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This article discusses the importance of physical activity (PA) for postpartum women and the need for support and guidance in engaging in PA after childbirth. The authors argue that PA is a human right and that access and education surrounding PA adaptation postpartum should be improved to support mothers' well-being. The article suggests strategies at the policy, community, interpersonal, and individual levels to support postpartum women's PA engagement, emphasizing the need for adequate maternity leave, healthcare guidelines, partnerships with healthcare providers, social support, and self-compassion. The authors conclude that achieving health equity for postpartum women requires input from all levels of society. [Extracted from the article]

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. The largest identified barrier to care for these patients is access to PFPT. For patients who cannot access PFPT, experts recommend at-home, guided pelvic floor relaxation, self-massage with vaginal wands, and virtual PFPT visits. CONCLUSION: A stepwise approach to the treatment of HTPFD is recommended, with patients often necessitating multiple lines of treatment either sequentially or in conjunction. However, PFPT should be offered first line.

Purpose: Chronic constipation is a common symptom. Constipation due to pelvic floor disorders remain a therapeutic challenge. Biofeedback therapy is considered as the first-choice treatment for pelvic floor disorders, whenever dedicated expertise is available. Type A botulinum toxin has been used to selectively weaken the external anal sphincter and puborectalis muscle in constipated patients. Method: Eighty-two patients with chronic outlet obstruction constipation were treated with 100 units type A botulinum toxin, injected into the puborectalis muscle and the external anal sphincter. Results: At the 2-month evaluation, a symptomatic improvement was noted in 69 patients. Seven (8.5%) patients had mild flatus incontinence. Stool frequency per week increased from 2.4 ± 0.9 to 5.1 ± 1.0 (P = 0.0001). Anorectal manometry demonstrated decreased tone during straining from 91 ± 28 mmHg to 61 ± 27 mmHg (P = 0.0001). Defecography after the treatment showed improvement in anorectal angle during straining, which increased from 96 ± 12° to 124 ± 14° (P = 0.0001). Conclusion: Type A botulinum toxin relaxes the puborectalis muscle. Pressure values decline after the treatment. Transrectal ultrasonography to guide injections is a safe procedure. Repeated injections were needed to maintain the clinical improvement. [ABSTRACT FROM AUTHOR]

Introduction: The pelvic floor is exposed to differing stresses and trauma depending on the mode of birth. At the same time, the pelvic floor plays a crucial role in female sexual functioning (FSF). Whereby FSF encompasses different dimensions, from subjective satisfaction to physiological aspects, such as lack of pain and orgasm ability. The aim of the study presented here is to assess FSF in relationship to postpartum pelvic floor disorder based on the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, IUGA‐Revised (PISQ‐IR), in a large convenience sample and to identify whether there is an association between mode of birth as well as perineal injuries and FSF of women up to 24 months postpartum. Material and Methods: We conducted a cross‐sectional online survey and recruited via social media women up to 24 months after birth of their last child. FSF was surveyed using the PISQ‐IR. Details were also collected on all previous births and birth‐related perineal trauma, as well as current breastfeeding, obesity, and socio‐demographics. Multivariate models were then calculated to determine a possible association between FSF and birth mode. Results: The data basis is the responses of 2106 survey participants within the first 24 months postpartum. Even 12–24 months postpartum, 21% of respondents are not sexually active, which burdens almost 44% of these women. With regard to mode of delivery, differences in FSF are only evident in individual dimensions of the PISQ‐IR. The dimensions "Condition Impact" and "Condition Specific" were significantly associated with more impairments in sexually active respondents up to 12 months postpartum whose last mode of delivery was forceps or vacuum extraction. If a perineal tear had occurred during last birth, this was significantly associated with a lower PISQ‐IR subscore in the "Condition Impact," "Condition‐Specific," "Global Quality," "Partner‐Related," and "Arousal" models. The low variance explanation shows that further relevant factors on female sexuality may exist. Conclusions: The issue of impairments in FSF following childbirth, persisting for an extended period of time, is a significant postpartum concern. Due to the very different dimensions of FSF, the influence of the mode of delivery must be considered in a differentiated way. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to determine the prevalence of pelvic floor disorders (PFDs) and associated risk factors among parous Ugandan women. Methods: We performed a cross‐sectional study of parous Ugandan women. Demographics and assessment for PFD were obtained. The presence of PFD was defined by participant symptom report, standardized questionnaires, and standard physical examination (pelvic organ prolapse quantification [POP‐Q] and cough stress test [CST]). Results: A total of 159 women were enrolled in the study between June 2022 and June 2023. The median age was 35 years and median parity was 4. Forty‐four (28%) women in the cohort reported symptoms of urinary incontinence. No women reported symptoms of pelvic organ prolapse or anal incontinence. Seventy‐two (46%) participants had a positive CST and 93 (58.3%) had stage II or greater prolapse based on the POP‐Q. Cesarean section was found to have a protective effect for the development of PFD (odds ratio [OR] 0.22, 95% confidence interval [CI] 0.07–0.59, P = 0.004). Conclusion: PFDs are prevalent among parous Ugandan women at rates similar to cohorts in other low‐ and middle‐income countries. Cesarean section seems to be a protective factor against developing PFDs. Synopsis: Pelvic floor disorders are prevalent among parous Ugandan women. Cesarean delivery seems to be protective for the development of these disorders. [ABSTRACT FROM AUTHOR]

Introduction: Surgeries for pelvic organ prolapse (POP) and stress urinary incontinence (SUI) are commonly performed in older adults, many of whom are also frail. A surgical risk calculator for older adults undergoing POP/SUI surgeries that incorporates frailty, a factor known to increase the risk of surgical complications, would be helpful for preoperative counseling but currently does not exist. Materials and Methods: Medicare Carrier, Outpatient, and MedPAR files were examined for beneficiaries undergoing POP and SUI surgery between 2014 and 2016. A total of 15 POP/SUI categories were examined. The Claims‐Based Frailty Index (CFI), a validated measure of frailty in Medicare data, and Charlson Comorbidity Index were deconstructed into their individual variables, and individual variables were entered into stepwise logistic regression models to determine which variables were most highly predictive of 30‐day complications and 1‐year mortality. To verify the prognostic accuracy for each model for surgical complications of interest, calibration curves and tests of model fit, including C‐statistic, Brier scores, and Spiegelhalter p values, were determined. Results: In total, 108 479 beneficiaries were included. Among these, 4.7% had CFI scores consistent with mild to severe frailty (CFI≥0.25). A total of 13 prognostic variable categories were found to be most highly predictive of postoperative complications. Calibration curves for each outcome of interest showed models were well‐fit. Most models demonstrated high c‐statistic values (≥0.7) and high Spiegelhalter p values (≥0.9), indicating good model calibration and excellent discrimination, and low Brier scores (<0.02), indicating high model accuracy. Conclusions: Urologic surgery for older Adults Risk Calculator serves as a novel surgical risk calculator that is readily accessible to both patients and clinicians that specifically factors in components of frailty. Furthermore, this calculator accounts for the heterogeneity of an aging population and can assist in individualized surgical decision‐making for these common procedures. [ABSTRACT FROM AUTHOR]

Background/Objectives: The postpartum period is marked by numerous physical changes, often leading to pelvic floor disorders (PFD) such as urinary incontinence (UI) and diastasis recti abdominis (DRA). This study aimed to assess the occurrence of UI and DRA in postpartum women and evaluate the effectiveness of physiotherapy in managing UI and DRA. Methods: A total of 396 women, between the 3rd and 5th postpartum day, were randomized into three groups: control (GrCon), online exercise group (GrOnl), and supervised group (GrSup). GrCon received only education, whereas GrOnl and GrSup had three sessions with exercises with physiotherapist—online or supervised. Data were collected through questionnaires, ICIQ FLUTS, body posture assessments, and DRA measurements. Results: The results showed a significant reduction in UI and DRA symptoms across all groups, with the GrSup group showing the greatest improvement. UI symptoms decreased from 49% during pregnancy to 36.9% postpartum, with GrSup women reporting fewer urological complaints compared to the GrOnl and GrCon groups (p < 0.001). DRA incidence dropped from 76.2% in the early postpartum days to 23.4% at six weeks, with GrSup showing the lowest rates (9.8%). Notably, supervised physiotherapy resulted in a higher frequency (94.7%) and correct performance of PFME (72.2%) compared to the online and control groups. Conclusions: The study concludes that supervised physiotherapy is more effective than online sessions in managing postpartum UI and DRA, emphasizing the importance of guided exercise for better outcomes. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion The primary aim was to adapt the Body Image in the Pelvic Organ Prolapse Questionnaire (BIPOP‐Q) to Turkish culture and evaluate its reliability and validity. The secondary aim was to examine how body image is affected by partner status and the presence of pelvic organ prolapse (POP) symptoms.The study included 150 women with POP stage ≥2. The reliability of the BIPOP‐Q was evaluated by internal consistency and test–retest analyses. To assess the criterion validity of BIPOP‐Q, genital image and POP questionnaires were administered. Correlation coefficients were determined by Spearman correlation analysis. To evaluate the construct validity of the BIPOP‐Q, confirmatory factor analysis was conducted. The Mann–Whitney U test was used to compare independent groups.The internal consistency of the BIPOP‐Q (Cronbach α = 0.918) was found to be high, and the test–retest reliability of the scale items (r = 0.538–0.828) ranged from moderate to excellent. Correlations between the BIPOP‐Q and criterion scale scores were found to be low to moderate (r = −0.450 to 0.377, P < 0.05). The two‐factor construct validity of the BIPOP‐Q was confirmed. Women without a partner or with symptomatic POP exhibited lower body image scores than women with a partner or with asymptomatic POP (P < 0.05).The Turkish BIPOP‐Q is a reliable and valid scale for assessing POP‐specific body image. Turkish women without a partner or with symptomatic POP appear to have more impaired body image. Further studies are needed to examine the responsiveness of the BIPOP‐Q to interventions. [ABSTRACT FROM AUTHOR]

