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OBJECTIVE: To develop evidence- and consensus-based clinical practice guidelines for management of high-tone pelvic floor dysfunction (HTPFD). High-tone pelvic floor dysfunction is a neuromuscular disorder of the pelvic floor characterized by non-relaxing pelvic floor muscles, resulting in lower urinary tract and defecatory symptoms, sexual dysfunction, and pelvic pain. Despite affecting 80% of women with chronic pelvic pain, there are no uniformly accepted guidelines to direct the management of these patients. METHODS: A Delphi method of consensus development was used, comprising three survey rounds administered anonymously via web-based platform (Qualtrics XM) to national experts in the field of HTPFD recruited through targeted invitation between September and December 2021. Eleven experts participated with backgrounds in urology, urogynecology, minimally invasive gynecology, and pelvic floor physical therapy (PFPT) participated. Panelists were asked to rate their agreement with rated evidence-based statements regarding HTPFD treatment. Statements reaching consensus were used to generate a consensus treatment algorithm. RESULTS: A total of 31 statements were reviewed by group members at the first Delphi round with 10 statements reaching consensus. 28 statements were reposed in the second round with 17 reaching consensus. The putative algorithm met clinical consensus in the third round. There was universal agreement for PFPT as first-line treatment for HTPFD. If satisfactory symptom improvement is reached with PFPT, the patient can be discharged with a home exercise program. If no improvement after PFPT, second-line options include trigger or tender point injections, vaginal muscle relaxants, and cognitive behavioral therapy, all of which can also be used in conjunction with PFPT. Onabotulinumtoxin A injections should be used as third line with symptom assessment after 2-4 weeks. There was universal agreement that sacral neuromodulation is fourth-line intervention.

Gynaecological cancers are the third most common type of cancer in women, accounting for 16% of cancers diagnosed in women worldwide. They include endometrial, cervical, ovarian, vulval, vaginal and fallopian tube cancers. The most common treatments for gynaecological cancer are surgery, most frequently hysterectomy, radiotherapy and chemotherapy. The sequelae of gynaecological cancer treatments impose a substantial burden on survivors and society. Gynaecological cancer survivors experience high rates of pelvic floor disorders, such as urinary incontinence, faecal incontinence and dyspareunia. However, many gynaecological cancer care pathways do not include screening for pelvic floor disorders, or only include screening and referral for sexual dysfunction, but not other pelvic floor disorders. Pelvic floor muscle training, an evidence-based treatment for urinary incontinence, faecal incontinence and dyspareunia in other populations, is currently not recommended in gynaecological cancer care pathways. More data are needed on the prevalence, history and experience of pelvic floor disorders in gynaecological cancer survivors, and the feasibility and effectiveness of pelvic floor muscle training in this population, before such recommendations can be included in gynaecological cancer care pathways. Therefore, this thesis aimed to investigate the prevalence and natural history of pelvic floor disorders after gynaecological cancer treatment, the experience of gynaecological cancer survivors with pelvic floor disorders and their preferences for treatment, and the feasibility and efficacy of pelvic floor muscle training for treating pelvic floor disorders in gynaecological cancer survivors. Study One documented the prevalence of pelvic floor disorders, including urinary incontinence, after gynaecological cancer surgery and involved the assessment of pelvic floor symptoms, health-related quality-of-life and physical activity before and after hysterectomy with or without radio

Physical inactivity is a global societal and economic burden, increasing the risk of chronic disease. Women participate in organised sports at lower rates than men and 86% of Australian women do not meet all components of the National Physical Activity Guidelines. Sport and exercise activities may provoke symptoms of pelvic floor (PF) disorders. Pelvic floor symptoms are highly prevalent in exercising women. One in three women report symptoms of urinary incontinence (UI) across all sports and up to 80% of women engaging in high impact sports or heavy weight-lifting report UI and/or anal incontinence (AI). It is therefore important to understand how PF symptoms limit or stop exercise participation in women. The thesis research aimed to: establish the impact of female PF symptoms (UI, AI and pelvic organ prolapse) on sport and exercise participation; determine current PF symptom screening and management within Australian sport and exercise settings; and explore the preferences, barriers and enablers for future PF symptom screening and management within sport and exercise settings from the perspectives of exercising women and health or exercise professionals. Study One was a systematic review of the impact of PF symptoms on sport and exercise. Whilst UI adversely impacted exercise in one in two women, the evidence certainty was low. Important gaps in the knowledge of other PF symptoms (beyond UI) and the degree and nature of impact of all PF symptoms on participation were established. Study Two, an observational, cross-sectional study of 4,556 Australian women with PF symptoms, examined the research gaps determined by systematic review. One in two women stopped a form of exercise they had previously participated in, secondary to PF symptoms. A secondary data analysis (Study Two, Part B) found that women with more severe UI symptoms (OR=4.77; 95% CI:7.24 to 14.37), and higher bother (UI: OR=10.19; 95% CI:7.24 to 14.37; POP: OR=22.38; 95% CI:13.0 to 36.60; AI: OR=29.66

Objective: To describe the development and validation process of an online course on urinary incontinence during pregnancy in Brazil. Materials and methods: This methodological study followed an online course’s literature search, development, and validation steps. A total of 22 specialists participated in the validation step, and the content validity index (CVI) was used. Fifty-one Physical Therapy students (target audience) also participated in the Suitability Assessment of Materials. Results: The synthesis reached in the integrative review provided the basis for the course’s theoretical content, which was regarded as suitable by the specialists regarding its content, language, presentation, stimulation/motivation, and cultural adequacy (CVI = 0.99). The target audience considered the course organized, easily understandable, engaging, and motivational, with a positive response index ranging from 84.3 % to 100 %. Conclusions: The Brazilian version of the online course was considered sufficiently adequate in content and interface quality by both specialists and the target audience., Objetivo: descrever o processo de desenvolvimento e validação de um curso on-line sobre incontinência urinária gestacional no Brasil. Materiais e método: trata-se de um estudo metodológico que contemplou as etapas de levantamento bibliográfico, elaboração e validação de um curso on-line. A validação teve a participação de 22 especialistas e foi empregado o índice de validade de conteúdo (IVC). Também participaram 51 estudantes de graduação em Fisioterapia (público-alvo), considerando o Suitability Assessment of Materials. Resultados: a síntese adquirida na revisão integrativa subsidiou o conteúdo teórico do curso, considerado adequado pelos especialistas quanto ao conteúdo, à linguagem, à apresentação, à estimulação/motivação e à adequação cultural (IVC = 0,99), bem como à aparência/interface (IVC = 0,95). O público-alvo considerou o curso organizado, de fácil entendimento, atrativo e motivador, com índice de concordância em repostas positivas a variar de 84,3 % a 100 %. Conclusões: informa-se que a versão brasileira do curso on-line desenvolvido foi considerada suficientemente adequada em termos de conteúdo e qualidade da interface, tanto pelos especialistas quanto pelo público-alvo., Objetivo: describir el proceso de desarrollo y validación de un curso en línea sobre incontinencia urinaria durante el embarazo en Brasil. Materiales y método: se trata de un estudio metodológico que contempló las etapas de recolección bibliográfica, elaboración y validación de un curso en línea. La validación contó con la participación de 22 expertos y se empleó el índice de validación de contenido (IVC). Además, participaron 51 estudiantes del pregrado en Fisioterapia (público objetivo) en la Evaluación de Idoneidad de los Materiales. Resultados: la síntesis adquirida en la revisión integrativa fundamentó el contenido teórico del curso, considerado adecuado por los expertos en cuanto al contenido, el lenguaje, la presentación, la estimulación/motivación y la adecuación cultural (IVC = 0,99), así como la apariencia/interfaz (IVC = 0,95). El público objetivo consideró el curso organizado, de fácil entendimiento, atractivo y motivador, con un índice de concordancia en respuestas positivas entre 84,3 % y 100 %. Conclusiones: la versión brasileña del curso en línea desarrollado se consideró lo suficientemente adecuada en términos de contenido y calidad de la interfaz, tanto por parte de los expertos como del público objetivo.

Background: Up to 80% of women are affected by a perineal laceration after their first vaginal birth. An estimated 40–50% of lacerations involve the perineal muscles, and up to 7% are obstetric anal sphincter injuries (OASI). There is a lack of knowledge about the extent of short-term complications such as pelvic floor dysfunction (PFD) following spontaneous or iatrogenic pelvic floor trauma. Women’s experiences of daily life after childbirth complicated by OASI is poorly understood. Three-dimensional endoanal ultrasonography (3D-EAUS) is a welldocumented method for evaluating damage to the anal sphincter in other contexts. Adding ultrasonography to standard clinical examination has revealed injuries previously missed, and research evaluating diagnostic methods for the routine screening of OASI has been called for. Aim: This thesis aims to evaluate the diagnostics of OASI, determine if the degree of perineal injury or anal sphincter defects after childbirth are associated with pelvic dysfunction, and explore women’s experiences of OASI.Methods Studies I and IV were prospective cohort-studies to evaluate any association between perineal tear or sphincter defect to PFD. Study II was an interview study addressing women’s experiences of OASI by qualitative content analysis. Study III was a cross-sectional study designed to examine the utility of endoanal ultrasound to detect OASI. Participants were clinically examined after birth and 3D-EAUS was performed immediately after giving birth and 3 months postpartum. PFD was evaluated using a web-based questionnaire one year after delivery. Results: A total of 511 women completed the one-year questionnaire (Study I) and a purposive sample of 11 women were invited to take part in Study II. In Study III, 680 women underwent a clinical examination and 3D-EAUS recording immediately after birth. In Study IV, 239 women who attended all follow-ups were included. PFD was experienced by women with a perineal laceration of any grade, bu

Background: Up to 80% of women are affected by a perineal laceration after their first vaginal birth. An estimated 40–50% of lacerations involve the perineal muscles, and up to 7% are obstetric anal sphincter injuries (OASI). There is a lack of knowledge about the extent of short-term complications such as pelvic floor dysfunction (PFD) following spontaneous or iatrogenic pelvic floor trauma. Women’s experiences of daily life after childbirth complicated by OASI is poorly understood. Three-dimensional endoanal ultrasonography (3D-EAUS) is a welldocumented method for evaluating damage to the anal sphincter in other contexts. Adding ultrasonography to standard clinical examination has revealed injuries previously missed, and research evaluating diagnostic methods for the routine screening of OASI has been called for. Aim: This thesis aims to evaluate the diagnostics of OASI, determine if the degree of perineal injury or anal sphincter defects after childbirth are associated with pelvic dysfunction, and explore women’s experiences of OASI.Methods Studies I and IV were prospective cohort-studies to evaluate any association between perineal tear or sphincter defect to PFD. Study II was an interview study addressing women’s experiences of OASI by qualitative content analysis. Study III was a cross-sectional study designed to examine the utility of endoanal ultrasound to detect OASI. Participants were clinically examined after birth and 3D-EAUS was performed immediately after giving birth and 3 months postpartum. PFD was evaluated using a web-based questionnaire one year after delivery. Results: A total of 511 women completed the one-year questionnaire (Study I) and a purposive sample of 11 women were invited to take part in Study II. In Study III, 680 women underwent a clinical examination and 3D-EAUS recording immediately after birth. In Study IV, 239 women who attended all follow-ups were included. PFD was experienced by women with a perineal laceration of any grade, bu

