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Pelvic floor disorders (PFDs) and obstetric fistula (OF) are common across the globe. PFDs include stress and urge urinary incontinence, overactive bladder, pelvic organ prolapse, fecal incontinence, sexual dysfunction, and pelvic pain. Although PFD and OF are common in low- and middle-income countries (LMIC) there is a lack of awareness and constraints in health care resources. This article focuses on epidemiology, risk factors, assessment, and treatment of PFD and OF in resource-poor settings. Adherence to basic medical ethics principles has to be maintained at all times, coupled with knowledge of and respect for local cultures, traditions, and perceptions of health norms.

Many women experience pelvic floor disorders which may require medical intervention such as transvaginal mesh implant surgeries (TVM; the abdominal or vaginal insertion of woven netting to support pelvic tissue). We examined women's perceptions of communication with their health professionals concerning TVM.We analysed 153 women's written submissions to an Australian Government Inquiry regarding their experiences of transvaginal mesh surgery to explore their perceptions of TVM-related doctor-patient communication. Data were analysed using deductive and inductive reflexive thematic analysis.Women expressed several challenges in their communication with their health professionals. Three themes regarding communication were generated: Insufficient information was abundant; Normalisation and minimisation of the procedure and risks; and, Desired communication interactions.According to women's accounts, doctor-patient communication was poor. Health professionals must be knowledgeable about medical procedures and their potential complications and provide their patients with adequate, accurate information to make informed choices about their health. Health professionals should also document informed consent.Health professionals should be well-informed about TVM, including best-practice treatments for pelvic floor disorders, indications for TVM, the risks, outcomes and potential complications from various forms of TVM, and ways to adequately communicate sufficient information to women.

A weakened pelvic floor is less efficient counteracting the increased intra-abdominal pressure during exercise. While intra-abdominal pressure is higher in Sit-up than in Curl-up, Sit-up continues to be practiced in fitness classes. This raises the question of whether it has advantages over the Curl-up for instance in reducing the interrecti distance (IRD), a goal searched by many parous women. IRD has been shown to be acutely reduced during Curl-up.To determine if the IRD is more reduced during Sit-up than during Curl-up.Parous women with an IRD greater than 15mm were included in the study. IRD was measured at 20mm above umbilicus with a caliper in Head-lift, Curl-up, Sit-up and Drawing-in+Curl-up. IRD was compared across the four conditions using a one-way Anova test with repeated measures and Bonferroni correction between pairwise comparisons.Nineteen parous women aged between 28 and 54 participated in this study. Compared to Head-lift (20.3±3.9mm), the IRD was significantly decreased during the Curl-up (12.2±3.0mm) and the Sit-up (12.1±3.6mm), but not during the Drawing-in+Curl-up (18.4±4.9mm). There was no significant difference in IRD between Curl-up and Sit-up.IRD was similarly acutely reduced during Curl-up and Sit-up. The long-term effect of Curl-up on the IRD and on the pelvic floor muscles needs to be studied.To reduce IRD in parous women Curl-up rather than Sit-up should be practiced. Fitness coaches should consider this information especially with classes attended by parous women, many of whom complain about pelvic floor disorders.EL05.

Objectives To examine the association between pelvic floor disorders (pelvic organ prolapse, urinary incontinence and anal incontinence) and bone mineral density (BMD). Study design: A cross-sectional study of 6809 women who participated in the third survey of the population-based Norwegian HUNT study was undertaken. BMD was measured by dual-energy X-ray absorptiometry. Information on BMD and self-reported pelvic floor disorders from the HUNT study was linked with hospital-derived data on diagnosis and surgical treatment of pelvic floor disorders. BMD was categorized according to the World Health Organization criteria (normal, osteopenia and osteoporosis). Multi-variate logistic regression models were used to estimate odds ratios (OR) with 95% confidence intervals (CI) for the association between pelvic floor disorders and BMD. Results Women with a hospital diagnosis of stress urinary incontinence (SUI) were less likely to have osteopenia (OR 0.66, 95% CI 0.50–0.87) or osteoporosis (OR 0.66, 95% CI 0.34–1.30) compared with women without a diagnosis of SUI. In women with self-reported information on pelvic floor disorders, women with a history of SUI had lower odds for osteopenia (OR 0.88, 95% CI 0.75–1.02) or osteoporosis (OR 0.69, 95% CI 0.46–1.01), while no association was found between anal incontinence, self-reported surgery for pelvic organ prolapse, and osteopenia or osteoporosis. Conclusion Pelvic organ prolapse was not associated with BMD. The reasons underlying the observed association between SUI and BMD require further investigation.

Aim To assess the knowledge of adolescent girls and young women on pelvic-perineal disorders (PPD). Method We searched on PubMed, Cochrane Library, Kinedoc and Semantic Scholar databases using the MeSH keywords: "knowledge" "awareness" "surveys" "young women" "pelvic floor" "adolescent" "teenager" "athletic injury" "urinary incontinence". The articles had to have been published within the last 15 years, written in French or English, and deal with the state of knowledge of adolescents and young women concerning the perineal sphere using questionnaires. Results A total of 8 studies were included in the review, 5 cross-sectional studies and 3 intervention studies. The knowledge of adolescent girls and young women interviewed about the anatomy of the pelvic floor, its function, and risk factors for PPD was low. The majority of the participants wanted more information about the pelvic floor. Two studies that conducted an educational intervention showed a significant improvement in knowledge. Conclusion Knowledge of pelvic-perineal disorders and pelvic floor function is poor in adolescent girls and young women. To better assess them, it would be necessary to validate a questionnaire containing all the items about knowledge.

It is known that pregnancy and childbirth bring biological, psychological and social changes in a woman's life. Studies regarding the pelvic floor function focus on the year after delivery, but unfortunately, long-term studies are rare. Furthermore, an association between postpartum pain and birth pain management on the pelvic floor function has rarely been examined. The aim of this study is the evaluation of the pelvic floor function years after delivery in order to detect possible risk factors.This is a retrospective cohort study. All women who delivered in our hospital between 2015 and 2016 were contacted by mail between 2018 and 2019 and asked to participate. The letters included study information, declaration of consent, the "Pelvic floor questionnaire for pregnant women and women after childbirth" (PFQ), contact information and pre-paid envelopes. Questions about pain after childbirth and the management of birth related fear and pain were particularly of interest in the surveys. The interested participants were asked to return the completed declaration of consent and the questionnaire. Overall, 308 women were included in the analysis. Due to the large number of participants, different subgroups were defined in order to compare influencing factors adequately.No significant association between the mode of delivery and the total score of the PFQ was found after 3-4 years in primiparous women (p = 0.688). Our study also showed that recorded pain after childbirth and insufficient pain and fear management after childbirth had a negative impact on the pelvic floor function (total scores: pain after childbirth p = 0.00; no pain management p = 0.04; no fear management p = 0.021).No association was found between delivery mode and pelvic floor function in primiparous women three to four years after childbirth. On the other hand, a negative impact of birth related pain and fears on the pelvic floor function years after delivery was significant. Therefore, these revealing findings should certainly be considered in postpartum management.