Featured Application: The proposed smartphone application guides female track and field athletes to perform an effective exercise program to improve pelvic floor symptoms and strength, while they are supervised by health professionals. Despite the high prevalence of pelvic floor (PF) dysfunctions in female athletes, help-seeking is low due to embarrassment and disinformation. This study evaluated the effects of a 6-week exercise program guided by a specific app, with and without intravaginal biofeedback on the PF symptoms, strength, and sonographic measures of female athletes. Compliance with the program was evaluated. Thirty-nine athletes with PF symptoms used the app with different functionalities: experimental group 1 (n = 13) (EG1: exercises, PF information, and physiotherapists contact); experimental group 2 (n = 14) (EG2: exercises with biofeedback, PF information, and physiotherapists contact); and the control group (n = 12) (CG: PF information, and physiotherapists contact). Before and after the 6 weeks, PF symptoms, strength with the Oxford scale, and sonographic measures were evaluated. EG1 and EG2 improved strength (p = 0.028 and p = 0.001, respectively) and incontinence urinary symptoms (p = 0.041 and p = 0.002, respectively) over the baseline, without between-group differences (p > 0.05). No significant differences were observed in sonography (p > 0.05). Regarding compliance, 84.6 and 71.4% of athletes from EG1 and EG2 completed the program twice per week or more. A 6-week PF exercise program guided by the app improved PF symptoms and strength of female athletes and ensured high compliance with the program but was insufficient to improve sonography. [ABSTRACT FROM AUTHOR]

Background: Estrogen deficiency during menopause, aging, reproductive history, and factors increasing intra-abdominal pressure may lead to structural and functional failure in the pelvic floor. Lifestyle choices, such as eating behavior, may contribute to pelvic floor disorders. Objectives: The objective of the study was to investigate associations of eating behavior with symptoms of pelvic floor disorders, that is, stress urinary incontinence, urgency urinary incontinence, fecal incontinence, and constipation or defecation difficulties among middle-aged women. Design: A cross-sectional, observational study was performed using a population sample of 1098 Finnish women aged 47–55 years. Methods: Eating behavior, food consumption frequency, demographical, gynecological, and physical activity variables were assessed using self-report questionnaires. Logistic regression models were used to assess the associations of eating behavior, food frequency, and symptoms of pelvic floor disorders. Models were adjusted with demographical, gynecological, and physical activity variables. Results: In adjusted models, middle-aged women with disordered eating style were more likely to experience the symptoms of stress urinary incontinence (odds ratio (OR) 1.5, p = 0.002), and constipation or defecation difficulties (OR 1.4, p = 0.041). Adding body mass index into the models abolished associations. Of the studied food items, more frequent consumption of ready-made, highly processed foods (OR 1.5, p = 0.001), and fast foods (OR 1.5, p = 0.005) were independently associated with symptoms of stress urinary incontinence regardless of eating style, whereas consuming ready-made foods (OR 1.4, p = 0.048) was associated with symptoms of urgency urinary incontinence. Daily consumption of fruits (OR 0.8, p = 0.034) was independently associated with symptoms of stress urinary incontinence. Furthermore, we observed that daily consumption of porridge was associated with symptoms of constipation or defecation difficulties (OR 1.7, p = 0.010) independently of eating style. Alcohol consumption (OR 0.9, p = 0.015) was inversely associated with constipation and defecation difficulties. Women with overall higher quality diet had lower odds for stress urinary incontinence (OR 0.9, p = 0.002). Conclusion: This study provides proof-of-concept evidence to the hypothesis that eating behavior and consuming certain food items are associated with perceived pelvic floor disorders. As a preventive action, eating behavior of women with the risk of these symptoms should be assessed, and guidance toward healthy eating patterns should be provided. [ABSTRACT FROM AUTHOR]

Background: Burnout disproportionately affects professionals who spend much of their time in direct patient care. The physical and emotional demands of pelvic floor therapists, coupled with identity-based stressors, may place Black women pelvic floor therapists at an increased risk for experiencing burnout. Objective: The purpose of this study was to explore the experiences of burnout among Black women pelvic floor therapists in the United States. Design: This is a short-form qualitative study with data collected from an online survey. Methods: We recruited Black women pelvic floor therapists from November 2023 to February 2024 to complete an online survey comprised of open-ended questions about their experiences of burnout. The coding team analyzed the short-form qualitative data using inductive structural tabular thematic analysis. Results: Of the 59 participants in the total sample, 37 reported experiencing professional burnout. Main themes were: (1) contributors to burnout, (2) signs of burnout, and (3) consequences of burnout. Notably, contributors to burnout were predominantly structural and included workplace factors, such as unrealistic productivity standards and experiences of discrimination and microaggressions. Signs of burnout were primarily emotional. Consequences of burnout included leaving the current work setting, a strong desire to transition to a different setting, or taking a break from the profession overall. Conclusion: This study revealed that it is not only the intensity of Black women pelvic floor therapists' workload but also the nature of their tasks and the contexts within which they operate that contribute to burnout. Plain language summary: Why is this study important? Pelvic floor therapy (PFT) is an increasingly popular medical treatment for genito-pelvic pain/penetration disorder (GPPPD). Black women pelvic floor therapists' are at a high risk of experiencing professional burnout due to the limited number of PFTs in general and the desire for Black women patients to have Black doctors. The current study sought to understand Black pelvic floor therapists' experiences of burnout. What did the researchers do? The research team surveyed Black women pelvic floor therapists and anticipated that these women would report burnout from the demands of their jobs, being overworked, and experiencing gendered racism within their workplaces. What did the researchers find? Out of a total of 59 Black women PFTs, 37 reported professional burnout. The main sources of burnout for participants were structural issues within the workplace, such as inadequate time for administrative duties, limited support for patients, unrealistic workloads and productivity standards, and workplace discrimination. Burnout manifested for participants through a lack of motivation and passion towards their work, emotional disengagement, and fatigue. As a result, some participants left their jobs or experienced health issues. Healthcare fields should consider ways to promote wellness and work–life balance, especially for Black women with physically and emotionally demanding roles. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Design Setting Population or Sample Methods Main Outcome Measures Results Conclusions First, to assess whether levator ani deficiency (LAD) is associated with pelvic floor dysfunction 1 year postpartum, including urinary, vaginal and bowel symptoms; and second, to explore at what cut‐off of LAD score such pelvic floor dysfunction arises.Nested case–control study.Örebro University Hospital, Örebro, Sweden.Primiparous women 1 year after vaginal birth.Three‐dimensional endovaginal ultrasound assessment of the levator ani muscle; LAD score based on this ultrasound, and validated questions about pelvic floor dysfunction. Logistic regression models were used.Symptoms of pelvic floor dysfunction associated with LAD.Altogether 190 women were included, 103 of whom were symptomatic cases and 87 asymptomatic controls. 53% in the case group, and 58% in the control group had a LAD score of 0. A greater LAD score was significantly associated with urinary incontinence (adjusted odds ratio [aOR] 1.11, 95% confidence interval [CI] 1.00–1.22) and vaginal laxity (aOR 1.14, 95% CI 1.03–1.25). The risk of urinary incontinence was increased when the LAD cut‐off score was set between ≥ 1 point and ≥ 4 points. The risk of vaginal laxity was increased when the cut‐off was set between ≥ 8 and ≥ 14 points.LAD was associated with both urinary incontinence and vaginal laxity. The risk of urinary incontinence increased already with minor LAD and defects of the most medial levator ani muscle portions normally supporting the midurethra may explain this increase. [ABSTRACT FROM AUTHOR]