Background: Up to 80% of women are affected by a perineal laceration after their first vaginal birth. An estimated 40–50% of lacerations involve the perineal muscles, and up to 7% are obstetric anal sphincter injuries (OASI). There is a lack of knowledge about the extent of short-term complications such as pelvic floor dysfunction (PFD) following spontaneous or iatrogenic pelvic floor trauma. Women’s experiences of daily life after childbirth complicated by OASI is poorly understood. Three-dimensional endoanal ultrasonography (3D-EAUS) is a welldocumented method for evaluating damage to the anal sphincter in other contexts. Adding ultrasonography to standard clinical examination has revealed injuries previously missed, and research evaluating diagnostic methods for the routine screening of OASI has been called for. Aim: This thesis aims to evaluate the diagnostics of OASI, determine if the degree of perineal injury or anal sphincter defects after childbirth are associated with pelvic dysfunction, and explore women’s experiences of OASI.Methods Studies I and IV were prospective cohort-studies to evaluate any association between perineal tear or sphincter defect to PFD. Study II was an interview study addressing women’s experiences of OASI by qualitative content analysis. Study III was a cross-sectional study designed to examine the utility of endoanal ultrasound to detect OASI. Participants were clinically examined after birth and 3D-EAUS was performed immediately after giving birth and 3 months postpartum. PFD was evaluated using a web-based questionnaire one year after delivery. Results: A total of 511 women completed the one-year questionnaire (Study I) and a purposive sample of 11 women were invited to take part in Study II. In Study III, 680 women underwent a clinical examination and 3D-EAUS recording immediately after birth. In Study IV, 239 women who attended all follow-ups were included. PFD was experienced by women with a perineal laceration of any grade, bu

Background: Up to 80% of women are affected by a perineal laceration after their first vaginal birth. An estimated 40–50% of lacerations involve the perineal muscles, and up to 7% are obstetric anal sphincter injuries (OASI). There is a lack of knowledge about the extent of short-term complications such as pelvic floor dysfunction (PFD) following spontaneous or iatrogenic pelvic floor trauma. Women’s experiences of daily life after childbirth complicated by OASI is poorly understood. Three-dimensional endoanal ultrasonography (3D-EAUS) is a welldocumented method for evaluating damage to the anal sphincter in other contexts. Adding ultrasonography to standard clinical examination has revealed injuries previously missed, and research evaluating diagnostic methods for the routine screening of OASI has been called for. Aim: This thesis aims to evaluate the diagnostics of OASI, determine if the degree of perineal injury or anal sphincter defects after childbirth are associated with pelvic dysfunction, and explore women’s experiences of OASI.Methods Studies I and IV were prospective cohort-studies to evaluate any association between perineal tear or sphincter defect to PFD. Study II was an interview study addressing women’s experiences of OASI by qualitative content analysis. Study III was a cross-sectional study designed to examine the utility of endoanal ultrasound to detect OASI. Participants were clinically examined after birth and 3D-EAUS was performed immediately after giving birth and 3 months postpartum. PFD was evaluated using a web-based questionnaire one year after delivery. Results: A total of 511 women completed the one-year questionnaire (Study I) and a purposive sample of 11 women were invited to take part in Study II. In Study III, 680 women underwent a clinical examination and 3D-EAUS recording immediately after birth. In Study IV, 239 women who attended all follow-ups were included. PFD was experienced by women with a perineal laceration of any grade, bu

The main objectives of this study were to carry out the translation and cross-cultural adaptation of the Australian Pelvic Floor Questionnaire (APFQ) into Spanish and the evaluation of its psychometric properties of validity and reliability in the Spanish population. The APFQ was translated into Spanish and back-translated into its original language by native speakers; it was verified that there was a semantic similarity. A pilot test was carried out on a group of 10 women. The study sample was made up of 104 subjects. They were asked to fill in the APFQ twice, 15 days apart. Codes were assigned so they could link to the test and retest. The Questionnaire on Pelvic Floor Dysfunctions–short version (PFDI-20) and the Women’s Sexual Function Questionnaire (FSM) were also completed. The reliability, criterion and construct validity, and stability were studied. ACronbach’s alpha of 0.795 was obtained from the complete questionnaire. For each dimension, Cronbach’s alpha was 0.864 for bladder function; 0.796 for bowel function; 0.851 for prolapse; and 0.418 for sexual function (0.67 with the suppression of item 37). The APFQ shows a significant correlation with PFDI-20 in urinary function (rho: 0.704, p = 0.000), intestinal function (rho: 0.462, p = 0.000), and prolapse symptoms (rho: 0.337, p = 0.000). The test-retest analysis showed high reproducibility. The Spanish version of the APFQ is a reliable and valid tool to assess symptoms and impacts on quality of life due to pelvic floor dysfunctions in the Spanish population. However, a review of some of its items could increase its reliability.

The main objectives of this study were to carry out the translation and cross-cultural adaptation of the Australian Pelvic Floor Questionnaire (APFQ) into Spanish and the evaluation of its psychometric properties of validity and reliability in the Spanish population. The APFQ was translated into Spanish and back-translated into its original language by native speakers; it was verified that there was a semantic similarity. A pilot test was carried out on a group of 10 women. The study sample was made up of 104 subjects. They were asked to fill in the APFQ twice, 15 days apart. Codes were assigned so they could link to the test and retest. The Questionnaire on Pelvic Floor Dysfunctions–short version (PFDI-20) and the Women’s Sexual Function Questionnaire (FSM) were also completed. The reliability, criterion and construct validity, and stability were studied. ACronbach’s alpha of 0.795 was obtained from the complete questionnaire. For each dimension, Cronbach’s alpha was 0.864 for bladder function; 0.796 for bowel function; 0.851 for prolapse; and 0.418 for sexual function (0.67 with the suppression of item 37). The APFQ shows a significant correlation with PFDI-20 in urinary function (rho: 0.704, p = 0.000), intestinal function (rho: 0.462, p = 0.000), and prolapse symptoms (rho: 0.337, p = 0.000). The test-retest analysis showed high reproducibility. The Spanish version of the APFQ is a reliable and valid tool to assess symptoms and impacts on quality of life due to pelvic floor dysfunctions in the Spanish population. However, a review of some of its items could increase its reliability.

The objective of our study is to determine the thickness of the pubovisceral fasciculus of the levator ani muscle and the area of the genital hiatus by means of three-dimensional perineal ultrasound, in pregnant women in the 2nd trimester, and to analyze the related maternal, perinatal and postpartum clinical variables. Furthermore, to compare the results of our study with two similar series previously published. An observational, prospective study of pelvic floor ultrasound was carried out, performed at week 20, whose delivery was attended in the obstetrics service of the Hospital General Universitario Gregorio Marañón de Madrid (HGUGM), during the period of August from 2021 to June 2022. Maternal, ultrasound, perinatal and postpartum clinical variables were collected from each participant. During the study period, a total of 54 patients were included in it. The mean gestational age at which the ultrasound was performed was 19.81 ± 0.91 weeks. In relation to the ultrasound variables, the mean thickness of the pubovisceral muscle was 0.87 ± 0.13 cm (95% CI, 0.64–1.38 cm), while, in the plane of minimum dimension of the genital hiatus, the hiatal area at rest was 13.41 ± 3.22 (95% CI, 4.60–18.78) cm2. There is a significant correlation between the age of pregnant women (over 35 years of age) and the increase in the area of the genital hiatus (r = 0.295, p = 0.031). 3D ultrasound of the pelvic floor performed at week 20 of gestation can to be an effective, non-invasive, reproducible and cheap tool in the prognosis of the development of labor and of possible subsequent perineal dysfunctions., Unión Europea, Comunidad de Madrid, Instituto de Salud Carlos III, Halekulani S.L, Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

Pelvic floor disorders, which include pelvic organ prolapse, and urinary and fecal incontinence, affect millions of women globally and represent a major public health concern. Pelvic floor muscle (PFM) dysfunction has been identified as one of the leading risk factors for the development of these morbid conditions. Even though childbirth, specifically vaginal delivery, has been long recognized as the most important potentially modifiable risk factor for PFM injury, the precise mechanisms of PFM dysfunction following childbirth remain elusive. In addition, treatments for PFM dysfunction are urgently needed as the current therapeutic approaches are delayed and mainly compensatory. Using a pre-clinical rat model, we first demonstrated that PFM undergoes atrophy and fibrosis following birth injury. The transcriptional signature of PFM post-injury indicated a sustained inflammatory response, impairment in muscle anabolism, and persistent expression of extracellular matrix (ECM) remodeling genes. We then evaluated the administration of an injectable skeletal muscle ECM hydrogel to prevent and mitigate the pathological alterations following simulated birth injury. Treatment of PFMs with the biomaterial either at the time of birth injury or 4 weeks post-injury reduced muscle atrophy and mitigated fibrotic degeneration. Through gene expression analyses, we show that improvement in PFM phenotype is potentially associated with the hydrogel-induced modulation of the immune response and intramuscular fibrosis and the enhancement of endogenous myogenesis. Lastly, we investigated the PFM response following repeated simulated birth injuries (SBIs), as multiparity further exacerbates the risk for pelvic floor disorders. We demonstrated that repeated SBIs increase pathological alterations and muscle dysfunction compared to a single injury. Gene expression analyses indicated a prolonged inflammatory response compared to a single SBI. Delayed administration of the acellular biomaterial

Pelvic floor disorders, which include pelvic organ prolapse, and urinary and fecal incontinence, affect millions of women globally and represent a major public health concern. Pelvic floor muscle (PFM) dysfunction has been identified as one of the leading risk factors for the development of these morbid conditions. Even though childbirth, specifically vaginal delivery, has been long recognized as the most important potentially modifiable risk factor for PFM injury, the precise mechanisms of PFM dysfunction following childbirth remain elusive. In addition, treatments for PFM dysfunction are urgently needed as the current therapeutic approaches are delayed and mainly compensatory. Using a pre-clinical rat model, we first demonstrated that PFM undergoes atrophy and fibrosis following birth injury. The transcriptional signature of PFM post-injury indicated a sustained inflammatory response, impairment in muscle anabolism, and persistent expression of extracellular matrix (ECM) remodeling genes. We then evaluated the administration of an injectable skeletal muscle ECM hydrogel to prevent and mitigate the pathological alterations following simulated birth injury. Treatment of PFMs with the biomaterial either at the time of birth injury or 4 weeks post-injury reduced muscle atrophy and mitigated fibrotic degeneration. Through gene expression analyses, we show that improvement in PFM phenotype is potentially associated with the hydrogel-induced modulation of the immune response and intramuscular fibrosis and the enhancement of endogenous myogenesis. Lastly, we investigated the PFM response following repeated simulated birth injuries (SBIs), as multiparity further exacerbates the risk for pelvic floor disorders. We demonstrated that repeated SBIs increase pathological alterations and muscle dysfunction compared to a single injury. Gene expression analyses indicated a prolonged inflammatory response compared to a single SBI. Delayed administration of the acellular biomaterial