Made available in DSpace on 2022-04-29T08:38:39Z (GMT). No. of bitstreams: 0 Previous issue date: 2022-01-01 Introduction: To investigate the influence of a training of mobility, gait speed and postural balance of pelvic floor muscles (PFM). Methods: A single-arm clinical trial study was approved and registered at the Brazilian Clinical Trials Registry (RBR-4rxhd4). Eighteen women over the age of 60 with pelvic floor dysfunction complaints were subjected to 10 sessions of functional electrical stimulation and digital palpation of PFM. Mobility and gait speed were evaluated by the Timed up and Go and the 10-m walk tests respectively. Standing balance was evaluated using a force plate. Results: No significant differences were found in mobility, gait speed, and standing balance. PFM contraction worsened mobility, gait speed, and standing balance performance. Conclusions: The training protocol enhanced PFM strength and endurance, but the improved ability to recruit PFM did not positively affect balance, mobility, and gait speed. Human Development and Technologies Program Institute of Biosciences São Paulo State University (UNESP) Department of Tocogynecology Botucatu Medical School (FMB) São Paulo State University (UNESP) Department of Physiotherapy and Occupational Therapy Faculty of Philosophy and Sciences São Paulo State University (UNESP) Human Development and Technologies Program Institute of Biosciences São Paulo State University (UNESP) Department of Tocogynecology Botucatu Medical School (FMB) São Paulo State University (UNESP) Department of Physiotherapy and Occupational Therapy Faculty of Philosophy and Sciences São Paulo State University (UNESP)

Objectives To establish the impact of pelvic floor (PF) symptoms (urinary incontinence [UI], anal incontinence [AI] and pelvic organ prolapse [POP]) on exercise participation in women. Design Observational, cross-sectional survey. Methods Australian, 18- to 65-year-old women with self-identified PF symptoms during exercise (current, past or fear of) were included. This survey included validated questionnaires: Questionnaire for female Urinary Incontinence Diagnosis, Incontinence Severity Index, Pelvic Floor Bother Questionnaire, International Physical Activity Questionnaire and purpose-designed questions on the impact of PF symptoms on sport/exercise participation. Analysis utilised descriptive statistics. Chi-square tests for independence and t-tests were used to explore differences between groups. Results Of 4556 women, 46% stopped exercise they had previously participated in due to their PF symptoms. Urinary incontinence had the largest impact; 41% with UI, followed by 37% with POP and 26% with AI stopped at least one form of exercise. Forty-two percent of women who experienced symptoms in high-impact sports stopped participation (versus low-impact: 21%). Sports commonly ceased included volleyball (63%), racquet-sports (57%) and basketball (54%). Exercise cessation was reported amongst younger (18–25 years: 35%) and nulliparous women (31%). Common exercise modifications included lowering the intensity (58%) or frequency (34%) of participation or changing to a low-impact form of sport/exercise (45%). Conclusions Pelvic floor symptoms stop women of all ages and levels of participation from exercising. High-impact sports were most affected but low-impact sports were also ceased. Symptomatic women also modify exercise to less vigorous/frequent participation, which may place them at risk of physical inactivity, and chronic illness.

Among the various risk factors of pelvic floor disorders, pregnancy has been reported to affect the pelvic floor structure; however, not all these effects have been understood yet. The aim of this study is to elucidate how pregnancy affects pelvic floor structure via magnetic resonance imaging (MRI).We conducted a retrospective study between January 2010 and December 2019 to extract clinical records of pregnant and non-pregnant women, who underwent MRI for obstetrical diseases and ovarian benign tumors, respectively. The data on age, body mass index (BMI), complications, gravida, parity, gestational age, and obstetrical history were collected, and pubo-coccygeal line (PCL), pubo-rectal line (PRL), and M line (ML) on their MR images were measured. Statistical analyses were performed with Wilcoxon test, chi-square test, and Kruskal-Wallis test with Steel-Dwass post hoc test as appropriate. Statistical significance was set at P 0.05.We analyzed the reports of 56 (pregnancy group) and 106 women (non-pregnancy group). There was no significant difference in age or BMI, while the obstetric history was significantly different between these groups. Median PCL, PRL, and ML in the pregnancy group were significantly longer than those in the non-pregnancy group (114.1 mm vs. 110.0 mm, P = 0.018; 48.6 mm vs. 41.6 mm, P0.0001 and 21.7 mm vs. 10.0 mm, p0.0001. respectively). The subgroup analysis of the effect of pregnancy and vaginal delivery (VD) history on changes in these lines revealed that pregnancy-induced PRL increase tended to recover to the reference level of "non-pregnant without VD," but ML increase did not fully recover.MRI revealed a strong effect of pregnancy on pelvic floor structure.

This article discusses various pelvic floor ultrasonographic modalities and the clinical applications of ultrasonography of the pelvic floor. Ultrasonography provides a detailed anatomic assessment of the muscles and surrounding organs of the pelvic floor. Different anatomic variabilities and pathologic conditions, such as prolapse, fecal incontinence, urinary symptoms, vaginal wall cysts, synthetic implanted material, and pelvic pain, are assessed with pelvic floor ultrasonography. This imaging modality is an important adjunct to the evaluation and diagnosis of pelvic floor disorders.

Background Coronavirus disease 2019 is revolutionizing healthcare delivery. The aim of this study was to reach a consensus among experts as to the possible applications of telemedicine in the proctologic field. Methods A group of 55 clinical practice recommendations was developed by a clinical guidance group based on coalescence of evidence and expert opinion. The Telemedicine in Proctology Italian Working Group included 47 Italian Society of Colorectal Surgery nominated experts evaluating the appropriateness of each clinical practice recommendations based on published RAND/UCLA methodology in 2 rounds. Results Stakeholder median age was 53 years (interquartile range limits 40–60), and 38 (81%) were men. Nine (19%) panelists reported no experience with telemedicine before the pandemic. Agreement was obtained on a minimum of 3 to 5 years of practice in the proctologic field before starting teleconsultations, which should be regularly paid, with advice and prescriptions incorporated into a formal report sent to the patient by e-mail along with a receipt. Of the panelists, 35 of 47 (74%) agreed that teleconsultation carries the risk of misdiagnosis of cancer, thus recommending an in-person assessment before scheduling any surgery. Fifteen additional clinical practice recommendations were re-elaborated in the second round and assessed by 44 of 47 (93.6%) panelists. The application of telemedicine for the diagnosis of common proctologic conditions (eg, hemorrhoidal disease, anal abscess and fistula, anal condylomas, and anal fissure) and functional pelvic floor disorders was generally considered inappropriate. Teleconsultation was instead deemed appropriate for the diagnosis and management of pilonidal disease. Conclusion This e-consensus revealed the boundaries of telemedicine in Italy. Standardization of infrastructures, logistics, and legality remain to be better elucidated.

