) were demographically similar to a sample of women with CPP who sought care at Bay Area hospitals (n = 701). Participants were on average 40 years of age, a majority of whom were racial/ethnic minorities with low household income (76%). Women who attended four or more sessions (n = 16) had improved health-related quality of life, including decreases in average number of unhealthy days in the past month (from 24 to 18, p < .05), depressive symptoms (from 11.7 to 9.0, p < .05), and symptom severity (from 4.2 to 3.1, p < .01). Sexual health outcomes also improved (30.5 to 50.3, p = .02). No improvements were observed for pain catastrophizing. Our pilot program provides preliminary data that an integrative health approach using a group-based model can be adapted and implemented to reach diverse women with CPP to improve physical and psychological well-being. Given these promising findings, rigorous evaluation of implementation and effectiveness of this approach compared with usual care is warranted.

Outcomes of a comprehensive nonsurgical approach to pelvic floor rehabilitation for urinary symptoms, defecatory dysfunction, and pelvic pain.

OBJECTIVE: The authors' intent was to determine the clinical efficacy of comprehensive pelvic floor rehabilitation among women with symptoms of pelvic floor dysfunction (PFD). METHODS: We performed a retrospective analysis of women referred to an academic female pelvic medicine and reconstructive surgery practice for PFD. Data were gathered from the records of 778 women referred for pelvic floor therapy for urinary, bowel, pelvic pain, and sexual symptoms over the course of 4 years. RESULTS: Patients who completed at least 5 therapy sessions reported a mean symptom improvement of 80% in each of the 3 main categories analyzed, namely, urinary incontinence, defecatory dysfunction, and pelvic pain. CONCLUSIONS: Comprehensive, nonoperative management of PFD including pelvic floor muscle training, biofeedback, electrogalvanic stimulation, constipation management, behavioral modification, incontinence devices, and pharmacotherapy including vaginal estrogen is effective in the treatment of women with PFD.

[Chronic pelvic pain syndrome: neurostimulation, neuromodulation and acupuncture]. / Chronisches Schmerzsyndrom des Beckens : Neurostimulation, Neuromodulation und Akupunktur.

Chronic pelvic pain syndrome (CPPS) is defined by the European Association of Urology guidelines as a non-malignant pain perceived in structures related to the pelvis of either women or men for at least 6 months without proven infection or other obvious pathology. It affects the quality of life of millions of people worldwide and has an impact similar to that reported for other chronic diseases, such as diabetes mellitus, Crohn's disease and congestive heart failure. The treatment of CPPS remains a challenge despite several established first line therapies because many patients are therapy refractory. Unconventional treatments, such as neurostimulation, neuromodulation and acupuncture may be highly successful for treating CPPS and have a favorable adverse event profile. Thus, these promising therapeutic alternatives should be considered more often in daily clinical practice.

Strengthening transversus abdominis in pregnancy related pelvic pain: the pressure biofeedback stabilization training.

UNLABELLED: Pregnancy related pelvic pain (PRPP) refers to musculoskeletal type of persistent posterior pelvic pain during and after pregnancy with feature of reduced endurance capacity for standing, walking and sitting which leads to severe discomfort and considerable impairment of daily activities. OBJECTIVE: To test the effect of pressure biofeedback stabilizer training, on the pain and dysfunction of a thirty year old subject who presented with PRPP. STUDY DESIGN: Single case design. OUTCOME VARIABLES: Oswestry pain and disability index, TrA efficacy. METHODOLOGY: An initial assessment was followed by treatment sessions which consist of 2 phases (Phase A & Phase B). The baseline phase (A) consists of conventional therapeutic exercises while the intervention phase (B) consists of pressure biofeedback training in conjunction with the conventional therapeutic exercises. RESULT: The study data demonstrated that the subject showed minimal improvement in pain, disability and TrA efficacy during the baseline phase and shown a steady improvement in all these variables during the intervention phase. CONCLUSION: Core muscle performance (TrA) can be retrained with pressure biofeedback stabilization training program in subject with PRPP thereby reducing pain and disability.

