Abstract
Introduction and hypothesis
There has been an increasing need for the terminology on the conservative management of female pelvic floor dysfunction to be collated in a clinically based consensus report.
Methods
This Report combines the input of members and elected nominees of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS), assisted at intervals by many external referees. An extensive process of nine rounds of internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus). Before opening up for comments on the webpages of ICS and IUGA, five experts from physiotherapy, neurology, urology, urogynecology, and nursing were invited to comment on the paper.
Results
A Terminology Report on the conservative management of female pelvic floor dysfunction, encompassing over 200 separate definitions, has been developed. It is clinically based, with the most common symptoms, signs, assessments, diagnoses, and treatments defined. Clarity and ease of use have been key aims to make it interpretable by practitioners and trainees in all the different specialty groups involved in female pelvic floor dysfunction. Ongoing review is not only anticipated, but will be required to keep the document updated and as widely acceptable as possible.
Conclusion
A consensus-based terminology report for the conservative management of female pelvic floor dysfunction has been produced, aimed at being a significant aid to clinical practice and a stimulus for research.
Similar content being viewed by others
Notes
Terminology for Female Anorectal Dysfunction [18].
A comprehensive definition of these terms is covered by Doggweiler et al. [123].
Symptoms of pelvic floor myalgia should be described in terms of location, quality, intensity, pattern, duration, frequency, moderating factors, and associated symptoms. Pain details may include:
-
a)
Whether pain is present at rest or mechanical in nature (related to muscle contraction or relaxation or body posture) and/or altered with a change of posture (lying to sitting, sitting to standing) or movement (bending, walking, sexual activity
-
b)
Whether uni- or bilateral in nature
-
c)
Whether accompanied by bladder or bowel dysfunction, vulvodynia or dyspareunia (superficial/deep)
-
a)
The evidence for the existence of trigger points is debated [124].
Muscle tone is evaluated clinically as the resistance provided by a muscle when a pressure/deformation or a stretch is applied to it [19–21]. Muscle tone may be altered in the presence or absence of pain. There is no single accepted or standardized way of measuring muscle tone, and there are no normative values.
The terms hyper- and hypotonicity are commonly used in neurology and muscle physiology. Messelink et al. [2] introduced the terms overactivity and underactivity related to PFM. These terms are not defined with cut-off points, nor are they based on comparison with normal populations. As activity can only relate to the active (i.e., contractile) portion of muscle tone, activity cannot be used interchangeably with muscle tone, unless it can be shown that the active component of the muscle is altered. If increased (over-) or decreased (under-) activity in the PFM can be demonstrated using electromyography (EMG) or another measure, then these terms may be used appropriately.
Muscle cramp either during or immediately after exercise is commonly referred to as “exercise-associated muscle cramping” [93]; however, cramps are not specific to exercise.
Local or referred pain may be reproduced. An active TrP is said to have a characteristic “twitch” response when stimulated; however, the twitch response to palpation has been shown to be unreliable [126]. The most reliable sign of a TrP is sensitivity to applied pressure. Trigger points are implicated in myofascial pain; however, the validity of this theory is controversial and has recently been refuted [124].
Palpation is less reliable and responsive than manometers and dynamometers [42].
The pressure measured does not confirm its origin, and pressure measurement is only valid when used in combination with other methods, e.g., simultaneous observation of the inward movement of the perineum or device during PFM contraction.
Today’s dynamometers for the pelvic floor also detect resting and contractile contributions from muscles other than the PFM, contributing to the force recordings. As dynamometers can be opened at different muscle lengths to measure PFM force, the process of measurement should respect the maximum achievable vaginal aperture without inducing discomfort, so as not to influence the validity of the measurement.
EMG in this case usually means “concentric needle EMG,” but other EMG methods exist. EMG is typically distinguished as either intramuscular or surface. EMG diagnosis is often used as a synonym for “neurophysiological diagnosis of the peripheral neuromuscular system,” and that would also include the measurement of motor and sensory conduction, the recording of reflex responses, etc. [36]. EMG does not directly measure muscle strength. The type of electrode being used should be specified.
This is not typically used in clinical assessment, but may be included in research or advanced examinations, for example, to diagnose striated muscle denervation/re-innervation [36].
Surface EMG is considered to be less specific than intramuscular EMG. The large surface area of the electrodes may result in cross-talk from adjacent muscles and other artifacts; therefore, technical expertise is required. EMG can reveal the pattern of activity of a particular muscle, as in the diagnosis of detrusor sphincter dyssynergia during urodynamics [2, 36].
Because pain is multidimensional, a single rating scale combines these dimensions in unknown quantities. One may separately assess pain intensity, pain distress, and interference of pain with activities of daily life.