Background Sarcopenia is a determinant of age-related skeletal muscle weakness. In this sense, it is believed that there may be a pathophysiological association between pelvic floor dysfunction (PFD) and sarcopenia; however, few articles investigating an association between these two pathologies have been published. Objectives To identify the prevalence of sarcopenia in older women with PFD and verify the association between the severity of PFD and the severity of sarcopenia. Methods This cross-sectional study was undertaken in urogynaecology outpatient clinics in Fortaleza, Ceara, Brazil. Women with PFD aged ≥ 60 years were included. Women with cognitive impairments, amputations and/or limb fractures were excluded. Sociodemographic, anthropometric and PFD data were evaluated, and tests for measuring muscle strength, muscle mass and physical performance were performed. Results In total, 217 women were included in this study; of these, 121 (55.8%) presented without sarcopenia, 71 (32.7%) presented with probable sarcopenia, 23 (10.6%) presented with confirmed sarcopenia, and two (0.9%) presented with severe sarcopenia. Regarding sarcopenia related to PFD, a higher prevalence of probable sarcopenia was observed in women with urinary incontinence (UI) (n = 55, 77.5%). Confirmed sarcopenia was more prevalent in women with pelvic organ prolapse (POP) (n = 19, 82.6%); among these cases, most women had POP of the anterior, posterior and apical compartments (n = 8, 42.1%). All the women with severe sarcopenia had UI and POP and, considering the specific types of these dysfunctions, the prevalence of severe sarcopenia was 50.0% in the women with UI and POP of the anterior and apical wall. The most severe stages of POP were associated with sarcopenia (p = 0.002). Conclusion The prevalence of sarcopenia in women with PFD was high. Healthcare providers who assist women with PFD should consider the possibility of assessing sarcopenia, especially when faced with more extensive POP in older women. The evaluation of sarcopenia may play a role in the management of women with PFD.

Objectives To determine the wait times to see an academic Female Pelvic Medicine and Reconstructive Surgery (FPMRS) urologist or gynecologist and to identify factors that may impact these wait times. Methods We reviewed all Accreditation Council for Graduate Medical Education accredited urology and gynecology residency programs. Offices of FPMRS providers were called to ascertain the earliest available new patient visit for a fictional female patient with “urine leakage.” Programs without FPMRS faculty (18.7%) were excluded. FPMRS providers that did not accept Medicaid (15.6%) were also excluded. Negative binomial regression was performed using SPSS v24. Results Final analysis included 362 FPMRS providers. Median wait time for a patient with Medicaid was 30 days (interquartile range [IQR] 15-51) and 26 days (IQR 14-42) for Medicare. The median wait time to see an FPMRS-trained gynecologist was 28 days (IQR 15-50) while FPMRS-trained urologists had a median wait time of 25 days (IQR 13.8-43.3). Female providers had longer median wait times when compared to male providers (30 vs 25 days). On regression analysis, only female gender of the provider was significant (P Conclusion Our study found that nearly 1 in 5 academic departments did not have an FPMRS-trained provider. We found that new patients with urinary incontinence encountered substantial wait times to see FPMRS providers at academic institutions. As we project increased demand for the FPMRS workforce, our findings reflect a challenging landscape where training additional FPMRS providers may be needed to meet demand.

Resume Contexte La grossesse et le post-partum sont des periodes de la vie au cours desquelles peuvent apparaitre des troubles pelviperineaux (TPP). Objectif L’objectif de cette revue est de preciser les connaissances des femmes en periode perinatale sur les TPP, leurs facteurs de risques et les mesures preventives. Sources documentaires Une revue systematique a ete realisee a partir des bases de donnees PubMed, Cochrane Library, LISSA et Kinedoc et a partir des mots-cles « knowledge », « awareness », « beliefs », « pelvic floor », « post-partum », « pregnancy ». Seules les etudes, redigees en anglais ou en francais, evaluant les connaissances des femmes a l’aide d’un questionnaire, ont ete incluses dans la revue. La recherche a ete effectuee sans limitation temporelle et jusqu’au 10 mai 2020. Selection des etudes Au total, sur 240 etudes, 14 etudes transversales ont ete retenues, regroupant un echantillon de 3950 participantes. Resultats Les themes abordes dans les questionnaires ont ete l’anatomie, la fonction du plancher pelvien, l’ensemble des TPP, leurs facteurs de risque et les mesures preventives. Les scores de connaissances des femmes interrogees sur ces differents themes sont faibles. Il a egalement ete montre que l’education des femmes sur les facteurs de risque et les mesures preventives concernant la survenue des TPP etait incomplete. Conclusion Au final, les femmes en periode perinatale ont peu de connaissances sur les TPP.

Objectives To evaluate whether percutaneous nerve evaluation (PNE) without fluoroscopy is inferior to fluoroscopy use in women undergoing trials of sacral neuromodulation (SNM) for pelvic floor disorders (PFDs). Materials and methods In an unblinded noninferiority trial, women undergoing PNE were randomized to fluoroscopy or no fluoroscopy. The primary outcome was "success" and defined as implantation of the permanent SNM device within three months of PNE. At an expected 40% success and a 30% noninferiority threshold, 33 participants in each group were needed for 80% power (α = 0.05). Univariate analyses and a logistic regression model adjusting for univariate variables associated with the primary outcome were performed. Results From April 2016 to December 2018, 74 participants underwent PNE of which 36 underwent PNE with fluoroscopy and 38 without. The fluoroscopy group had less baseline mean daily voids compared to the no fluoroscopy group (10.79 ± 6.48 vs. 16.21 ± 10.05, p = 0.01). PNE performed without fluoroscopy had similar success (18/38, 47.4%) compared to fluoroscopy (21/36, 58.3%), meeting our noninferiority definition (difference 10.9%, 90% CI -8% to 30%, p = 0.049). In a logistic regression model adjusting for age, Charlson comorbidity index, stage of prolapse, and number of baseline voids per day, trial success was still similar between the two groups (adjOR 1.82, 95% CI 0.52 to 6.94, p = 0.36). Conclusions PNE performed without fluoroscopy is noninferior to PNE with fluoroscopy use for the outcome of SNM device implantation within three months among women undergoing therapy for PFDs.

Obstetrical perineal and anal sphincter lacerations can be associated with significant sequelae. Diagnosis of short-term bowel, bladder and healing problems can be delayed if patients are not seen until the traditional postpartum visit at 4–6 weeks. Specialized peripartum clinics create a unique opportunity to collaborate with obstetric specialists in order to provide early, individualized care for patients experiencing a variety of pelvic floor issues during pregnancy and in the postpartum period. While implementation of these clinics requires thoughtful planning and partnering with care providers at all levels in the obstetrics care system, many of the necessary resources are likely available in routine gynecologic practice. Using a multi-disciplinary approach with pelvic floor physical therapists, nursing, advanced practice providers and other specialists is important for the success of this service line and enhances the level of care provided. Overall, these clinics provide a structured means by which pregnant and postpartum women with pelvic floor symptoms can receive specialized counseling and treatment.

