This patient-focused self-help book contains 10 chapters and 5 appendices. There is a glossary that defines all of the terms used in the book. It is nice to see some references in a self-help book (between 2 and 18 per chapter). Most are less than 10 years old; however, 50% are not from peer-reviewed publications.

To make the reader more at ease and feel that she is not alone, the authors' approach is "user friendly," beginning each chapter with a patient's view of her problem.

As a physical therapist who has been working with women's health, pelvic floor rehabilitation, incontinence-or whatever the going descriptor is these days, I see treatment methods described as if the authors themselves invented them. Most of the techniques are not new and have been taken from older literature.

Chapter 2, "Stress Urinary Incontinence," provides a most interesting overview of Dr Arnold Kegel, most likely because of the geographical proximity of the authors to the Dr Kegel's son.

Chapter 3, "Your Treatment Plan to End Stress Urinary Incontinence," guidelines and "treatment" timelines are presented in a manner that the patient can understand and employ. I like the 8-week framework and think this is a reasonable perspective to prepare the committed patient and keep her motivated. Kari Bo's theory of muscle strengthening and more recent literature on motor learning could have been cited here to justify the time involved in strengthening. Also, it would have been interesting to read about the "novel" incorporation of functional pelvic floor into exercise plans (eg, per Gary Gray's functional approach to the body). Gary Gray, PT, has found that the use of dynamic broadbased squatting exercises, combined with a variety of upper extremity movements in frontal, sagittal, and transverse planes, facilitates pelvic floor strengthening (see functional video digest series at http://www.grayinstitute.com). There are alternate resistance exercisers to the Kegel Master, which is decidedly more suited to a younger patient. The device is actually quite large, and if vaginal tissue is lax or stenotic, it could preclude the insertion of the device or become pinched in its lateral jaws. The Gyneflex device (http://www.gyneflex.com) is more suited to a variety of vaginal tissues and requires no set-up time.

Chapter 4, "Urge Urinary Incontinence," and Chapter 5, "Your Treatment Plan to End Urge Urinary Incontinence," contain patient education material that I would cite and/or provide to specific patients with credit to the authors.

Chapter 6, "Your Treatment Plan: Adding Pilates," likewise provides an interesting overview of Joseph Pilates. I am not sure, however, that this amount of information on an exercise philosophy can be taught or learned correctly from the volume of information in this chapter. I do not think that it lends value to the reader.

Chapter 7, "Your Treatment Plan to Support Organ Prolapse," defines prolapse and recommends pelvic floor muscle (PFM) strengthening. True, in cases of mild prolapse, the PFM muscular support base may be strengthened, but, if bad body mechanics and torn or deficient ligaments exist, gravity is eventually going to take the organ down. Therefore, it would have been appropriate to discuss the possibility of pessary placement while the PFM is being strengthened.

Chapter 8, "Your Treatment Plan for Pelvic Floor Pain and Sexual Issues," starts out describing a patient with vaginismus (our interpretation) and, in the discussion of her treatment, expands into other areas/diagnoses of pelvic pain. The problem is complex and multifaceted and I think that the treatments are too general. I think this chapter tries to be too all-encompassing, including too much information about diagnoses that are clearly complicated. This topic would truly be a book unto itself.

Unfortunately, there are editing errors in the book and the authors discuss their practice and success throughout. The cover and title itself implies a self-help book on incontinence and that is what will immediately appeal to the woman with incontinence. The chapters of most value to the patient, therefore, are 1 to 5. I would recommend the book for selected information in these chapters.

Jane Frahm

Detroit, Michigan

Beth Shelly

Moline, Illinois