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Abstract Background Stress urinary incontinence (SUI) is a common condition that requires proper evaluation to select a personalized therapy. Vaginal Tactile Imaging (VTI) is a novel method to assess the biomechanical parameters of the pelvic floor. Methods Women with SUI were enrolled in this cross-sectional study. Participants completed the Medical, Epidemiologic, and Social Aspects of Aging (MESA) questionnaire and the Patient Global Impression of Severity Question (PGI-S) and underwent a VTI examination. Based on the MESA and PGI-S questionnaires, participants were divided into mild, moderate, and severe SUI groups. Fifty-two biomechanical parameters of the pelvic floor were measured by VTI and compared between the groups (mild vs. moderate and severe). SUI Score and Index were calculated from the MESA questionnaire. Pearson correlation was used to determine the strength of association between selected VTI parameters and the MESA SUI Index and MESA SUI Score. Results Thirty-one women were enrolled into the study. Significant differences were observed in the VTI parameters 16, 22–24, 38, 39 when the difference between mild and severe subgroups of SUI based on the PGI-S score was examined. Parameter 16 refers to the maximum gradient at the perineal body, parameter 22–24 refers to the pressure response of the tissues behind the vaginal walls, and parameter 38, 39 refers the maximum pressure change and value on the right side at voluntary muscle contraction. VTI parameter 49, describing the displacement of the maximum pressure peak in the anterior compartment, showed a significant difference between the mild SUI and the moderate-severe SUI according to the MESA SUI score (mean ± SD 14.06 ± 5.16 vs. 7.54 ± 7.46, P = 0.04). The MESA SUI Index and SUI Score displayed a positive correlation concerning VTI parameters 4 (the maximum value of the posterior gradient) and 27 (the displacement of the maximum pressure peak in the anterior compartment) (VTI4 vs. MESA SUI Index r = 0.373, P = 0.039; VTI4 vs. MESA SUI Score r = 0.376, P = 0.037; VTI27 vs. MESA SUI Index r = 0.366, P = 0.043; VTI27 vs. MESA SUI Score r = 0.363, P = 0.044). Conclusions Female pelvic floor biomechanical parameters, as measured by VTI, correlate significantly with the severity of SUI and may help guide therapeutic decisions.

Background and Objectives: Urinary incontinence (UI) is the involuntary loss of urine caused by a weakness in the pelvic floor muscles (PFMs) that affects urethral closure. Myostatin, which prevents the growth of muscles, is a protein expressed by human skeletal muscle cells. Indeed, it has been observed that myostatin concentration rises during skeletal muscle inactivity and that suppressing serum myostatin promotes muscle growth and strength. Furthermore, therapeutic interventions that reduce myostatin signalling may lessen the effects of aging on skeletal muscle mass and function. For this reason, the aim of the study was to assess if flat magnetic stimulation technology affects serum myostatin levels, as myostatin can block cell proliferation at the urethral sphincter level. Materials and Methods: A total of 19 women, 75% presenting stress urinary incontinence (SUI) and 25% urgency urinary incontinence (UUI), were enrolled. A non-invasive electromagnetic therapeutic system designed for deep pelvic floor area stimulation was used for eight sessions. Results: The ELISA (enzyme linked immunosorbent assay) test indicated that the myostatin levels in blood sera had significantly decreased. Patients’ ultrasound measurements showed a significant genital hiatus length reduction at rest and in a stress condition. The Pelvic Floor Bother Questionnaire consistently revealed a decrease in mean scores when comparing the pre- and post-treatment data. Conclusions: Effective flat magnetic stimulation reduces myostatin concentration and genital hiatus length, minimizing the severity of urinary incontinence. The results of the study show that without causing any discomfort or unfavourable side effects, the treatment plan significantly improved the PFM tone and strength in patients with UI.

Pelvic floor muscle (PFM) strength is a critical factor for optimal pelvic floor function. Fluctuations in strength values based on different phases of the menstrual cycle (MC) could signify a need for a paradigm shift in evaluating, approaching, and planning training. This research aims to examine and contrast the pelvic floor muscle strength during different phases of the menstrual cycle. A prospective observational study employing digital assessment with the modified Oxford scale and vaginal dynamometry measurements was performed, in order to assess the baseline strength and the contraction strength of the PFMs in eumenorrheic females at three different phases of the MC: the early follicular phase (EFP), the late follicular phase (LFP), and the mid-luteal phase (MLP). During two complete cycles, tympanic temperature and body weight were measured and the urinary luteinizing hormone concentration was tested to determine the time of ovulation. In total, 216 dynamometric measurements of PFM strength were obtained from eighteen nulliparous women (25.72 ± 5.03 years). There were no differences between the baseline strength (p = 0.886) and the contraction strength (p = 0.756) with the dynamometric speculum. In the post hoc analysis, the baseline strength, contraction strength, and strength showed no significant differences between MC phases. As no differences in PFM strength in women were found, the PFMs do not seem to be weaker at any time during the menstrual cycle. It appears that the assessment, establishment, and monitoring of a PFM training program could be initiated at any point in the cycle.