Introduction and Hypothesis: Pregnancy and childbirth predispose to pelvic floor dysfunction (PFD), coinciding with functional and anatomical changes in the pelvic floor. To some extent, these can be assessed by transperineal ultrasound (TPUS), yet the correlation between ultrasound findings and symptoms has not been well elucidated. We hypothesised that pregnant women with PFD would show different findings at TPUS. Methods: This is a planned secondary analysis of a prospective cohort study. Pregnant women were asked to fill out standardised questionnaires on PFD and undergo TPUS at 12–14 weeks and 28–32 weeks of gestation. We compared bladder neck descent, urethral rotation, retrovesical angle, pelvic organ descent, genital hiatus dimensions and the presence of anal sphincter defects between women with and those without PFD using t test and Fisher's exact test. Linear mixed-effects models were used to assess the correlation between TPUS findings and PFD severity. As this is a secondary subgroup analysis of participants who underwent TPUS, no sample size was determined upfront. Results: At Valsalva, women with urinary incontinence had more pronounced bladder neck descent (p = 0.02) and urethral rotation (p < 0.01), as well as wider retrovesical angles (p = 0.04) and larger genital hiatus areas (p < 0.01). After controlling for age, BMI and parity, the retrovesical angle was the only persistent predictor of urinary incontinence. No correlation was observed between any TPUS marker and symptoms of either prolapse or anorectal dysfunction. Conclusions: In pregnant women, symptoms of urinary incontinence, but not of prolapse and anorectal dysfunction, are associated with differences in pelvic floor anatomy at TPUS. [ABSTRACT FROM AUTHOR]

Introduction and Hypothesis: Currently, little is known about how daily self-management of cube pessaries influences sexual function. We hypothesized that removing the cube pessary prior to sexual activity did not negatively influence the sexual function, and pessary self-care did not lead to a deterioration of sexual wellbeing. Methods: We conducted a planned secondary analysis of a prospective cohort study in which 214 patients with symptomatic pelvic organ prolapse (stage 2+) were enrolled (2015). Each patient was size fitted with a cube pessary and completed a questionnaire online or by phone ≥ 5 years after her initial fitting. Changes in quality of life were measured using the Patient Global Impression of Improvement (PGI-I). Results: Of the 143 women included in our analyses, 92 (64.3%) were sexually active during the study period. These patients (73.9%; 68 out of 92) described their sexual wellbeing as "better" or "much better" than their pretreatment status. Sexually active patients had a better quality of life as measured by the PGI-I than the sexually inactive patients. Of the sexually active patients, 91.3% (84 out of 92) described their condition as "better" or "much better" than their pretreatment status, whereas 84.3% (43 out of 51) of the sexually inactive patients reported the same improvement. Over 90% of sexually active patients reported that removal of the vaginal cube pessary before sexual activity is not disruptive. Conclusions: The overwhelming majority of the patients with symptomatic pelvic organ prolapse using daily self-management of cube pessaries reported that removal of the vaginal cube pessary before sexual activity is not disruptive, and its use was accompanied by improved sexual wellbeing. [ABSTRACT FROM AUTHOR]

Introduction and Hypothesis: Pregnancy is associated with an increase in pelvic floor dysfunction. Yoga, an ancient Indian practice involving asanas (physical postures), pranayam (breathing patterns) and meditation, can help women to control their pelvic floor muscles. However, the literature to support yoga as a remedy for pelvic floor dysfunction is lacking. We hypothesized that yoga could be an important method in improving pelvic floor dysfunction in pregnancy. Methods: In a randomised control study, 200 pregnant women matched for age, weight, parity and physical activity were randomised at the 13– to 20-week period of gestation into two groups: group I (n = 100, undergoing yoga therapy) and group II (n = 100, given usual antenatal care). A trained instructor provided two physical sessions, each lasting for 60 min and further online sessions for 5 days a week for 3 months. The Pelvic Floor Distress Inventory (PFDI-20) questionnaire was used to assess the primary outcome at recruitment, 32 weeks (antenatal), 1 week and 6 weeks post-partum in both groups. Results: In the 200 women randomised and matched for age and parity, there were no complications seen throughout the pregnancy and none of the patients was lost to follow-up in either group. The proportion of women exhibiting a decline in PFDI-20 scores was greater in group 1 (24%) than in group 2 (8%). The mean difference of scores between recruitment and 6 weeks post-partum was statistically significant (p value = 0.0026). Conclusions: Yoga in pregnancy significantly improves pelvic floor dysfunction in an easy manner with no proven adverse effects. [ABSTRACT FROM AUTHOR]

Introduction and Hypothesis: The anatomy of the skeletal muscles located between the vagina and anus is important during complex obstetric laceration reconstructions. We aimed to clarify the composition of skeletal muscles located between the vagina and anal canal and their three-dimensional configuration relevant to perineum repair. Methods: This observational study involved ten female cadavers. An anatomical dissection was performed to observe the muscles around the vagina and anal canal. Immunohistological analysis of the midsagittal section was performed to clarify the composition of the muscles, and dissection was performed to correspond to the cross-section. Wide-range serial sectioning and three-dimensional reconstruction were used to support these findings histologically and visualize the three-dimensional arrangement. Results: The region between the vagina and anal canal included the anterior part of the external anal sphincter, superficial transverse perineal muscle approaching from the lateral side, and levator ani, located cranially. They converge three-dimensionally in the median from each direction, forming a muscle complex between the vagina and anal canal. Conclusions: The medial region between the vagina and anal canal in those giving birth includes a skeletal muscle complex formed by the confluence of the external anal sphincter, anterior bundle of the levator ani, and superficial transverse perineal muscle. In cases of severe perineal lacerations, these muscles could be injured. The anatomical knowledge that a part of the levator ani forms a muscle sling anterior to the anal canal is particularly important for obstetricians and gynecologists repairing obstetric lacerations and treating pelvic floor disorders. [ABSTRACT FROM AUTHOR]

Introduction and Hypothesis: Vaginal laxity (VL) is a common symptom of pelvic floor dysfunction. Although VL has become a frequent topic for research in the last decade, its pathogenesis is still not well understood. The objective was to determine whether vaginal parity or mode of delivery is associated with vaginal laxity. Methods: This was a retrospective observational study involving women seen in a tertiary urogynecology clinic between May 2016 and November 2018 with symptoms of pelvic floor dysfunction. Patients underwent a standardized interview, clinical examination (POP-Q), and four-dimensional (4D) pelvic floor ultrasound (PFUS). Data regarding vaginal parity and the mode of delivery were based on patient-reported information. Archived 4D-PFUS volumes were analyzed offline to evaluate levator hiatal area on Valsalva. Results: Data from 1,051 patients were analyzed. VL was reported by 236 women (23%) who were younger on average (mean age 54 vs 59 years, p < 0.001) and less likely to be menopausal (530 out of 815 [65.0%] vs.129 out of 236 [54.7%]), p = 0.004]. Symptoms of prolapse were much more common in the VL group (214 out of 236 [91%] vs 316 out of 815 [39%], p = < 0.001) and on imaging mean levator hiatal area (HA) on Valsalva was larger (31 vs 26 cm2, p = 0.01). Vaginal parity was associated with VL symptoms (235 out of 236 [99%] vs 767 out of 815 [94%], p = 0.008), but neither VL prevalence nor bother increased with higher parity. Women who delivered vaginally were three times more likely to complain of VL than those who delivered only by cesarean section. Conclusions: Vaginal laxity was found to be more prevalent in vaginally parous women. This effect seems to be largely attributable to the first delivery. Instrumental delivery was not shown to increase association with VL compared with normal vaginal delivery. [ABSTRACT FROM AUTHOR]

Painful conditions of the pelvic floor include a set of disorders of the pelvic region, discreetly prevalent in the female population, in which pain emerges as the predominant symptom. Such disorders have a significant impact on quality of life as they impair couple relationships and promote states of anxiety and irascibility in affected individuals. Although numerous treatment approaches have been proposed for the management of such disorders, there is a need to identify strategies to promote muscle relaxation, counter pelvic pain, and reduce inflammation. The endocannabinoid system (ECS) represents a complex system spread throughout the body and is involved in the regulation of numerous physiological processes representing a potential therapeutic target for mood and anxiety disorders as well as pain management. Cannabidiol (CBD), acting on the ECS, can promote relief from hyperalgesia and allodynia typical of disorders affecting the pelvic floor and promote muscle relaxation by restoring balance to this delicate anatomical region. However, its use is currently limited due to a lack of evidence supporting its efficacy and harmlessness, and the mechanism of action on the ECS remains partially unexplored to this day. This comprehensive review of the literature examines the impact of pain disorders affecting the pelvic floor and major treatment approaches and brings together the main evidence supporting CBD in the management of such disorders. [ABSTRACT FROM AUTHOR]