Evaluación del dolor lumbo-pélvico tras la aplicación de la manipulación global de la pelvis en pacientes con dismenorrea primaria: estudio piloto / Assessment of low back and pelvic pain after applying the pelvis global manipulation technique in patients with primary dysmenorrhea: a pilot study

Introducción: La dismenorrea primaria (DP) es un desorden ginecológico común en mujeres en edad reproductiva. Se define como el conjunto de síntomas que preceden a la menstruación, siendo el más característico de ellos el dolor en la zona baja del abdomen seguido del dolor lumbo-pélvico. Objetivos: Valorar el efecto de la manipulación global de la pelvis (MGP) sobre el dolor lumbar en pacientes con DP a través de: (i) el dolor lumbo-pélvico percibido; (ii) el umbral del dolor a la presión (UDP) en las articulaciones sacroilíacas (ASIS); (iii) la respuesta endógena del cuerpo frente al dolor con la liberación de catecolaminas y serotonina. Material y Métodos: Estudio experimental, controlado, aleatorizado, doble ciego. Han participado 20 pacientes con DP, 10 formaron parte del Grupo Experimental (GE) y 10 del Grupo Control (GC). Se midió el dolor lumbo-pélvico con una escala visual analógica (EVA), el UDP con un dinamómetro digital y los niveles de catecolaminas/serotonina con una analítica sanguínea. Resultados: El GE obtuvo una mejoría significativa en el UDP de ambas ASIS (p=0.001), no así en el dolor lumbo-pélvico percibido (p=0.129). Asimismo, aumentaron los niveles de serotonina y dopamina en el GE aunque no de manera significativa (p=0.447) y (p=0.255) respectivamente, mientras que disminuyó la concentración en plasma de adrenalina (p=0.819) y noradrenalina (p=0.218). Conclusiones: La MGP mejora el UDP en ambas ASIS en pacientes con DP, no así el dolor lumbo-pélvico medido con EVA. La MGP también aumenta los niveles de serotonina, aunque no de manera significativa, mientras que no produce ningún cambio en los niveles plasmáticos de catecolaminas (AU)

Introduction: Primary Dysmenorrhea (PD) is a common gynaecological disorder in women of childbearing age. The most common premenstrual symptom is pain in the lower abdomen, followed by low back and pelvic pain. Objectives: We aim to assess the effect of global pelvic manipulation (GPM) on low back pain in subjects with PD through the evaluation of the: (i) self-perceived low back-pelvic pain; (ii) pressure pain threshold (PPT) in right and left sacroiliac joints (SIJ), and (iii) endogenous response of the organism to pain following catecholamines and serotonin release. Material and Methods: A randomized, double-blind, controlled clinical trial was performed to evaluated the efficacy of the GPM in the treatment of women with PD. Twenty patients (n=20) with PD were screened, ten (n=10) belonged to the control group (CG) and ten (n=10) to the experimental group (EG). The low back-pelvic pain was measured using Visual Analogue Scale (VAS) scores, the PPT was determined with a digital algometer, and a blood test was performed to determine catecholamines (adrenaline, noradrenalin, and dopamine) and serotonin levels. Results: A significant improvement of the PPT of both SIJ (p = 0.001) was observed in the EG, although there were no differences in the self-perceived low back-pelvic pain (p = 0.129). There was a nonstatistically significant increase in serotonin (p=0.447) and dopamine (p = 0.255) levels, as well as a nonsignificantly decrease in plasma levels of adrenaline (p = 0.819) and noradrenalin (p=0.218) in the EG. Conclusions: The bilateral GPM technique improves the PPT in both SIJ in patients with PD, but it does not affect the self-perceived low back-pelvic pain. The GPM also increases serotonin levels, but not significantly, although no changes are detected in the catecholamines plasma levels(AU)

A preliminary report of musculoskeletal dysfunction in female chronic pelvic pain: a blinded study of examination findings.