Objective: This study investigated morphological changes in the composition of the pelvic floor muscles, degree of atrophy, and urethral function in a rat of simulated birth trauma induced by vaginal distension (VD) model. Methods: Female Sprague–Dawley rats were classified into four groups: a sham group, and 1, 2, and 4 weeks post-VD (1 W, 2 W, and 4 W, respectively) groups. We measured the amplitude of urethral response to electrical stimulation (A-URE) to evaluate urethral function. After measuring the muscle wet weight of the pubococcygeus (Pcm) and iliococcygeus (Icm) muscles, histochemical staining was used to classify muscle fibers into Types I, IIa, and IIb, and the occupancy and cross-sectional area of each muscle fiber were determined. Results: There were 24 Sprague–Dawley rats used. A-URE was significantly lower in the 1 W group versus the other groups. Muscle wet weight was significantly lower in the VD groups versus the sham group for Pcm. The cross-sectional area of Type I Pcm and Icm was significantly lower in the VD groups versus the sham group. Type I muscle fiber composition in Pcm was significantly lower in the VD groups versus the sham groupand lowest in the 2 W group. Type I muscle fiber composition in Icm was significantly lower in the 2 and 4 W groups versus the sham group. Conclusion: Muscle atrophy and changes in muscle composition in the pelvic floor muscles were observed even after improvements in urethral function. These results may provide insight into the pathogenesis of stress urinary incontinence after VD. [ABSTRACT FROM AUTHOR]

Background: Control of pelvic floor muscles (PFM) is emphasized as important to obtain functional breath support in opera singing, but there is not much research that proves PFM function as part of breath support in classical singing. Transperineal ultrasound is a reliable method for quantification of PFM contraction in urogynecology. Our aim was to establish if transperineal ultrasound can be used for observation of movement of the PFM during singing and to quantify pelvic floor contraction. Methods: Cross sectional study of 10 professional opera singers examined with transperineal ultrasound in the supine position at rest and contraction, and standing at rest and during singing. Levator hiatal area was measured in a 3D rendered volume. Levator hiatal anteroposterior (AP) diameter and bladder neck distance from symphysis were measured in 2D images. Results: The AP diameter was shortened from supine rest to contraction (15 mm), standing (6 mm) and singing (9 mm), all p < 0.01. The bladder neck had a non-significant descent of 3 mm during singing. The mean proportional change in AP diameter from rest to contraction was 24.2% (moderate to strong contraction) and from rest to singing was 15% (weak to moderate contraction). Conclusions: Transperineal ultrasound can be used to examine the PFM during singing. The classically trained singers had good voluntary PFM contraction and moderate contraction during singing. AP diameter was significantly shortened from supine to upright position, with further shortening during singing, confirming that female opera singers contracted their pelvic floor during singing. Brief summary: Transperineal ultrasound can be used to assess pelvic floor muscle contraction during singing. Clasically trained singers contract their pelvic floor muscles during singing. [ABSTRACT FROM AUTHOR]