Other urological, gynecological, gastrointestinal and colorectal pain conditions without related PFM dysfunction, are well described in standard texts. Many pelvic floor pain-related conditions or syndromes (e.g., vulvodynia, interstitial cystitis/bladder pain syndrome, irritable bowel syndrome) are described in the Standard for Terminology in Chronic Pelvic Pain Syndromes (CPPS): A Report from the Ad Hoc Working Group of the International Continence Society Standardization Steering Committee (ICS-SSC) on Chronic Pelvic Pain, ICS Standardization of Terminology document on Chronic Pelvic Pain [123]. Several other systemic disorders (e.g., chronic fatigue syndrome, diabetes) may have an impact on the pelvic floor; however, PFD is not part of their recognized etiology.
We recommend that “behavioral” be limited to studies that evaluate how people do or do not behave as desired, e.g., commencement or cessation of PFM training or change of a diet.
We recommend that the specific treatment is described, e.g., PFM training, electrical stimulation, rather than the unspecific term physiotherapy, the latter also referring to a specific profession. Publications should report the actual professional who provided the intervention (e.g., physiotherapist, general practitioner, urogynecologist, urologist, midwife, nurse, fitness instructor), rather than using the vague term, “therapist”/“clinician”/“researcher.”
Adherence is usually reported as the number or percentage of clinical visits attended and home exercises or regimen components followed or completed by the client/patient.
The term “adherence” is generally preferred within healthcare, as it acknowledges client/patient autonomy and implies a willingness on their part to participate and cooperate rather than the traditional view, inherent in “compliance,” of an expert clinician dictating to a naive patient [62, 63]. Simply, adherence is agreeing what to do; compliance is being told what to do.
An increase in the physical activity level may affect UI positively via weight reduction in obese persons. Conversely, several studies have shown that there is a high prevalence of UI in physically active women during exercise (especially during high impact activity, defined as running and jumping). Strenuous exercise/work has been suggested to be a risk factor for the development of PFD [71]. A well-functioning pelvic floor responds before and during an increase in intra-abdominal pressure.
Ideally, the voiding intervals should be increased by 15–30 min each week, according to the patient’s tolerance to the schedule, until a voiding interval of 3–4 h is achieved. Use of a bladder diary is recommended for self-monitoring of progress [70].
A bowel habit intervention may: encourage bowel emptying at a specific time of day, mainly after a meal (to utilize the gastrocolic response), encourage patients to adopt a sitting or squatting position where possible while emptying the bowel, teach patients techniques to facilitate bowel evacuation and stress the importance of avoiding straining [74, 127, 128].
Speed changes little with training. Thus, power is increased almost exclusively by gaining strength [35].
PFM training can be isometric, concentric or eccentric or a combination of any of these.
Whether PFMT is performed with or without previous assessment of the ability to contract should be reported.
The original shape was conical; however, different shapes are currently available. Maintenance of the weight in position can be challenged via different body positions and activities.
PFM feedback can be provided by the therapist or patient during manual palpation internally or externally, or with a mirror. The purpose of feedback is to increase accuracy of contraction for maximum benefit.
Biofeedback can be visual, auditory or both. Biofeedback is not a treatment on its own. It is an adjunct to training and can be used to help the patient be more aware of muscle function, and to enhance and motivate patient effort during training [129]. The correct terminology should be PFM strength training with biofeedback or relaxation training with biofeedback. Types of PFM biofeedback include: perianal, vaginal, and anal surface EMG, urethral, vaginal or anal manometry, vaginal dynamometry, real-time ultrasound [129].
Clinicians are to be cautious with regard to the interpretation of the information, as many factors influence amplitude, including muscle activity, skin conductance, and artifact. “EMG amplitude does not equal force” [87]. More microvolt activity means more muscle activity, but does not always mean more strength.
Artifact examples include movement or contact quality artifact, cross talk, heart rate, skin electrode shear, and electrode bridging.
Minimizing cross talk is essential in research into quality EMG tracings.
Recording with surface electrodes is prone to artifact and cross talk. The user should be trained appropriately and understand the limits of the EMG instrument and of the methodology. It is not within the scope of this document to define all EMG terms. Readers are referred to other texts for further terminology [87, 88].
Baseline EMG reading can be influenced by many factors and therapists must take into account the patient’s symptoms, digital palpation results, overall tension of the patient, the possibility of artifacts, and other factors in determining the meaning of the baseline muscle activity.
Slow recruitment can be symptomatic of leakage during coughing and sneezing when a quick muscle contraction is needed to counteract increased intra-abdominal pressure.
Slow de-recruitment can be indicative of a hypertonic PFM.
