Pelvic Floor Muscle Performance, Hip Mobility, and Hip Strength in Women With and Without Self-Reported Stress Urinary Incontinence Objective: To describe pelvic floor muscle (PFM) function, hip mobility, and hip strength profiles and compare measures between women with and without self-reported stress urinary incontinence (SUI). Study Design: Descriptive. Background: Women with SUI present with PFM and hip impairments; yet comparative data in asymptomatic women are lacking. Methods and Measures: Adult women with (n = 21) or without (n = 20) SUI, with regular menses, were recruited. PFM performance, passive hip range-of-motion angles, and hip maximum isometric voluntary contractions (Nm/kg) (Biodex) were measured. Values were compared between groups and legs (dominant [Dom] and nondominant [Non-dom]) (significance: P < .05). Results: Women with SUI were older (P < .001), had higher parity, more tender points (Dom, P = .020), greater prone hip internal rotation (IR) angles (Non-dom, P = .025), lesser flexibility per Ober test (Non-dom, P = .013; Dom, P = .050), lower seated hip external rotation (ER) force (Non-dom, P = .008; Dom, P = .033), and lower hip abduction force (Non-dom and Dom, P < .001) than women without SUI. Leg differences for the SUI group were prone hip IR angles (P = .033), seated hip IR force (P = .015), and prone hip ER force (P < .001). Leg differences in women without SUI were PFM power (P = .005), prone hip angles (IR, P = .038; ER, P = .004), and prone hip ER force (P < .001). Conclusions: The lack of significant differences in PFM function between the 2 groups was unexpected. Greater hip strength and mobility along with unique between-leg differences may suggest a coping mechanism in asymptomatic women with similar PFM function as women with SUI. Investigating relationships among PFM and hip profiles and severity of SUI appears warranted. We have included a Video Abstract that highlights interesting findings in our article (see the Video Abstract, Supplemental Digital Content 1, available at:http://links.lww.com/JWHPT/A23)

Outcomes Following Multidisciplinary Management of Women With Residual Pelvic Pain and Dyspareunia Following Synthetic Vaginal Mesh and/or Mesh Sling Removal Background: Transvaginal synthetic mesh and mesh sling placement for the treatment of stress urinary incontinence and pelvic organ prolapse can yield adverse outcomes, including pelvic pain and dyspareunia, that persist after implant removal. Objective: To describe the clinical presentations of women with residual pelvic pain or dyspareunia after synthetic vaginal mesh and/or mesh sling removal and the effectiveness of treatments using a multidisciplinary approach. Study Design: After receiving institutional review board approval, a neutral reviewer retrospectively analyzed a prospectively maintained database of women who experienced pelvic pain/dyspareunia after implant removal and were referred to a physiatrist specializing in pelvic rehabilitation medicine. Methods: Included were women who were evaluated by a physiatrist following implant removal. Excluded were women seen for symptoms other than pain or pending subsequent resection procedures. Primary outcome was pelvic pain score assessed by a Numeric Pain Rating Scale obtained at each physiatrist and physical therapy visit. Success was defined as a 50% or greater reduction in pain score. All patients underwent pelvic floor physical therapy, with medications and injections as necessary. Results: From 2010 to 2015, 37 women were included in the analysis. Of these, 4 had isolated dyspareunia and the remaining 33 had general pelvic pain. Eight of these 33 (24%) achieved a successful outcome. When evaluating compliance, half (14 of 28) of the compliant patients achieved improvement in pain scores. Compliant patients treated for isolated dyspareunia experienced more than 80% improvement. Conclusion: Pelvic pain-focused interventions are a worthwhile recommendation in women with refractory pelvic pain after vaginal mesh or mesh sling removal.

Perceptions of Physical Activity While Breastfeeding Using the Self-determination Theory Background: Engaging in physical activity and breastfeeding are 2 of the healthiest behaviors a new mother can participate in, yet a majority of mothers are not achieving physical activity or breastfeeding recommendations. Breastfeeding mothers may experience additional barriers to physical activity; however, more research is needed. Therefore, the purpose of this cross-sectional study was to determine the physical activity levels of breastfeeding women as well as to better understand their motivation and barriers for engaging in physical activity. Methods: A total of 633 breastfeeding mothers completed a 30-question survey developed under the constructs of self-determination theory. Results: Findings indicate the majority of breastfeeding mothers are engaging in light activity (eg, walking) regularly; nevertheless, 1 in 5 mothers is predominantly sedentary and only 1 in 20 mothers is engaging in heavy exercise (eg, running) regularly. Furthermore, mothers appear motivated by extrinsic factors related to improving fitness and appearance. Finally, physical discomfort due to breastfeeding and concerns for reduction in milk supply were found to be substantial barriers to physical activity. Conclusion: These findings suggest breastfeeding women may need additional support for engaging in physical activity and further education and resource development is needed.

