All the characteristics and driving force of The Cleveland Clinic are to be found in this book on pelvic ?oor function. The Cleveland Clinic is a group practice founded in 1921 on the principles of cooperation,collaboration,and collegiality.Its founders believed that many physicians working together will discover better solutions to medical problems than physicians working in isolation. They believed that the combination of disciplines, with their inherent differences in philosophy and skills, will produce a better outcome than might have evolved singularly. The power of the collaborative approach is on full display in this book. The pelvic ?oor unites three separate organ systems. Before this time, each has been approached individually. Urologists, gynecologists, and colorectal surgeons are each trained in their own disciplines, and the pelvic ?oor is subsumed in these larger ?elds of study. When they combine their focus on the pelvic ?oor, they bring their unique perspectives and different approaches to a common goal: the relief of pelvic ?oor syndromes such as incontinence and pelvic organ prolapse.

This textbook provides a comprehensive, state-of-the art review of the Overactive Pelvic Floor (OPF) that provides clinical tools for medical and mental health practitioners alike. Written by experts in the field, this text offers tools for recognition, assessment, treatment and interdisciplinary referral for patients with OPF and OPF related conditions. The text reviews the definition, etiology and pathophysiology of non-relaxing pelvic floor muscle tone as well as discusses sexual function and past sexual experience in relation to the pelvic floor. Specific pelvic floor dysfunctions associated with pelvic floor overactivity in both men and women are reviewed in detail. Individual chapters are devoted to female genital pain and vulvodynia, female bladder pain and interstitial cystitis, male chronic pelvic and genital pain, sexual dysfunction related to pelvic pain in both men and women, musculoskeletal aspects of pelvic floor overactivity, LUTS and voiding dysfunction, and anorectal disorders. Assessment of the pelvic floor is addressed in distinct chapters describing subjective and objective assessment tools. State of the art testing measures including electromyographic and video-urodynamic analysis, ultrasound and magnetic resonance imaging are introduced. The final chapters are devoted to medical, psychosocial, and physical therapy treatment interventions with an emphasis on interdisciplinary management The Overactive Pelvic Floor serves physicians in the fields of urology, urogynecology and gastroenterology as well as psychotherapists, sex therapists and physical therapists.

Bridging the gap between evidence-based research and clinical practice, Physical Therapy for the Pelvic Floor has become an invaluable resource to practitioners treating patients with disorders of the pelvic floor. The second edition is now presented in a full colour, hardback format, encompassing the wealth of new research in this area which has emerged in recent years. Kari Bø and her team focus on the evidence, from basic studies (theories or rationales for treatment) and RCTs (appraisal of effectiveness) to the implications of these for clinical practice, while also covering pelvic floor dysfunction in specific groups, including men, children, elite athletes, the elderly, pregnant women and those with neurological diseases. Crucially, recommendations on how to start, continue and progress treatment are also given with detailed treatment strategies around pelvic floor muscle training, biofeedback and electrical stimulation. aligns scientific research with clinical practice detailed treatment strategies innovative practice guidelines supported by a sound evidence base colour illustrations of pelvic floor anatomy and related neuroanatomy/ neurophysiology MRIs and ultrasounds showing normal and dysfunctional pelvic floor incorporates vital new research and material uses key summary boxes throughout new edition to highlight quick reference points now in full colour throughout and a hardback format

Pelvic Floor Re-education encompasses a variety of techniques for increasing the strength of, and control over, the pelvic floor muscles. These techniques are now emerging as an effective and viable alternative to surgery in the treatment of urinary incontinence and related conditions. This volume presents a reasoned, scientific approach to the use of pelvic floor re-education. Starting with the latest theories on anatomy, pathophysiology and possible causes of pelvic floor damage, the text then describes the importance of pelvic floor evaluation in determining the type of treatment required. A number of re-education techniques are assessed including isolated muscle exercise, vaginal cones, biofeedback control and electrical stimulation. Recent research work is also reviewed which allows the reader to evaluate the different modalities advocated in the management of pelvic floor dysfunction.

The initial objective of this work was to reduce stress incontinence surgery from a major surgical procedure (requiring up to ten days in hospital) to a minor day-care operation. From the beginning it was clear that the two major impediments to achieving this goal were post operative pain and urinary retention. Addressing these problems became a long and winding road and culminated in the Integral Theory. The IVS 'tension-free' tape operation was inspired by Dr Robert Zacharin's anatomical studies. Though Zacharin suggested that the ligaments and muscles around the urethra were important for urinary continence control, he did not say how. The observation that implanted foreign materials created scar tissue led to the hypothesis that a plastic tape inserted in the position of the pubourethrallig ament, would leave behind sufficient scar tissue to reinforce that ligament, which would then anchor the muscles for urethral closure. In September 1986, two prototype Intravaginal Sling operations were per formed. A Mersilene tape was inserted with neither tension nor elevation, in the position of the pubourethral ligament. Restoration of continence was immediate and both patients were discharged on the day following surgery without require ment for catheterization. There was minimal pain, and immediate restoration of continence. After six weeks the tapes were removed. Both patients were still conti nent at last review 10 years later. The results appeared to confirm the importance of a midurethral anchoring point.

With mesh surgery for prolapse sometimes proving problematic, there has been a resurgence of professional medical interest in more traditional methods for the management of prolapse and of stress urinary incontinence. This concise guide to the practical aspects of pessary use will be of interest to all gynecologists involved in the clinical management of the patient with these problems. Contents: Historical review * Pessaries for pelvic organ prolapse * Incontinence pessaries * Pessary fitting * Pessary care * Outcomes of pessary use * Current clinical studies on vaginal pessaries Cover image of vaginal pessaries © 2019 Rick Hicaro, Jr., Chicago, IL 60647, USA

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.