Problems related to bladder, bowel, sexual and pelvic floor (PF) muscle function are collectively termed PF disorders. Previous literature suggests that women with breast cancer may experience PF disorders at higher rates following cancer treatment than prior to cancer treatment. A causal pathway for this observation has not been clearly established. Pelvic floor muscle training (PFMT), the first-line management for treating PF disorders such as urinary incontinence (UI) and pelvic organ prolapse (POP), currently does not appear in breast cancer clinical care pathways. More data about PF disorders in women with breast cancer are required before PFMT can be included in clinical care pathways. Therefore, the aim of this thesis was to investigate PF disorders in women with breast cancer. While the abrupt precipitation of female sexual dysfunction (FSD) after breast cancer treatments is well documented, much less is known about bladder and bowel symptoms in this population. Study one, a systematic review and meta-analysis, assessed the prevalence and impact of bladder and bowel disorders in women with breast cancer. Results showed that 33% of women with breast cancer reported experiencing bladder disorders and 18% reported bowel disorders. The impact of bladder and bowel disorders in studies that used cancer-specific questionnaires was rated as low. Further studies using validated PF-specific questionnaires are required to assess the prevalence and impact of PF symptoms in this population. To address the research gap identified in the previous study, study two, a cross-sectional study, was conducted to compare the prevalence, distress and impact of PF disorders between women with and without breast cancer. Women in this study with breast cancer had a higher prevalence (although not significant) of UI, and significantly higher distress and impact of UI compared to women without breast cancer. These findings highlight that more studies are needed to understand which subgr

ObjectiveThe objective of this study was to determine whether pelvic floor physical therapy (PFPT) attendance differs based on referring provider specialty and identify factors related to PFPT initiation and completion.MethodsThis was an institutional review board-approved retrospective cohort study examining referrals from female pelvic medicine and reconstructive surgery (FPMRS) and non-FPMRS providers at a single academic medical center to affiliated PFPT clinics over a 12-month period. Demographics, referring specialty and diagnoses, prior treatment, and details regarding PFPT attendance were collected. Characteristics between FPMRS and non-FPMRS referrals were compared and multivariate logistic regression analyses were performed to identify factors associated with PFPT initiation and completion.ResultsA total of 497 referrals were placed for PFPT. Compared with non-FPMRS referrals, FPMRS referrals were for patients who were older (54.7 years vs 35.6 years), and had higher parity; more were postmenopausal (56% vs 18%) and had Medicare insurance (22% vs 10%) (all P < 0.001). Most FPMRS referrals were for patients with urinary incontinence (69% vs 31%), whereas non-FPMRS referrals were for patients with pelvic pain (70% vs 27%) (both P < 0.0001). Pelvic floor physical therapy attendance was similar in both groups when comparing rates of initiation (47% vs 45%) and completion (13% vs 16%). In multivariate analysis, factors associated with initiation were age 65 years or older, additional therapy provided at referring visit, private insurance, Asian race, pregnant or postpartum at time of referral, and more than 1 referring diagnosis (all P < 0.05). No factors were associated with completion.ConclusionsLess than half of the patients referred to PFPT initiate therapy, and only 15% complete PFPT. The populations referred by FPMRS and non-FPMRS providers are different, but ultimately PFPT utilization is similar.

La dystrophie myotonique de type 1 (DM1) est une maladie neuromusculaire multisystémique pouvant affecter les muscles lisses et striés. Quelques études ont rapporté des atteintes des muscles du plancher pelvien et pourraient ainsi avoir un impact important sur la fonction urogynécologique et anorectale. Une revue systématique a été réalisée dans le cadre de ce mémoire afin de documenter les conditions génito-urinaires et gastro-intestinales basses chez les personnes atteintes de DM1. Cette revue a permis de conclure que plusieurs études ont identifié des signes et symptômes variés associés à ces systèmes ; toutefois, peu d’études ont investigué ces désordres de manière spécifique, avec des outils standardisés. Cela résulte en des prévalences très variables et limite les conclusions sur la fréquence de ces symptômes. Les conditions génito-urinaires et gastro-intestinales sont souvent qualifiées comme des désordres du plancher pelvien étant donné l’implication des muscles du plancher pelvien. L’objectif principal de cette étude était de documenter la prévalence, les caractéristiques et les impacts de l’incontinence urinaire et des autres désordres du plancher pelvien chez les femmes atteintes de DM1. Les associations entre les désordres du plancher pelvien et le phénotype, en tenant compte de l’âge et la parité, ont été explorées. Une étude épidémiologique a été réalisée au Saguenay–Lac-St-Jean auprès de 80 femmes adultes atteintes de la DM1 à l’aide de questionnaires validés, notamment l’International Consultation Incontinence Questionnaire – Urinary Incontinence short form (ICIQ-UI-SF)), le Pelvic Floor Disorder Inventory (PFDI), et le Pelvic Floor Impact Questionnaire short form (PFIQ-SF). Les femmes étaient âgées entre 23 et 78 ans et présentaient une prévalence élevée d’incontinence urinaire (60%), d’incontinence anale (56.3%) et d’autres désordres du plancher pelvien, ce qui suggèrent une prévalence plus élevée que dans la population générale. Un large éventail, Myotonic dystrophy type 1 (DM1) is a neuromuscular multisystemic disease that can affect both smooth and striated muscles. Some studies have reported alteration to the pelvic floor muscles and could therefore have a significant impact on urogynecological and anorectal function. A systematic review was conducted as part of this thesis to document genitourinary and lower gastrointestinal conditions in people with DM1. This review concluded that several studies have identified various signs and symptoms associated with these systems; however, few studies have studied these disorders specifically, with standardized tools. This results in a wide range of prevalence and limits conclusions on the frequency of these symptoms. Genitourinary and gastrointestinal conditions are often referred to as pelvic floor disorders due to the involvement of the pelvic floor muscles. The main objective of this study was to document the prevalence, characteristics and impacts of urinary incontinence and other pelvic floor disorders in women with DM1. Associations between pelvic floor disorders and phenotypes, taking into account age and parity, were explored. An epidemiological study was carried out in Saguenay–Lac-St-Jean among 80 adult women with DM1 using validated questionnaires, in particular the International Consultation Incontinence Questionnaire – Urinary Incontinence short form (ICIQ-UI-SF)), the Pelvic Floor Disorder Inventory (PFDI), ant the Pelvic Floor Impact Questionnaire short form (PFIQ-SF). Women had a high prevalence of urinary incontinence (60%), anal incontinence (56.3%) and other pelvic floor disorders. A wide range of disorders are reported, consistent with the well-known clinical variability in DM1. The impact of these disorders on participation and emotional domains was higher for colorectal-anal disorders. Using linear and logistic regressions, associations with phenotypes for ICIQ-UI-SF total score, prevalence of anal incontinence and abdominal pain wer

Introducción: Al tener una disfunción del suelo pélvico aumentan las probabilidades de desarrollar incontinencia urinaria o prolapso genital. Estas condiciones, a su vez, podrían generar una infección del tracto urinario (ITU). En la población de mujeres embarazadas, la disfunción del suelo pélvico ocurre principalmente por la carga de peso del vientre, el cual podría ser una causa de la ITU. Objetivo: Determinar la asociación entre la disfunción del suelo pélvico y la ocurrencia de la ITU en gestantes. Métodos: Estudio observacional de tipo transversal analítico. La población fueron gestantes entre 18 a 35 años de 5 centros de salud en Lima. La disfunción del suelo pélvico se evaluó con el cuestionario The Pelvic Floor Inventories Leiden (PeLFIs) dividiéndose en 3 componentes: sensación de flacidez, patrón de orina e incontinencia urinaria. La ITU se midió incluyendo una sección en el cuestionario abarcando 3 preguntas. Las variables edad, actividad física, ocupación y peso fueron incluidas en la sección de preguntas generales dentro del cuestionario. Resultados: En total fueron 146 gestantes encuestadas que cumplieron criterios de selección. La prevalencia de ITU durante el embarazo fue de 42.5%. Las gestantes con ITU durante el embarazo tienen un puntaje mayor en los componentes de sensación de flacidez (p=0.036), patrón de orina (p=0.001) e incontinencia urinaria (p=0.011). Conclusión: Luego de ajustar las variables confusoras se determinó que existe asociación entre los 3 componentes de disfunción del suelo pélvico y la ITU, ya que la mayoría de las gestantes tuvieron tratamientos contra la ITU para no perjudicar su embarazo., Introduction: Upon occurrence of a pelvic floor dysfunction, the chances of developing urinary incontinence or vaginal prolapse increase. Such conditions, in turn, may lead to a urinary tract infection (UTI). In pregnant women, the pelvic floor dysfunction mainly occurs due to the weight of the womb, which could be a cause of the UTI. Objective: To determine the association between the pelvic floor dysfunction and the occurrence of UTI in pregnant women. Methods: Observational research of analytical cross-sectional type. The population included pregnant women between 18 to 35 years old from 5 health centers of Lima. The pelvic floor dysfunction was assessed through the questionnaire “The Pelvic Floor Inventories Leiden” (PelFIs), and it was divided into three components: vaginal swelling, urination pattern, and urinary incontinence. The UTI was measured based on three questions in a section of the questionnaire. Variables such as age, physical activity, occupation, and weight were included in the section of general questions within the questionnaire. Results: A total of 146 pregnant women surveyed met the selection criteria. The prevalence of UTI during pregnancy was 42.5 %. The pregnant women suffering from UTI during the pregnancy period show a higher score in the components of vaginal swelling (p=0.036), urination pattern (p=0.001), and urinary incontinence (p=0.011). Conclusion: After adjusting the confounding variables, it was determined that there is no association between the three components of the pelvic floor dysfunction and the UTI since most of the pregnant women followed treatments against UTI to avoid any harm during pregnancy., Tesis

Funding: Part of this research was funded through 2 PERIS grants from the Catalonian Health Department (SLT002/16/00214 and SLT008/18/00168). CIBERehd is funded by Instituto de Salud Carlos III, Barcelona, Spain, Fecal incontinence (FI) is a prevalent condition among community-dwelling women, and has a major impact on quality of life (QoL). Research on treatments commonly used in clinical practice-Kegel exercises, biofeedback, electrostimulation, and transcutaneous neuromodulation-give discordant results and some lack methodological rigor, making scientific evidence weak. The aim is to assess the clinical efficacy of these 4 treatments on community-dwelling women with FI and their impact on severity, QoL and anorectal physiology. A randomized controlled trial was conducted on 150 females with FI assessed with anorectal manometry and endoanal ultrasonography, and pudendal nerve terminal motor latency, anal/rectal sensory-evoked-potentials, clinical severity, and QoL were determined. Patients were randomly assigned to one of the following groups Kegel (control), biofeedback + Kegel, electrostimulation + Kegel, and neuromodulation + Kegel, treated for 3 months and re-evaluated, then followed up after 6 months. Mean age was 61.09 ± 12.17. Severity of FI and QoL was significantly improved in a similar way after all treatments. The effect on physiology was treatment-specific Kegel and electrostimulation + Kegel, increased resting pressure (P < 0.05). Squeeze pressures strongly augmented with biofeedback + Kegel, electrostimulation + Kegel and neuromodulation + Kegel (P < 0.01). Endurance of squeeze increased in biofeedback + Kegel and electrostimulation + Kegel (P < 0.01). Rectal perception threshold was reduced in the biofeedback + Kegel, electrostimulation + Kegel, and neuromodulation + Kegel (P < 0.05); anal sensory-evoked-potentials latency shortened in patients with electrostimulation + Kegel (P < 0.05). The treatments for FI assessed have a strong and similar efficacy on severity and QoL but affect specific pathophysiological mechanisms. This therapeutic specificity can help to develop more efficient multimodal algorithm treatments for FI based on pathophysiological phenotyp

