Please select the eligibility criteria that correspond to the clinical trial below.
Title: Effects of Physical Therapy on Pelvic Floor Symptoms and Quality of Life in Postpartum Women Following Severe Perineal Trauma: a Randomized Controlled Trial
Brief Summary: Our primary objective is to determine if physical therapy (PT) and behavioral therapy (BT) in the post-partum period after a vaginal delivery complicated by genital trauma help to improve a woman's quality of life, specifically in regard to anal incontinence. To be able to study this, the investigators need to know how well the muscles of a woman's pelvic floor function after a vaginal delivery and this requires measuring their strength during a pelvic exam. At present, there are no studies that have looked at whether the intervention of PT/BT improves a woman's anal incontinence quality of life after sustaining genital trauma during vaginal deliveries


Options:
A: Inclusion Criteria:

* Primiparous women aged 18 years of older
* Vaginal delivery, vacuum-assisted-vaginal-delivery (VAVD), or forceps-assisted-vaginal-delivery (FAVD) of a neonate of gestational age:
* 27 completed weeks
* Singleton or vaginal delivery of multiple gestation
* Able to read and speak the English language

Exclusion Criteria:

* Unable to comply with physical therapy or office visits
* Unreliable transportation
* Preexisting neurologic, musculoskeletal or neuromuscular disorder rendering them unable to perform physical therapy requirements
* Cesarean delivery
* History of prior surgery for anorectal incontinence (i.e. sphincteroplasty
B: Inclusion Criteria:

* Male
* Community-dwelling
* Veteran
* Self-reported urgency
* Self-reported frequent urination
* Mean of \> 8 voids per 24-hour day on bladder diary
* Able to come to clinic

Exclusion Criteria:

* Urologic surgery in the past 6 months
* Nonambulatory (unless has independent transfer skills)
* Flow rate \< 5mL at baseline and \< 10mL/sec after run-in (on simple uroflowmetry)
* Post-void residual urine volume \> 250mL at baseline and \> 150mL after run-in (on bladder ultrasound)
* Continual leakage
* Urinary tract infection (growth of \> 100,000 colonies per ml of a urinary pathogen on urine culture). May be reconsidered after treatment and negative culture.
* Fecal impaction
* Poorly controlled diabetes (glycosylated hemoglobin \>9 within last 3 months)
* Hematuria on microscopic examination in the absence of infection
* Any unstable medical condition (particularly: decompensated congestive heart failure, malignant arrhythmias, unstable angina)

  -- Impaired mental status (\< 24 on Folstein's Mini-Mental State Exam)
* Narrow angle glaucoma
* Gastric retention (by medical history)
* Hypersensitivity to tamsulosin or oxybutynin
* Current use of anticholinergic agents for detrusor instability. May be reconsidered after 2-week wash-out.
* If on diuretic, dose has not been stable for at least three months
* Sleep apnea, unless surgically corrected
C: Inclusion Criteria:

* nulliparous
* aged 18 years or more
* pregnant between 20 and 28 weeks
* French language reader

Exclusion Criteria:

* No medical insurance
* multiple or pathologic pregnancy
* Previous pelvic floor exercises with a physiotherapist less than 6 months before pregnancy
D: Inclusion Criteria:

* Type 2 diabetes
* Overweight
* BMI of 25 kg/m2 or greater
* If on insulin, BMI of 27 kg/m2 or greater
* Blood pressure less than 160/100 mmHg
* HbA1c less or equal to 11%
* Triglycerides less than 600 mg/dl
* Willingness to participate

Exclusion Criteria:

* Unable or unwilling to give informed consent or communicate with local study staff.
* Current diagnosis of schizophrenia, other psychotic disorders, or bipolar disorder.
* Hospitalization for depression in past six months.
* Self-report of alcohol or substance abuse within the past twelve months.
* Current consumption of more than 14 alcoholic drinks per week.
* Current acute treatment or rehabilitation program for these problems.
* Plans to relocate to an area not served by Look AHEAD or travel plans that do not permit full participation in the study.
* Lack of support from primary care health provider or family members.
* Failure to complete the two-week run-in for dietary intake and exercise.
* Weight loss exceeding 10 lbs. in past three months.
* Current use of medications for weight loss.
* Self reported inability to walk two blocks.
* History of bariatric surgery, small bowel resection, or extensive bowel resection.
* Chronic treatment with systemic corticosteroids.
* Another member of the household is a participant or staff member in Look AHEAD.
* Currently pregnant or nursing.
* Cancer requiring treatment in the past five years, except for non-melanoma skin cancers or cancers that have clearly been cured.
* HIV positive (self-report), due to effects on weight and body composition of HIV and medications used to treat HIV.
* Active tuberculosis (self-report).
* Cardiovascular disease (heart attack or procedure within the past three months).
* Participation in a cardiac rehabilitation program within last three months.
* Stroke or history/treatment for transient ischemic attacks in the past three months.
* Pulmonary embolus in past six months.
* Unstable angina pectoris or angina pectoris at rest.
* A history of cardiac arrest.
* Complex ventricular arrhythmia at rest or with exercise (e.g., ventricular tachycardia).
* Uncontrolled atrial fibrillation (heart rate of 100 beats per minute or more).
* New York Heart Association (NYHA) Class III or IV congestive heart failure.
* Acute myocarditis, pericarditis or hypertrophic myocardiopathy.
* Clinically significant aortic stenosis.
* Left bundle branch block or cardiac pacemaker unless evaluated and cleared for participation by a cardiologist.
* Cardiac defibrillator.
* Heart transplant.
* History of aortic aneurysm of at least 7 cm in diameter or aortic aneurysm repair.
* Resting heart rate less than 45 beats per minute or greater than 100 beats per minute.
* Any abnormality during the maximum exercise stress test that indicates that it would be unsafe to participate in the Lifestyle Intervention.
* Angina pectoris.
* Significant ST segment depression at low levels of exercise. (ST segment is the flat, isoelectric section of the ECG between the end of the S wave (the J point) and the beginning of the T wave)
* Exercise induced ventricular arrhythmias.
* Abnormal hemodynamics, such as flat or decreasing systolic blood pressure with increasing workload.
* Those at moderate to high risk for cardiac complications during exercise.
* Those who are unable to self-regulate activity or understand the recommended activity level.
* Renal disease or dialysis.
* Chronic obstructive pulmonary disease that would limit ability to follow the protocol.
* Self-reported chronic hepatitis B or C or cirrhosis.
* Inflammatory bowel disease requiring treatment in past year.
* Cushing's syndrome.
* Acromegaly.
* Amputation of lower limbs as result of non-traumatic causes.
* Any major organ transplant.

Answer: A