Pelvic floor dysfunction (PFD) symptoms are prevalent during pregnancy and are mostly reversible thereafter. The pelvic floor muscles and their surrounding connective tissue support are estrogen-responsive. Breastfeeding is a condition of estrogen deficiency. We hypothesized that in breastfeeding women there may be a slower spontaneous recovery of PFD symptoms following birth. We aimed to determine the impact of breastfeeding on recovery from gestational PFD symptoms.We conducted a prospective cohort study of women who gave birth at the Soroka University Medical Center, Beer-Sheva, Israel. Those who have consented completed the Pelvic Floor Distress Inventory-20 (PFDI-20), after delivery and three months postpartum. Breastfeeding status was evaluated three months after delivery. Clinical and obstetrical characteristics were retrieved from the participants' medical records.A total of 119 women had completed the PFDI-20 after delivery and three months postpartum. We found a significant difference between PFD during pregnancy, and PFD three months postpartum (P0.001). The overall PFDI-20 score was significantly decreased from a scale score of 64 to 27 (delta 36, P0.001), and this decrease remained significant for all components of the PFDI-20: pelvic organ prolapse distress (delta 14, P0.001); colorectal and anal dysfunction (delta 3.9, P = 0.01); and urinary dysfunction (delta 18, P0.001). No significant differences were noted in the extent of recovery of PFD symptoms between women who did and did not breastfeed (P = 0.59).There is a clinical and statistically significant spontaneous recovery from gestational PFD symptoms at three months postpartum. Women with PFD symptoms prior to or during pregnancy can be reassured that breastfeeding probably does not delay the pelvic floor recovery.

This article focuses on advanced MR imaging techniques of the female pelvis and clinical applications for benign and malignant disease. General and abbreviated protocols for female pelvic MR imaging are reviewed. Diffusion-weighted imaging, dynamic contrast-enhanced MR imaging, and susceptibility-weighted imaging are discussed in the context of adnexal mass characterization using the ADNEx-MR scoring system, evaluation of endometriosis, local staging of cervical and endometrial cancers, assessment of nodal and peritoneal metastasis, and potential detection of leiomyosarcoma. MR defecography is also discussed regarding evaluation of multicompartmental pelvic floor disorders.

This study aimed to review the literature to establish the prevalence of pelvic floor disorders in the fibromyalgia population. A systematic literature search through computerized databases including PubMed and EMBASE was completed using medical subject heading (MeSH) terms from January 1, 1990 to November 1, 2017. Articles were included if the focus was prevalence of pelvic floor disorders in the population of persons with fibromyalgia. To provide consistency of diagnosis, use of the American College of Rheumatology 1990 or 2010 criteria was required. Evidence was graded according to Canadian Task Force on Preventive Health Care and Newcastle-Ottawa quality assessment scales. A total of 11 studies were deemed eligible for inclusion from 1024 articles initially identified. Only one study used the most recent 2010 American College of Rheumatology diagnostic criteria. There was significant heterogeneity in the reporting of fibromyalgia populations. Outcomes reported were variable and not consistent across studies; thus, data could not be pooled. There appears to be a high prevalence of gastrointestinal, genitourinary, and gynaecological dysfunction. In case-control studies, these dysfunctions appeared to be more prevalent in the fibromyalgia group than in the control populations. However, this difference could not be quantified more specifically. In conclusion, the small number of eligible studies and the variety of pelvic floor outcomes reported limited formation of conclusive prevalence of pelvic floor disorders in the fibromyalgia population. From the small number of studied patients, there may be a higher prevalence of gastrointestinal, genitourinary, and gynaecological concerns in women with fibromyalgia.

International audience; Vaginal delivery is reported as a main risk factor of pelvic floor dysfunction. Nevertheless, data with a high level of evidence are lacking to confirm the hypothetic protective effect of pre-labor caesarean section. In order to promote a preventive strategy for a disease, it is necessary to know perfectly its pathophysiology and to be sure that the strategy is in place before the beginning of the pathological process. In other words, the causality between the exposure factor and the disease must be certain. Due to the maternal and neonatal morbidities associated with caesarean section it is essential to be careful before promoting prophylactic pre-labor caesarean section policies [1,2]. The objective of this scientific review is to provide a systematic analysis of the causality between vaginal delivery and pelvic floor dysfunction using Hill’s criterion for causality in order to devise a policy of advising pre-labor caesarean section to prevent pelvic floor dysfunction

Study Objective To determine the prevalence and awareness of pelvic floor disorder symptoms among female adolescents. Design Cross-sectional study via a written, anonymous survey of adolescents. The survey was composed of validated measures for determination of symptom prevalence. Setting Pediatric and adolescent gynecology clinic in the southeast United States. Participants Female adolescents ages 14-21 years. Interventions None. Main Outcome Measures We used χ2 analyses for categorical variables and t test for continuous variables. Results Two hundred sixteen questionnaires were completed. The mean age of respondents was 17.1 (±2.1) years and most respondents had at least heard about urinary (UI) and fecal incontinence (FI; 62.9%). The prevalence of any UI was 31.5%. Urgency UI (UUI) was reported by 15.7% and stress UI was reported by 6.9% of adolescents; 8.8% of participants experienced UUI and stress UI symptoms. FI and pelvic organ prolapse symptoms were reported by 0.9%. There were no differences in reported prevalence rates of UI (31.7% vs 27.9%), FI (1.4% vs 0%), or pelvic organ prolapse (1.4% vs 0%) between younger (14-17 years) and older (18-21 years) adolescent participants, respectively (all P > .05). Although UI was fairly prevalent among respondents, most stated that it had a minimal effect on daily living. Conclusion UI symptoms were common among female adolescents, with UUI being the most reported. Early education regarding pelvic floor disorder symptoms might lead to prevention or empowerment to seek treatment as adolescents age.

Objective: The aim of this study was to analyse the prevalence of pelvic floor disorders and to describe health-related quality of life (HRQoL) among older women. We also compared participants' HRQoL with the age-matched general female population and analysed factors associated with HRQoL. Study design: This is a population-based study of a cohort of women born in 1948 and in 1950 (n = 143) which is also part of the Women's Gynaecological Health study in Lieto, Finland. Methods: The data were collected by questionnaires which pertained to socio-demographics, health-related variables, pelvic floor disorders and HRQoL (15D). Linear model was conducted to estimate a model of factors that associated with HRQoL. Results: The prevalence of urinary incontinence, faecal incontinence and pelvic organ prolapse was 50%, 13% and 12%, respectively. The overall HRQoL score of the study cohort is broadly similar to that of the age-matched general Finnish female population (mean +/- SD15D scores 0.905 +/- 0.084 vs 0.912 +/- 0.077). Higher number of medications was the most important explanatory factor for lower HRQoL. Conclusion: Urinary incontinence was common; however, the impact on HRQoL was minor. The overall HRQoL score of the study cohort was broadly similar to that of age-matched general female population. Women who used a higher number of medications had lower HRQoL compared to women who used fewer medications.

