CHARACTERISTICS AND MANAGEMENT OF MEN REFERRED TO PELVIC FLOOR PHYSIOTHERAPY IN ABU DHABI

L. Lial¹, G. Walker¹, E. Dalkilinc¹, A. Thrush¹

¹Cleveland Clinic Abu Dhabi, Rehab Medicine, Abu Dhabi, United Arab Emirates

Background: Pelvic floor dysfunction (PFD) is the inability to adequately relax, contract, or coordinate the pelvic floor muscles, which leads to a variety of debilitating symptoms including incontinence, difficulty emptying the bowel or bladder, sexual dysfunction, and pain. PFD is most common and best understood in women, and less so among men. Physiotherapy has become a first-line and effective treatment for women with PFD, but evidence for the same among men is scant.Physiotherapists observed a growth in the number of men referred to outpatient pelvic floor physiotherapy at a tertiary hospital in Abu Dhabi, where very few clinics or clinicians specialize in providing care to this patient population.

Purpose: This study reports the demographics, clinical characteristics, interventions, and outcomes of men attending pelvic floor physiotherapy.

Methods: This is a retrospective review of medical charts, beginning from May 2019. Male patients between the ages of 21 to 50 years were included if they completed ≥3 physiotherapy sessions and had a pre- and post- record of the Patient Specific Functional Scale (PSFS). Men with dysfunction due to prostatectomy were excluded because physiotherapy management for this population is well described in literature. Data regarding patient demographics, symptoms, interventions, and outcomes were reported with descriptive statistics.

Results: 21 patients met inclusion criteria.61.9% were Emirati nationals, and median age was 41 (35, 44). The most common medical diagnoses were stress urinary incontinence (47.6%), pelvic pain (23.8%), and dysfunctional voiding of urine (14.3%); less frequent were urinary retention and urgency, post-void dribbling, neuralgias, urethral stricture, nocturia, bladder outflow obstruction, erectile dysfunction, and genital pain. Patients set goals specific to their symptoms, most often related to normalizing urination frequency/function and relieving pain. On evaluation, the physiotherapist problem list included PFD (100% of patients), musculature tightness/tension of pelvic or non-pelvic floor musculature (42.9%), and less often trigger points (abdominal, diaphragm, or pelvic floor), poor posture, and poor breathing pattern. Patients attended a median of 4 (3,7) physiotherapy sessions. 95.2% of patients were provided education, and 95.2% were provided biofeedback (66.7% EMG, 33.3% tactile), as interventions. Other interventions included exercise (80.1%), pelvic floor muscle training (61.9%), manual therapy (42.9%), and dry needling (4.8%). The median final PSFS score was 6 (4,7).

Conclusions: Despite being a minority of the Abu Dhabi population, nationals represented the majority of male patients in the clinic, and at a young age. Medical diagnoses were heterogeneous, while physiotherapy assessment consistently attributed PFD to musculoskeletal weaknesses and tonal impairments. Nearly all patients were recipients of educational and biofeedback interventions, while exercise training, pelvic floor muscle training, and manual therapy were also common and presumably applied as per individual patient findings and needs. Patient achieved good levels of function on their self-identified goal via the PSFS, within a small number of physiotherapy sessions.

Implications: The importance of understanding baseline clinical characteristics and management of a population which has little previously published evidence can lead to insights which may facilitate patient care and outcomes, while also highlighting the need for further research into this important area of rehabilitation.

Funding acknowledgements: This work is unfunded.

Keywords:
Dysfunctional voiding
Pelvic floor dysfunction
Urinary incontinence

Topics:
Pelvic, sexual and reproductive health
Musculoskeletal
Health promotion & wellbeing/healthy ageing/physical activity

Did this work require ethics approval? No

Reason: The intent of this study was to perform a quality improvement project in order to better develop the Pelvic Floor Physical Therapy service line at Cleveland Clinic Abu Dhabi - a new and growing clinical specialty. As part of the development and maintenance of good practice it is essential to standardize services, improve on program quality, provide evidence-based management, and optimize care and outcomes. CCCAD is among very few facilities in the region to provide male pelvic floor physiotherapy treatment, and is providing a pioneering service to this specialized population. The Pelvic Floor Physical Therapy service at CCAD has experienced higher than expected volumes of male patients with Dysfunctional Voiding (DV). This prompts our team to organize a review of patient presentation, management, and outcomes – in order to standardize services and meet patients needs most effectively. Typical proven treatments for women with DV include physiotherapy and techniques such as biofeedback. We seek to better understand what interventions are being provided in our clinic and what outcomes have been observed. We can build upon this to have a more efficient and effective patient experience and continue to grow our service to young men in Abu Dhabi suffering from this poorly understood condition.