Objective: To assess the prevalence and the characteristics of pelvic floor dysfunction (PFD) in women with endometriosis. Methods: This is a methodological paper that describes the 'Endometriosis and Pelvic Floor Dysfunction' (EndoPFD) multicenter study protocol. It involves three sites: the University Hospital of Pisa, the San Raffaele Hospital of Milan and the Vanvitelli University Hospital of Naples. Women are recruited through web links and are asked whether they want to participate to the clinical evaluation or only to the web survey. The web survey gathers personal history, endometriosis history and symptoms, and performs a subjective evaluation of PFD through questionnaires: Urinary Distress Inventory 6, Colorectal-Anal Distress Inventory 8, Wexner Scale for Fecal Incontinence, Wexner Constipation Scoring System, and Female Sexual Function Index. Those interested in the clinical evaluation will add to the questionnaires the following exams: gynecological and proctological exam, pelvic ultrasound, urodynamic test, and anorectal manometry. Preliminary results: Recruitment for the web survey was completed. A total of 1,149 women signed the electronic consent, 329 were excluded due to inclusion/exclusion criteria; hence, 525 completed all the questionnaires (response rate of 64.02%). Recruitment for the clinical evaluation is ongoing. Discussion: This study protocol offers the possibility to define the prevalence of PFD in endometriosis patients with a subjective and an objective assessment of signs and symptoms. This may pave the way for changing the approach to patients with endometriosis. Moreover, it demonstrates the validity of the method used (online survey and recruitment) to reach a high number of patients. [ABSTRACT FROM AUTHOR]

Purpose: Investigate the relationship between female pelvic floor muscle (PFM) function and body composition. Methods: Cross-sectional study—participants answered sociodemographic and urogynecological questions. The amount of fat mass was measured by dual-emission X-ray densitometry (DXA), and subcutaneous fat thickness was assessed by abdominal ultrasound. PFM assessment was performed using the Modified Oxford Scale and vaginal manometry. Descriptive analysis, independent t test, spearman correlation, and univariate regression were performed. Results: Ninety-nine women were included. All body composition variables evaluated, except subcutaneous fat thickness, indicated that women with a higher concentration of fat in the pelvic, android, and visceral region have lower maximum voluntary PFM contraction strength assessed by Modified Oxford Scale and manometry. The univariate model pointed out that the fat concentration increases the chances of reduced PFM strength in the entire body (0.6%), android (5.4%), visceral region (25.3%), and pelvic (89.9%). There was a correlation between the concentration of total, pelvic, and android fat with MVC/average peak. Conclusion: The accumulation of "total", "pelvic", "android", and "visceral" fat mass is correlated with reduction in PFM strength, and there is an association between MVC and the variables of total and segmented fat. However, pelvic fat concentration is predictive in 89.9% of cases. [ABSTRACT FROM AUTHOR]

Background/Objectives: Anal incontinence is linked to pelvic floor dysfunction. Diagnosis involves assessing both the function and structure of the anorectal unit. Although transperineal ultrasound has gained attention as a less invasive option, its effectiveness as a diagnostic tool for evaluating the relationship between structure and function is still debated. This study aimed to explore the relationship between quantitative measurements of anal sphincter and pelvic floor structures as well as the subjective symptoms and objective assessments of sphincter function regarding anal incontinence. Methods: 50 women with pelvic floor dysfunction were recruited for the study. The severity of anal incontinence was assessed using the CACP score. Ultrasound imaging was employed to measure anal sphincter area, while sphincter pressures were evaluated through manometry. The relationships between variables were analyzed using Pearson's and Spearman's correlation tests. Results: The mean anal sphincter area was 5.51 cm2 at rest and 4.06 cm2 during maximal contraction. Resting anal sphincter pressure had an average of 46.29 mmHg, and contraction pressure averaged 103.25 mmHg. No significant correlation was found between the anal sphincter area and pressure at rest (r = 0.018) or during contraction (r = −0.210). However, a moderate correlation was observed between the change in sphincter pressure and area during contraction (r = 0.312). The CACP score showed no significant correlation with the sphincter area at rest (r = −0.084) but was weakly correlated during contraction (r = −0.270). Conclusions: Conventional diagnostic tools for evaluating anal incontinence can be uncomfortable and are not always readily available. Perineal sonography presents a promising, less invasive alternative for dynamic assessment of the anal sphincter. [ABSTRACT FROM AUTHOR]

Background: The prevalence of POP in women ranges from 30–40%, with 10–20% requiring surgical intervention. Annually, over 225,000 surgical procedures for POP are performed in the United States. The severity of prolapse is assessed using the four-stage POP-Q system, which facilitates clinical research by providing a standardized measure of defect severity. Surgical intervention is indicated for more severe cases, with various techniques available through vaginal or abdominal access. Synthetic meshes, primarily made of polypropylene (PP), are commonly used in POP surgeries due to their biocompatibility and mechanical support. This research aims to evaluate the effectiveness and safety of a non-resorbable, light polypropylene gynecological mesh (G-Mesh®, Tricomed S.A., Łódź, Poland) in the surgical treatment of pelvic floor prolapse in women. Methods: The meshes were implanted via laparoscopy (Dubuisson method) and laparotomy or transvaginally. A multicenter, retrospective study was conducted involving 81 patients aged 28–83. Results: The results collected at three follow-up visits indicated a high level of patient satisfaction, minimal discomfort, and no significant pain. Many patients emphasized significant improvement in quality of life and the lack of any adverse events associated with the presence of the implant. Conclusions: The G-Mesh® gynecological mesh has emerged as an effective and safe intervention for treating pelvic floor dysfunction in women, addressing conditions such as cystocele, rectocele, uterine prolapse, and ureterocele. [ABSTRACT FROM AUTHOR]

Women's rugby is experiencing unprecedented growth and professionalisation, yet the research underpinning player welfare and performance remains significantly underdeveloped. This special issue of the European Journal of Sport Science addresses the critical need for evidence‐based practices tailored to female rugby players. Current literature is predominantly male‐focused, despite known sex differences impacting training, injury mechanisms and health outcomes. In particular, the underrepresentation of female‐specific studies presents risks to player safety and performance optimisation. This issue presents cutting‐edge research, from world‐leading interdisciplinary experts and applied practitioners, on three main themes: female‐specific injury and illness surveillance and education, tackle safety and performance, and intersectional research agendas. Contributions include insights into female‐specific health domains, such as breast and pelvic floor health, emphasising the need for tailored care pathways and interventions. Additionally, the importance of gender‐responsive coaching and tackle skill acquisition is highlighted, advocating for progressive, context‐specific training frameworks. Moreover, an intersectional approach to research is proposed, to address the broader social and material contexts affecting marginalised women and girls in rugby. These findings aim to drive interdisciplinary, inclusive research, ensuring that the professionalisation of women's rugby is matched by advancements in scientific understanding and applied practice. This special issue not only celebrates the progress made, but also calls for ongoing efforts to bridge the knowledge gap, ensuring holistic support for female rugby players from participation, through to retirement and beyond. [ABSTRACT FROM AUTHOR]

The pelvic floor and its associated disorders are a unique and often overlooked aspect of women's rugby. This review discusses relevant biopsychosocial considerations specific to the pelvic floor and rugby. Pelvic floor disorders can present at any time across the female lifespan but are more prevalent during pregnancy and postpartum. This is due to the substantial physiological and anatomical changes experienced during pregnancy and vaginal childbirth. Consequently, pelvic floor disorders can impact a player's ability to perform, maintain engagement with, or return to, rugby due to symptoms. Players need to be informed, supported, and guided through focused pelvic floor muscle training to condition the muscles and 'ready' them for the varied demands of rugby. Health and fitness professionals should understand the risk of pelvic floor disorders across the female lifespan and screen players for symptoms when supporting them to maintain or return to rugby. Rugby players who are symptomatic of pelvic floor disorders should be signposted to specialist services and/or resources to manage their symptoms. Once engaging in rugby training, ongoing evaluation of player load tolerance and implementation of individualized strategies to support managing rugby‐related loads to the pelvic floor should be considered. Finally, surveillance and research focusing specifically on rugby players and pelvic floor function are needed. Highlights: High force‐related activities, such as rugby, challenge the pelvic floor muscles (PFMs) and can increase a player's susceptibility to pelvic floor disorders (e.g., stress urinary incontinence, feeling a bulge inside or outside the vagina)Pelvic floor disorders can present at any time across the female lifespan, with pregnancy and childbirth being two commonly reported risk factors for such disordersPredisposing (genetics), inciting (pregnancy and vaginal childbirth) and intervening (lifestyle, aging) factors likely influence pelvic floor load tolerancePFM training has level 1 evidence to be a first line treatment for urinary incontinence and pelvic organ prolapse in the general female population. We encourage PFM training to be incorporated into rugby training programmes across all ages, levels and roles regardless of whether pelvic floor disorder symptoms are present or not [ABSTRACT FROM AUTHOR]

Objectives: This cross-sectional study aimed to compare the sexual function (SF) and pelvic floor function of men with systemic sclerosis (SSc) with age-matched healthy controls (HC) and to identify the implications of clinical features on SF. Material and method: Twenty SSc males and 20 HC aged 18–70 years completed eleven questionnaires assessing SF [International Index of Erectile Function (IIEF), Male Sexual Health Questionnaire (MSHQ)]; sexual quality of life: Sexual Quality of Life Questionnaire-Male (SQoL-M); pelvic floor function: Pelvic Floor Impact Questionnaire-Short Form 7 (PFIQ-7), fatigue, depression, physical fitness, functional disability, and quality of life. Clinical data were collected. Results: Significantly worse SF was observed in patients (median IIEF erectile function 12 in SSc versus 29 in HC, p < 0.001), with 70% reporting erectile dysfunction (ED) compared to 15% in HC. However, no significant difference was observed regarding pelvic floor function (median PFIQ7 8.8 in SSc versus 7.0 in HC, p = 0.141). Impaired SF was associated with higher disease activity, increased systemic inflammation, more pronounced fatigue, reduced physical fitness, severe depression, impaired overall quality of life, dyspepsia, and arthralgias (p < 0.05 for all). Conclusions: Sexual dysfunction is highly prevalent in our SSc patients, whereas pelvic floor dysfunction is unlikely to be associated with these problems. [ABSTRACT FROM AUTHOR]

