16th Physiotherapy Round Table

Committee Activity

To download the handout and slides for this session click here

The Physiotherapy Round Table is an opportunity for physiotherapists, or anyone interested in physiotherapy, to network, enjoy presentations from emerging and established researchers and clinical leaders and most of all, have fun. The Round Table programme includes a variety of presentations and the opportunity to attend two workshops of your choice. The preliminary programme can be found below.

A light breakfast will be provided on arrival for our early start this year!

Pre-registration to this session is required and will cost €20. Spaces are limited so please register early. Please note you must be registered for the ICS Annual Meeting in order to also register for the Round Table session.

Everyone is also welcome to a drinks reception on Wednesday, September 13. The Physiotherapy drinks reception will start at 18:30 and will be held in the Fortezza da Basso convention centre. Tickets are €15 and are limited and are sold on a first come first served basis. Please note you do not need to have registered for the Round Table to join in with this event. So why not enjoy an early evening reception with your friends and colleagues. To get a ticket sign up via the online registration system or email Keren Abuhasira.

|07:30|08:00|Doors open/coffee with light breakfast|
|08:00|08:05|Welcome|Petra Voorham- van der Zalm|
|08:05|08:25|Prolapse and pelvic floor muscle training – state of the science|Suzanne Hagen|
|08:25|08:45|Vulvodynia|Murina Filippo|
|08:45|09:05|Overactive Bladder (OAB)|Stefan de Wachter|
|09:05|09:25|Is Pelvic Floor Muscle Training a Physical Therapy or a Behavioural Therapy?|Helena Frawley|
|09:25|09:45|Forum Discussion: Is pelvic floor muscle training a physical therapy or a behavioural therapy?|Helena Frawley, Sarah Dean, Susan Slade and Jean Hay-Smith|
|09:45|10:30|Report of the ICS Physiotherapy Committee|Doreen McClurg|
|11:00|11:45|Workshop Choice 1- See workshop choices below|
|11:45|12:30|Workshop Choice 2- See workshop choices below|

Workshop Choices

|1|Effective, clinically feasible and sustainable care interventions to promote pelvic floor rehabilitation|Antonella Biroli and Gianfranco Lamberti|
|2|Male Incontinence|Heather Moky|
|3|Male Pelvic Pain|Cristiane Carboni|
|4|Sexual Dysfunction|Rhonda K Kotarinos|
|5|OAB|Rebekah Das|
|6|Anorectal dysfunction in adults|Danielle van Reijn|
|7|Therapeutic neuroscience education: how to teach patients about pain|Beth Shelly|
|8|Anorectal dysfunction in children|Bernadette Berendes|
|9|How to Exam and Train Involuntary Pelvic Floor Muscle Function|Jacqueline de Jong|
|10|Which factors are impacting on her pelvic pain more – local, psychological or central factors|Margaret Sherburn|
|11|Electrostimulation of the pelvic floor|Dorien Bennik|
|12|The use of radiofrequency in the pelvic floor dysfunctions|Marta Jerez Sainz|
|13|The pelvic floor: a neglected contributor of vulvar pain in the lifespan - medical considerations|Alessandra Graziottin|
|14|Post partum consult|Nicole van Bergen|

Is pelvic floor muscle training a physical therapy or a behavioural therapy?
Frawley HC, Dean S, Slade S, Hay-Smith EJ.

This presentation will discuss whether pelvic floor muscle training (PFMT), in the management of female urinary incontinence and prolapse, is a physical or behavioral therapy. Our aim is to demonstrate it is both. We will also show that the plethora of terms used for PFMT is potentially confusing and current terminology inadequately represents the full intent, content and delivery of this complex intervention. While Physical Therapists (PT) may be familiar with exercise terms, the details are often incompletely reported; furthermore PTs are less familiar with the terminology to accurately represent cognitive and behavioral therapy interventions, which results in these elements being even less well reported. Thus, our additional aim is to provide greater clarity in the terminology used in the reporting of PFMT interventions, specifically the descriptions of the exercise and behavioral elements. First, we explain PFMT as a physical and exercise therapy informed predominantly by the discipline of physical therapy. However, effective implementation requires that we utilize the cognitive and behavioral perspectives of the discipline of psychology. Second, we summarise the theoretical underpinning of psychology-informed elements of PFMT. Third, to address some identified limitations and confusion in current terminology and reporting we recommend how PTs can incorporate the psychology-informed elements to PFMT alongside the more familiar exercise therapy-informed elements. Fourth, we provide an example of how both elements can be described and reported in a PFMT intervention. In summary, this presentation will explore the underlying concepts of PFMT to demonstrate that it is both a physical and a behavioral intervention, can and needs to be described as such, and we will provide an example of optimal description of integration of these elements into clinical practice.