INTRODUCTION AND HYPOTHESIS: Female chronic pelvic pain is prevalent and causes disability. Can women with self-reported chronic pelvic pain (CPP) be distinguished from pain-free women by demonstrating a greater number of abnormal musculoskeletal findings on examination? METHODS: In this cross-sectional study, blinded examiners performed 9 physical exam maneuvers on 48 participants; 19 with CPP, and 29 pain-free. Frequency of positive findings between groups, total number of positive exam findings, cluster analysis, and sensitivity - specificity analyses were performed. RESULTS: Women with CPP presented with significantly more abnormal findings than pain-free women. By using two examination maneuvers, examiners correctly classified women with self-reported CPP from pain-free women 85% of the time. CONCLUSIONS: Abnormal findings on musculoskeletal exam are more common in women with self-reported CPP. Women with CPP might benefit from a faster time to diagnosis and improved treatment outcomes if a musculoskeletal contribution to CPP was identified earlier.

Paradigm for assessment and treatment of SIJ mechanical dysfunction.

The sacroiliac joint (SIJ) is an integral part of both the lumbar spine and the pelvic girdle. It is frequently the source of low back pain and pelvic girdle pain. Recent research has permitted a deeper understanding of its function and assessment. The mechanical assessment of the SIJ as a transmitter of load between trunk and lower limbs, and as a means to absorb torsion stresses of the pelvis absorber of torsion is examined; history, clinical examination and imaging modalities are explored and the role of exercise and some interventional therapies are described in general terms.

The effect of biofeedback physical therapy in men with Chronic Pelvic Pain Syndrome Type III.

UNLABELLED: Recent studies suggest that the symptoms of chronic non-bacterial prostatitis (CP) or Chronic Pelvic Pain Syndrome (CPPS) may be due to or associated with pelvic floor muscle dysfunction. Therapies aimed to improve relaxation and proper use of the pelvic floor muscles such as biofeedback physical therapy and pelvic floor re-education are expected to give symptom improvement. The objective of this study was to evaluate the effect of biofeedback physical therapy on the symptoms of men with CPPS. MATERIALS AND METHODS: Between March 2000 to March 2004, 33 consecutive men were diagnosed with CP/CPPS based on history including the NIH-CPSI questionnaire and physical examination including pelvic floor muscle tonus, urinalysis, uroflowmetry with residual urine measurement and transrectal ultrasonography of the prostate. All patients participated in a pelvic floor biofeedback re-educating program. A rectal EMG probe was used to measure resting tone of the pelvic floor muscles and was helpful for instruction pelvic floor muscles contraction and relaxation. RESULTS: Two of the 33 men dropped out. In the remaining 31 men, mean age 43.9 years (range 23-70), the mean total Chronic Prostatitis Symptom Index (NIH-CPSI) changed from 23.6 (range 11-34) at baseline to 11.4 (range 1-25) after treatment (p<0.001). The mean value of the pelvic floor muscle tonus was 4.9 at diagnosis (range 2.0-10.0) and decreased to 1.7 (range 0.5-2.8) after treatment (p<0.001). CONCLUSIONS: Our study clearly demonstrates a significant effect of biofeedback physical therapy and pelvic floor re-education for CP/CPPS patients, leading to a significant improvement of the symptom score. The correlation between the pelvic muscle tonus results with NIH-CPSI score is highly suggestive that the pelvic floor plays an important role in the pathophysiology of CP/CPPS.

Pelvic floor spasms in children: an unknown condition responding well to pelvic floor therapy.

OBJECTIVE: During a study period of 4 years, 21 children are seen for night time pelvic pain. These children typical wake up in the middle of the night with severe lower abdominal or perineal pain. During day some of them suffer urge syndrome. During urodynamic investigation extremely high pelvic floor activity as recorded by high urethral pressure was observed in these children. We therefore started pelvic floor relaxation biofeedback in these children. METHODS: All children diagnosed with pelvic floor spasms underwent biofeedback pelvic floor relaxation therapy in order to learn them to counteract pelvic pain due to these spasms. In those girls in whom detrusor hyperactivity was seen on urodynamics concomitant anticholinergic treatment was given (oxybutynin). RESULTS: Between January 1998 and January 2002 symptomatic pelvic floor spasms were diagnosed in 21 children (19 girls/2 boys). Pelvic floor relaxation biofeedback was successful for treatment of this condition in 17 of 21 children. Mean duration of therapy was 3 months (12 weekly sessions) and on long term follow-up relapse was seen in 3 of 17 successfully treated children. 10 of 17 successfully treated children received anticholinergics. CONCLUSION: Pelvic floor spasms in children (which can be secondary to detrusor overactivity) respond well to pelvic floor relaxation therapy.