Elective caesarean delivery is increasing rapidly in many countries, and one of the reasons might be that caesarean delivery is widely believed to protect against pelvic floor disorders, including anal incontinence. Previous studies on this issue have been small and with conflicting results. The aim of present study was to compare the risk of developing anal incontinence in women who had a caesarean delivery, in those who had a vaginal delivery, and in two age-matched control groups (nulliparous women and men).In this observational population-based study, we included all women in the Swedish Medical Birth Register who gave birth by caesarean delivery or vaginal delivery during 1973-2015 in Sweden and were diagnosed with anal incontinence according to ICD 8-10 in the Swedish National Patient Register during 2001-15. Exclusion criteria were multiple birth delivery, mixed vaginal and caesarean delivery, and four or more deliveries. We compared the diagnosis of anal incontinence between women previously delivered solely by caesarean delivery and those who solely had delivered vaginally. We also compared it with two age-matched control groups of nulliparous women and men from the Swedish Total Population Register. Finally, we analysed risk factors for anal incontinence in the caesarean delivery and vaginal delivery groups.3 755 110 individuals were included in the study. Between 1973 and 2015, 185 219 women had a caesarean delivery only and 1 400 935 delivered vaginally only. 416 (0·22 %) of the 185 219 women in the caesarean delivery group were diagnosed with anal incontinence compared with 5171 (0·37%) of 1 400 935 women in the vaginal delivery group. The odds ratio (OR) for being diagnosed with anal incontinence after vaginal delivery compared with caesarean delivery was 1·65 (95% CI 1·49-1·82; p0·0001). When the combination vaginal delivery and caesarean delivery was compared with the nulliparous control group, the OR of being diagnosed with anal incontinence was 2·05 (1·92-2·19; p0·0001). For the nulliparous women compared with men, the OR for anal incontinence was 1·89 (1·75-2·05; p0·0001). The strongest risk factors for anal incontinence after vaginal delivery were high maternal age, high birthweight of the child, and instrumental delivery. The only risk factor for anal incontinence after caesarean delivery was maternal age.The risk of developing anal incontinence increases after pregnancy and delivery. Women with known risk factors for anal incontinence should perhaps be offered a more qualified post-partum examination to enable early intervention in case of injury. Further knowledge for optimal management are needed.County Council of Jämtland.

Objectives To evaluate a dual-phase protocol for vaginal ablative Erbium:YAG laser treatment in pelvic floor medicine. Study design Data from consecutive patients undergoing vaginal Erbium:YAG laser for first-degree pelvic floor complaints at a certified university urogynecological unit were analyzed. Fractional ablative and thermal treatment with adjustable pulse duration, fluence, and pulse interval was performed in single ten-minute treatment course. Followed up interval was 6 weeks including interviews on expectations, goal setting, goal achievement, and satisfaction (EGGS), vaginal pH, and determination of the Gloria-Bachmann-Index (VHI). Post-procedural complications were classified according to definition and classification of the Clavien-Dindo system. Results Of 84 patients treated, 71 (21% pre-, 79% post-menopausal) were evaluated. 27% had single urogynecological symptoms, 35% had three or more combined symptoms. Minor post-procedural complications occurred in three patients (CD I, n = 1; CD II, n = 3). The ranges of fluence, determined according to the atrophy state, in the first and second phases were 15–35 and 3–12 J/cm2, respectively. In patients with genitourinary syndrome of menopause, pre- and post-treatment VHI and pH differed significantly [15.3 ± 4.5 vs. 19.9 ± 2.8 (p Conclusions Vaginal ablative Erbium:YAG laser dual-phase protocol for early urogynecological symptoms was successful and safe, with high patient satisfaction and few, minor complications. Prospective studies are needed to confirm our first data.

Objective The association of vitamin D deficiency and pelvic floor dysfunction has been examined by numerous studies. Lower urinary tract symptoms (LUTS) associated with bladder filling and voiding functions are common in both sexes. A recent study reports a higher incidence of LTUS in men over 50 years old with vitamin D deficiency. The aim of the study is to investigate whether there is a difference in the Lower Urinary Tract Symptoms frequency between women with vitamin D deficiency and the control group or not. Study design In this case control study, a total of 150 women who had a measured vitamin D level within a month were divided into two groups, one with a serum vitamin D deficiency and the other with a normal vitamin D level. Both groups were evaluated in terms of menopausal status, numbers of pregnancy and delivery, pelvic examination findings, pelvic floor muscle strength, level of pelvic organ prolapse, LUTS scores, and the findings were recorded. Both groups were compared for the presence of lower urinary system symptoms. The BFLUTS validated for Turkish-speaking populations was used to assess lower urinary system symptoms. Statistical analyses were performed via IBM SPSS Statistics 23.0. The results were considered significant at p Results Vitamin D deficiency was detected in 67.3% of the participants. No significant differences were found between the groups regarding variables that could affect lower urinary system symptoms such as menopausal status, presence of pelvic organ prolapse and neonatal weight (fetal macrosomia) The Pelvic Floor Muscle Strength was significantly lower in the group with vitamin D deficiency than the control group. BFLUTS scores of premenopausal women with vitamin D deficiency were found to be similar to the control group, likewise no significant differences in the BFLUTS scores were detected in postmenopausal women. Conclusion Although vitamin D deficiency causes a significant reduction in pelvic floor muscle strength, no significant correlation was found between lower urinary tract symptoms and vitamin D deficiency. There is a necessity of prospective randomized controlled trials to investigate the relationship between vitamin D deficiency and pelvic floor functions.

Objective To examine the feasibility of implementing a standardized, clinically relevant genitourinary examination for both men and women, and to identify physical examination findings characteristic of urologic chronic pelvic pain syndrome (UCPPS). Materials and Methods This study analyzed 2 samples: men and women with UCPPS who participated in the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network Epidemiology and Phenotyping (EP) Study, and age-matched controls who were either positive for chronic fatigue syndrome or healthy (pain-free). We compared physical examination findings in both positive and healthy controls with UCPPS cases: findings from both the EP examinations and from an extended genitourinary examination. Results EP and extended examinations were performed on 143 participants: 62 UCPPS cases (30 women, 32 men), 42 positive controls (15 women, 27 men), and 39 healthy controls (22 women, 17 men). EP examinations showed that pelvic floor tenderness was more prevalent in cases (55.0%) than in positive (14.6%) or healthy controls (10.5%). Extended examinations revealed specific areas of tenderness in the pelvic floor musculature. Cases were also more likely than healthy controls to report tenderness in multiple areas, including suprapubic, symphysis pubis, and posterior superior iliac spine, and on bimanual examination. No comparative findings were specific to biological sex, and no evidence of pudendal neuropathy was observed on extended examination of cases or controls. Conclusion The extended genitourinary examination is an easily administered addition to the assessment of men and women during evaluation for UCPPS. Physical findings may help to better categorize patients with UCPPS into clinically relevant subgroups for optimal treatment.

Botulinum toxin's (BoNT) success in treating several pain disorders has triggered interest in its application for pelvic pain disorders. This article summarizes results presented at the recent Neurotoxins Meeting in Madrid, Spain, in January 2017. It does not include BoNT use for Interstitial Cystitis/Bladder Pain Syndrome, which was the topic of a separate lecture. It includes studies documenting the beneficial effects of OnaBoNTA for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) in men using both transrectal and transurethral injection techniques. It also focuses on research using OnaBoNTA to treat levator spasms in women with chronic pelvic pain. Finally, it presents a novel approach using high density quantitative surface EMG to map out innervation zones and allow for more precise targeting of hypertonic pelvic floor muscles.

