Wolff Birte J, Joyce Cara J, McAlarnen Lindsey A, Brincat Cynthia A, Mueller Elizabeth R, Fitzgerald Colleen M
Department of Obstetrics/Gynecology and Urology, Loyola University Chicago Stritch, School of Medicine and Loyola University Medical Center, United States.
Center for Translational Research and Education, Loyola University Chicago, United States.
J Bodyw Mov Ther. 2020 Apr;24(2):144-150. doi: 10.1016/j.jbmt.2019.10.018. Epub 2019 Nov 6.
Physical therapy has been shown to be effective for women with overactive bladder (OAB). We report on our experience with pelvic floor physical therapy (PFPT) with or without myofascial release as treatment for women with symptoms of urinary urgency or urge incontinence.
We performed a retrospective chart review, of patients who presented to our tertiary care Urogynecology practice. These women were evaluated and treated between August 2016 and December 2016. We abstracted for symptoms as per history of present illness and the pelvic floor muscle examination. PFPT progress notes were reviewed to determine whether patients received myofascial release techniques, or if therapy was limited to behavioral interventions and urge suppression techniques. We recorded the number of PFPT sessions attended, and whether the patient reported improvement.
77 patients with symptoms of OAB met inclusion criteria and initiated PFPT. Myofascial tenderness of the pelvic floor muscles was found in 56.5% of patients. PFPT was limited to behavioral and urge suppression in 18 patients, while 59 patients received myofascial release techniques. Improvement was reported by 71.4% (n = 55/77) of patients. Improvement increased with number of sessions attended: 1-2: 6% (1/17), 3-5: 94% (16/17), 6-8: 91% (29/32), and >8: 80% (9/11) improved, respectively (p < 0.001). Among patients who had myofascial release, 84.7% reported improvement when compared to only 27.8% of patients without myofascial release.
The data support the inclusion of myofascial release during pelvic floor physical therapy for overactive bladder. At least three sessions of PFPT are necessary for patient reported improvement.
物理治疗已被证明对膀胱过度活动症（OAB）女性有效。我们报告了我们在有或没有肌筋膜松解的盆底物理治疗（PFPT）治疗尿急或急迫性尿失禁症状女性方面的经验。
我们对到我们三级医疗泌尿妇科诊所就诊的患者进行了回顾性病历审查。这些女性在2016年8月至2016年12月期间接受了评估和治疗。我们根据现病史和盆底肌肉检查提取症状。审查PFPT进展记录以确定患者是否接受了肌筋膜松解技术，或者治疗是否仅限于行为干预和尿急抑制技术。我们记录了参加PFPT的次数以及患者是否报告有改善。
77名有OAB症状的患者符合纳入标准并开始接受PFPT。56.5%的患者发现盆底肌肉有肌筋膜压痛。18名患者的PFPT仅限于行为和尿急抑制，而59名患者接受了肌筋膜松解技术。71.4%（n = 55/77）的患者报告有改善。随着参加疗程数的增加改善情况增加：1 - 2次：6%（1/17），3 - 5次：94%（16/17），6 - 8次：91%（29/32），>8次：80%（9/11）有改善，分别（p < 0.001）。在接受肌筋膜松解的患者中，84.7%报告有改善，而未接受肌筋膜松解的患者中只有27.8%报告有改善。
数据支持在膀胱过度活动症的盆底物理治疗中纳入肌筋膜松解。患者报告有改善至少需要三次PFPT疗程。
