ICS 2021 Highlights

Shan, Leonie, Jane and Kathryn attended the ICS conference in October, which was held virtually this year. Associate Professor Helena Frawley, the original founder of Women’s & Men’s Health Physiotherapy was on the scientific committee and contributed to bringing together a stimulating program.  There were so many fascinating and inspiring workshops and presentations (which we watched bleary eyed very early in the morning or late at night!). We have included some of our favourite ‘pearls’ from the conference below.

1. Physiotherapy Is Now First Line Treatment For Bladder Pain Syndrome (BPS)
   
   Philip Hanno (Urologist), Peter Dwyer (Uro-Gynaecologist), Ali Harding (Pelvic Health Physiotherapist) and Kristina Cvach (Uro-Gynaecologist) delivered an amazing workshop on the management of BPS.  They announced that when the new (7th) International consultation on Incontinence (ICI) guidelines are published later this year, physiotherapy will be included as first line treatment for people with BPS (moved from second line due to an increased evidence base supporting the role of physiotherapy). We were reminded to “not forget the BPS in BPS”- highlighting the importance of a biopsychosocial framework for BPS management.  Physiotherapy management aims to reduce the pain and urgency associated with bladder filling, which we can achieve through urge suppression strategies, pelvic floor relaxation exercises, general relaxation exercises, imagery techniques, pain education and many other interventions and approaches to help effectively ‘wind down’ the overly sensitised peripheral and central nervous system in this group of patients. 
   
   We will be discussing more about BPS in a future edition of our newsletter in 2022, so stay tuned for more insight into the role of physiotherapy for this challenging condition. 
    
2. Men Need A ‘Superhuman’ Pelvic Floor Following Prostate Cancer Surgery To Regain Their Continence
   
   Paul Hodges and his team at the University of Queensland (including our Director Shan, who was a co-author on the groups most recent paper) have published fascinating insights into the required pelvic floor function of men to regain their continence following radical prostatectomy.  The imagery cue to elicit an optimal pelvic floor contraction combined with visual feedback from transperineal ultrasound is vital to establish sufficient urethral pressure control, as well as to reduce abdominal pressure from above.  They found that continent men after prostatectomy have better function of their pelvic floor than men with no history of prostate cancer, meaning they really do need a superhuman pelvic floor post surgery! To read the article, click here. These themes were further explored at the Asia-Pacific Prostate Cancer Conference on December 2-3, co-convened by Rachel Heerey, with Shan and Rachel leading round table discussions on the management of post-prostatectomy incontinence. 
    
3. Overactive Bladder And The Nervous System
   
   Dr Rebecca Das presented fascinating insights into current thinking about OAB and the role of the brain in the experience of urinary urgency.  She reminded us that urgency is a sensation, which is an output of the brain.  Urgency is also a multidimensional perceptual experience, highly dependent on context and is both affective as well as physical.  It has been well documented that in OAB, the sensation of bladder fullness doesn’t correlate with sensation intensity.  We also know that only half of patients with OAB will have detrusor overactivity, therefore treating the sensation of urgency is imperative to improve OAB symptoms.  Rebecca argued that more cognitive behavioural approaches including mindfulness should be part of OAB management.  A better approach to bladder training may be to teach people to be mindful of the sensation of urgency rather than being afraid of it, then arming them with strategies regarding how to appropriately respond to their urgency.
    
4. Maternal Health Summit Summary
   
   There were a wide range of impressive speakers in the Maternal Birth Summit that we were privileged to listen to from our living rooms!  Some highlights were:

• The incredible John Delancey (Gynaecologist, USA) questioned whether the 10% of women that have had a levator injury during childbirth should be screened for and counselled away from a subsequent vaginal birth to reduce their risk of developing POP in the future.
• Jean Hay-Smith (Physiotherapist and Researcher, NZ) spoke about the lost opportunity to prevent urinary incontinence in women of childbearing age by not offering pelvic floor muscle training to women during pregnancy.
• Amy Dawes (CEO and founder of Australasian Birth Trauma Association) talked about her inspiring foundation that offers support and resources to women who have experienced birth trauma.  They have collaborated to design a series of modules to inform, educate and support women about perineal tears and birth trauma. The first module is available here https://www.youtube.com/watch?v=_pd0F1JrrV0.

We came away from the conference inspired and energised by these presentations and look forward to seeing the publication of the International Consultation on Incontinence guidelines later this year. These have become an invaluable resource that collates and summarises the research and makes evidence-based recommendations on a range of pelvic health topics.