Introduction: Risk factors for pelvic floor disorders are often related to pregnancy and delivery. Consistent evidence is needed to develop prevention strategies targeting risk factors. The objective of this study is to identify which pregnancy- and/or obstetric-related risk factors can predict urinary incontinence, fecal incontinence, or pelvic organ prolapse later in life by means of a systematic review and meta-analysis. Material and methods: Systematic review Prospero number: CRD42019131758. Literature searches of PubMed, EMBASE, CINAHL, and Cochrane Library were conducted according to PRISMA guidelines (April 2020). Prospective cohort studies describing more than two pregnancy- and/or obstetric-related risk factors on urinary incontinence, fecal incontinence (including flatal incontinence), or pelvic organ prolapse were eligible. Risk of bias was assessed (using Quality In Prognosis Studies [QUIPS]). Studies with high risk of bias were excluded. Data were extracted and checked for accuracy with the CHARMS checklist. Sub-groups were used to distinguish between a short- and long-term follow-up period: <18 months (shortterm) and >18 months (long-term) postpartum. Odds ratios were calculated from reported prevalence rates. Log odds ratios were calculated using SPSS v.24. Variables were pooled using RevMan5. Results: Data were extracted from nineteen studies for urinary incontinence, nine for fecal incontinence, and two for pelvic organ prolapse. Multivariate analysis was not possible because of the heterogeneity of the population and outcome measures. Pooled univariate risk factors for urinary incontinence were: urinary incontinence during pregnancy, instrumental vaginal delivery, episiotomy, tears, and constipation. Pooled univariate risk factors for fecal incontinence were: fecal incontinence during pregnancy, maternal age over 35 years, prenatal body mass index over 30 kg/m2, instrumental vaginal delivery, a spontaneous vaginal delivery, oxyt

Bakgrund: Bäckenbotten utsätts för stor påfrestning under graviditet och förlossning. I samband med förlossning kan skador på bäckenbotten uppstå. Dessa skador kan leda till både kort- och långsiktiga besvär som i sin tur kan påverka kvinnors livskvalitet och dagliga liv. Syfte: Syftet med studien var att kartlägga vilka bäckenbottenbesvär kvinnor upplever 6-16 veckor efter vaginal förlossning samt att beskriva dess påverkan på livskvalitet och dagligt liv. Metod: Studien var en kvantitativ tvärsnittsstudie där datainsamling skedde via en webbenkät. Webbenkäten bestod av bakgrundsfrågor utformade av författarna samt två validerade enkäter, PFDI-20 och PFIQ-7. Insamlad data analyserades i statistikprogrammet SPSS. Totalt deltog 135 kvinnor i studien. Resultat: I kartläggningen framkom att en stor andel kvinnor drabbats av bäckenbottenbesvär efter förlossning. Trots det uppgav majoriteten av kvinnorna att de ej hade besvär från sin bäckenbotten som inverkade på deras livskvalitet eller dagliga liv. Bland de kvinnor som upplevde besvär var det främst förmågan att utföra dagliga hushållsarbeten, förmågan till fysisk aktivitet och påverkan på psykisk hälsa som påverkade livskvaliteten. Konklusion: Studiens resultat antyder på att en stor andel kvinnor drabbas av bäckenbottenbesvär efter vaginal förlossning. Det är viktigt att belysa denna problematik så att kvinnor kan få adekvat stöd och behandling vid besvär. Trots att majoriteten av respondenterna ej upplevde att bäckenbottenbesvären inverkade på deras livskvalitet eller dagliga liv är det viktigt att ej normalisera bäckenbottenbesvär eller att se dem som en naturlig följd av graviditet och förlossning., Background: The pelvic floor is exposed to great stress during pregnancy and childbirth. In connection to childbirth, injuries to the pelvic floor can occur, so called birth injuries. These injuries can lead to both short- and long term problems for women. These problems can have an impact on womens quality of life and daily life. Aim: The purpose of the study was to chart which pelvic floor disorders women experience 6–16 weeks after vaginal delivery and describe its impact on quality of life and daily life. Method: The study was a quantitive cross-sectionalstudy where the data collection was done through a online questionnarie. The online questionnarie consisted of background questions designed by the authors and two validated questionnaries, PFDI-20 and PFIQ-7. Collected data was analyzed using the statistical program SPSS. A total of 135 women participated in the study. Result: In the survey of pelvic floor disorders, it was found that a large proportion of women suffered from pelvic floor disorders after childbirth. Despite this, the majority of women stated that they did not have problems from their pelvic floor that affected their quality of life or daily life. Among the women who experienced problems it was mainly the ability to perform household chores, the ability for physical activity and the impact on mental health that affected quality of life. Conclusion: The results of the study suggest that a large proportion of women suffer from pelvic floor disorders after vaginal delivery. It is important to shed light on this issue so that women can receive adequate support and treatment for their problems. Despite the fact that the majority of the respondents stated that their pelvic floor disorders did not affect quality of life or daily life, it is important to not normalize or see pelvic floor disorders as a natural consequence of pregnancy and childbirth.

Age-related pelvic floor muscle (PFM) dysfunction is a critical defect in the progression to pelvic floor disorders (PFDs). Despite dramatic prevalence of PFDs in older women, the underlying pathophysiology of age-related PFM dysfunction remains poorly understood. Using cadaveric specimens, we quantified aging effects on functionally relevant PFM properties and compared PFMs with the appendicular muscles from the same donors. PFMs, obturator internus, and vastus lateralis were procured from younger (N = 4) and older (N = 11) donors with known obstetrical and medical history. Our findings demonstrate that PFMs undergo degenerative, rather than atrophic, alterations. Importantly, age-related fibrotic degeneration disproportionally impacts PFMs compared to the appendicular muscles. We identified intramuscular lipid accumulation as another contributing factor to the pathological alterations of PFMs with aging. We observed a fourfold decrease in muscle stem cell (MuSC) pool of aged relative to younger PFMs, but the MuSC pool of appendicular muscles from the same older donors was only twofold lower than in younger group, although these differences were not statistically significant. Age-related degeneration appears to disproportionally impact PFMs relative to the appendicular muscles from the same donors. Knowledge of tissue- and cell-level changes in aged PFMs is essential to promote our understanding of the mechanisms governing PFM dysfunction in older women.

Bakgrund: Bäckenbotten utsätts för stor påfrestning under graviditet och förlossning. I samband med förlossning kan skador på bäckenbotten uppstå. Dessa skador kan leda till både kort- och långsiktiga besvär som i sin tur kan påverka kvinnors livskvalitet och dagliga liv. Syfte: Syftet med studien var att kartlägga vilka bäckenbottenbesvär kvinnor upplever 6-16 veckor efter vaginal förlossning samt att beskriva dess påverkan på livskvalitet och dagligt liv. Metod: Studien var en kvantitativ tvärsnittsstudie där datainsamling skedde via en webbenkät. Webbenkäten bestod av bakgrundsfrågor utformade av författarna samt två validerade enkäter, PFDI-20 och PFIQ-7. Insamlad data analyserades i statistikprogrammet SPSS. Totalt deltog 135 kvinnor i studien. Resultat: I kartläggningen framkom att en stor andel kvinnor drabbats av bäckenbottenbesvär efter förlossning. Trots det uppgav majoriteten av kvinnorna att de ej hade besvär från sin bäckenbotten som inverkade på deras livskvalitet eller dagliga liv. Bland de kvinnor som upplevde besvär var det främst förmågan att utföra dagliga hushållsarbeten, förmågan till fysisk aktivitet och påverkan på psykisk hälsa som påverkade livskvaliteten. Konklusion: Studiens resultat antyder på att en stor andel kvinnor drabbas av bäckenbottenbesvär efter vaginal förlossning. Det är viktigt att belysa denna problematik så att kvinnor kan få adekvat stöd och behandling vid besvär. Trots att majoriteten av respondenterna ej upplevde att bäckenbottenbesvären inverkade på deras livskvalitet eller dagliga liv är det viktigt att ej normalisera bäckenbottenbesvär eller att se dem som en naturlig följd av graviditet och förlossning., Background: The pelvic floor is exposed to great stress during pregnancy and childbirth. In connection to childbirth, injuries to the pelvic floor can occur, so called birth injuries. These injuries can lead to both short- and long term problems for women. These problems can have an impact on womens quality of life and daily life. Aim: The purpose of the study was to chart which pelvic floor disorders women experience 6–16 weeks after vaginal delivery and describe its impact on quality of life and daily life. Method: The study was a quantitive cross-sectionalstudy where the data collection was done through a online questionnarie. The online questionnarie consisted of background questions designed by the authors and two validated questionnaries, PFDI-20 and PFIQ-7. Collected data was analyzed using the statistical program SPSS. A total of 135 women participated in the study. Result: In the survey of pelvic floor disorders, it was found that a large proportion of women suffered from pelvic floor disorders after childbirth. Despite this, the majority of women stated that they did not have problems from their pelvic floor that affected their quality of life or daily life. Among the women who experienced problems it was mainly the ability to perform household chores, the ability for physical activity and the impact on mental health that affected quality of life. Conclusion: The results of the study suggest that a large proportion of women suffer from pelvic floor disorders after vaginal delivery. It is important to shed light on this issue so that women can receive adequate support and treatment for their problems. Despite the fact that the majority of the respondents stated that their pelvic floor disorders did not affect quality of life or daily life, it is important to not normalize or see pelvic floor disorders as a natural consequence of pregnancy and childbirth.