A 22-year-old woman presented with 12 years of progressive constipation; she had increased joint flexibility, hyperextensible skin, and excessive perineal descent on examination. Radiological studies confirmed evidence of rectal evacuation disorder due to descending perineum syndrome, enterocele, and rectocele. In a wide genetic screen (∼611,000 single nucleotide polymorphisms), 4 variations were identified in COL1A1 gene ([rs72656352, Chr17: 50,185,535-50,185,539, deletion], [rs72654794, Chr17: 50,188,575, deletion], [rs72667023, Chr17: 50,198,170, deletion], [rs67828806, Chr17: 50,198,177 G→C]). These mutations result in an increase in the number of base pairs in the C' end, as well as replacement of the glycine amino acid in the N' end, leading to incomplete cleavage of procollagen by proteases and resulting in collagen weakness. Our observations suggest that COL1A1 gene mutations are plausible biological factors predisposing to descending perineum syndrome in association with joint hypermobility in this patient.

Objectives To determine the real-world effectiveness of pelvic floor muscle therapy (PFMT) recommendations for patients. Methods We conducted a cross-sectional study of 70 women who were advised to undergo PFMT after their initial urogynaecology consultation for lower urinary tract symptoms and/or pelvic organ prolapse. About half (51%) of potential participants consented to answer our telephone survey. We calculated the proportion of patients who complied with the recommendation of PFMT, and we subjectively assessed whether these patients found PFMT to be helpful. We also collected demographic data and looked for reasons why patients did not attend PFMT. Chi-square, 2-tailed t, or Fisher exact tests were used to compare differences between patients who attended and those who did not. Results During the 6-month period after their initial consultation, only 28 of 70 women (40%) followed the recommendation to attend PFMT. Sixteen of the 28 women who attended PFMT (57%) reported that they found it helpful. Therefore, the “real-world effectiveness” of the entire study sample was 23%, with only 16 of 70 women benefiting from PFMT. Time constraints (27%) and cost (18%) were the top 2 reasons given for not attending. Conclusions Despite evidence-based recommendations in favour of PFMT for various pelvic floor disorders, its real-world effectiveness is quite low. A public health commitment to providing access to PFMT would be of significant benefit.

Objective A likely contributor to pelvic floor disorders is injury and degradation of connective tissue components such as collagen and elastin, leading to weakening of the pelvic floor. Prior studies have found similar connective tissue component changes in women with cervical insufficiency (CI). However, the connection between pelvic floor disorders and cervical insufficiency has not previously been evaluated. Our objective was to determine whether a history of cervical insufficiency is associated with an increased risk of pelvic organ prolapse and stress urinary incontinence after controlling for confounders. Study design The study used de-identified clinical data from a large multi-institution electronic health records HIPAA-compliant data web application, Explorys Inc. (Cleveland, Ohio, USA). Women with a history of at least one prior delivery after at least 20 weeks’ gestation between the years 1999 and 2016 were identified. Logistic regression models were used to identify risk factors and adjust for confounders. Main outcome measures The primary outcome was subsequent development of either stress incontinence or pelvic organ prolapse. Results A total of 1,182,650 women were identified, of whom 30,890 (2.6%) had a history of cervical cerclage or insufficiency. A history of cervical insufficiency was associated with an increased risk of either pelvic organ prolapse or stress urinary incontinence (aOR = 1.93, 95%CI: 1.84–2.02). A history of cervical insufficiency was more strongly associated with an increased risk of pelvic organ prolapse (aOR = 2.06, 95%CI: 1.91–2.21) than with stress urinary incontinence (aOR = 1.91, 95%CI: 1.80–2.02). Conclusion A history of cervical insufficiency is associated with an increased risk of development of pelvic organ prolapse and stress urinary incontinence.

Objectives: The ability to perform a correct pelvic floor muscle contraction (PFMC) is necessary to start pelvic floor muscle training after delivery. COMMOV are "c"ontractions of "o"ther "m"uscles (m. rectus abdominus, the gluteal muscles, and the adductors), and other "mov"ements (pelvic tilt, breath holding, and straining) performed in addition to or instead of the PFMC. COMMOV are probably the most common errors in attempt to contract the pelvic floor muscles during the first days after delivery. The aims of this study were to observe the prevalence of COMMOV, to investigate whether COMMOV influence the ability to perform a PFMC, and whether verbal instructions are effective to unlearn the COMMOV postpartum. Study design: A Prospective Observational Study was performed in women during the first through sixth day postpartum. PFMC and COMMOV were evaluated with visual observation. Women who did not show correct isolated PFMC received verbal instructions and were re-evaluated. Interobserver variability and agreement were calculated. Chi-square, Kappa, Risk Ratio, and McNemar were used. Results: A total of 382 women participated, 2.36 (1.2) days postpartum. Twohundred sixteen, 57%, CI (52-62%), showed COMMOV. The chance to perform a correct PFMC was 2.65 times higher without COMMOV (p = 0.0001). Verbal feedback was effective (57% reduced to 3%) to abandon COMMOV during PFMC. Conclusion: COMMOV are common errors performed during attempts to contract the pelvic floor muscles after delivery. They can reduce the ability to contract the pelvic floor muscles, but can easily been unlearned with visual observation and verbal feedback. (C) 2017 Elsevier B.V. All rights reserved.

Objective Many women experience pelvic floor dysfunction (PFD) during the perinatal period. Knowledge of PFD among women is poor, which may reflect inadequate provision of information by healthcare workers. The aim of this study was to explore obstetrical healthcare workers' knowledge, attitude, and practice regarding PFD. Material and Methods This study had a cross-sectional design. We developed a 65-question survey to explore obstetrical healthcare workers' knowledge, attitude, and practice regarding PFD. An electronic version of the questionnaire was distributed to healthcare workers from 31 provinces in the People’s Republic of China by convenience sampling in July and August 2019. This research complied with the guidelines of the Strengthening of the Reporting of Observational Studies in Epidemiology checklist. Results In total, 1545 valid questionnaires were collected. The mean scores for the knowledge, attitude, and practice of obstetrical healthcare workers were 23.67 ± 4.70 out of 30, 31.91 ± 6.68 out of 40, and 47.88 ± 9.17 out of 65, respectively. Approximately 50 % of the respondents reported providing practical pelvic floor muscle training (PFMT) guidance and evaluation of its correct performance only "sometimes" or even "never". Nearly 30 % of respondents denied asking patients about PFD-related symptoms. Respondents' PFD-related practice were affected not only by their knowledge and attitude but also by their age, treatment or nursing experience of PFD, own PFD history and that of relatives or friends, and the PFD-related departmental setup of their hospital (P Conclusion Most obstetrical healthcare workers have knowledge of PFD and hold a positive attitude but fail to routinely provide PFD counseling and mentoring to patients. Many factors affect the respondents' PFD-related practice.