The general principles of strength training are the same with and without biofeedback. (See the sections “Mode of exercise training” and “Dose–response issues related to exercise training”)
The general principles of relaxation training are the same with and without biofeedback.
Manual therapy is used to treat soft tissues and joint structures for the purpose of modulating pain; increasing the range of motion; reducing soft tissue edema; inducing relaxation; improving contractile and noncontractile tissue extensibility, and/or stability; facilitating movement; and improving function. This broad group of skilled hands-on treatments can be divided into two groups: joint therapies and soft-tissue therapies.
Neither mobilization nor manipulation should be used when referring to muscle.
The notion of trigger points causing myofascial pain is controversial [124].
Depending on the particular device being used, the type of electrical current, the specific health problem and condition being treated, and the individual’s needs and circumstances, many electrical stimulation parameters may be adjusted by the therapist administering the treatment.
The slower the current intensity rises to the preset amplitude or threshold level, the more comfortable the stimulation may feel. Conversely, the faster the ramp, or the more vertical the ramping up signal, the more discomfort may be felt.
Terminology for female anorectal dysfunction [18].
References
Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Am J Obstet Gynecol. 2002;187(1):116–26.
Messelink B, Benson T, Berghmans B, Bo K, Corcos J, Fowler C, et al. Standardization of terminology of pelvic floor muscle function and dysfunction: report from the pelvic floor clinical assessment group of the International Continence Society. Neurourol Urodyn. 2005;24(4):374–80. doi:10.1002/nau.20144.
Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29(1):4–20. doi:10.1002/nau.20798.
Bump RC, Norton PA. Epidemiology and natural history of pelvic floor dysfunction. Obstet Gynecol Clin North Am. 1998;25(4):723–46.
Bottomley JM. Quick reference dictionary for physical therapy. 3rd ed. Thorofare, NJ: Slack; 2013.
Abrams P, Cardozo L, Wein A. Fourth international consultation on incontinence-research society 2013. Neurourol Urodyn. 2014;33(5):571–2. doi:10.1002/nau.22617.
Oxford Dictionary. http://oxforddictionaries.com/. Accessed 20 October 2015.
Merriam-Webster Online Dictionary http://www.merriam-webster.com/dictionary/. Accessed 20 October 2015.
Bo K, Herbert RD. There is not yet strong evidence that exercise regimens other than pelvic floor muscle training can reduce stress urinary incontinence in women: a systematic review. J Physiother. 2013;59(3):159–68. doi:10.1016/s1836-9553(13)70180-2.
Bo K, Herbert RD. When and how should new therapies become routine clinical practice? Physiotherapy. 2009;95(1):51–7. doi:10.1016/j.physio.2008.12.001.
IASP Taxonomy. International Association for the Study of Pain (IASP). 2012. http://www.iasp-pain.org/Taxonomy-Pain. Accessed 5 November 2015.
Harris P, Nagy S, Vardaxis N. Mosby’s dictionary of medicine, nursing and health professions. 2nd ed. Chatswood, NSW: Elsevier Australia; 2010.
Baranowski A, Abrams P, Berger R, Buffington T, Collett B, Emmanuel A, et al. Classification of chronic pain: descriptions of chronic pain syndromes and definitions of pain terms. International Association for the Study of Pain (IASP). http://www.iasp-pain.org/PublicationsNews/Content.aspx?ItemNumber=1673&navItemNumber=677. International Association for the Study of Pain (IASP); 2012.
Engeler D, Baranowski AP, Borovicka J, Cottrell A, Dinis-Oliveira P, Elneil S, et al. EAU guidelines on chronic pelvic pain. 2012. http://www.uroweb.org/guidelines/online-guidelines. Accessed 20 October 2015.
Giamberardino MA, Affaitati G, Fabrizio A, Costantini R. Myofascial pain syndromes and their evaluation. Best Pract Res Clin Rheumatol. 2011;25(2):185–98. doi:10.1016/j.berh.2011.01.002.
Bump RC, Mattiasson A, Bo K, Brubaker LP, DeLancey JO, Klarskov P, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996;175(1):10–7.
Henry MM, Parks AG, Swash M. The pelvic floor musculature in the descending perineum syndrome. Br J Surg. 1982;69(8):470–2.
Sultan A, Monga A, Lee J, Emmanuel A, Norton C, Santoro G et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) Joint Report on the Terminology for Anorectal Dysfunction in Women. Int Urogynecol J. 2016. doi:10.1007/s00192-016-3123-4 and Neurourol Urodyn. 2016. doi:10.1002/nau.23055.
Mense S, Simons DG, Russell IJ. Muscle pain: understanding its nature, diagnosis, and treatment. Philadelphia: Lippincott Williams & Wilkins; 2001.