Introduction: Risk factors for pelvic floor disorders are often related to pregnancy and delivery. Consistent evidence is needed to develop prevention strategies targeting risk factors. The objective of this study is to identify which pregnancy- and/or obstetric-related risk factors can predict urinary incontinence, fecal incontinence, or pelvic organ prolapse later in life by means of a systematic review and meta-analysis. Material and methods: Systematic review Prospero number: CRD42019131758. Literature searches of PubMed, EMBASE, CINAHL, and Cochrane Library were conducted according to PRISMA guidelines (April 2020). Prospective cohort studies describing more than two pregnancy- and/or obstetric-related risk factors on urinary incontinence, fecal incontinence (including flatal incontinence), or pelvic organ prolapse were eligible. Risk of bias was assessed (using Quality In Prognosis Studies [QUIPS]). Studies with high risk of bias were excluded. Data were extracted and checked for accuracy with the CHARMS checklist. Sub-groups were used to distinguish between a short- and long-term follow-up period: <18 months (shortterm) and >18 months (long-term) postpartum. Odds ratios were calculated from reported prevalence rates. Log odds ratios were calculated using SPSS v.24. Variables were pooled using RevMan5. Results: Data were extracted from nineteen studies for urinary incontinence, nine for fecal incontinence, and two for pelvic organ prolapse. Multivariate analysis was not possible because of the heterogeneity of the population and outcome measures. Pooled univariate risk factors for urinary incontinence were: urinary incontinence during pregnancy, instrumental vaginal delivery, episiotomy, tears, and constipation. Pooled univariate risk factors for fecal incontinence were: fecal incontinence during pregnancy, maternal age over 35 years, prenatal body mass index over 30 kg/m2, instrumental vaginal delivery, a spontaneous vaginal delivery, oxyt

[Resumen] Objetivo. Analizar la evidencia científica publicada sobre la eficacia de las diferentes intervenciones de fisioterapia en el tratamiento de las disfunciones sexuales femeninas. Material y método. Este trabajo consiste en la realización de una revisión bibliográfica de los artículos publicados en los últimos 5 años, en las bases de datos de PubMed, PEDro, Cochrane y SCOPUS, así como en el buscador libre “Google académico” y en las páginas de asociaciones específicas en este campo de la Fisioterapia, tales como ADOPEC, IPPS y la Sociedad Española de Algias Perineales y Neuralgias Pudendas. Durante la búsqueda de material todos los artículos que se encontraron pasaron los filtros de los criterios de inclusión, lo que quiere decir que todos los documentos fueron publicados en los últimos 5 años y se aplicaron los filtros de “sexo”, limitándolo al sexo femenino y el filtro de “humanos”. Del mismo modo, la principal disfunción del suelo pélvico debó ser la disfunción sexual, dejando al margen los tratamientos para afecciones como la incontinencia urinaria o fecal o la disfunción sexual derivada de procesos oncológicos, metabólicos, prolapsos o postparto. Resultados. Se analizaron 16 artículos (6 ensayo clínicos aleatorizados, 2 análisis secundarios de ensayos clínicos aleatorizados, 1 ensayo clínico paralelo no aleatorizado, 2 estudios prospectivos y 5 revisiones sistemáticas). Los tratamientos de Fisioterapia analizados se dividieron en: entrenamiento de los músculos del suelo pélvico, técnicas de terapia manual, técnicas instrumentales y terapia multimodal. Tras el análisis de los 16 artículos, el tratamiento mediante técnicas de Fisioterapia proporcionó mejorías en los diferentes tipos de disfunciones sexuales femeninas (vaginismo, dispareunia, vulvodinia, entre otras). Conclusiones. La Fisioterapia parece ser un tratamiento eficaz en las disfunciones sexuales femeninas. Sin embargo, es necesaria más investigación y publicación de artículos de alta calidad m, [Abstract] Objetive. To make a review of the published scientific evidence on the efficacy of different Physical Therapy interventions in the treatment of female sexual dysfunctions. Methods. This work consists of a bibliographic review of the articles published in the last 5 years, in PubMed, PEDro, Cochrane and Scopus databases, as well as in the free search engine “Google Academic” and in the websites of specific associations in this field of physical therapy, such as ADOPEC, IPPS and Spanish Society of Perineal Algias and Pudendas Neuralgias. During the search of material all articles that were found passed the filters of the inclusion criteria, which means that all the documents were published in the last 5 years as well as being applied the “sex” filter, limiting it to “female” and the “human” filter. In the same way, the main dysfunction of the pelvic floor must have been sexual dysfunction, leaving aside treatments for pelvic floor dysfunctions such as incontinence or sexual dysfunction derived from oncological or metabolic pathologies, prolapse or postpartum. Outcomes. 16 articles were analyzed (6 randomized clinical trials, 2 secondary analyzes of randomized clinical trials, 1 non-randomized parallel clinical trial, 2 prospective studies and 5 systematic reviews). The analyzed Physical Therapy treatments were divided into: training of the pelvic floor muscles, manual techniques, instrumental techniques and multimodal therapy. After analyzing the 16 articles, Physical Therapy treatment provided improvements in the different types of female sexual dysfunction (vaginismus, dyspareunia, vulvodynia, among others). Conclusions. Physical Therapy appears to be an effective treatment for female sexual dysfunction. However, more research and publication of articles of high methodological quality on this subject are necessary, due to the absence of an “Gold Sandard” treatment., [Resumo] Obxectivo. Revisar a evidencia científica publicada sobre a eficacia das diferentes intervencións de Fisioterapia no tratamento das disfuncións sexuais femininas. Material e método. Este traballo consiste na realización dunha revisión bibliográfica dos artigos publicados nos últimos 5 anos, nas bases de datos de PubMed, PEDro, Cochrane e SCOPUS, así como no buscador libre “Google académico” e nas páxinas das asociacións específicas neste campo da Fisioterapia, tales como ADOPEC, IPPS e a Sociedade Española de Alxias Perineais e Neuralxias Pudendas. Durante a búsqueda do material todos os artigos que se atoparon pasaron os filtros dos criterios de inclusión, o que quere dicir que todos os documentos foron publicados nos últimos 5 años e aplicáronse os filtros do “sexo”, limitándoo o sexo feminino e o filtro de “humano”. Do mesmo modo, a principal disfunción do solo pélvico debío ser a disfunción sexual, deixando á marxe os tratamentos para afecións como a incontinencia urinaria ou fecal ou a disfunción sexual derivada de procesos oncolóxicos, metabólicos, prolapsos ou posparto. Resultados. Analizáronse 16 artígos (6 ensaios clínicos aleatorios, 2 análises secundarias de ensaios clínicos aleatorios, 1 ensaio clínico non aleatorio paralelo e 5 revisións sistemáticas). Os tratamentos de Fisioterapia analizados dividíronse en: adestramento dos músculos do chan pélvico, técnicas de terapia manual, técnicas instrumentais e terapia multimodal. Despois de analizar os 16 artígos, o tratamento mediante técnicas de Fisioterapia proporcionou melloras nos diferentes tipos de disfuncións sexuais femininas (vaxinismo, dispareunia, vulvodinia, entre outras). Conclusións. A Fisioterapia parece ser un tratamento eficaz para a disfunción sexual femenina. Non obstante, é necesario máis investigación e publicación de artigos de alta calidade metodolóxica sobre este tema debido á ausencia dun tratamento “Gold Standard”.

Around 80% of women experience vaginal tears during labor when the diameter of the vagina must increase from ~2.5 cm to ~9.5 cm to allow the passage of a full-term baby. Vaginal tears vary from superficial cuts of the mucosal lining to tears propagating through the entire vaginal wall and into the surrounding tissues and organs. Complications associated with vaginal tears include postpartum hemorrhaging, fecal incontinence, urinary incontinence, and dyspareunia. Beyond the agonizing pain, these complications are emotionally and psychologically traumatic for women. Prevention, evaluation, and treatment of vaginal tears and subsequent conditions are limited due to the lack of studies examining the mechanical behavior of the pelvic floor tissues. Therefore, the mechanical response of healthy and torn vaginal tissue is investigated here to establish quantitative metrics for maternal healthcare. Toward this end, swine and rat vaginal tissue is subjected to biaxial loads until tearing to reveal its mechanical properties. The resulting large inhomogeneous deformations are measured by the digital image correlation optical method to calculate material strain. The influence of these strains near to and far from the immediate vicinity of the tears on the tearing behavior is studied. Coupling mechanisms of the mechanical properties in the circumferential and axial directions as well as their effect on the nature of tear resistance is studied. Collagen fibers, the component within tissue responsible for its strength under tension, are imaged using a multiphoton microscopy technique known as second-harmonic generation imaging to investigate the change in organization with mechanical loading. Furthermore, imaging is performed in the near-regions of tears to reveal the relationship between collagen fibers and tearing resistance. The data collected through these studies provide new knowledge on the nonlinear elastic behavior of vaginal tissue, the geometrical and micro-structural ch

Around 80% of women experience vaginal tears during labor when the diameter of the vagina must increase from ~2.5 cm to ~9.5 cm to allow the passage of a full-term baby. Vaginal tears vary from superficial cuts of the mucosal lining to tears propagating through the entire vaginal wall and into the surrounding tissues and organs. Complications associated with vaginal tears include postpartum hemorrhaging, fecal incontinence, urinary incontinence, and dyspareunia. Beyond the agonizing pain, these complications are emotionally and psychologically traumatic for women. Prevention, evaluation, and treatment of vaginal tears and subsequent conditions are limited due to the lack of studies examining the mechanical behavior of the pelvic floor tissues. Therefore, the mechanical response of healthy and torn vaginal tissue is investigated here to establish quantitative metrics for maternal healthcare. Toward this end, swine and rat vaginal tissue is subjected to biaxial loads until tearing to reveal its mechanical properties. The resulting large inhomogeneous deformations are measured by the digital image correlation optical method to calculate material strain. The influence of these strains near to and far from the immediate vicinity of the tears on the tearing behavior is studied. Coupling mechanisms of the mechanical properties in the circumferential and axial directions as well as their effect on the nature of tear resistance is studied. Collagen fibers, the component within tissue responsible for its strength under tension, are imaged using a multiphoton microscopy technique known as second-harmonic generation imaging to investigate the change in organization with mechanical loading. Furthermore, imaging is performed in the near-regions of tears to reveal the relationship between collagen fibers and tearing resistance. The data collected through these studies provide new knowledge on the nonlinear elastic behavior of vaginal tissue, the geometrical and micro-structural ch