Objective: To systematically review and synthesise what is known about the effectiveness of non‐pharmaceutical conservative interventions for the management of urinary incontinence (UI) experienced by women during physical exercise. Methods: A systematic search was performed in the following databases in September 2023: the Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Excerpta Medica dataBASE (EMBASE), Scientific Electronic Library Online (SciELO), Latin American and Caribbean Health Sciences Literature (LILACS), and Physiotherapy Evidence Database (PEDro). Studies were deemed eligible if population consisted of females who reported symptoms of UI while participating in physical exercise, and the interventions involved any non‐pharmaceutical conservative treatment to manage symptoms during exercise. The primary outcome was severity of UI signs and symptoms. The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO identifier: CRD42022379138). Results: Of the 3429 abstracts screened, 19 studies were retained. Pelvic floor muscle training (PFMT) and intravaginal devices were the most commonly investigated modalities. Only two randomised controlled trials (RCTs), both among volleyball players, compared PFMT with no PFM exercise, showing a reduction in pad weight gain after the intervention in the experimental groups only. PFMT with and without biofeedback randomised among soldiers demonstrated a reduction in the frequency of urine leakage episodes in both groups, while supervised and unsupervised PFMT randomised among athletes from different sports showed pad weight gain reduction in the supervised group only. Seven single‐arm studies suggested that PFMT alone or combined with other modalities may reduce UI severity in active women based on questionnaires, bladder diaries, and self‐reported symptoms. A single‐arm and a crossover study found pessary use beneficial in reducing urine leakage based on questionnaires and pad weight gain, respectively. When comparing pessary, tampon, and no intervention, two repeated‐measures studies found tampons may reduce leakage more than pessaries in CrossFit exercisers and women performing aerobic exercises. A vaginal sponge also reduced pad weight gain during aerobic exercises. Other modalities (i.e., an intraurethral device, photobiomodulation, and combined therapies) were investigated using case series or single case studies. While all interventions showed some evidence of effectiveness, the results must be interpreted with caution due to methodological limitations and high risk of bias. In particular, despite a high reliance on pad tests as a primary outcome, we identified inconsistencies in how pad tests were administered and interpreted. Conclusion: Only the effectiveness of PFMT to reduce urine leakage during exercise has been evaluated through RCTs, with some evidence of effectiveness. We identified a clear need for higher quality studies, with better reporting on the interventions, and more judicious use and interpretation of outcome measures. [ABSTRACT FROM AUTHOR]

Objective: To investigate pelvic floor dysfunction (PFD; urinary incontinence (UI), faecal incontinence (FI) and prolapse) ≥20 years after childbirth and their association with delivery mode history and demographic characteristics. Design: Cohort study with long‐term follow‐up. Setting: Maternity units in Aberdeen and Birmingham (UK) and Dunedin (NZ). Population: Women giving birth in 1993/1994. Methods: Postal questionnaires at 20 (New Zealand) or 26 (United Kingdom) years after index birth (n = 6195). Regression analyses investigated associations between risk factors and UI, FI and prolapse symptoms. Main Outcome Measures: Prevalence of self‐reported UI, FI, 'something coming down' from or in the vagina (SCD), and the Pelvic Organ Prolapse‐Symptom Score, and relationships with delivery method. Results: Thirty‐seven per cent (n = 2270) responded at 20/26 years, of whom 61% reported UI (59% of whom reported more severe UI), 22% FI and 17% prolapse symptoms. Having only caesarean section (CS) was associated with a significantly lower risk of UI (OR 0.63, 95% CI 0.46–0.85), FI (OR 0.63, 95% CI 0.42–0.96) and SCD (OR 0.44, 95% CI 0.27–0.74) compared to only spontaneous vaginal deliveries (SVDs). Having any forceps delivery was associated with reporting FI compared to only SVDs (OR 1.29, 95% CI 1.00–1.66), but there was no association for UI (OR 0.95, 95% CI 0.76–1.19) or SCD (OR 1.05, 95% CI 0.80–1.38). Higher current BMI was associated with all PFD outcomes. Conclusions: Prevalence of PFD continues to increase up to 26 years following index birth, and differences were observed according to delivery mode history. Exclusive CS was associated with less risk of UI, FI and any prolapse symptoms. [ABSTRACT FROM AUTHOR]

Introduction: Erection dysfunction (ED) is an important health problem that affects millions of men throughout the world. Biofeedback (BF) pelvic floor training is reeducation therapy to teach patients with erectile dysfunction how to strengthen their PFMs which play a role in erection through the enhancement of blood flow to the penis. Aim of the Work: The aim of this study was to assess improvement of BF pelvic floor training in the management of patients with erectile dysfunction (ED). Material & Methods: Thirty men presenting with ED were evaluated with Erectile function domain of International Index of Erectile Function (IIEF), Erectile Dysfunction-Effect on Quality of Life (ED-EQoL) and Maximum squeezing pressure of pelvic floor muscles (PFMS) according to manometric BF before and after receiving BF pelvic floor training. Results: The patients who received BF showed significant subjective improvement in their Erectile functions according to (IIEF)and (ED-EQoL) questionnaires and significant objective improvement in the form of mean of maximum squeezing pressure of PFM susing BF (McNemar test, McN = 0.031, p = 0.001*). Conclusion: Biofeedback pelvic floor training is highly effective easily applicable tool of management in the patients with ED with good outcomes on patient's complaints and quality of life through their effect on improving strength of their PFMs. [ABSTRACT FROM AUTHOR]

Research on justifications has shown their significance in advice-giving, decision-making and children disputes. However, the majority of studies gloss over practical functions of justifications in patient-physician interactions as they are often expected and pursued by patients and in turn, are adopted by physicians to support their stance and authority. This study, through conversation analysis (CA), aims to explore a) what are pragmatic functions of justifications in patient-physician interaction? b) how and when do physicians unfold their justifications for treatment recommendations? c) how do physicians deal with different responses based on their epistemic and deontic domains?. A total of 32 video-recordings between postpartum women and physicians are collected and studied. Four pragmatic functions of justifications drawn upon by physicians are explored: justifications as face-saving, reassurance, risk discussion and clarification-seeking. Despite physicians' attempts to justify their positions as less challenged by patients, this is not the entire picture as they demonstrate their desire to resolve patients' concerns and coordinate their viewpoints to achieve the best practice that facilitates patients' well-being. [ABSTRACT FROM AUTHOR]

Background and Objectives: Urinary incontinence (UI) prevalence reaches the 80% rate in female athletes involved in high-impact sports. In this context, although conservative treatment represents the first therapeutic choice, there is still a lack of knowledge on the efficacy of conservative programs in young female athletes. Therefore, the aim of this study was to investigate the role of pelvic floor rehabilitation in the treatment of UI in young nulliparous female athletes. We performed a literature search using PubMed, Medline, Cochrane Library, Web of Science, and Scopus. The selection of articles was conducted using a specific search string: "[((pelvic floor dysfunction) OR (urinary incontinence) OR (dyspareunia) OR (dysuria)) AND ((sport) OR (sports)) AND ((female) OR (woman) OR (women) OR (girl)) AND ((rehabilitation) OR (rehab) OR (pelvic rehabilitation) OR (exercise))]". The review protocol was registered in PROSPERO with the ID CRD42024559990. A total of 1018 articles were found in all searches of the databases. After removing duplicates, 663 papers were reviewed in terms of title and abstract. Finally, a total of six studies were included in the present review. The results of this review show that conservative treatment with a personalised pelvic floor muscle training program (PFMTP) represents an effective treatment for UI, decreasing urine loss and improving maximum voluntary pelvic contraction; this is linked with an improvement in quality of life and sports performance, in particular when supervised by a physical therapist. Moreover, due to the reluctance of athletes to talk about UI, an educational program should be considered as part of a prevention programme in pre-season training. [ABSTRACT FROM AUTHOR]