Simons DG, Mense S. Understanding and measurement of muscle tone as related to clinical muscle pain. Pain. 1998;75(1):1–17.
Enoka RM. Acute adjustments. In: Enoka RM, editor. Neuromechanics of human movement. 4th ed. Champaign: Human Kinetics; 2008. p. 305–47.
Masi AT, Hannon JC. Human resting muscle tone (HRMT): narrative introduction and modern concepts. J Bodyw Mov Ther. 2008;12(4):320–32. doi:10.1016/j.jbmt.2008.05.007.
Nordin M, Frankel VH. Biomechanics of Bone. In: Nordin M, Frankel VH, editors. Basic biomechanics of the musculoskeletal system. 4th ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins Health; 2012. p. 24–56.
Gajdosik RL. Passive extensibility of skeletal muscle: review of the literature with clinical implications. Clin Biomech (Bristol, Avon). 2001;16(2):87–101.
Mumenthaler M. Neurologic differential diagnosis. 2nd ed. Neurologische Differentialdiagnostik. Stuttgart: Thieme; 1992.
Preston DC, Shapiro BE. Electromyography and neuromuscular disorders: clinical-electrophysiologic correlations. Boston: Butterworth-Heinemann; 1998.
Gerwin R. Myofascial pain syndrome: here we are, where must we go? J Musculoskelet Pain. 2010;18(4):329–47. doi:10.3109/10582452.2010.502636.
Dietz HP, Shek C. Validity and reproducibility of the digital detection of levator trauma. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(8):1097–101. doi:10.1007/s00192-008-0575-1.
Kruger JA, Dietz HP, Budgett SC, Dumoulin CL. Comparison between transperineal ultrasound and digital detection of levator ani trauma. Can we improve the odds? Neurourol Urodyn. 2014;33(3):307–11. doi:10.1002/nau.22386.
Kruger J, Dietz P, Botelho C, Dumoulin C. Can we feel with our fingers as well as we see with ultrasound? Neurourol Urodyn. 2010;29:1176–7.
Dietz HP, Hyland G, Hay-Smith J. The assessment of levator trauma: a comparison between palpation and 4D pelvic floor ultrasound. Neurourol Urodyn. 2006;25(5):424–7. doi:10.1002/nau.20250.
Knuttgen HG, Kraemer WJ. Terminology and measurement in exercise performance. J Strength Cond Res. 1987;1(1):1–10. doi:10.1519/00124278-198702000-00001.
Howley ET. Type of activity: resistance, aerobic and leisure versus occupational physical activity. Med Sci Sports Exerc. 2001;33(6 Suppl):S364–9, discussion S419–20.
Komi V. Strength and power in sport. 2nd ed. Osney Mead: Blackwell Science; 2003.
Wilmore JH, Costill DL. Physiology of sport and exercise. 2nd ed. Leeds: Human Kinetics; 1999.
Vodusek DB. Electromyography. In: Bo K, Berghmans B, Morkved S, Van Kampen M, editors. Evidence-based physical therapy for the pelvic floor : bridging science and clinical practice. Edinburgh: Churchill Livingstone; 2015.
Knudson D. Fundamentals of biomechanics. 2nd ed. Boston: Springer Science + Business Media; 2007.
Sherwood L. Human physiology: from cells to systems. 8th ed. Belmont: Brooks/Cole; 2013.
Kent M. The Oxford dictionary of sports science and medicine. 2nd ed. Oxford Medical Publications. Oxford: Oxford University Press; 1998.
Alter MJ. Science of flexibility. 3rd ed. Champaign: Human Kinetics; 2004.
Møller AR. Intraoperative neurophysiological monitoring. 3rd ed. New York: Springer; 2011.
Bo K, Sherburn M. Evaluation of female pelvic-floor muscle function and strength. Phys Ther. 2005;85(3):269–82.
Dietz HP, Bernardo MJ, Kirby A, Shek KL. Minimal criteria for the diagnosis of avulsion of the puborectalis muscle by tomographic ultrasound. Int Urogynecol J. 2011;22(6):699–704. doi:10.1007/s00192-010-1329-4.
Dietz HP, Abbu A, Shek KL. The levator-urethra gap measurement: a more objective means of determining levator avulsion? Ultrasound Obstet Gynecol. 2008;32(7):941–5. doi:10.1002/uog.6268.
DeLancey JO, Kearney R, Chou Q, Speights S, Binno S. The appearance of levator ani muscle abnormalities in magnetic resonance images after vaginal delivery. Obstet Gynecol. 2003;101(1):46–53.
