Pelvic Floor Disorders.

Pelvic Floor Disorders Bourcier AP, McGuire EJ, Abrams P. Philadelphia, PA 19106, Elsevier Saunders, 2004, hardcover, 478 pp, illus, ISBN: 0-7216-9194-3, $99.

This book, which contains extensive bibliographies, is a valuable resource for physical therapists with a specific interest in women's health issues. More than 30 specialists from around the world contributed to this book, and only 5 of them are physical therapists. Because there are multiple authors, there are several areas where material is duplicated.

Part I of the book is devoted to a review of the gross anatomy and physiology of the pelvic region, including a discussion of male and female sexual functions. Although the book contains illustrations of anatomy, there should be more of them, because the orientation is not always easy to grasp.

Part II addresses the effects of pregnancy, childbirth, advanced age, and neurological disorders, as well as issues with fecal incontinence and rectal prolapse. According to the research referenced in this part of the book, the perineum returns to its antepartum position 5 years after vaginal delivery. This is the one focus that most relates to physical therapist practice in this book. This part also discusses the effect of episiotomy, vacuum and forceps, and anesthesia on the integrity of the pelvic floor; post-prostatectomy incontinence; and the various types and prevalence of urinary incontinence.

Part III of the book is devoted to patient examination and the ensuing diagnostic workup, which can range from the physical examination to advanced magnetic resonance imaging and dynamic tests. Defining the problem accurately has a significant effect on the resulting treatment. It is important to know the differences among stress incontinence, urge incontinence, and true incontinence and to know the appropriate questions to ask. A chapter is devoted to erectile dysfunction in men and the different ways to define it, and another chapter discusses fecal incontinence, constipation, and other dysfunctions of the region.

Part IV, which is devoted to conservative treatment and techniques, would be of most interest to the physical therapist. Chapter 28, "Pelvic Floor Muscle Exercises," would be the most important chapter for physical therapists to read. Guidelines are given for activating different muscle fibers, different training programs, frequency of exercise, coactivation of surrounding musculature, and duration of exercise. Unfortunately, the information presented is somewhat inconclusive. Routines for teaching pelvic floor exercises are provided, but with minimal research substantiation. There are many references to research, and plenty of references for further reading, but very few show conclusive results. This book offers things to think about, but no definitive protocols. It is definitely not a quick reference.

There are also chapters on electrical stimulation and biofeedback, which would be relevant in some physical therapy settings. Incontinence aids currently available on the market also are mentioned. Another conservative measure not used by physical therapists that is discussed in this book is extracorporeal electromagnetic stimulation therapy.

The last section, part V, is devoted to the many surgical and pharmacological approaches to treatment. Descriptions and illustrations of products, such as pubovaginal slings, tension-free vaginal tape, and artificial sphincters, are provided. Surgery for men and children also is addressed.

Although many approaches are discussed in this book, it is difficult to assess which technique is most appropriate. I think the book offers comprehensive information on the pelvic floor, with quite a lot of repetition. Not much of it relates directly to physical therapist practice. I do not think it would be of significant use to a physical therapist in a general practice setting, but it would probably be of great use to the physical therapist specializing in pelvic floor and incontinence issues.

Bernice Kegel, PT

Harborview Hospital

Seattle, Wash

Mrs Kegel works in acute rehabilitation and outpatient therapy at Harborview Hospital and teaches for the Childbirth Education Association of Seattle.