Background and Purpose Recent changes to medical recommendations for exercise in pregnancy and postpartum have expanded to include recreational athletes. While women are transitioning into motherhood at the height of their athletic careers, there is limited guidance on musculoskeletal training from pregnancy through safe return to activity. The lack of education and support in this population may lead to increased prevalence of symptoms and delay of treatment, ultimately hindering athletic performance. The purpose of this case series is to assess pelvic floor symptoms through implementing a new pre- and postnatal exercise training paradigm in a group of women aiming to return to recreational athletics. Study Design Case series Methods Six recreationally athletic women between 25-35 years of age were referred to physical therapy during pregnancy to participate in this protocol. The women completed a standardized pregnancy and postpartum rehabilitation plan focused on core and pelvic floor control in addition to specific strength and mobility training. Results Pain, urinary dysfunction, and pelvic floor muscle strength were assessed at six weeks postpartum and at discharge. Meaningful improvement was noted in pain, urinary dysfunction, and muscle strength by the time of discharge. Conclusion The decrease in symptoms and improvements in measures of musculoskeletal health suggests that a physical therapist guided rehabilitation protocol may be useful as part of the standard of care to reduce prevalence of pain and dysfunction, particularly in the recreational athlete population. Improving understanding of exercise training in this population may minimize musculoskeletal symptoms and encourage additional research to improve the standard of care for this group of patients. Level of Evidence Level 4 [ABSTRACT FROM AUTHOR]

Background Pelvic floor dysfunction (PFD) occurs when muscles of the pelvic floor become weakened, impaired, or experience tension leading to a variety of complications. Due to the reactive nature and high demands of many sports, athletes are at increased susceptibility and of particular interest concerning PFD. Hypothesis/Purpose The purpose of this study was to explore the prevalence of PFD among college-aged athletes, assess how PFD impacted athletic performance, and identify contributing factors for increased likelihood of PFD in athletes. Study Design Cross-Sectional Study Methods All fully active LVC NCAA Division 3 athletes were recruited for screening for PFD using the Cozean Pelvic Dysfunction Screening Protocol and were surveyed on their self-knowledge of PFD. Athletes who scored > 3 on this tool completed an additional survey, created by the investigators, to identify the impact PFD had on their athletic performance and personal life and were then randomly assigned to one of three investigators to undergo a noninvasive coccygeal assessment to determine underactive, overactive, or normal pelvic floor muscle (PFM) activity. Results Fifty-three Division III male and female athletes between the ages of 18-25 years old participated in the study. Statistically significant differences were found between Cozean scores and demographic factors of age (p <0.001), gender (p <0.05), self-knowledge of PFD (p <0.001), and sport (p <0.001) among all participants that contributed to the increased likelihood of PFD. Thirteen athletes scored > 3 on the Cozean with the 92.3% experiencing under/over active PFM activity and the majority indicating that PFD significantly impacted their athletic performance and quality of life. Conclusion The results indicate that older female NCAA Division III college athletes who participate in swimming and who possess self-knowledge of PFD are more likely to experience PFD. Additionally, these athletes are likely to encounter a significant impact on their athletic performance and quality of life. These results provide preliminary evidence on the need of PFD awareness and assessment among college athletes. [ABSTRACT FROM AUTHOR]

Background: Stress urinary incontinence (SUI), a common disorder of the pelvic floor, often results in anxiety, poor quality of life, and psychological issues among its sufferers. The relationship between lipid accumulation products (LAP) and stress-related urine incontinence remains unclear. This research aimed to investigate any possible correlation between the risk of SUI and the level of lipid accumulation products. Methods: For this cross-sectional research, people with SUI who were 20 years of age or older were recruited using information from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018. A weighted multivariate logistic regression model was used to evaluate the findings. As a potential biomarker, lipid accumulation product levels were sorted among individuals in ascending order and subjected to a trend test (P for trend). Additionally, a nonlinear analysis was conducted using smooth curve-fitting methods. Lipid accumulation products' effectiveness in predicting SUI was evaluated using receiver operating characteristic (ROC) curves. Finally, a subgroup analysis was performed to confirm that the connection between SUI and lipid accumulation products was consistent across all demographic groups. Results: A thorough survey performed on 14,945 participants indicated that 23.61% of the respondents had SUI. A noteworthy association was observed between higher lipid accumulation product values and a greater probability of SUI in multivariate logistic regression analysis. Specifically, the stratification of lipid accumulation products into quartiles demonstrated a substantial positive correlation between the upper and lower quartiles, as evidenced by an elevated odds ratio for SUI (OR = 1.92; 95%CI 1.51–2.44; P < 0.0001). The subgroup analysis supported link consistency across all cohorts under investigation. Finally, the ROC curve indicated that lipid accumulation products (AUC = 0.67, 95%CI 0.654–0.690) had a superior predictive effect on the likelihood of SUI. Conclusions: Increased lipid accumulation product values are associated with a higher chance of SUI in adult participants. This suggests that lipid accumulation products could be a valuable marker for detecting SUI, offering new perspectives for its evaluation and treatment. [ABSTRACT FROM AUTHOR]

Electromyography is a widely used instrument in clinical practice to evaluate and treat pelvic floor disorders in pregnant and postpartum women. The objective of this study is to analyze the scientific evidence on the electromyography parameters used for treatment of pelvic floor disorders in pregnant women in any gestational week and postpartum women up to 12 months after delivery. A systematic review of randomized controlled experimental studies (clinical trials) and quasi-experimental studies in English, Portuguese or Spanish, which used electromyography as an intervention for treatment of pelvic floor disorders in pregnant or postpartum women up to 12 months after delivery will be performed in online databases (Scopus, Medline, Pedro, Scielo and Pubmed),. Risk of bias assessment will be performed using Cochrane group tools. The Rob 2.0 tool will be used for experimental studies and the Robins-I tool for non-experimental studies. The protocol was registered in PROSPERO (no.433510). The quality of the evidence will be analyzed using the GRADE System Methodological Guide and the systematic review structure will be performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. [ABSTRACT FROM AUTHOR]

Introduction and Hypothesis: Vaginal delivery and resulting pelvic floor muscle (PFM) dysfunction are significant risk factors for pelvic floor dysfunction (PFD). Despite this, the biological basis underlying PFD after childbirth remain unclear. This study was aimed at assessing the early response of the vaginal wall and PFM to simulated birth injury (SBI) in rats. Methods: Forty female Sprague–Dawley rats were divided into four groups: control (sham operation), and 1, 4, and 14 days post-injury. In the SBI groups, a catheter was inserted into the vagina with 130 g of weight attached to the end, and the balloon was inflated to 5 ml for 2 h. Evaluation of vaginal tissues and PFMs included histological, immunohistochemical, Western blot, and uniaxial biomechanical testing. Results: In the vaginal wall, the SBI group showed significantly lower COL1A1 expression and higher MMP-2 and MMP-9 expression. At 4 and 14 days post-injury, there was a significant decrease in PFM fiber area and increased collagen content. The SBI group also exhibited significant increases in the expression of Nrf2, NQO1, HO-1, and SOD-2, indicating involvement of oxidative stress in both the vaginal wall and PFMs. Protein expression of Pax7 and MyoG, as well as the number of fibers with centralized nuclei, continued to increase significantly after SBI. Additionally, the vaginal wall of the SBI group showed a decreasing trend in tensile strength and elastic modulus, with a greater ultimate strain. Conclusion: Extracellular matrix remodeling, oxidative stress, decreased biomechanical properties, and muscle dysmyogenesis may collectively contribute to increased susceptibility to PFD development. [ABSTRACT FROM AUTHOR]

Purpose: Globally, postnatal women endure a prominent issue caused by midline separation of abdominal recti muscles, characterized by a sagging and pouch-like appearance of the belly termed as Diastasis Recti Abdominis (DRA). The necessity of ensuring the efficacy of rehabilitative workouts for individuals with DRA cannot be overstated, as inaccurate exercises can exacerbate the condition and deteriorate the health of affected women. The purpose of these exercises is to specifically focus on the rectus abdominis muscles to facilitate the reapproximation of the linea alba. The primary aim of this research work is to assess the effectiveness of rehabilitation exercises for DRA women obtained from Inertial Measurement Unit (IMU) and Electromyography (EMG) sensors. Design/methodology/approach: Convolutional neural networks (CNN) employs convolutional activation functions and pooling layers. Recently, 1D CNNs have emerged as a promising approach used in various applications, including personalized biomedical data classification and early diagnosis, structural health monitoring and anomaly detection. Yet another significant benefit is the feasibility of a real-time and cost-effective implementation of 1D CNN. The EMG and IMU signals serve as inputs for the 1D CNN. Features are then extracted from the fully connected layer of the CNN and fed into a boosting machine learning algorithm for classification. Findings: The findings demonstrate that a combination of sensors provides more details about the exercises, thereby contributing to the classification accuracy. Practical implications: In real time, collecting data from postnatal women was incredibly challenging. The process of examining these women was time-consuming, and they were often preoccupied with their newborns, leading to a reluctance to focus on their own health. Additionally, postnatal women might not be fully aware of the implications of DRA and the importance of rehabilitation exercises. Many might not realize that neglecting DRA can lead to long-term issues such as back pain, pelvic floor dysfunction, and compromised core strength. Social implications: During our data collection camps, there were educational sessions to raise awareness about the DRA problem and the benefits of rehabilitation exercises. This dual approach helped in building trust and encouraging participation. Moreover, the use of wearable sensors in this study provided a non-invasive and convenient way for new mothers to engage in rehabilitation exercises without needing frequent visits to a clinic, which is often impractical for them. Originality/value: The utilization of discriminating features retrieved from the output layer of 1D CNN is a significant contribution to this work. The responses of this study indicate that 1D convolutional neural network (1D CNN) and Boosting algorithms used in a transfer learning strategy produce successful discrimination between accurate and inaccurate performance of exercises by achieving an accuracy of 96%. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has brought significant attention to the respiratory system, with much focus on lung-related disorders. However, the diaphragm, a crucial component of respiratory physiology, has not been adequately studied, especially in the context of long COVID. This review explores the multipotential role of the diaphragm in both respiratory health and disease, emphasizing its involvement in long-term complications following SARS-CoV-2 infection. The diaphragm's fundamental role in respiratory physiology and its impact on balance and posture control, breathing patterns, and autonomic nervous system regulation are discussed. This review examines complications arising from COVID-19, highlighting the diaphragm's involvement in neurological, musculoskeletal, and inflammatory responses. Particular attention is given to the neuroinvasive impact of SARS-CoV-2, the inflammatory response, and the direct viral effects on the diaphragm. The diaphragm's role in long COVID is explored, with a focus on specific symptoms such as voice disorders, pelvic floor dysfunction, and sleep disturbances. Diagnostic challenges, current methods for assessing diaphragmatic dysfunction, and the complexities of differentiating it from other conditions are also explored. This article is the first to comprehensively address diaphragmatic dysfunction resulting from COVID-19 and long COVID across various physiological and pathological aspects, offering a new perspective on its diagnosis and treatment within a multisystem context. [ABSTRACT FROM AUTHOR]