Introduction Diastasis rectus abdominis (DRA) diagnosis via clinical examination is well defined, however, the assessment of symptoms has been less investigated. Currently, there is also scant knowledge on the consequences of DRA. The aim of this review is to identify the relevant self-reported variables in the study of DRA in women. Methods We performed a systematic review of observational studies through Medline, Embase, and Cochrane Library databases. Studies evaluating the link between DRA and self-reported symptoms were searched using the following terms: "Diastasis rectus abdominis", "Diastasis recti", "Abdominis Rectus Muscle Diastasis", "Questionnaire", "Scale", "Survey", "Interview", "Index" and "Inventory”. The methodological quality was assessed independently by two evaluators using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Results Fourteen observational studies met the eligibility criteria and were included in the qualitative analysis. Most of the studies were of low to fair quality. Different categories of symptoms were analyzed: quality of life, body image, lumbopelvic pain, other types of pain and pelvic floor dysfunction. A significant positive correlation was found between the presence of DRA and physical health and functioning, abdominal discomfort and body image. Heterogenous data were identified in relation to disability related with low back pain. No correlation has been found between DRA and urinary incontinence, severity and presence of low back pain, voiding symptoms, vaginal symptoms or sexual matters. Conclusions DRA presents with reduced quality of life due to compromised physical health and functioning; poorer physical perception; lower body image satisfaction; and higher degrees of abdominal pain that is frequently perceived as discomfort or bloating.

Objective To assess the efficacy of a brief telephone call to patients on a waiting list for physiotherapy treatment of pelvic floor dysfunction on initial attendance. Design Three-armed randomized controlled trial. Setting Outpatient physiotherapy clinic at a hospital. Participants Female patients (N=130; mean age, 51.47±13.33y; range, 26–84y) with various pelvic floor dysfunction problems. Interventions Telephone support call (2–10min) 3 days before or 3 days after receiving an invitation letter to physiotherapy sessions. Main Outcome Measures Attendance at the initial physiotherapy group session. Results Groups receiving a telephone call demonstrated 80% attendance at the session, with no significant difference between these groups. The group receiving no call had significantly lower attendance rates (50%) than did the call groups. The telephone support was more effective in those people who were older, came from less economically deprived areas, and had been on the waiting list for less time. Conclusions A brief telephone support call may be an effective method to enhance patient attendance at treatment, but it may work best when targeted at certain groups of individuals.

Objectives Electromyography (EMG) is a well-established method to quantify the relative pelvic floor muscle (PFM) activity. PFM EMG has shown good reliability in healthy women. However, its reliability has not been tested in women with PFM dysfunction. The reliability of EMG analysis methods concerning EMG normalization needs to be determined to assess specific therapeutic interventions. Therefore, the aim of this study was to investigate the intra-session reliability of PFM EMG variables by using 3 different analysis methods in women with PFM dysfunction. Methods EMG data analysis involved women who were healthy, had weak PFM and had stress urinary incontinence (SUI). We evaluated the reliability of EMG during rest and maximum voluntary contraction and compared muscle activity onset by visual determination and by calculation. All variables were checked for normality (Shapiro-Wilk). Descriptive statistics (mean, SD), systematic error within repeated measures (Wilcoxon) and reliability indexes were tested and presented descriptively (intraclass correlation coefficient [ICC], standard error of measurement [SEM], SEM%, minimal difference [MD], MD%). Results For 20 women who were healthy, 17 with weak PFM and 50 with SUI, ICC values were high for all variables (0.780–0.994), and SEM and MD values were relatively high (SEM%: 7.5–15.7; MD%: 21.0–43.8). Conclusion We need reliable methods to analyse clinical intervention studies. PFM EMG variables had high ICCs, but relatively high SEM and MD values modified the reliability. All EMG analysis methods were comparable in healthy women, but only the visual-onset determination was dependable in women with PFM dysfunction.

Objective To investigate radiation therapy as a risk factor for urinary or fecal incontinence, pelvic organ prolapse, and sexual dysfunction in endometrial cancer survivors. Study design We performed a retrospective cohort study of endometrial cancer survivors. Data were collected using a mailed survey and the medical record. Validated questionnaires were used to generate rates of urinary incontinence and other pelvic floor disorders. The incidence rates of pelvic floor disorders were compared across groups with different exposures to radiation. Results Of the 149 endometrial cancer survivors, 41% received radiation therapy. Fifty-one percent of women reported urine leakage. The rates of urinary incontinence in women exposed and not exposed to vaginal brachytherapy (VBT) or whole-pelvis radiation were 48% and 58%, respectively (p = 0.47). The incidence of fecal incontinence did not differ between groups, but the score for overall sexual function was significantly higher in women who did not undergo radiation therapy. On multivariable analysis, significant risk factors for urinary incontinence were age (AOR 1.06 95% CI 1.02, 1.10) and BMI (AOR 1.07 95% CI 1.02, 1.11), but treatment with radiation was not significantly associated with urinary incontinence, or fecal incontinence (p > 0.05). Age, BMI, and radiation exposure were independent predictors of decreased sexual function score (p Conclusion Local or regional radiation is not associated with urinary or fecal incontinence, but may contribute to sexual dysfunction in endometrial cancer survivors.

Resume Objectifs Le Female Pelvic Floor Questionnaire (FPFQ) est un outil auto-administrable qui explore les symptomes perineaux. Notre objectif etait de realiser l’adaptation culturelle du FPFQ en langue francaise et d’evaluer ses proprietes psychometriques. Methodes Apres l’adaptation culturelle en francais, l’acceptabilite et la fiabilite du questionnaire ont ete evaluees dans un echantillon de 56 femmes dans le cadre d’un test–retest. La validite de construction discriminative a ete evaluee en comparant les resultats obtenus par le FPFQ a ceux d’autres questionnaires valides. Le suivi longitudinal des 282 femmes enceintes incluses dans l’etude prevention perineale prenatale (3PN) a permis l’evaluation de sa sensibilite aux changements. Resultats La proportion de donnees manquantes ne depassait pas 4 % pour les questions concernant le domaine urinaire, le domaine anorectal et le prolapsus genital ; 10 % pour les questions sur la sexualite. La question 9 a ete jugee difficile a comprendre par 14 % des femmes. Apres reformulation, cette question a ete testee dans un nouvel echantillon de 52 femmes et n’a pas pose de probleme de comprehension. Le coefficient de correlation intraclasse etait superieur ou egal a 0,7 pour tous les domaines au cours du test–retest. Le FPFQ etait fortement et significativement correle (Spearman r > 0,5) avec les autres questionnaires valides. La version francaise du FPFQ a enregistre des changements dans les symptomes urinaires et sexuels pour les femmes incluses dans l’essai 3PN avec une reponse moyenne standardisee egale a 0,83 et 0,44, respectivement. Conclusion La version francaise du FPFQ est auto-administrable, fiable, valide et peut detecter un changement de symptomatologie au cours d’un suivi longitudinal. Niveau de preuve Niveau 4.

