“Isn’t it good for my pelvic floor to be tight? Isn’t a tight pelvic floor a strong pelvic floor?” These are two questions we are often asked, and the answer to both is NO! More and more commonly we are diagnosing pelvic floor muscle overactivity as a contributing factor to bladder and bowel dysfunction, pelvic pain and dyspareunia. Shan and Leonie attended a workshop at the International Continence Society 2018 conference run by prominent researchers in this field. The workshop explored the latest in pelvic floor muscle overactivity, and how it is best managed.

Gynaecological cancer is the third most commonly diagnosed cancer among women. Thankfully the survival rates are increasing, but, as a consequence, many women are now having to live with the adverse effects of treatment. These often include bothersome bladder, bowel and sexual dysfunction. Research and awareness in this area is improving, with Associate Professor Helena Frawley from Monash University leading a project investigating pelvic oncology and the side effects of treatment. Ms Carina Siracusa, American pelvic floor Physiotherapist, also presented at the International Continence Society meeting late last year, exploring what can be done to enhance recovery for these women.

Anthony was referred to WMHP with incontinence and painful voiding 3 months after a transurethral resection of the prostate (TURP). This case study explores the complex and diverse aetiology of lower urinary tract symptoms (LUTS) and highlights the contribution of increased tension in pelvic floor muscles.

Endometriosis, a disease affecting 1 in 10 Australian women, is rarely spoken about but can have devastating effects on many aspects of a woman’s life. Thankfully, this should change, with the release of a National Action Plan (NAP) for Endometriosis, delivered by Health Minister Greg Hunt last year.

Many health professionals endorse drinking 2 litres of water each day, despite a lack of scientific evidence to support this1. In patients with overactive bladder (OAB), excessive fluid intake is known to exacerbate urinary frequency and urgency. A new systematic review has just been published, investigating fluid intake and OAB, and the results are fascinating.

Vulvodynia affects 10-20% of women, and its prevalence is on the rise. It affects women across the lifespan, and its pathophysiology is still poorly understood. Associate Professor Melanie Morin, Canadian researcher and Pelvic Floor Physiotherapist, recently presented an update on Provoked Vestibulodynia (PVD) at the International Continence Society 2018 in Philadelphia. Her fascinating presentation outlined the latest in pathophysiology and management of PVD, and the exciting results of a soon-to-be published large randomised clinical trial of multimodal physiotherapy in women with PVD.

Jill was referred by a Urologist to WMHP for management of Urgency Urinary Incontinence, but during subjective assessment disclosed that Faecal Incontinence was actually her most bothersome symptom. This case study highlights the absolutely devastating effect Faecal Incontinence can have on a person’s quality of life, and how a structured treatment program can cure this highly bothersome condition.

Leonie Yeap, Clinical Manager at WMHP, and I were fortunate enough to travel to Philadelphia, USA to attend the 48th annual meeting of the International Continence Society held in August. The meeting, attended by around 1500 delegates from across the globe, is a forum for researchers, clinicians and students to explore the latest research on urinary and faecal incontinence and pelvic floor disorders. Our favourite workshop was one titled The Overactive Pelvic Floor which inspired another of our articles in this newsletter on Provoked Vestibulodynia. There were many interesting presentations and we explore five of them.

Rectal balloon therapy is emerging as an exciting biofeedback tool to effectively treat a variety of benign anorectal disorders. Wald and co-authors recently published the American College of Gastroenterology Clinical Guideline: Management of Benign Anorectal Disorders1, and strongly recommended the use of biofeedback with rectal balloon therapy for treatment of defecatory disorders, chronic proctalgia, and faecal incontinence.

Fred was referred to WMHP with significant incontinence after surgical treatment for prostate cancer. This case study is a fascinating example of the complexity and diverse etiological factors which can contribute to post-prostatectomy incontinence, and explores Fred’s journey on the road to recovery of continence.