Miller JM, Brandon C, Jacobson JA, Low LK, Zielinski R, Ashton-Miller J, et al. MRI findings in patients considered high risk for pelvic floor injury studied serially after vaginal childbirth. AJR Am J Roentgenol. 2010;195(3):786–91. doi:10.2214/ajr.09.3508.
Morgan DM, Umek W, Stein T, Hsu Y, Guire K, DeLancey JO. Interrater reliability of assessing levator ani muscle defects with magnetic resonance images. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18(7):773–8. doi:10.1007/s00192-006-0224-5.
Berger MB, Morgan DM, DeLancey JO. Levator ani defect scores and pelvic organ prolapse: is there a threshold effect? Int Urogynecol J. 2014;25(10):1375–9. doi:10.1007/s00192-014-2388-8.
Kegel AH. Progressive resistance exercise in the functional restoration of the perineal muscles. Am J Obstet Gynecol. 1948;56(2):238–48.
Dumoulin C, Bourbonnais D, Lemieux MC. Development of a dynamometer for measuring the isometric force of the pelvic floor musculature. Neurourol Urodyn. 2003;22(7):648–53. doi:10.1002/nau.10156.
Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res. 2011;63 (Suppl 11):S240–52. doi:10.1002/acr.20543.
Dworkin RH, Turk DC, Wyrwich KW, Beaton D, Cleeland CS, Farrar JT, et al. Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations. J Pain. 2008;9(2):105–21. doi:10.1016/j.jpain.2007.09.005.
Droz J, Howard FM. Use of the Short-Form McGill Pain Questionnaire as a diagnostic tool in women with chronic pelvic pain. J Minim Invasive Gynecol. 2011;18(2):211–7. doi:10.1016/j.jmig.2010.12.009.
Barber MD, Chen Z, Lukacz E, Markland A, Wai C, Brubaker L, et al. Further validation of the short form versions of the Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ). Neurourol Urodyn. 2011;30(4):541–6. doi:10.1002/nau.20934.
Gerstenberger EP, Rosen RC, Brewer JV, Meston CM, Brotto LA, Wiegel M, et al. Sexual desire and the Female Sexual Function Index (FSFI): a sexual desire cutpoint for clinical interpretation of the FSFI in women with and without hypoactive sexual desire disorder. J Sex Med. 2010;7(9):3096–103. doi:10.1111/j.1743-6109.2010.01871.x.
Derogatis LR, Rosen R, Leiblum S, Burnett A, Heiman J. The Female Sexual Distress Scale (FSDS): initial validation of a standardized scale for assessment of sexually related personal distress in women. J Sex Marital Ther. 2002;28(4):317–30.
Quaghebeur J, Wyndaele JJ. Comparison of questionnaires used for the evaluation of patients with chronic pelvic pain. Neurourol Urodyn. 2013;32(8):1074–9. doi:10.1002/nau.22364.
Body Mapping. Public and Commercial Services Union. http://www.pcs.org.uk/en/resources/health_and_safety/health_and_safety_reps_toolkit/body-mapping.cfm. Accessed 20 October 2015.
The Free Dictionary http://medical-dictionary.thefreedictionary.com. Accessed 20 October 2015.
Oxford Learner’s Dictionary. http://www.oxfordlearnersdictionaries.com. Accessed 14 November 2015.
Policy statement: Description of physical therapy. World Confederation for Physical Therapy (WCPT). http://www.wcpt.org/policy/ps-descriptionPT. Accessed 29 November 2015.
World Health Organization. Adherence to long-term therapies: evidence for action. Geneva: World Health Organization; 2003.
Nunes V, Neilson J, O’Flynn N, Calvert N, Kuntze S, Smithson H, et al. Clinical guidelines and evidence review for medicines adherence: involving patients in decisions about prescribed medicines and supporting adherence. London: National Collaborating Centre for Primary Care and Royal College of General Practitioners; 2009.
Friedlander JI, Shorter B, Moldwin RM. Diet and its role in interstitial cystitis/bladder pain syndrome (IC/BPS) and comorbid conditions. BJU Int. 2012;109(11):1584–91. doi:10.1111/j.1464-410X.2011.10860.x.
Shorter B, Lesser M, Moldwin RM, Kushner L. Effect of comestibles on symptoms of interstitial cystitis. J Urol. 2007;178(1):145–52. doi:10.1016/j.juro.2007.03.020.
Bouchard C, Shephard RJ, Stephens T. Physical activity, fitness, and health: consensus statement. Champaign: Human Kinetics; 1993.
Meijlink JM. A patient perspective. In: Nordling J, Wyndaele JJ, Van de Merwe JP, Bouchelouche P, Cervigni M, Fall M, editors. Bladder pain syndrome: a guide for clinicians. New York: Springer Science + Business Media; 2013.