[Resumen] Objetivo. Analizar la evidencia científica publicada sobre la eficacia de las diferentes intervenciones de fisioterapia en el tratamiento de las disfunciones sexuales femeninas. Material y método. Este trabajo consiste en la realización de una revisión bibliográfica de los artículos publicados en los últimos 5 años, en las bases de datos de PubMed, PEDro, Cochrane y SCOPUS, así como en el buscador libre “Google académico” y en las páginas de asociaciones específicas en este campo de la Fisioterapia, tales como ADOPEC, IPPS y la Sociedad Española de Algias Perineales y Neuralgias Pudendas. Durante la búsqueda de material todos los artículos que se encontraron pasaron los filtros de los criterios de inclusión, lo que quiere decir que todos los documentos fueron publicados en los últimos 5 años y se aplicaron los filtros de “sexo”, limitándolo al sexo femenino y el filtro de “humanos”. Del mismo modo, la principal disfunción del suelo pélvico debó ser la disfunción sexual, dejando al margen los tratamientos para afecciones como la incontinencia urinaria o fecal o la disfunción sexual derivada de procesos oncológicos, metabólicos, prolapsos o postparto. Resultados. Se analizaron 16 artículos (6 ensayo clínicos aleatorizados, 2 análisis secundarios de ensayos clínicos aleatorizados, 1 ensayo clínico paralelo no aleatorizado, 2 estudios prospectivos y 5 revisiones sistemáticas). Los tratamientos de Fisioterapia analizados se dividieron en: entrenamiento de los músculos del suelo pélvico, técnicas de terapia manual, técnicas instrumentales y terapia multimodal. Tras el análisis de los 16 artículos, el tratamiento mediante técnicas de Fisioterapia proporcionó mejorías en los diferentes tipos de disfunciones sexuales femeninas (vaginismo, dispareunia, vulvodinia, entre otras). Conclusiones. La Fisioterapia parece ser un tratamiento eficaz en las disfunciones sexuales femeninas. Sin embargo, es necesaria más investigación y publicación de artículos de alta calidad m, [Abstract] Objetive. To make a review of the published scientific evidence on the efficacy of different Physical Therapy interventions in the treatment of female sexual dysfunctions. Methods. This work consists of a bibliographic review of the articles published in the last 5 years, in PubMed, PEDro, Cochrane and Scopus databases, as well as in the free search engine “Google Academic” and in the websites of specific associations in this field of physical therapy, such as ADOPEC, IPPS and Spanish Society of Perineal Algias and Pudendas Neuralgias. During the search of material all articles that were found passed the filters of the inclusion criteria, which means that all the documents were published in the last 5 years as well as being applied the “sex” filter, limiting it to “female” and the “human” filter. In the same way, the main dysfunction of the pelvic floor must have been sexual dysfunction, leaving aside treatments for pelvic floor dysfunctions such as incontinence or sexual dysfunction derived from oncological or metabolic pathologies, prolapse or postpartum. Outcomes. 16 articles were analyzed (6 randomized clinical trials, 2 secondary analyzes of randomized clinical trials, 1 non-randomized parallel clinical trial, 2 prospective studies and 5 systematic reviews). The analyzed Physical Therapy treatments were divided into: training of the pelvic floor muscles, manual techniques, instrumental techniques and multimodal therapy. After analyzing the 16 articles, Physical Therapy treatment provided improvements in the different types of female sexual dysfunction (vaginismus, dyspareunia, vulvodynia, among others). Conclusions. Physical Therapy appears to be an effective treatment for female sexual dysfunction. However, more research and publication of articles of high methodological quality on this subject are necessary, due to the absence of an “Gold Sandard” treatment., [Resumo] Obxectivo. Revisar a evidencia científica publicada sobre a eficacia das diferentes intervencións de Fisioterapia no tratamento das disfuncións sexuais femininas. Material e método. Este traballo consiste na realización dunha revisión bibliográfica dos artigos publicados nos últimos 5 anos, nas bases de datos de PubMed, PEDro, Cochrane e SCOPUS, así como no buscador libre “Google académico” e nas páxinas das asociacións específicas neste campo da Fisioterapia, tales como ADOPEC, IPPS e a Sociedade Española de Alxias Perineais e Neuralxias Pudendas. Durante a búsqueda do material todos os artigos que se atoparon pasaron os filtros dos criterios de inclusión, o que quere dicir que todos os documentos foron publicados nos últimos 5 años e aplicáronse os filtros do “sexo”, limitándoo o sexo feminino e o filtro de “humano”. Do mesmo modo, a principal disfunción do solo pélvico debío ser a disfunción sexual, deixando á marxe os tratamentos para afecións como a incontinencia urinaria ou fecal ou a disfunción sexual derivada de procesos oncolóxicos, metabólicos, prolapsos ou posparto. Resultados. Analizáronse 16 artígos (6 ensaios clínicos aleatorios, 2 análises secundarias de ensaios clínicos aleatorios, 1 ensaio clínico non aleatorio paralelo e 5 revisións sistemáticas). Os tratamentos de Fisioterapia analizados dividíronse en: adestramento dos músculos do chan pélvico, técnicas de terapia manual, técnicas instrumentais e terapia multimodal. Despois de analizar os 16 artígos, o tratamento mediante técnicas de Fisioterapia proporcionou melloras nos diferentes tipos de disfuncións sexuais femininas (vaxinismo, dispareunia, vulvodinia, entre outras). Conclusións. A Fisioterapia parece ser un tratamento eficaz para a disfunción sexual femenina. Non obstante, é necesario máis investigación e publicación de artigos de alta calidade metodolóxica sobre este tema debido á ausencia dun tratamento “Gold Standard”.

Background and Objectives: Rugby players engage in demanding, high loading muscular activity in the spine. Study of the abdominal wall architecture in female rugby athletes is relevant to the possible muscular asymmetry secondary to sport practice and the relationship between the abdominal wall and the pelvic floor muscles. Activation of the transversus abdominis (TrAb) generates an increase in the bladder neck muscle. Moreover, an increased interrecti distance (IRD) is related to urinary incontinence and has a higher prevalence in athletic women. The aim of the present study was to compare and quantify, with ultrasound imaging (USI), the thickness of the transversus abdominis (TrAb), external oblique (EO), internal oblique (IO), rectus abdominis (RA), and interrecti distance (IRD) in female rugby players versus non-athletic women in order to improve upon existing knowledge about abdominal wall configuration in female athletes. Materials and Methods: A sample of 32 women was recruited at the Universidad Europea Research Lab and divided in two groups: a rugby group (n = 16) and a non-athletic women group (n = 16). The thickness of the TrAb, EO, IO, RA, and IRD were assessed by USI in both groups. Results: There were statistically significant differences for the ultrasound evaluation thickness of the right TrAb (p = 0.011; d = 0.10), EO (p = 0.045; d = 0.74), IO (p = 0.003; d = 1.32), and RA (p = 0.001; d = 1.38) showing a thickness increase for the rugby group with respect to the control group. For the IRD thickness, there were no significant differences (p > 0.05) between groups. Conclusions: An increased TrAb, IO, EO, and RA thickness may be shown in female rugby players versus non-athletic women. Nevertheless, statistically relevant differences were not found for the IRD between both groups.

ObjectivesA significant body of knowledge implicates menopausal estrogen levels in the pathogenesis of the common pelvic floor disorders (PFDs). These health conditions substantially decrease quality of life, increase depression, social isolation, caregiver burden, and economic costs to the individuals and society.MethodsThis review summarizes the epidemiology of the individual PFDs with particular attention to the understanding of the relationship between each PFD and menopausal estrogen levels, and the gaps in science and clinical care that affect menopausal women. In addition, we review the epidemiology of recurrent urinary tract infection (rUTI)-a condition experienced frequently and disproportionately by menopausal women and hypothesized to be potentiated by menopausal estrogen levels.ResultsThe abundance of estrogen receptors in the urogenital tract explains why the natural reduction of endogenous estrogen, the hallmark of menopause, can cause or potentiate PFDs and rUTIs. A substantial body of epidemiological literature suggests an association between menopause, and PFDs and rUTIs; however, the ability to separate this association from age and other comorbid conditions makes it difficult to draw definitive conclusions on the role of menopause alone in the development and/or progression of PFDs. Similarly, the causative link between the decline in endogenous estrogen levels and the pathogenesis of PFDs and rUTIs has not been well-established.ConclusionsInnovative human studies, focused on the independent effects of menopausal estrogen levels, uncoupled from tissue and cellular senescence, are needed.

Background and Objectives: Rugby players engage in demanding, high loading muscular activity in the spine. Study of the abdominal wall architecture in female rugby athletes is relevant to the possible muscular asymmetry secondary to sport practice and the relationship between the abdominal wall and the pelvic floor muscles. Activation of the transversus abdominis (TrAb) generates an increase in the bladder neck muscle. Moreover, an increased interrecti distance (IRD) is related to urinary incontinence and has a higher prevalence in athletic women. The aim of the present study was to compare and quantify, with ultrasound imaging (USI), the thickness of the transversus abdominis (TrAb), external oblique (EO), internal oblique (IO), rectus abdominis (RA), and interrecti distance (IRD) in female rugby players versus non-athletic women in order to improve upon existing knowledge about abdominal wall configuration in female athletes. Materials and Methods: A sample of 32 women was recruited at the Universidad Europea Research Lab and divided in two groups: a rugby group (n = 16) and a non-athletic women group (n = 16). The thickness of the TrAb, EO, IO, RA, and IRD were assessed by USI in both groups. Results: There were statistically significant differences for the ultrasound evaluation thickness of the right TrAb (p = 0.011; d = 0.10), EO (p = 0.045; d = 0.74), IO (p = 0.003; d = 1.32), and RA (p = 0.001; d = 1.38) showing a thickness increase for the rugby group with respect to the control group. For the IRD thickness, there were no significant differences (p > 0.05) between groups. Conclusions: An increased TrAb, IO, EO, and RA thickness may be shown in female rugby players versus non-athletic women. Nevertheless, statistically relevant differences were not found for the IRD between both groups.

Background and Objectives: Rugby players engage in demanding, high loading muscular activity in the spine. Study of the abdominal wall architecture in female rugby athletes is relevant to the possible muscular asymmetry secondary to sport practice and the relationship between the abdominal wall and the pelvic floor muscles. Activation of the transversus abdominis (TrAb) generates an increase in the bladder neck muscle. Moreover, an increased interrecti distance (IRD) is related to urinary incontinence and has a higher prevalence in athletic women. The aim of the present study was to compare and quantify, with ultrasound imaging (USI), the thickness of the transversus abdominis (TrAb), external oblique (EO), internal oblique (IO), rectus abdominis (RA), and interrecti distance (IRD) in female rugby players versus non-athletic women in order to improve upon existing knowledge about abdominal wall configuration in female athletes. Materials and Methods: A sample of 32 women was recruited at the Universidad Europea Research Lab and divided in two groups: a rugby group (n = 16) and a non-athletic women group (n = 16). The thickness of the TrAb, EO, IO, RA, and IRD were assessed by USI in both groups. Results: There were statistically significant differences for the ultrasound evaluation thickness of the right TrAb (p = 0.011; d = 0.10), EO (p = 0.045; d = 0.74), IO (p = 0.003; d = 1.32), and RA (p = 0.001; d = 1.38) showing a thickness increase for the rugby group with respect to the control group. For the IRD thickness, there were no significant differences (p > 0.05) between groups. Conclusions: An increased TrAb, IO, EO, and RA thickness may be shown in female rugby players versus non-athletic women. Nevertheless, statistically relevant differences were not found for the IRD between both groups.

ObjectivesA significant body of knowledge implicates menopausal estrogen levels in the pathogenesis of the common pelvic floor disorders (PFDs). These health conditions substantially decrease quality of life, increase depression, social isolation, caregiver burden, and economic costs to the individuals and society.MethodsThis review summarizes the epidemiology of the individual PFDs with particular attention to the understanding of the relationship between each PFD and menopausal estrogen levels, and the gaps in science and clinical care that affect menopausal women. In addition, we review the epidemiology of recurrent urinary tract infection (rUTI)-a condition experienced frequently and disproportionately by menopausal women and hypothesized to be potentiated by menopausal estrogen levels.ResultsThe abundance of estrogen receptors in the urogenital tract explains why the natural reduction of endogenous estrogen, the hallmark of menopause, can cause or potentiate PFDs and rUTIs. A substantial body of epidemiological literature suggests an association between menopause, and PFDs and rUTIs; however, the ability to separate this association from age and other comorbid conditions makes it difficult to draw definitive conclusions on the role of menopause alone in the development and/or progression of PFDs. Similarly, the causative link between the decline in endogenous estrogen levels and the pathogenesis of PFDs and rUTIs has not been well-established.ConclusionsInnovative human studies, focused on the independent effects of menopausal estrogen levels, uncoupled from tissue and cellular senescence, are needed.