Background & Aims Nonrelaxing pelvic floor dysfunction (N-RPFD), or dyssynergic defecation, is the paradoxical contraction and/or impaired relaxation of pelvic floor and anal muscles during defecation. Few studies have evaluated this disorder in patients with an ileal pouch–anal anastomosis (IPAA). We investigated the frequency of N-RPFD in patients with and without chronic pouchitis following IPAA and the effectiveness of biofeedback therapy within this population. Methods We conducted a retrospective study of all patients with an IPAA who underwent anorectal manometry between January 2000 and March 2015 (n = 111). N-RPFD was diagnosed in patients with symptoms consistent with a pouch evacuation disorder and 1 or more of the following abnormal tests: anorectal manometry, balloon expulsion test, barium or magnetic resonance defecography, or external anal sphincter electromyography. Patients who completed biofeedback therapy were identified and assessed to determine symptomatic response. Results Of the 111 patients evaluated, 83 (74.8%) met criteria for N-RPFD. A significantly higher proportion of patients with chronic pouchitis were diagnosed with N-RPFD than patients without chronic pouchitis (83.3% vs 62.2%, respectively; P = .012). Most patients diagnosed with N-RPFD had abnormal results from the balloon expulsion test (78.3%); 53.0% of patients diagnosed with N-RPFD had abnormal findings from external anal sphincter electromyography, 25.3% had abnormal defecography findings, and 20.5% had abnormal findings from anorectal manometry. Twenty-two patients completed biofeedback therapy: 15 patients (68.2%) had mild–moderate improvement and 5 patients (22.7%) had significant improvement of symptoms. Conclusions N-RPFD occurs in almost 75% of patients with an IPAA, especially in patients with chronic pouchitis. Biofeedback seems to be an effective therapy for patients with an IPAA and N-RPFD, but further studies are needed for validation.

Abstarct Objective The aim of this study was to assess the 1 and 2 years outcomes of transvaginal single incision mesh surgery (SIMS) for anterior pelvic organ prolapse (POP). Material and methods This was a prospective study including all patients from November 2008 to December 2012 who underwent SIMS for symptomatic anterior prolapse stage ≥2, according to the POP Quantification (POP-Q). Symptoms and quality of life were assessed using validated questionnaires: Pelvic Floor Distress Inventory (PFDI-20), Pelvic Floor Impact questionnaire (PFIQ-7), and Prolapse/Incontinence Sexual Questionnaire (PISQ-12). The main outcome was subjective success (question 3 of PFDI-20 score = 0). Safety, anatomic and functional outcomes were used as the secondary outcomes. Results A total of 270 patients were included in the study. Subjective success rate was 95,4% and 92,2% at 1 and 2 years. Objective success rate was 65,9%and 60,5% at 1 and 2 years. At 1 year, composite failure (subjective + objective) occurred for 11 patients (4,6%), 5 patients with direct recurrence and 6 with indirect recurrence. At 2 years, composite failure was reported for 14 patients (6,4%): 6 direct recurrences and 8 indirect recurrences. Re-treatment was performed in one case (0,4%). One case (0,4%) of asymptomatic mesh exposure occurred. The reoperation rate for mesh-related complications was 3%. We reported a de novo dyspareunia rate of 8,4%, 5,3% considered as mesh-related. A significant improvement was noted for symptoms and quality of life. Conclusion POP repair using SIMS is a safe and efficient treatment of anterior compartment prolapse in the medium term with a low rate of mesh-related complications. Longer-term follow-up is ongoing.

Our aim was to assess incidence and risk factors for pelvic pain after pelvic mesh implantation.Retrospective study (Canadian Task Force classification II-2).Single university hospital.Women who have undergone surgery with pelvic mesh implant for treatment of pelvic floor disorders including prolapse and incontinence.Telephone interviews to assess pain, sexual function, and general health.Pain was measured by the McGill Short-Form Pain Questionnaire for somatic pain, Neuropathic Pain Symptom Inventory for neuropathic pain, Pennebaker Inventory of Limbic Languidness for somatization, and Female Sexual Function Index (FSFI) for sexual health and dyspareunia. General health was assessed with the 12-item Short-Form Health Survey. Among 160 enrolled women, mean time since surgery was 20.8 ± 10.5 months, mean age was 62.1 ± 11.2 years, 93.8% were white, 86.3% were postmenopausal, and 3.1% were tobacco users. Types of mesh included midurethral sling for stress incontinence (78.8%), abdominal/robotic sacrocolpopexy (35.7%), transvaginal for prolapse (6.3%), and perirectal for fecal incontinence (1.9%), with 23.8% concomitant mesh implants for both prolapse and incontinence. Our main outcome, self-reported pelvic pain at least 1 year after surgery, was 15.6%. Women reporting pain were younger, with fibromyalgia, worse physical health, higher somatization, and lower surgery satisfaction (all p .05). Current pelvic pain correlated with early postoperative pelvic pain (p .001), fibromyalgia (p = .002), worse physical health (p = .003), and somatization (p = .003). Sexual function was suboptimal (mean FSFI, 16.2 ± 12.1). Only 54.0% were sexually active, with 19.0% of those reporting dyspareunia.One in 6 women reported de novo pelvic pain after pelvic mesh implant surgery, with decreased sexual function. Risk factors included younger age, fibromyalgia, early postoperative pain, poorer physical health, and somatization. Understanding risk factors for pelvic pain after mesh implantation may improve patient selection.

The evaluation of the patient with gas and bloating can be complex and the treatment extremely challenging. In this article, a simplified approach to the history and relevant physical examination is presented and applied in a case-oriented manner, suitable for application in the primary care setting.

Resume Introduction Le role de la grossesse dans l’apparition des troubles de la statique pelvienne est discute. Il pourrait y avoir au cours de cette periode un lien entre les modifications de laxite ligamentaire et les modifications de la statique pelvienne. Notre objectif etait de realiser une revue non systematique de la litterature concernant les modifications de la statique pelvienne et les modifications de laxite ligamentaire au cours de la grossesse puis du post-partum. Methodes A partir des bibliotheques PubMed, Medline, ScienceDirect, Cochrane Library et Web of Science nous avons selectionne les travaux traitant de l’evaluation clinique de la statique pelvienne ( pelvic organ prolapse quantification ), de l’evaluation echographique du hiatus des muscles elevateurs de l’anus et de la mobilite uretrale, de la laxite ligamentaire pendant la grossesse et en post-partum. Resultats Les examens cliniques realises pendant ces etudes mettent en evidence une distension clinique du plancher pelvien et une augmentation de sa mobilite pendant la grossesse puis une recuperation progressive en post-partum. L’imagerie du plancher pelvien montre une augmentation de surface du hiatus des muscles elevateurs de l’anus et de la mobilite uretrale pendant la grossesse puis une recuperation en post-partum. Differentes etudes attestent d’une augmentation de laxite ligamentaire (membres superieurs et inferieurs) pendant la grossesse puis une diminution en post-partum. Conclusion La statique pelvienne, la laxite ligamentaire, le hiatus des muscles elevateurs de l’anus, et la mobilite uretrale evoluent de maniere similaire (distension, augmentation de mobilite) et le post-partum (recuperation). Niveau de preuve 3.