The first line of treatment for urinary incontinence is pelvic floor muscle (PFM) training, aimed at reducing leakage episodes by strengthening these muscles. However, many women struggle with performing correct PFM contractions or have misconceptions about their contractions. To address this issue, we present a novel PFM contraction quality assessment system. This system combines a PFM contraction detector with a maximal PFM contraction performance classifier. The contraction detector first identifies whether or not a PFM contraction was performed. Then, the contraction classifier autonomously quantifies the quality of maximal PFM contractions across different features, which are also combined into an overall rating. Both algorithms are based on artificial intelligence (AI) methods. The detector relies on a convolutional neural network, while the contraction classifier uses a custom feature extractor followed by a random forest classifier to predict the strength rating based on the modified Oxford scale. The AI algorithms were trained and tested using datasets measured by vaginal dynamometry, combined in some cases with digital assessment results from expert physiotherapists. The contraction detector was trained on one dataset and then tested on two datasets measured with different dynamometers, achieving 97% accuracy on the first dataset and 100% accuracy on the second. For the contraction performance classifier, the results demonstrate that important clinical features can be extracted automatically with an acceptable error. Furthermore, the contraction classifier is able to predict the strength rating within a ± 1 scale point with 97% accuracy. These results demonstrate the system's potential to enhance PFM training and rehabilitation by enabling women to monitor and improve their PFM contractions autonomously. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the correlation between 3-dimensional ultrasonography parameters and pelvic floor dysfunction (PFD) and its application value in diagnosis and treatment. Methods: Ninety-two patients with PFD and 22 without who underwent 3-dimensional ultrasonography were selected. Transperineal 3-dimensional ultrasonography was performed by Voluson E8 colour Doppler ultrasonography to analyse the anteroposterior diameter (LHAD), transverse diameter (LHLD), pelvic diaphragmatic hiatus area (LHA), and bladder neck mobility (BND) of the patients. Diagnostic sensitivity and specificity of ultrasound parameters in PFD were analysed using Receiver Operating Characteristic (ROC) curves. Paired sample t test was used to analyse the improvement of pelvic floor muscle training (PFMT) in patients with PFD. Results: Patients with PFD had significantly higher levels of △LHAD, △LHLD, △LHA, and BND than controls (all P < .01). Binary logistic regression analysis showed that △LHA or BND levels were independent risk factors for the development of PFD. The ROC results showed that the area under the ROC curve with BND level was the highest (0.917). The diagnostic sensitivity of BND in PFD was 100.0% and the specificity was 70.7%. In urinary incontinence (UI) patients, there was a significant positive correlation between the occurrence of UI and BND levels (all r > 0, P < .05). After PFMT treatment, the levels of △LHAD, △LHLD, △LHA, and BND in patients with PFD were significantly decreased (all P < .001). Conclusions: The abnormal changes in the level of 3-dimensional ultrasound parameters can be used as a sensitive indicator to evaluate PFD and a guiding parameter for PFMT treatment. Advances in knowledge: The feasibility of operation and repetition by 3-dimensional pelvic floor ultrasonography could provide a reliable imaging basis for clinical diagnosis and treatment of patients with PFD. [ABSTRACT FROM AUTHOR]

Background: Female pelvic floor dysfunction (PFD) is a common condition affecting the emotional well‐being of women. Objective: To estimate the prevalence of depressive and anxiety symptoms in women with PFD. Search Strategy, Selection Criteria, Data Collection and Analysis: Following prospective registration (PROSPERO CRD42022362095) we conducted a search of three electronic databases (PubMed, Web of Science and Scopus) from inception to April 2023 without language restriction to capture studies reporting the prevalence of depression/anxiety among women with PFD (chronic pelvic pain [CPP], urinary incontinence [UI], pelvic organ prolapse [POP], and/or fecal incontinence [FI]). Only studies with validated tools were included. Data extraction and study quality assessment were performed by two independent reviewers. Stratifying by type of PFD, rates of depression and anxiety were pooled using random effects model computing 95% confidence interval (CI) and assessing heterogeneity using the I2 statistic. Funnel plots were used to detect potential reporting biases and small‐study effects. Main Results: The search yielded 767 articles, from which 54 studies containing 632 605 women were included. All the studies were high quality. The prevalence of depression was: CPP 26.8% (95% CI: 19.2–34.4, I2 = 98.7%; 12 studies, 4798 participants with 491 cases; Egger's P value = 0.009); UI 26.3% (95% CI: 19.4–33.2, I2 = 99.9%; 26 studies, a total of 346 114 participants with 25 050 cases; Egger's P value = 0.944); POP 34.9% (95% CI: 24.3–45.6, I2 = 68%; three studies, 297 participants with 104 cases; Egger's P value = 0.973); and FI 25.3% (95% CI: 0.68–49.9, I2 = 99.7%; six studies, 14 663 participants with 1773 cases; Egger's P value = 0.780). The prevalence of anxiety was: CPP 29.5% (95% CI: 16.3–42.7, I2 = 97.7%; nine studies, 2483 participants with 349 cases; Egger's P value = 0.001); UI 46.91% (95% CI: 39.1–54.6, I2 = 99.6%; 11 studies, 198 491 participants with 40 058 cases; Egger's P value = 0.337); and POP 28% (95% CI: 13.6–42.4, I2 = 89%; three studies with 355 participants with 90 cases; Egger's P value = 0.306). Conclusion: The prevalence of mental health illness was variable in the different types of PFDs. This meta‐analysis helps quantify the burden of depression and anxiety in PFD and will help inform the policies regarding screening of emotional well‐being by healthcare professionals engaged in care of women with PFD. Synopsis: This meta‐analysis helps quantify the burden of depression/anxiety in pelvic floor disease (PFD) and will help inform policies regarding screening of emotional well‐being of women with PFD. [ABSTRACT FROM AUTHOR]

Background: Pelvic floor stability is influenced by various biomechanical, anatomical, and physiological factors. Understanding these dynamics is crucial for improving the treatment of pelvic organ prolapse (POP) and related conditions. Objective: To analyze the key factors affecting pelvic floor integrity and explore both non-surgical and surgical interventions to enhance stability and treatment outcomes. Methods: This review draws from biomechanical research to assess the role of the uterosacral ligament in pelvic support, while also examining the potential of both traditional and emerging therapeutic approaches, including non-surgical interventions like vitamin C supplementation. Results: - The uterosacral ligament demonstrates superior strength and stiffness, making it essential for structural support of pelvic organs. - Non-surgical interventions, such as vitamin C supplementation, show potential in improving ligament integrity and preventing pelvic floor disorders. - Emerging surgical techniques, including tendon-based procedures and injectable fibrous hydrogel composites, offer promising improvements in outcomes for patients with pelvic organ prolapse. - Additional factors such as muscle strength and neural deficiencies contribute to the complexity of pelvic floor biomechanics, indicating the need for multifaceted treatment approaches. Conclusion : This analysis provides a comprehensive framework for understanding and managing pelvic floor stability by integrating biomechanical, physiological, and anatomical insights. The findings highlight the potential for personalized treatment strategies to improve patient outcomes in pelvic floor disorders. [ABSTRACT FROM AUTHOR]