Chief of Lower Genital Tract Disease Unit V. Buzzi Hospital-University of Milan

The International Society for the Study of Vulvovaginal Disease defines vulvodynia as vulvar pain of at least 3 months’ duration without a clear identifiable cause that may have potential associated factors. This definition has been recently introduced in consensus with the International Society for the Study of Women’s Sexual Health and the International Pelvic Pain Society as a component of new terminology around vulvar pain. It outlines vulvodynia as a multifactorial condition, rather than a specific entity, in which the associated factors are themselves pathophysiological components of the disease, with differing relevance in each individual. Vestibulodynia describes the most common localization, at the vulvar vestibule. Burning, pain, and introital dyspareunia, the intensity of which may inhibit or prevent intercourse, are often the presenting symptoms.
The etiology of vulvodynia is not fully understood. Many findings suggest that neuropathic mechanisms may underlie the clinical symptoms of the disease including neural hyperplasia, inflammation, central or peripheral nociceptive dysfunction, and involvement of contiguous pelvic floor muscles. Central and peripheral sensitization seems to be responsible for perpetuation of
the symptoms long after any “triggering factor” (infections, trauma, allergy, hormonal
factors,etc.) has been resolved. These sensitized afferent nerve fibers discharge more readily and at lower thresholds, helping to explain why apparently imperceptible or minimal stimulation sometimes causes pain.

End-points for vulvodynia therapy can be summarized as follows:
● Reduction of triggers and irritating stimuli
● Peripheral nociceptive blockade
● Central inhibition
● Limit associated pelvic floor dysfunction
● Limit psychosexual dysfunctions of the syndrome

Prolapse and pelvic floor muscle training – state of the science
Suzanne Hagen

Pelvic organ prolapse refers to the loss of support for the uterus, bladder, colon or rectum leading to prolapse of one or more of these organs into the vagina. Prolapse is characterised by a variety of pelvic floor symptoms, the most commonly reported being a sensation of bulging into the vagina, or “something coming down”. Treatment depends on the severity of the prolapse and its symptoms, and the woman's general health. Conservative treatment is generally considered for those with a lesser degree of prolapse, those who wish to have more children, those with frailty or those unwilling to undergo surgery.

Conservative management of prolapse includes the delivery of pelvic floor muscle training. The pelvic floor muscles play a critical role in giving structural support to the pelvic organs and pelvic openings. It is hypothesized that improving pelvic floor muscle function may improve this structural support for the pelvic organs.

More than 30 trials now exist relating to the role of pelvic floor muscle training in the treatment of prolapse. The role of pelvic floor muscle training as an adjunct to surgery or pessary has also been the subject of randomised studies. A Cochrane review specifically addressing this question was first published in 2004, and updated in 2011 and 2017, and the International Consultation on Incontinence has also reviewed and offered recommendations from the evidence in its 3rd, 4th, 5th and 6th editions.

This presentation will report on the now substantial body of evidence relating to pelvic floor muscle training and its effectiveness in the management of prolapse.

Overactive Bladder (OAB)
Stefan de Wachter

The overactive bladder syndrome is a prevalent condition in male and female patients characterized by urgency. This is a clinical condition, not limited to the presence of detrusor overactivity. Beside changes in bladder activity during filling, other phenotypes also exist, which may be based on dysfunctions of the urethra and or pelvic floor. Furthermore changes in the peripheral or central nervous system as changes in the genital or colorectal system may also influence symptoms of overactive bladder. During the presentation, the data on diagnosis and treatment of the different phenotypes will be discussed and the possible role of pelvic floor physiotherapy will be highlighted.