Rollnick S, Miller WR. What is motivational interviewing? Behav Cogn Psychother. 1995;23(04):325–34. doi:10.1017/S135246580001643X.
Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84(2):191–215.
Wyman JF, Burgio KL, Newman DK. Practical aspects of lifestyle modifications and behavioural interventions in the treatment of overactive bladder and urgency urinary incontinence. Int J Clin Pract. 2009;63(8):1177–91. doi:10.1111/j.1742-1241.2009.02078.x.
Moore K, Dumoulin C, Bradley C, Burgio K, Chambers T, Hagen S, et al. Adult conservative management. In: Abrams P, Cardozo L, Khoury S, Wein A, editors. Incontinence, 5th International Consultation on Incontinence, Paris, February, 2012. Paris: ICUD-EAU; 2013. p. 1101–228.
Chiarelli P, Markwell S. Let’s get things moving. Sydney: Gore and Osment; 1992.
Markwell S, Sapsford R. Physiotherapy management of pelvic floor dysfunction. In: Sapsford R, Markwell S, Bullock-Saxton J, editors. Women’s health: a textbook for physiotherapists. London: Saunders; 1998. p. 383–407.
NICE. Faecal incontinence: The management of faecal incontinence in adults. NICE clinical guideline 49 June 2007: 6. http://www.nice.org.uk/guidance/cg49/evidence/full-guideline-195116653.
Kraemer WJ, Häkkinen K. Strength training for sport. Handbook of Sports Medicine and Science. Oxford: Blackwell Science; 2002.
American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Med Sci Sports Exerc. 2009;41(3):687–708. doi:10.1249/MSS.0b013e3181915670.
Fleck SJ, Kraemer WJ. Designing resistance training programs. 3rd ed. Champaign: Human Kinetics; 2004.
Tortora GJ, Derrickson B. Principles of anatomy and physiology. 12th ed. New York: Wiley; 2009.
Bo K, Hagen RH, Kvarstein B, Jørgensen J, Larsen S, Burgio KL. Pelvic floor muscle exercise for the treatment of female stress urinary incontinence. III. Effects of two different degrees of pelvic floor muscle exercises. Neurourol Urodyn. 1990;9(5):489–502. doi:10.1002/nau.1930090505.
Plevnik S. A new method for testing and strengthening pelvic floor muscle. In: Proceedings of the International Continence Society. 1985. p. 267–8.
Coville CA. Relaxation in physical education curricula. Phys Educ. 1979;36(4):176–81.
Jacobson E. Progressive relaxation. Chicago: University of Chicago Press; 1938.
Astin JA. Meditation. In: Novey D, editor. Clinician’s complete reference to complementary and alternative medicine. St. Louis: Mosby; 2000.
Baer RA. Mindfulness training as a clinical intervention: a conceptual and empirical review. Clin Psychol Sci Pract. 2003;10(2):125–43. doi:10.1093/clipsy.bpg015.
Shumway-Cook A, Woollacott MH. Motor control : theory and practical applications. Baltimore: Williams & Wilkins; 1995.
Schwartz GE, Beatty J. Biofeedback, theory and research. New York: Academic; 1977.
Cram JR, Kasman GS, Holtz J. Introduction to surface electromyography. Gaithersburg: Aspen; 1998.
Schwartz MS, Andrasik F. Biofeedback: a practitioner’s guide. 3rd ed. New York: Guilford Press; 2003.
Haslam J, Mantle J. Bowel and anorectal function and dysfunction. In: Mantle J, Haslam J, Barton S, editors. Physiotherapy in obstetrics and gynaecology. 2nd ed. London: Butterworth-Heinemann; 2004. p. 417–20.
Beckmann MM, Stock OM. Antenatal perineal massage for reducing perineal trauma. Cochrane Database Syst Rev. 2013;4, CD005123. doi:10.1002/14651858.CD005123.pub3.
Cyriax JH, Cyriax PJ. Cyriax’s illustrated manual of orthopedic medicine. 2nd ed. Oxford: Butterworth Heinemann; 1998.
Thiele GH. Tonic spasm of the levator ani, coccygeus and piriformis muscles. Trans Am Proct Soc. 1936;37:145–55.
Brukner P, Khan K. Brukner & Khan’s clinical sports medicine. 4th ed. Sydney: McGraw-Hill; 2012.
Robinson AJ, Snyder-Mackler L. Clinical electrophysiology: electrotherapy and electrophysiologic testing. 3rd ed. Baltimore: Lippincott Williams & Wilkins; 2007.
Schreiner L, Santos TG, Souza AB, Nygaard CC, Silva Filho IG. Electrical stimulation for urinary incontinence in women: a systematic review. Int Braz J Urol. 2013;39(4):454–64. doi:10.1590/s1677-5538.ibju.2013.04.02.
