10 responsibility. They may serve their patients best with a visionary approach, informed by a holistic and multidisciplinary approach. Mindfulness is one treatment approach that offers the possibility to enhance awareness of the pelvic region as well as to change unconscious patterns of (15) muscle use, through bringing them conscious . This makes it an effective treatment for restoring pelvic function. Although it has been extensively tested as an isolated treatment modality and found to be effective, it’s value as part of a basket treatment regime remains relatively untested. Discussion The brain has two goals: survival of the individual and survival of the species. One of its tools for ensuring this survival is the motor system, which consists of the voluntary and the emotional and involuntary motor systems. Pelvic oor dysfunction (PFD), refers to a broad constellation of symptoms and anatomic changes, related to abnormal function of the PFM. The disordered function is broadly divided into two groups: hypotonicity (diminished activity in the PFM) and the problems associated with this (pelvic organ prolapse and incontinence) and hypertonicity (increased activity in the PFM). Non-relaxing PFM dysfunction, may present with a broad range of nonspecic symptoms: pain, problems with defecation and urination and problems with sexual function. The retraining here requires relaxation and coordination of PFM and (1) anal and urinary sphincters . PF tension myalgia (PFTM) may result from hypertonicity, and may be the cause of pelvic pain. Sometimes, the PFD is neither hypertonicity nor hypotonicity, but is instead faulty recruitment, inadequate control or co-ordination of the muscle. Just as a lift, needs to be able to go from the ground oor to the tenth oor in a building, the PFM needs to be able to contract partially, fully or anywhere in between. Neither lift nor PFM contraction can work effectively if it gets stuck on any “oor” or is unable to go all the way to the top or all the way to the bottom. A precise diagnosis of any dysfunction that presents, needs to be made and treatment must be deliberately directed at that exact problem. PFD can't be handled like elephant dung which sprays seeds into the earth in the hope that some of those (31) seeds will germinate . Effective PFD management requires insight, expertise and laser-focused treatment with ongoing reassessment. The results of PFD may be urologic, gynecologic or colorectal. All health care professionals working in these elds need to be specically trained and educated in PFD and the symptoms it produces as well as the treatments that are available to rectify the dysfunctions. This will enable them to refer where needed and not use a recipe-type mindset when dealing with pelvic patients. (17) A study by Khan et al in 2013 found a high correlation between depression, anxiety, and failure to respond to PF retraining. Baraa Mazi et al in (24) 2019 concluded that there was a signicant association between depression and PFD. Stress can lead to nonrelaxing PFD. Persisting pelvic pain is a common outcome of pelvic dysfunction. Patients with PPP, often have co-existing factors that disrupt (28) the usual cortisol cycle . These studies show the inextricable entwinement of mental health, and PFD. Since psychological or even psychiatric factors may be the outcome as well as the cause of PFD, they need to be part of the treatment, along with (19) the rehabilitation . Psycho-social questionnaires may be needed to assess the variety of stressors that may be impacting the patient’s pelvic health. Mindfulness offers effective treatment for depression, anxiety, Persistent Pelvic Pain (PPP) and PFD and offers agency to patients suffering from stress. The PFM is Integral to Sexual Pleasure The PFM is active in both male and female genital arousal and orgasm. Inadequate or excessive PFM tone may impact negatively on these phases of function. Evidence suggests a close relationship between the (9) tone of the PFM and male sexual dysfunction . The impact of PPP on sexual function in men is underestimated. The incidence of PPP in men was found to be 2,7% (not age dependent) in a large (1) (22) cohort study performed by Marszalek et al . They found that PPP syndrome had a negative effect on erectile function. A strong therapeutic benet has been demonstrated from pelvic oor (PF) therapy for men who suffer from erectile dysfunction and ejaculatory or orgasmic problems as well as ejaculatory pain and decreased libido. This PF therapy includes pelvic muscle trigger point release concomitant with paradoxical relaxation training. Benet was seen in urinary problems in men as well, using PF trigger point therapy and mindful release of (1) the muscle . An association has also been found between the PF and chronic prostatitis/Pelvic Pain syndrome with rehabilitation demonstrating a signicant benecial effect. This comprehensive bioneuromusculoskeletal-psychosocial approach to the treatment of male sexual dysfunction and pelvic pain is best described as mindfulness informed rehabilitation and is most effectively (12) carried out through a mindfulness training format . Pelvic Floor Function The pelvic oor muscle was “assigned” so many crucial and nely tuned functions to perform. In order to support this function, neural control of the muscle and pelvic organs is affected by a (20) combined, nely coordinated, dual innervation . UROLOGY, URO-ONCOLOGY AND SEXOLOGY UPDATE
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