I recently had the pleasure of writing an article for Urology News, the first in a line of collaborative articles with the ICS. The Editor described the article as "a wonderful summary of the history of pelvic floor physiotherapy". Here is a short summary of my article, to read the full version click here.
Physiotherapy and in particular pelvic floor muscle training (PFMT) is nowadays first-line management for pelvic floor dysfunction (PFD). PFMT is originally attributed to Dr Arthur Kegel however actually entered modern medicine in 1936 courtesy of Margaret Morris, a physiotherapist at St Thomas’ Hospital (London).
The beginnings of the role of a pelvic floor physiotherapist, as we know it today was facilitated in the 1970’s by encouragement of the physiotherapist Dorothy Mandelstam. She was the first non-medical member and the first physiotherapist to be admitted to the International Continence Society (ICS) in 1975. In 1988 the first research papers by physiotherapists Kari Bø and Jo Laycock were presented at the ICS annual scientific meeting. Since those days when physiotherapy was poorly understood, the physiotherapy committee at ICS has grown, and a high number of physiotherapy studies and accepted abstracts with some of them receiving awards, has catapulted and consolidated our role in continence care.
In the UK, physiotherapy is first line management for stress urinary incontinence (SUI) and mixed urinary incontinence (MUI) for women and men (NICE 2015), faecal incontinence (NICE 2007) and pelvic organ prolapse (Hagen and Starck 2011). In particular PFMT for SUI and MUI has the highest grade of evidence and this is due to multiple studies and the large number of patients involved in these research studies. International and European guidelines also recommend physiotherapy as first-line management for MUI (Abrams et al. 2013; Lucas et al. 2014). There is also evidence that for women having their first baby, PFMT can prevent urinary incontinence up to six months after delivery and is an appropriate treatment for women with persistent postpartum urinary incontinence (Boyle et al. 2012). As part of the overall management, pelvic floor physiotherapists also give advice to women with urinary incontinence on weight loss, reduction of caffeine, fluid intake, cessation of smoking and an increase and/or modification of physical exercise (Boyle et al. 2012). These interventions are important in the reduction of symptoms but more importantly improve the quality of life of these patients. It is well-known that untreated pelvic floor dysfunction can lead to social isolation, reduced emotional well-being, embarrassment and reduced work productivity amongst others (Abrams et al. 2013).
What is the main difference between the days of Margaret Morris and nowadays?
- Our well-established position within the national healthcare system.
- Our involvement in the management of bowel dysfunction and the use of devices to contain fecal incontinence as well as the use of rectal irrigation and abdominal massage
- The use of mobile and medical devices to improve compliance with physiotherapy
- Self –referral to pelvic floor physiotherapy
- Physiotherapy management of men with urinary symptoms
- Physiotherapy pre and post gynecological surgery
- Physiotherapy management of PFD in the postpartum period
- Manual therapy for chronic pelvic pain and PFD
There is no doubt that our profession has moved forward because of our involvement in research. In order to maintain our position as first-line continence care providers in our economically driven NHS, it is imperative that we continue to demonstrate that our interventions are cost-effective.
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Article by Paula Igualada-Martinez on behalf of the ICS Physiotherapy Committee