Health Care: Chronic Pain Syndrome (CPPS)

Running head: HEALTH CARE

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Clemens et al, 2000
Purpose of the study

Symptoms of male patients with chronic pain syndrome (CPPS) may be contributed by pelvic floor tension myalgia. Measures that lessen pelvic floor muscle spasm may therefore improve these symptoms.

Nature of the subjects

The mean age of the nineteen patients was thirty six years (range 18 to 67).Ten patients were present during all the six sessions.
Brief outline of methods of study
The first thing was to teach the patients on how to recognize the Pelvic Floor Muscle Group and then use contraction exercise to put the muscle through its normal dynamic range. Pretreatment assessment incorporated pressure-flow urodynamic studies. A 9F rectal catheter was used to record abdominal pressure.Custaneous electrodes were placed on the perineum and used to record sphincter activity. Abrams and Griffiths normogram determined the presence or absence of bladder outlet obstruction. An involuntary rise in detrusor pressure of more than 15 cmH2O was defined as detrusor instability. Bladder capacity of less than 250ml was described as a reduced bladder capacity. The existence of high level of electromyographic (EMG) motion throughout voiding in the nonexistence of abdominal straining was classified as detrusor-sphincter pseudodyssynergia. A standardized procedure of bladder instruction combined with pelvic floor re-education is known as biofeedback program. The patient is instructed by the manufacturer on contraction and relaxation of the pelvic floor musculature through the EMPI biofeedback program. The patient is educated on how to exercise while they are at home. They are required to exercise three times daily by similar combination of quick and sluggish contractions and relaxations throughout the instructional session.
Statistical analysis

Pretreatment urodynamics was carried out to the fourteen of the nineteen patients in our laboratory. Five patients showed the evidence of destrusor instability while other four showed reduced bladder capacity. Based on Abrams-Griffiths method, there was no obstruction in any patient although in six patients, dysfunctional voiding was confirmed .A combination of cystometric abnormalities and pseudodyssynergia was detected in three patients’ .Less than three sessions were attended by four patients. Notable improvement in all outcomes was statistically recorded. After treatment there were low symptoms of AUA in every patient. Wilcoxon signedrank examination was carried to differentiate between treatment before and after symptoms as well as voiding frequencies.
Outcomes
Following all the results there was no post void residue urine volume that was above sixty Ml. All six biofeedback sessions were finished by ten patients, five patients completed three to five sessions while four finished less than three. Two patients failed to comply due to insurance issues, four did not comply as they had improved sufficiently and it is not known why one patient did not comply. It is not clear if patients who improved in one area were contented with the outcome of their treatment. This is because general quality of life was not evaluated by the current study. Grouping in patients was done according to detection or absence of cystometric abnormalities as well as presence or nonexistence of pseudodyssynergia.
Author’s conclusion

There was a follow-up after six months that was a well arranged program of biofeedback-assisted pelvic floor exercises as well as timed voiding. This program resulted in great improvement in men who had CPPS. Assessable effects were noted due to reduced treatments. These results suggest this treatment undertaking can be of benefit to patients with CPPS dysfunctional voiding and pelvic pain.
Limitations of the study

This study failed to investigate whether patients who only improved in a single area were pleased the outcome of the treatment.
(Dean et. al, 2008)
Purpose of the study

The purpose of this study is to find out the connection between sexual function and history of delivery mode as well as Pelvic Floor Muscle Exercise and its relation to incontinence.
Nature of the subjects

It involved a cross-section of women who had stayed six years after their last delivery.
Brief outline of methods of study

A class of women who had given birth in three maternity entities was sent a postal questionnaire three months after giving birth .Information concerning lack of control of feces and urine and at the same time the presentation of PFME was collected. Seven hundred and forty seven (28%) of those who responded were asked for participation in a Randomized Controlled Trial(RCT).It involved comparison of PFME training post delivery through a standard care control group. A nurse trained the women about PMFE. They were also taught about urgency symptoms of the bladder and this was during their fifth, seventh and nine month after delivery. There was an evaluation which was done at twelve months. There was a second questionnaire sent to 7879 women who had replied the first one and it was six years following the index delivery. It contained ten questions derived from Golombok Rust Inventory of Sexual Satisfaction (GRISS). There was a secondary questionnaire to determine if present PFME performance and lack of feces and urine control were related with improved sexual function.
Statistical analysis

The questions about sexual function were considered to be continuous. They were scrutinized by a three-way analysis considering PFME, delivery history along with incontinences aspects.
Outcomes
The reply was achieved at fifty four percent which was four thousand two hundred and fourteen out of seven thousand eight hundred and seventy two. Women with urinary incontinence were less than those without in all ten questions about sexual function. It was noticed that PFME and urinary incontinence were independently related. It was confirmed that during sexual intercourse, more women who had cesarean section delivery experienced pain. It was also noted that less women who had mixed spontaneous vaginal delivery and caesarean section experienced pain during sexual intercourse. There was no significance difference in pain with the pelvic floor muscle exercise between those individuals experienced pain with sexual intercourse and those who never experienced pain. There was also minimal difference on sexual function outcomes to urinary incontinence at six years among the individuals. There was no big difference among the individuals on sexual function outcomes according to allocation in randomized controlled trial of pelvic floor muscle exercise. There was a notable difference between individuals on sexual function outcomes according to fecal incontinence at six years

Author’s conclusion
The study has shown that women presently carrying out PFME have improved achievement on most of the sexual function questions and experience no pain when having sex. The history on method of delivery seems to contain fewer effects on sexual function. Present PFME performance has a constructive relation with the majority of sexual function aspects.
Limitations of the study
Some of the data collected relied on memory from the women as they replied in the questionnaire which makes it questionable as errors might have occurred. Another limitation is that the questions were optional and women who were not sexually active had not been considered. It did not give women a chance to explain why they would not want to answer those questions.
References
J. Quentin Clemens, Robert B.Nadler,Anthony J. Schaeffer, Jay Belani, Jeff Albaugh &Wade Bushman,(2000).Biofeedback, Pelvic Floor Re-Education, And Bladder Training For Male Chronic Pelvic Pain Syndrome.

Nicola Dean, Don Wilson, Peter Herbison, Cathryn Glazener, Thiri Aung & Christine Macarthur, (2008). Sexual Function, Delivery Mode History, Pelvic Floor, Muscle Exercises and Incontinence: A Cross –Sectional Study Six Years Post-Partum.