Background and Objectives: Rugby players engage in demanding, high loading muscular activity in the spine. Study of the abdominal wall architecture in female rugby athletes is relevant to the possible muscular asymmetry secondary to sport practice and the relationship between the abdominal wall and the pelvic floor muscles. Activation of the transversus abdominis (TrAb) generates an increase in the bladder neck muscle. Moreover, an increased interrecti distance (IRD) is related to urinary incontinence and has a higher prevalence in athletic women. The aim of the present study was to compare and quantify, with ultrasound imaging (USI), the thickness of the transversus abdominis (TrAb), external oblique (EO), internal oblique (IO), rectus abdominis (RA), and interrecti distance (IRD) in female rugby players versus non-athletic women in order to improve upon existing knowledge about abdominal wall configuration in female athletes. Materials and Methods: A sample of 32 women was recruited at the Universidad Europea Research Lab and divided in two groups: a rugby group (n = 16) and a non-athletic women group (n = 16). The thickness of the TrAb, EO, IO, RA, and IRD were assessed by USI in both groups. Results: There were statistically significant differences for the ultrasound evaluation thickness of the right TrAb (p = 0.011; d = 0.10), EO (p = 0.045; d = 0.74), IO (p = 0.003; d = 1.32), and RA (p = 0.001; d = 1.38) showing a thickness increase for the rugby group with respect to the control group. For the IRD thickness, there were no significant differences (p > 0.05) between groups. Conclusions: An increased TrAb, IO, EO, and RA thickness may be shown in female rugby players versus non-athletic women. Nevertheless, statistically relevant differences were not found for the IRD between both groups.

BackgroundLittle is known about short- and long-term pain and functional activity after surgery for pelvic organ prolapse.ObjectiveThe objectives of the study were to describe postoperative pain and functional activity after transvaginal native tissue reconstructive surgery with apical suspension and retropubic synthetic midurethral sling and to compare these outcomes between patients receiving 2 common transvaginal prolapse repairs, uterosacral ligament, and sacrospinous ligament vaginal vault suspension.Study designThis planned secondary analysis of a 2 × 2 factorial randomized trial included 374 women randomized to receive uterosacral (n = 188) or sacrospinous (n = 186) vaginal vault suspension to treat both stages 2-4 apical vaginal prolapse and stress urinary incontinence between 2008 and 2013 at 9 medical centers. Participants were also randomized to receive perioperative pelvic muscle therapy or usual care. All patients received transvaginal native tissue repairs and a midurethral sling. Participants completed the Surgical Pain Scales (0-10 numeric rating scales; higher scores = greater pain) and Activity Assessment Scale (0-100; higher score = higher activity) prior to surgery and at 2 weeks, 4-6 weeks, and 3 months postoperatively. The MOS 36-item Short-Form Health Survey was completed at baseline and 6, 12, and 24 months after surgery; the bodily pain, physical functioning, and role-physical subscales were used for this analysis (higher scores = less disability). Self-reported pain medication use was also collected.ResultsBefore surgery, average pain at rest and during normal activity were (adjusted mean ± SE) 2.24 ± 0.23 and 2.76 ± 0.25; both increased slightly from baseline at 2 weeks (+0.65, P = .004, and +0.74, P = .007, respectively) and then decreased below baseline at 3 months (-0.87 and -1.14, respectively, P < .001), with no differences between surgical groups. Pain during exercise/strenuous activity and

AIMS: To verify intra and inter-rater reliability and concordance in the assessment of perineal pressure in nulliparous women.METHODS: Young, healthy, nulliparous, non-pregnant women who had had sexual intercourse and had a correct contraction of the perineal musculature on physical examination were included. Women were excluded if they used other muscles in a visually perceptible way during the perineal contraction; with changes in the pelvic muscles tone; with urinary incontinence; with cognitive alterations; with disease that could affect the muscular and nervous tissues; or practitioners of high-impact physical activity. The participants were submitted to two assessments of perineal pressure on the same day, with different evaluators. After one week the protocol was repeated. Perineal pressure was determined by means of a perineometer and obtained by the difference between the maximum pressure (Pmax) and the minimum pressure (Pmin) recorded by the device, in millimeters of mercury. Sustained contraction (SC) was evaluated by the time in seconds. In order to determine reliability, the intraclass correlation coefficient (ICC) was used. Bland-Altman test was used for the concordance analysis. Comparison of means was performed by the Wilcoxon test. A value of p≤0.05 was considered significant.RESULTS: Ten participants were included, with a mean age of 23.8±2.9 years and a body mass index of 22.2±1.8 kg / m². The evaluator A obtained excellent intra-rater reliability for Pmin (ICC=0.86, p<0.01) and Pmax (ICC=0.92, p<0.01); very good reliability for perineal pressure (ICC=0.65, p=0.01); and no statistical significance for SC. For evaluator B, there was no statistical significance for Pmin and Pmax, but there was very good reliability for perineal pressure (ICC=0.78, p<0.01) and SC (ICC = 0.70, p<0.01). In the inter-rater analysis (A vs B), on day 1 there was no statistical significance for Pmin, Pmax and perineal pressure; but there was very good reliability for SC (I, OBJETIVOS: Verificar a confiabilidade e concordância intra e interavaliadores na avaliação da pressão perineal em nulíparas.MÉTODOS: Foram incluídas mulheres jovens, saudáveis, nulíparas, não gestantes, que já haviam tido relação sexual e apresentavam correta contração da musculatura perineal ao exame físico. Foram excluídas mulheres que na contração perineal utilizavam outros músculos de forma visualmente perceptível; com alteração do tônus dos músculos pélvicos; com incontinência urinária; com alterações cognitivas; com doença que pudesse afetar os tecidos muscular e nervoso; ou praticantes de atividade física de alto impacto. As participantes foram submetidas a duas avaliações da pressão perineal no mesmo dia, com avaliadores distintos. Após uma semana repetiu-se o protocolo. A pressão perineal foi determinada por meio de um perineômetro e obtida pela diferença entre a pressão máxima (Pmáx) e a pressão mínima (Pmín), registradas pelo aparelho, em milímetros de mercúrio. A contração sustentada (CS) foi avaliada pelo tempo em segundos. Para determinar a confiabilidade foi utilizado o coeficiente de correlação intraclasse (ICC). Para a análise de concordância foi utilizado o teste de Bland-Altman. A comparação de médias foi realizada pelo teste de Wilcoxon. Um valor de p≤0,05 foi considerado significativo.RESULTADOS: Foram incluídas 10 participantes, com média de idade de 23,8±2,9 anos e índice de massa corporal de 22,2±1,8kg/m². O avaliador A obteve confiabilidade intra-avaliador excelente para Pmín (ICC=0,86; p<0,01) e Pmáx (ICC=0,92; p<0,01); muito boa para pressão perineal (ICC= 0,65; p=0,01); e sem significância estatística para CS. Para o avaliador B, não houve significância estatística para Pmín e Pmáx, mas houve confiabilidade muito boa para pressão perineal (ICC=0,78; p<0,01) e CS (ICC= 0,70; p<0,01). Na análise interavaliadores (A vs B),no dia 1 não houve significância estatística para Pmín, Pmáx e pressão perineal; mas houve confiabilidade muito boa para

Background and Objectives: Rugby players engage in demanding, high loading muscular activity in the spine. Study of the abdominal wall architecture in female rugby athletes is relevant to the possible muscular asymmetry secondary to sport practice and the relationship between the abdominal wall and the pelvic floor muscles. Activation of the transversus abdominis (TrAb) generates an increase in the bladder neck muscle. Moreover, an increased interrecti distance (IRD) is related to urinary incontinence and has a higher prevalence in athletic women. The aim of the present study was to compare and quantify, with ultrasound imaging (USI), the thickness of the transversus abdominis (TrAb), external oblique (EO), internal oblique (IO), rectus abdominis (RA), and interrecti distance (IRD) in female rugby players versus non-athletic women in order to improve upon existing knowledge about abdominal wall configuration in female athletes. Materials and Methods: A sample of 32 women was recruited at the Universidad Europea Research Lab and divided in two groups: a rugby group (n = 16) and a non-athletic women group (n = 16). The thickness of the TrAb, EO, IO, RA, and IRD were assessed by USI in both groups. Results: There were statistically significant differences for the ultrasound evaluation thickness of the right TrAb (p = 0.011; d = 0.10), EO (p = 0.045; d = 0.74), IO (p = 0.003; d = 1.32), and RA (p = 0.001; d = 1.38) showing a thickness increase for the rugby group with respect to the control group. For the IRD thickness, there were no significant differences (p > 0.05) between groups. Conclusions: An increased TrAb, IO, EO, and RA thickness may be shown in female rugby players versus non-athletic women. Nevertheless, statistically relevant differences were not found for the IRD between both groups.

OBJECTIVES: A significant body of knowledge implicates menopausal estrogen levels in the pathogenesis of the common pelvic floor disorders (PFDs). These health conditions substantially decrease quality of life, increase depression, social isolation, caregiver burden, and economic costs to the individuals and society. METHODS: This review summarizes the epidemiology of the individual PFDs with particular attention to the understanding of the relationship between each PFD and menopausal estrogen levels, and the gaps in science and clinical care that affect menopausal women. In addition, we review the epidemiology of recurrent urinary tract infection (rUTI)-a condition experienced frequently and disproportionately by menopausal women and hypothesized to be potentiated by menopausal estrogen levels. RESULTS: The abundance of estrogen receptors in the urogenital tract explains why the natural reduction of endogenous estrogen, the hallmark of menopause, can cause or potentiate PFDs and rUTIs. A substantial body of epidemiological literature suggests an association between menopause, and PFDs and rUTIs; however, the ability to separate this association from age and other comorbid conditions makes it difficult to draw definitive conclusions on the role of menopause alone in the development and/or progression of PFDs. Similarly, the causative link between the decline in endogenous estrogen levels and the pathogenesis of PFDs and rUTIs has not been well-established. CONCLUSIONS: Innovative human studies, focused on the independent effects of menopausal estrogen levels, uncoupled from tissue and cellular senescence, are needed.

Background and Objectives: Rugby players engage in demanding, high loading muscular activity in the spine. Study of the abdominal wall architecture in female rugby athletes is relevant to the possible muscular asymmetry secondary to sport practice and the relationship between the abdominal wall and the pelvic floor muscles. Activation of the transversus abdominis (TrAb) generates an increase in the bladder neck muscle. Moreover, an increased interrecti distance (IRD) is related to urinary incontinence and has a higher prevalence in athletic women. The aim of the present study was to compare and quantify, with ultrasound imaging (USI), the thickness of the transversus abdominis (TrAb), external oblique (EO), internal oblique (IO), rectus abdominis (RA), and interrecti distance (IRD) in female rugby players versus non-athletic women in order to improve upon existing knowledge about abdominal wall configuration in female athletes. Materials and Methods: A sample of 32 women was recruited at the Universidad Europea Research Lab and divided in two groups: a rugby group (n = 16) and a non-athletic women group (n = 16). The thickness of the TrAb, EO, IO, RA, and IRD were assessed by USI in both groups. Results: There were statistically significant differences for the ultrasound evaluation thickness of the right TrAb (p = 0.011; d = 0.10), EO (p = 0.045; d = 0.74), IO (p = 0.003; d = 1.32), and RA (p = 0.001; d = 1.38) showing a thickness increase for the rugby group with respect to the control group. For the IRD thickness, there were no significant differences (p > 0.05) between groups. Conclusions: An increased TrAb, IO, EO, and RA thickness may be shown in female rugby players versus non-athletic women. Nevertheless, statistically relevant differences were not found for the IRD between both groups.