Surface-Applied Electrical Muscle Stimulation for Self-administered Treatment of Female Stress Urinary Incontinence Background: Female stress urinary incontinence is effectively treated with pelvic floor physical therapy. However, many of the devices available to therapists necessitate vaginal insertion, which many women perceive as invasive. The Elitone device delivers a noninvasive alternative for delivering electrical muscle stimulation to the pelvic floor, which may promote broader access to this therapeutic modality. Further, the device's configuration enables home use, which may be used to complement in-clinic therapy sessions. Objective: This research investigates the safety and efficacy of surface-applied electrical muscle stimulation in the treatment of female stress urinary incontinence in an at-home, patient-administered use case. Study Design: Cohort study without control group. Methods: Twenty female participants with mild/moderate stress urinary incontinence self-administered daily treatments with the Elitone device for 6 weeks. Participants recorded incontinence episodes and absorbent pad use in a daily log. Pre- and poststudy questionnaires were used to assess quality of life, participant satisfaction, and product usability. Results: Incontinence episode frequency, pad usage, and quality-of-life measures improved to a clinically significant degree for 75%, 85%, and 67% of participants, respectively. The pre- to poststudy changes were statistically significant (P < .001) for all 3 measures. Eighty-three percent of participants were satisfied with the treatment. Conclusion: Participants receiving treatment with the conservative, noninvasive Elitone device achieved meaningful improvement in incontinence symptoms across multiple, patient-centric outcome measures. The degree of improvement aligned with historical performance of more invasive, intravaginal therapies. The therapy may particularly benefit those women who oppose use of vaginally inserted devices. Further, although this study evaluated efficacy as a stand-alone, at-home treatment, physical therapists may realize additional benefits by using the device as an at-home complement to in-office therapy sessions.

Blood Flow Restriction and Its Potential Use in Women With Pelvic Organ Prolapse and Stress Incontinence: A Case Report Introduction/Background: One side effect of vaginal delivery is urinary incontinence and pelvic organ prolapse due to the weakness and difficulty activating the pelvic floor musculature. The purpose of this case study is to report on the outcomes associated with the addition of blood flow restriction (BFR) to conventional pelvic floor treatments in a patient with relapsing pelvic organ prolapse. Case Description: A 39-year-old woman who was gravida 5 para 3 presented with cystocele, rectocele, and stress incontinence following the birth of her third child. Her primary goal was to return to running without a “falling out”–type feeling. Impairments were consistent with pelvic floor musculature weakness and difficulty with coordination of movement. Blood flow restriction was added as an adjunct to the current evidence-based strategies of pelvic floor exercises, biofeedback, electrical stimulation, and education. Outcomes: The patient had improvements in biofeedback values, increased muscle strength of the pelvic floor via the Modified Oxford Scale, statistically significant scores on the Pelvic Floor Distress Inventory (PFDI-20), reduction of pelvic organ prolapse, and stress incontinence. There was a 75% improvement in her ability to run without symptoms. Discussion: This case report demonstrates that BFR, along with traditional pelvic floor treatment, was associated with improvements in the patient's pelvic floor function. Blood flow restriction training may be a promising addition to pelvic floor rehabilitation for patients with pelvic floor musculature atrophy who do not fully respond to current best practice methods. Informed Consent: Informed consent was obtained for this case report.

A Review of Literature on the Diagnosis, Clinical Implications, and Treatment of Diastasis Recti in Older Males Purpose: To provide information on objective diagnostic methods, clinical implications, and appropriate interventions for older male patients presenting with signs and symptoms indicative of diastasis recti. Methods: Searches were conducted for the diagnosis, clinical implications, and treatment of diastasis recti to provide an analysis on current published data. Because of a limited amount of published work directly related to diastasis recti in males, broad search criteria were utilized. References of selected articles were searched for additional articles appropriate to the aforementioned topics and a current list of relevant studies was compiled. Results: Several articles were reviewed on appropriate tools and techniques to evaluate the presence or absence of diastasis recti. Articles analyzed to determine clinical implications in older males presenting with diastasis recti indicated the importance of taking a thorough subjective history to determine appropriate treatment approaches and establishing awareness clinically of potential underlying conditions that may indicate when further screening is appropriate for patients. Discussion: Although diastasis recti in males is relatively rare, physical therapists should be aware of clinical methods for diagnosis, possible implications indicating the need for further screening, and intervention approaches that address anatomical and functional relationships between the anterior abdominal wall, low back, and pelvic floor, when working with patients.

Book Reviews No abstract available