Purpose: Hysterectomy may be a risk factor for pelvic organ prolapse (POP). We assessed the risk of recurrent POP (operations and visits) after hysterectomy among women with previous POP. We also studied patient and operation related risk factors for POP recurrence. Methods: This retrospective cohort study included 1697 women having previous POP diagnosis or POP at the time of hysterectomy (FINHYST 2006 cohort). Follow-up was until the end of 2016. The data was derived from the Finnish National Care register linked to the cohort. Hysterectomy approaches and other demographics were compared to the risk of a prolapse diagnosis and/or surgery. Cox regression model was used to identify hazard ratios. Results: Following hysterectomy, a total of 280 women (16.5%) had a POP reoperation and 359 (21.2%) had an outpatient visit due to POP. Vaginal vault prolapse repair was the most common POP reoperation (n = 181, 10.7%), followed by anterior wall repair (n = 120, 7.1%). Median time to POP reoperation was 3.7 years. Hysterectomy approach did not affect reoperations or visits. Previous cesarean section and anterior repair during hysterectomy were associated with decreased risk, whereas concomitant sacrospinous fixation and uterus prolapse as the main indication led to increased risk of anterior/vault prolapse reoperations. Concomitant posterior repair decreased posterior reoperations and visits, but uterus weight over 500 g caused a fivefold increased risk of posterior prolapse visit. Residential status was associated with elevated risk of any POP reoperations and visits. Conclusions: Approximately one out of five women suffering from POP ensue POP reoperation or visit after hysterectomy. These high rates are independent on hysterectomy approach, but probably indicate that hysterectomy may worsen previous pelvic floor dysfunction. [ABSTRACT FROM AUTHOR]

• Sedentary older women more severe pelvic floor disorders symptoms than active older women, worse performance in gait speed correlated with urinary incontinence. • The urinary symptoms observed in sedentary older women, were correlated with poor performance in the physical tests evaluating agility (habitual gait speed and maximum gait speed). The study aimed to compare symptoms of pelvic floor disorders (PFD) and physical fitness (PF) between active and sedentary older women and to verify the correlation between PF and PFD. PFD was determined using the Pelvic Floor Distress Inventory (PFDI-20), with the highest score indicating the greatest distress. PF was evaluated by measuring lower limb strength and endurance, agility, mobility, dynamic balance and physical mobility. Regarding PFD, pelvic organ prolapses (p<.001), and anorectal (p<.0 01) symptoms were more frequent among sedentary older women. The summary score of PFDI-20 was also higher among sedentary older women. Sedentary older women group, maximum (rho= -.40) and habitual gait speed (rho= -.46) were correlated negatively with urinary symptoms. The same pattern was observed for the summary score of PDFI-20 (rho= -.33; rho= -.46, respectively). Sedentary older women more severe PFD symptoms than active older women, worse performance in gait speed correlated with urinary incontinence. [ABSTRACT FROM AUTHOR]

Introduction: Gender‐affirming genital surgery is one of several surgical procedures available to transgender and nonbinary (TGNB) individuals to improve congruence between their gender identity and sex assigned at birth. Despite increasing utilization of these procedures, patient‐reported outcome measures (PROMs) to assess subjective outcomes following gender‐affirming genital surgery remain limited. Our aim was to provide a synopsis of PROMs currently being used to evaluate urinary outcomes among TGNB patients following gender‐affirming genital surgery and to assess each PROM for content that is relevant to TGNB patients. Methods: A multidatabase search was performed (Embase and PubMed) using search terms that included transgender, patient‐reported outcome measures, questionnaire, and gender‐affirming surgery. Studies that assessed subjective outcomes related to urinary outcomes and pelvic floor dysfunction following gender‐affirming genital surgery were reviewed. Gender‐affirming genital surgery included vaginal reconstruction (vaginoplasty) and penile reconstruction (phalloplasty and metoidioplasty). Included studies were evaluated for relevant content items and summarized in table. Results: Our literature search identified 820 unique articles. Twenty‐seven full articles were included in the final review. Until recently, measurement tools have been limited to unvalidated ad hoc questionnaires or PROMs developed for other conditions, such as urinary incontinence or vaginal prolapse, that are validated among the predominantly cisgender general population. Of the selected studies, PROMs used to evaluate urinary and pelvic floor dysfunction following gender‐affirming genital surgery included self‐construced ad hoc questionnaires (10 studies), Amsterdam Overactive Pelvic Floor Scale (four studies), King's Health Questionnaire (two studies), Pelvic Floor Distress Inventory (PFDI)−20 (two studies), Sheffield Pelvic Organ Prolapse (one study), International Consultation on Incontinence Questionnaire‐Urinary Incontinence (ICIQ‐UI) (one study), and ICIQ‐Female Lower Urinary Tract Symptoms (one study). The PFDI‐20 asked about the most relevant symptoms to TGNB patients following genital surgery; however, not all cisgender validated questionnaires included important questions about voiding position, splayed or misdirected stream. The Affirming Surgery Form and Function Individual Reporting Measure (AFFIRM) questionnaire is the first PROM for assessing subjective urinary outcomes that are validated for TGNB individuals, and the GENDER‐Q is a promising new PROM with the aim of evaluating outcomes following surgical and other gender‐affirming treatments. Conclusion: Despite recent advancements, a need remains for standardized assessment tools to evaluate pelvic floor dysfunction and urinary symptoms following gender‐affirming genital surgery. Questionnaires developed for the general population to assess symptoms of pelvic organ prolapse and other urinary dysfunction do not fully capture the experiences unique to TGNB individuals undergoing this type of surgery. Nonetheless, PROMs validated specifically for TGNB individuals are necessary to more accurately evaluate outcomes of gender‐affirming genital surgery, allow for informed patient counseling, and create evidence‐based changes to improve these interventions. [ABSTRACT FROM AUTHOR]

Introduction: Today there is Level 1, recommendation A for pelvic floor muscle training (PFMT) to be effective in treatment of stress urinary incontinence (SUI) and pelvic organ prolapse (POP). However, the mechanisms of action are discussed. The aim of the present overview was to give an update of studies evaluating the effect of PFMT on pelvic floor morphology and associations between changes in PFM strength and symptoms of female SUI and POP. Materials and Methods: This was a narrative review retrieving studies from systematic reviews of PFMT for SUI and POP. In addition, an open search on PubMed with the search terms PFMT and morphology was conducted. Both randomized controlled trials (RCTs) and pre–posttest design studies were included. PEDro rating scale (0–10) was used to assess risk of bias. Results: Ten studies were found reporting on morphological changes after PFMT. The four RCTs had PEDro score between 5 and 8/10. The studies found significant higher bladder neck position and narrower levator hiatus dimensions, thicker external urethral sphincter, increased cross‐sectional area of PFM, improvement in PFM tears and blood flow. Twenty studies analyzed associations between changes in different PFMT variables and SUI and POP. Eleven studies found a positive weak to moderate association and six studies reported no association. Studies comparing responders and nonresponders to PFMT found statistically significant better PFM variables in responders. Conclusion: PFMT can change pelvic floor muscle and external urethral sphincter anatomy. This contributes to the understanding on how PFMT can be effective in prevention and treatment of SUI and POP. [ABSTRACT FROM AUTHOR]

Background: Studies show a significant association between the first vaginal delivery and injuries of the levator ani muscle (LAM), which can cause pelvic floor disorders (PFDs). Objectives: This study aims to identify the prevalence of short and long‐term LAM injuries after vaginal delivery in primiparous women and its influence on PFDs. Method: A systematic review was conducted according to the PRISMA methodology. The databases used were Pubmed, Cochrane, and PEDro. The quality assessment of the evidence was carried out using the Critical Appraisal Skills Programme (CASP). Both the selection of studies and their evaluation were done by two researchers and a third reviewer in cases of disagreement. Results: From the search, 57 articles were gathered, and 19 were included to match the eligibility criteria. The prevalence of avulsion of the LAM was found in association with vaginal delivery between 13% and 28% ≤ 1 year after delivery and between 16% and 29% > 1 year after delivery. Ballooning was detected between 20% and 37% ≤ 1 year, and 33% of women > 1 year after delivery, appearing to be more common when compared to avulsion. Pelvic organ prolapse (POP) was considered the most common disorder associated with injuries of the LAM, and there seems to be some connection with sexual dysfunction. Conclusion: Avulsion of the LAM and ballooning of the hiatal area have a high prevalence in primiparous women after vaginal delivery and have a strong direct relation to the development of POP. [ABSTRACT FROM AUTHOR]

Aim: To analyse experience in postnatal nurses returning to work within 3 months following the delivery of a second or third child and recommend appropriate measures to relieve pressure and enhance work engagement among this group. Method s : This study adopted a descriptive phenomenological approach. Semi‐structured interview was carried out with 12 postnatal nurses who had returned to work in the postpartum period following the delivery of a second or third child. The collected data were analysed using the Colaizzi method. Results: Experience among postnatal nurses with two or three children was found to stem from three factors: declining physical quality after childbirth (pelvic floor disorder, fatigue, postpartum memory decline and sleep disturbance), poor psychological adjustment after childbirth (work–family conflict, conflict between clinical work and breastfeeding and role maladjustment) and lack of clear career planning. Conclusion: This study emphasised the importance of psychological experience when postnatal nurses returning to clinical work in the early phase. Postnatal nurses and nurse leaders can use these results to make comprehensive solution in order to improve work engagement in the postpartum return. Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]