Background and Objectives: Rugby players engage in demanding, high loading muscular activity in the spine. Study of the abdominal wall architecture in female rugby athletes is relevant to the possible muscular asymmetry secondary to sport practice and the relationship between the abdominal wall and the pelvic floor muscles. Activation of the transversus abdominis (TrAb) generates an increase in the bladder neck muscle. Moreover, an increased interrecti distance (IRD) is related to urinary incontinence and has a higher prevalence in athletic women. The aim of the present study was to compare and quantify, with ultrasound imaging (USI), the thickness of the transversus abdominis (TrAb), external oblique (EO), internal oblique (IO), rectus abdominis (RA), and interrecti distance (IRD) in female rugby players versus non-athletic women in order to improve upon existing knowledge about abdominal wall configuration in female athletes. Materials and Methods: A sample of 32 women was recruited at the Universidad Europea Research Lab and divided in two groups: a rugby group (n = 16) and a non-athletic women group (n = 16). The thickness of the TrAb, EO, IO, RA, and IRD were assessed by USI in both groups. Results: There were statistically significant differences for the ultrasound evaluation thickness of the right TrAb (p = 0.011; d = 0.10), EO (p = 0.045; d = 0.74), IO (p = 0.003; d = 1.32), and RA (p = 0.001; d = 1.38) showing a thickness increase for the rugby group with respect to the control group. For the IRD thickness, there were no significant differences (p > 0.05) between groups. Conclusions: An increased TrAb, IO, EO, and RA thickness may be shown in female rugby players versus non-athletic women. Nevertheless, statistically relevant differences were not found for the IRD between both groups.

The two fundamental research questions of this thesis are: 1) Can we lay the foundations to construct a complete diagnostic and prognostic prediction model in pelvic floor disorders in the future? 2) Can we construct the first part of this prediction model, a prognostic model that predicts the outcome of urge urinary incontinence treatment?

Ventral mesh rectopexy (VMR) is an expanding procedure in the surgical treatment of external or internal rectal prolapse and rectocele, and can be performed by a laparotomy, a laparoscopic approach or by robotics. Sometimes, mesh can be attached to levator muscles (perineosacropexy), and/or vagina posterior wall (colposacropexy) making this procedure an attractive resource in the treatment of multicompartimental prolapse. In spite of procedure’s functional advantages, VMR is associated with morbidity due to mesh as infection, pelvic abscess, erosion, fistulization to rectum or vagina and anal stenosis questioning its effectiveness. Overall VMR morbidity is around 3.6-23.5%, mild complications (grade I or II of Clavien-Dindo classification). In this paper we consider most frequent and severe complications after laparoscopic VMR, role of new approaches as robotic and therapeutic considerations in most severe complications due to this procedure., La rectopexia ventral con malla (RVM) es una técnica cada vez más extendida para el tratamiento del prolapso rectal externo e interno y el rectocele y puede realizarse por vía laparotómica (RVMA), laparoscópica (RVML) o mediante un procedimiento robótico (RVMR). En ciertos casos, la malla puede fijarse a los músculos elevadores del ano (perineorectosacropexia) y/o a la cara posterior de la vagina (colporectosacropexia) haciendo de este procedimiento un recurso interesante para el tratamiento de la disfunción multicompartimental del suelo pélvico. A pesar de sus ventajas en términos de funcionalidad, la RVM se asocia a morbilidad relacionada con la malla como infección, absceso pélvico, erosión y fistulización en órganos de vecindad, ya sea recto o vagina, así como estenosis anal, que han cuestionado su efectividad. De forma global, la morbilidad asociada a la RVM se sitúa entre 3,6-23,5% de los pacientes, predominando las complicaciones leves (grado I y II de la clasificación de Clavien-Dindo). En este artículo analizamos las complicaciones más frecuentes descritas tras RVLM, el papel que juegan nuevos abordajes como la robótica y las posibilidades terapéuticas en las complicaciones más habituales tras este procedimiento.

PurposeTo establish validity for the Pelvic Floor Disorders Network (PFDN) self-administered Adaptive Behavior Index (ABI) and to assess whether ABI assesses known discordance between severity of pelvic floor symptoms and self-reported bother.MethodsIn addition to the ABI questionnaire, participants in 1 of 6 Pelvic Floor Disorders Network trials completed condition-specific measures of pretreatment symptom severity (including Pelvic Floor Distress Inventory; PFDI) and health-related quality of life (Pelvic Floor Impact Questionnaire; PFIQ). The final survey was developed from an iterative process using subject and expert endorsement, factor analyses, and response distributions. Domains were created using a development cohort (n = 304 women), reliability and validity were established using a validation cohort (n = 596 women), and test-retest reliability was assessed (n = 111 women).ResultsFactor analyses supported an 11-item avoidance domain and a 6-item hygiene domain. Cronbach' alphas were 0.88 and 0.68, respectively. Test-retest reliability was 0.84 for both domains. Construct validity was demonstrated in correlations between the ABI domains and baseline PFDI and PFIQ (r values, 0.43-0.79 with all P values <0.0001). Moreover, the ABI accounted for 8% to 26% of unexplained variance between the symptoms severity measure and the impact on health related quality of life. After treatment, avoidance domain scores improved for urinary and fecal incontinence groups and hygiene scores improved for the fecal incontinence group.ConclusionsThe ABI is a reliable and valid measure in women with pelvic floor disorders. Adaptive behaviors account in part for discordance between pelvic floor symptom severity and bother.

IntroductionPelvic floor disorders (PFDs), including pelvic organ prolapse (POP), stress and urgency urinary incontinence, and faecal incontinence, are common and arise from loss of pelvic support. Although severe disease often does not occur until women become older, pregnancy and childbirth are major risk factors for PFDs, especially POP. We understand little about modifiable factors that impact pelvic floor function recovery after vaginal birth. This National Institutes of Health (NIH)-funded Program Project, 'Bridging physical and cultural determinants of postpartum pelvic floor support and symptoms following vaginal delivery', uses mixed-methods research to study the influences of intra-abdominal pressure, physical activity, body habitus and muscle fitness on pelvic floor support and symptoms as well as the cultural context in which women experience those changes.Methods and analysisUsing quantitative methods, we will evaluate whether pelvic floor support and symptoms 1 year after the first vaginal delivery are affected by biologically plausible factors that may impact muscle, nerve and connective tissue healing during recovery (first 8 weeks postpartum) and strengthening (remainder of the first postpartum year). Using qualitative methods, we will examine cultural aspects of perceptions, explanations of changes in pelvic floor support, and actions taken by Mexican-American and Euro-American primipara, emphasising early changes after childbirth. We will summarise project results in a resource toolkit that will enhance opportunities for dialogue between women, their families and providers, and across lay and medical discourses. We anticipate enrolling up to 1530 nulliparous women into the prospective cohort study during the third trimester, following those who deliver vaginally 1 year postpartum. Participants will be drawn from this cohort to meet the project's aims.Ethics and disseminationThe University of Utah and Intermountain Healthcare Institutional Review B

IntroductionPelvic floor disorders (PFDs), including pelvic organ prolapse (POP), stress and urgency urinary incontinence, and faecal incontinence, are common and arise from loss of pelvic support. Although severe disease often does not occur until women become older, pregnancy and childbirth are major risk factors for PFDs, especially POP. We understand little about modifiable factors that impact pelvic floor function recovery after vaginal birth. This National Institutes of Health (NIH)-funded Program Project, 'Bridging physical and cultural determinants of postpartum pelvic floor support and symptoms following vaginal delivery', uses mixed-methods research to study the influences of intra-abdominal pressure, physical activity, body habitus and muscle fitness on pelvic floor support and symptoms as well as the cultural context in which women experience those changes.Methods and analysisUsing quantitative methods, we will evaluate whether pelvic floor support and symptoms 1 year after the first vaginal delivery are affected by biologically plausible factors that may impact muscle, nerve and connective tissue healing during recovery (first 8 weeks postpartum) and strengthening (remainder of the first postpartum year). Using qualitative methods, we will examine cultural aspects of perceptions, explanations of changes in pelvic floor support, and actions taken by Mexican-American and Euro-American primipara, emphasising early changes after childbirth. We will summarise project results in a resource toolkit that will enhance opportunities for dialogue between women, their families and providers, and across lay and medical discourses. We anticipate enrolling up to 1530 nulliparous women into the prospective cohort study during the third trimester, following those who deliver vaginally 1 year postpartum. Participants will be drawn from this cohort to meet the project's aims.Ethics and disseminationThe University of Utah and Intermountain Healthcare Institutional Review B

PurposeTo establish validity for the Pelvic Floor Disorders Network (PFDN) self-administered Adaptive Behavior Index (ABI) and to assess whether ABI assesses known discordance between severity of pelvic floor symptoms and self-reported bother.MethodsIn addition to the ABI questionnaire, participants in 1 of 6 Pelvic Floor Disorders Network trials completed condition-specific measures of pretreatment symptom severity (including Pelvic Floor Distress Inventory; PFDI) and health-related quality of life (Pelvic Floor Impact Questionnaire; PFIQ). The final survey was developed from an iterative process using subject and expert endorsement, factor analyses, and response distributions. Domains were created using a development cohort (n = 304 women), reliability and validity were established using a validation cohort (n = 596 women), and test-retest reliability was assessed (n = 111 women).ResultsFactor analyses supported an 11-item avoidance domain and a 6-item hygiene domain. Cronbach' alphas were 0.88 and 0.68, respectively. Test-retest reliability was 0.84 for both domains. Construct validity was demonstrated in correlations between the ABI domains and baseline PFDI and PFIQ (r values, 0.43-0.79 with all P values <0.0001). Moreover, the ABI accounted for 8% to 26% of unexplained variance between the symptoms severity measure and the impact on health related quality of life. After treatment, avoidance domain scores improved for urinary and fecal incontinence groups and hygiene scores improved for the fecal incontinence group.ConclusionsThe ABI is a reliable and valid measure in women with pelvic floor disorders. Adaptive behaviors account in part for discordance between pelvic floor symptom severity and bother.

Pelvic floor disorders affect up to 24% of adult women in the United States, and many patients with pelvic organ prolapse (POP) choose to undergo surgical repair to improve their quality of life. While a variety of surgical repair approaches and techniques are utilized, including mesh augmentation, there is limited comparative effectiveness and safety outcome data guiding best practice. In conjunction with device manufacturers, federal regulatory organizations, and professional societies, the American Urogynecologic Society developed the Pelvic Floor Disorders Registry (PFDR) designed to improve the quality of POP surgery by facilitating quality improvement and research on POP treatments. The PFDR will serve as a resource for surgeons interested in benchmarking and outcomes data and as a data repository for Food and Drug Administration-mandated POP surgical device studies. Provider-reported clinical data and patient-reported outcomes will be collected prospectively at baseline and for up to 3 years after treatment. All data elements including measures of success, adverse events, and surgeon characteristics were identified and defined within the context of the anticipated multifunctionality of the registry, and with collaboration from multiple stakeholders. The PFDR will provide a platform to collect high-quality, standardized patient-level data from a variety of nonsurgical (pessary) and surgical treatments of POP and other pelvic floor disorders. Data from this registry may be used to evaluate short- and longer-term treatment outcomes, patient-reported outcomes, and complications, as well as to identify factors associated with treatment success and failure with the overall goal of improving the quality of care for women with these conditions.