Berghmans B, van Waalwijk van Doorn E, Nieman F, de Bie R, van den Brandt P, Van Kerrebroeck P. Efficacy of physical therapeutic modalities in women with proven bladder overactivity. Eur Urol. 2002;41(6):581–7.
Jabs CF, Stanton SL. Urge incontinence and detrusor instability. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12(1):58–68.
Edenfield AL, Amundsen CL, Wu JM, Levin PJ, Siddiqui NY. Posterior tibial nerve stimulation for the treatment of fecal incontinence: a systematic evidence review. Obstet Gynecol Surv. 2015;70(5):329–41.
Eriksen BC, Eik-Nes SH. Long-term electrostimulation of the pelvic floor: primary therapy in female stress incontinence? Urol Int. 1989;44(2):90–5.
Yamanishi T, Yasuda K, Sakakibara R, Hattori T, Ito H, Murakami S. Pelvic floor electrical stimulation in the treatment of stress incontinence: an investigational study and a placebo controlled double-blind trial. J Urol. 1997;158(6):2127–31.
Yamanishi T, Sakakibara R, Uchiyama T, Suda S, Hattori T, Ito H, et al. Comparative study of the effects of magnetic versus electrical stimulation on inhibition of detrusor overactivity. Urology. 2000;56(5):777–81.
Yamanishi T, Yasuda K, Sakakibara R, Hattori T, Suda S. Randomized, double-blind study of electrical stimulation for urinary incontinence due to detrusor overactivity. Urology. 2000;55(3):353–7.
Govier FE, Litwiller S, Nitti V, Kreder Jr KJ, Rosenblatt P. Percutaneous afferent neuromodulation for the refractory overactive bladder: results of a multicenter study. J Urol. 2001;165(4):1193–8.
Janknegt RA, Weil EH, Eerdmans PH. Improving neuromodulation technique for refractory voiding dysfunctions: two-stage implant. Urology. 1997;49(3):358–62. doi:10.1016/s0090-4295(96)00506-7.
Van Balken MR, Vandoninck V, Gisolf KW, Vergunst H, Kiemeney LA, Debruyne FM, et al. Posterior tibial nerve stimulation as neuromodulative treatment of lower urinary tract dysfunction. J Urol. 2001;166(3):914–8.
Belanger A-Y. Therapeutic electrophysical agents: evidence behind practice. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2010.
Electrotherapeutic Terminology in Physical Therapy. American Physical Therapy Association (APTA), American Physical Therapy Association (APTA). 2000. https://iweb.apta.org/Purchase/ProductDetail.aspx?Product_code=P-72. Accessed 20 November 2015.
Cottenden A, Bliss D, Buckley B, Fader M, Gartley C, Hayder D, et al. Management using continence products. In: Abrams P, Cardozo L, Khoury S, Wein A, editors. Incontinence, 5th International Consultation on Incontinence, Paris, February 2012. Paris: ICUD-EAU; 2013. p. 1651–786.
Deutekom M, Dobben AC. Plugs for containing faecal incontinence. Cochrane Database Syst Rev. 2012;4, CD005086. doi:10.1002/14651858.CD005086.pub3.
Merriam-Webster. Webster’s new world dictionary. 3rd ed. New York: Wiley; 2008.
Lipp A, Shaw C, Glavind K. Mechanical devices for urinary incontinence in women. Cochrane Database Syst Rev. 2011;7, CD001756. doi:10.1002/14651858.CD001756.pub5.
Adams E, Thomson A, Maher C, Hagen S. Mechanical devices for pelvic organ prolapse in women. Cochrane Database Syst Rev. 2004;2, CD004010. doi:10.1002/14651858.CD004010.pub2.
Oliver R, Thakar R, Sultan AH. The history and usage of the vaginal pessary: a review. Eur J Obstet Gynecol Reprod Biol. 2011;156(2):125–30. doi:10.1016/j.ejogrb.2010.12.039.
Urinary tract infection in women—self-care. MedlinePlus http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000391.htm. Accessed 20 November 2015.
Epp A, Larochelle A, Lovatsis D, Walter JE, Easton W, Farrell SA, et al. Recurrent urinary tract infection. J Obstet Gynaecol Can. 2010;32(11):1082–101.
National Vulvodynia Association. http://www.nva.org. Accessed 20 October 2015.
Braunstein S, van de Wijgert J. Preferences and practices related to vaginal lubrication: implications for microbicide acceptability and clinical testing. J Womens Health (Larchmt). 2005;14(5):424–33. doi:10.1089/jwh.2005.14.424.