Rehabilitation of the short pelvic floor. II: Treatment of the patient with the short pelvic floor.

Several urogynecologic syndromes are associated with the clinical finding of a short, painful, tender and weak pelvic floor and a variety of connective tissue abnormalities. Techniques for rehabilitation include the avoidance of perpetuating factors, rehabilitation of extrapelvic musculoskeletal abnormalities, the use of manual techniques and needling to promote resolution of connective tissue problems, closure of any diastasis recti, and transvaginal/transrectal manual release of muscular trigger points and contractures. Therapy can be facilitated by pudendal or epidural nerve block. Patients contribute to their success through home maintenance programs.

Issues in planning a placebo-controlled trial of manual methods: results of a pilot study.

OBJECTIVE: There are fundamental differences between the administration of medications and the application of manual procedures, such as those used by chiropractors. The objective of this study was to gather preliminary information on how to address these differences in the design of a multisite, randomized placebo-controlled trial of chiropractic care for women with chronic pelvic pain (CPP). DESIGN: Pilot study for a multisite, randomized, placebo-controlled clinical trial. SETTING: Three chiropractic research clinics in the midwest United States. SUBJECTS: Thirty-nine (39) women with CPP of at least 6 months' duration, diagnosed by board-certified gynecologists. INTERVENTIONS: The active intervention consisted of the chiropractic technique, lumbar spine flexion-distraction, combined with manual Trigger Point Therapy. The placebo intervention consisted of a sham chiropractic procedure performed with an instrument combined with effleurage (light massage). OUTCOME MEASURES: The primary outcome measure was the change in the Pain Disability Index (PDI) from baseline to the end of treatment (6 weeks), assessed by group and site. If the change score was in the same direction at all sites, the results were to be combined to estimate treatment effect size. RESULTS: Patient characteristics were similar to those of patients with CPP in other studies. Recruitment methods, particularly in respect to the eligibility criteria and screening protocols, would require modification in order to recruit an adequate sample for the planned randomized controlled trial. Clinicians followed standardized procedures with apparently minimal deviation, patients in both groups were satisfied with their care and blinding appeared to be successful. PDI change scores were not consistent across sites and so results were not combined and overall treatment effect sizes were not estimated. CONCLUSIONS: The technical and personnel resources required to achieve adequate standardization of procedures at multiple sites may make a placebo-controlled trial unfeasible, given our current lack of knowledge about the active agent in manual chiropractic procedures.

Chiropractic care for women with chronic pelvic pain: a prospective single-group intervention study.

OBJECTIVE: To assess the role of chiropractic care for women with chronic pelvic pain (CPP) as a first step in designing a randomized clinical trial. DESIGN: Prospective single-group intervention study. SETTING: Chiropractic Research Center. SUBJECTS: Nineteen volunteer female subjects meeting inclusion/exclusion criteria for chiropractic treatment of chronic pelvic pain. INTERVENTIONS: Chiropractic treatment consisting of flexion/distraction and trigger point techniques administered by faculty clinician over a period of 6 wk. MAIN OUTCOME MEASURES: Pain Disability Index (PDI) was the primary measure; secondary outcome measures were Visual Analog Scale for pain (VAS), RAND-36 Health Survey and Beck Depression Inventory (BDI). All were administered at baseline and at 6 wk. RESULTS: Eighteen subjects completed the study, with an attrition rate of 5%. The mean improvement in the PDI score was 13.0 points (p = .001); in the VAS it was 4.0 cm (p = .001); and in the BDI it was 6.1 points (p < .001). All eight subscales of the RAND-36 Health Survey increased post-intervention, with the largest differences in role function limitations because of physical problems (45.8%), emotional problems (44.4%) and pain (40.6%). CONCLUSION: The chiropractic treatment used in this study had positive short-term effects. These results will be used to design a randomized clinical trial to investigate the efficacy of chiropractic care in the treatment of CPP.