Sonya was referred to WMHP for obstructed defecation and pain with bowel emptying. However, following a thorough biopsychosocial assessment, it emerged that Sonya’s main concern was dyspareunia. This case study explores the complex inter-relationships of bladder, bowel, and sexual function, and highlights the sequela of increased tension in the pelvic floor muscles (previously termed an “overactive pelvic floor”).

Chronic Pelvic Pain Syndrome (CPPS) is only recently being recognised as the “black hole” of men’s health. It’s not well understood by health professionals and has a huge impact on men’s physical, emotional and social health and wellbeing. A holistic management approach is needed to address the complex influences of psycho-social factors as well as the biological ones.

Provoked vulvodynia is one of the many chronic pelvic pain syndromes we see presenting in women. This complex and multifactorial condition has a significant impact on every aspect of the lives of these women who are often young. There is increasing evidence supporting a multi-disciplinary, biopsychosocial approach. This case study illustrates Physiotherapy best practice.

The recently published and highly anticipated 6th edition of the ‘International Consultation on Incontinence’ book highlights the very strong evidence base supporting pelvic floor muscle training as an effective treatment for many bladder and bowel disorders. Pelvic floor muscle training is Grade A recommended treatment for female urinary incontinence and pelvic organ prolapse.

Interstitial cystitis / painful bladder syndrome (IC/PBS) is a complex condition, and often difficult to treat. Professor Curtis Nickel, urologist and pelvic pain guru from Canada, was a key note speaker at the recent USANZ conference, and shared ‘10 Tips For Managing IC/PBS’. His overwhelming message, loud and clear, was that IC/PBS is a multi-factorial condition, and a multidisciplinary treatment approach is essential.

Dr Wendy Bower, physiotherapist and researcher at Royal Melbourne Hospital, is leading a research team in Australia, Europe and Asia, investigating nocturia, its multifactorial aetiology, and how to most effectively treat it. They have developed a new screening tool TANGO, which aids the user in targeting the aetiology of nocturia and guiding individualised treatment.

Chronic pain is a huge health problem, and is expected to cost the western world as much as diabetes and cancer combined.  Dr David Butler and Professor Lorimer Moseley have pioneered the understanding and treatment of chronic pain internationally and, luckily for us, they live right here in Australia and work at the University of South Australia.  Their latest research tells us that educating patients in the science of chronic pain is the single most important thing we can do to help their recovery^.

I recently received an email from a referring GP asking for a copy of our bladder diary. This request made me think about the importance of bladder diaries because patients are typically very poor historians regarding their bladder function. Often their subjective history will be quite different from what is actually happening!  Bladder diaries are an extremely useful diagnostic tool and their utilisation has evolved with research advances in lower urinary tract dysfunctions.

Patient motivation and adherence is the most important predictor of treatment success.  The International Continence Society (ICS) acknowledges the importance of this and recently invited an expert panel to review the literature in this area and provide recommendations for research and clinical practice.

A 2010 Harvard Medical School study showed that about 20 percent of first-time prescriptions are never filled. This means that 1 in 5 patients don’t follow their doctor's recommendations. This was reinforced recently when we received some feedback from a patient who had been struggling with bladder symptoms for two years. She was seeing both a urologist and gynaecologist and had been referred to WMHP but it took her many months before she actually did anything about it.