The Pelvic Physiotherapy Clinic (PPC) at the London Spinal Cord Injury Centre, Royal National Orthopaedic Hospital, NHS Trust is a relatively new clinic developed following results of a ‘proof of principle study’ on Pelvic floor muscle training in incomplete spinal cord injury subjects and its impact on bladder dysfunction and incontinence.  The purpose of this Service Evaluation was to assess the PPC and the outcomes of patients with neurogenic  bladder and bowel dysfunction.

Twenty eight patients who were referred to the Pelvic Physiotherapy Clinic due to neurogenic bladder and bowel dysfunction completed  the ICIQ (International Consultation on Incontinence- Urinary Incontinence)-ICIQ-UI short form questionnaire and the NBD (Neurogenic Bowel Dysfunction) symptom based score before and after a course of pelvic physiotherapy sessions. Following an initial assessment, patients were given verbal and written instruction for a home exercise plan and some patients were offered several visits to the clinic which ranged from 2 to 12. The service currently includes elements of patient education, pelvic floor muscle retraining, manual therapy and biofeedback to promote patient independence in bladder and bowel management.

For the data analysis, the group was divided into four diagnoses namely Cauda Equina Syndrome (n=11), Tarlov Cyst (n=3), Lumbar Stenosis (n=5) and upper motor neuron Spinal Cord Injury (n=7). The mean ICIQ score for all patients prior to treatment was 7.8 +/- 5.8 and after treatment was 5.4 +/- 5.5. A decrease in ICIQ indicates an improvement in symptoms. The pre and post treatment ICIQ scores for each patient group is shown in Figure 1. The mean NBD score for all patients prior to treatment was 8.1 +/- 5.2. The pre and post treatment NBD scores for each patient group is shown in Figure 1. A decrease in NBD score indicates an improvement in symptoms.

All the groups showed an improvement in the ICIQ-UI score apart from the Lumbar stenosis group (n=5).  The CES group showed significant improvement (p<0.5).  All the groups showed an improvement in NBD symptom score and this was significant for both the Lumbar stenosis and Spinal cord injury group (p<0.5)

The results from this Service Evaluation are encouraging and demonstrate that a conservative intervention such as pelvic physiotherapy can improve the outcomes associated with bladder and bowel dysfunction in the neurogenic population. The outcomes of this Service Evaluation suggest that a pelvic physiotherapy service within a spinal injuries unit could offer a cost effective first line alternative to more invasive and costly interventions for the management of bladder and bowel dysfunction