NEVDGP. http://www.nevdgp.org.au/info/incontinence/i_aids.htm. Accessed 10 October 2015.
Schumm K, Lam TB. Types of urethral catheters for management of short-term voiding problems in hospitalised adults. Cochrane Database Syst Rev. 2008;2, CD004013. doi:10.1002/14651858.CD004013.pub1.
Logan K, Shaw C, Webber I, Samuel S, Broome L. Patients’ experiences of learning clean intermittent self-catheterization: a qualitative study. J Adv Nurs. 2008;62(1):32–40. doi:10.1111/j.1365-2648.2007.04536.x.
Shaw C, Logan K, Webber I, Broome L, Samuel S. Effect of clean intermittent self-catheterization on quality of life: a qualitative study. J Adv Nurs. 2008;61(6):641–50. doi:10.1111/j.1365-2648.2007.04556.x.
Clinical Practice Guidelines Adult Clean Intermittent Catheterization. SUNA, Society of Urologic Nurses and Associates http://www.suna.org/resources/adultCICGuide.pdf. Accessed 20 October 2015.
Doggweiler R, Whitmore KE, Meijlink JM, Drake MJ, Frawley H, Nordling J, et al. A standard for terminology in chronic pelvic pain syndromes (CPPS): a report from the Working Group of the International Continence Society Standardisation Steering Committee (ICS-SSC) on Chronic Pelvic Pain. 2016. doi: 10.1002/nau.23072
Quintner JL, Bove GM, Cohen ML. A critical evaluation of the trigger point phenomenon. Rheumatology (Oxford). 2015;54(3):392–9. doi:10.1093/rheumatology/keu471.
Leiblum S, Bachmann G, Kemmann E, Colburn D, Swartzman L. Vaginal atrophy in the postmenopausal woman. The importance of sexual activity and hormones. JAMA. 1983;249(16):2195–8.
Lucas N, Macaskill P, Irwig L, Moran R, Bogduk N. Reliability of physical examination for diagnosis of myofascial trigger points: a systematic review of the literature. Clin J Pain. 2009;25(1):80–9. doi:10.1097/AJP.0b013e31817e13b6.
Norton C, Whitehead WE, Bliss DZ, Harari D, Lang J. Management of fecal incontinence in adults. Neurourol Urodyn. 2010;29(1):199–206. doi:10.1002/nau.20803.
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) – National Institute for Health (NIH). http://digestive.niddk.nih.gov/ddiseases/pubs/fecalincontinence/Fecal_Incontinence_508.pdf. Accessed 20 November 2015.
Bo K, Berghmans B, Morkved S, Van Kampen M. Evidence-based physical therapy for the pelvic floor: bridging science and clinical practice. 2nd ed. Edinburgh: Churchill Livingstone; 2015.
Acknowledgements
We thank Professors Jacques Corcos (Urologist McGill University, Montreal Canada, Mandy Fader (Nurse, University of Southampton, UK), Ingrid Nygaard (Urogynecologist, University of Utah, Salt Lake City, USA), Marijke van Kampen (Physiotherapist, University Hospital Gasthuisberg, K.U. Leuven, Belgium) and David Vodusek (Neurophysiologist, University of Ljubljana, Slovenia) for expert advice on the draft manuscript.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclaimer
Any products/companies referred to in this document are not necessarily recommended or endorsed by the ICS.
Conflicts of interest
Elizabeth Shelly is a consultant to Analytica and Amanda Wells is a consultant to ARC Health Services. None of the other authors have any conflicts of interest.
Additional information
This document is being published simultaneously in Neurourology and Urodynamics (NAU) and the International Urogynecology Journal (IUJ), the respective journals of the sponsoring organizations, the International Continence Society (ICS) and the International Urogynecological Association (IUGA)
Standardization and Terminology Committees of the IUGA* and ICS#: Bernard T. Haylen*, Jane Meijlink#, Elizabeth Shelly#
Joint IUGA/ICS Working Group on the Conservative Management of Pelvic Floor Dysfunction: Kari Bo, Helena Frawley, Bernard Haylen, Yoram Abramov, Fernando Almeida, Bary Berghmans, Maria Bortolini, Chantale Dumoulin, Mario Gomes, Doreen McClurg, Jane Meijlink, Elizabeth Shelly, Emanuel Trabuco, Carolina Walker, and Amanda Wells
Published online in Wiley Online Library (wileyonlinelibrary.com). DOI 10.1002/nau.23107
Rights and permissions
About this article
Cite this article
Bo, K., Frawley, H.C., Haylen, B.T. et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction. Int Urogynecol J 28, 191–213 (2017). https://doi.org/10.1007/s00192-016-3123-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00192-016-3123-4