Background: Urinary retention is a common complication of spinal cord injury (SCI), which can seriously affect the quality of life of patients. Function magnetic stimulation (FMS) has been widely used in the recovery of neurological function in various diseases, but its application in urinary retention after SCI remains unclear. Therefore, we would like to conduct a pilot randomized controlled trial (RCT) to observe the feasible effect of FMS on urinary retention after SCI, to explore its mechanism of action. Method/design: This is a single-center pilot RCT, which 60 patients with urinary retention after SCI will be selected, numbered in chronological order of hospitalization, and randomly divided into 4 groups using the random number table method, Groups A (control group), Group B, Group C, and Group D; Each group will receive the same conventional rehabilitation treatment. The whole intervention period 2 weeks and will be evaluated before and after treatment to collect data on residual bladder volume, functional near-infrared spectroscopy (fNIRS), changes in voiding condition, changes in surface electromyography (SEMG) values of pelvic floor muscle and quality of life scores (QoL). Study hypothesis: We hypothesized that FMS for the treatment of urinary retention after SCI would have a significant clinical feasible effect;and that peripheral combined with central FMS would be more effective than single-site FMS for the treatment of urinary retention after SCI. Objective: (1) To illustrate the clinical effectiveness of FMS in the treatment of urinary retention after SCI and to provide a new treatment modality for the patients; (2) Comparison of the differences in the efficacy of central and peripheral single FMS and combined central and peripheral FMS in the treatment of urinary retention after SCI; (3) To explore the central control mechanisms of bladder function recovery after SCI in conjunction with changes in fNIRS. Trial registration: This study has been ethically approved by the Scientific and Ethics Committee of the First Affiliated Hospital of Gannan Medical university with approval number (LLSC-2022112401). It has been registered with the China Clinical Trials Registry with the registration number: ChiCTR2200067143. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic sacral colpopexy (LSC) is the gold standard treatment for women with apical/anterior pelvic organ prolapse (POP). For isolated posterior vaginal prolapse, instead, the literature suggests fascial native tissue repair. This is a retrospective 2-year quality-of-life follow-up study after laparoscopic posterior plication (LPP) combined with LSC in patients with anterior/apical prolapse combined with severe posterior colpocele. The primary endpoint was to evaluate the subjective outcomes quality of life (QoL), sexual function, and patient satisfaction rate. The secondary endpoint was to evaluate perioperative and anatomical outcomes at the 2-year follow-up. Methods: A total of 139 consecutive patients with anterior and/or apical prolapse (POP-Q stage ≥ II) and severe posterior vaginal prolapse (posterior POP-Q stage ≥ III) were retrospectively selected from our database among women who underwent, from November 2018 to February 2021, a "two-meshes" LSC. The patients were classified into Group A (81 patients; LSC plus LPP) and Group B (67 patients; LSC alone). The primary endpoint was evaluated using the Patient Global Impression of Improvement (PGI-I), the Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6), the Pelvic Floor Impact Questionnaire-7 (PFIQ-7), the Female Sexual Distress Scale (FSDS), the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12), and the EuroQol (EQ-5D). The secondary endpoint was studied using the POP-Q study and an intra-, peri-, and post-operative complications assessment. Two-year follow-up data were analyzed for the study. Results: At 2 years, all women showed a statistically significant amelioration of their symptoms on the QoL questionnaires. We found a statistical difference in favor of posterior plication in terms of the PGI-I successful outcome rate (Group A versus B: 85.3% versus 67.1%), FSDS (median 11 versus 21), and PISQ-12 (median 89 versus 62) (p < 0.05 for all comparisons). A significant improvement of all EQ-5D values was observed from baseline to 2-year follow-up, and only for the "pain/discomfort" domains did we observe a significant improvement in LSC plus LPP patients versus LSC alone (p < 0.05). LSC plus LPP women showed, at 2 years, a significant amelioration of their Ap and GH POP-Q points. We observed no statistical differences in terms of intra-post-operative complications or anatomic failure rate between groups. Conclusions: Our LPP approach to LSC appears to be a safe, feasible, and effective treatment for advanced pelvic organ prolapse with a significant impact on the patient's general health and sexual quality of life. Adding laparoscopic posterior vaginal plication to "two-meshes" sacral colpopexy is recommended in patients with apical/anterior prolapse and concomitant severe posterior colpocele. This surgical approach, in addition to improving the anatomical results of these patients, is associated with a significant improvement in sexual and quality of life indexes. [ABSTRACT FROM AUTHOR]

Mammalian pregnancy requires gradual yet extreme remodeling of the reproductive organs to support the growth of the embryos and their birth. After delivery, the reproductive organs return to their non-pregnant state. As pregnancy has traditionally been understudied, there are many unknowns pertaining to the mechanisms behind this remarkable remodeling and repair process which, when not successful, can lead to pregnancy-related complications such as maternal trauma, pre-term birth, and pelvic floor disorders. This study presents the first longitudinal imaging data that focuses on revealing anatomical alterations of the vagina, cervix, and uterine horns during pregnancy and postpartum using the mouse model. By utilizing advanced magnetic resonance imaging (MRI) technology, T1-weighted and T2-weighted images of the reproductive organs of three mice in their in vivo environment were collected at five time points: non-pregnant, mid-pregnant (gestation day: 9–10), late pregnant (gestation day: 16–17), postpartum (24–72 h after delivery) and three weeks postpartum. Measurements of the vagina, cervix, and uterine horns were taken by analyzing MRI segmentations of these organs. The cross-sectional diameter, length, and volume of the vagina increased in late pregnancy and then returned to non-pregnant values three weeks after delivery. The cross-sectional diameter of the cervix decreased at mid-pregnancy before increasing in late pregnancy. The volume of the cervix peaked at late pregnancy before shortening by 24–72 h postpartum. As expected, the uterus increased in cross-sectional diameter, length, and volume during pregnancy. The uterine horns decreased in size postpartum, ultimately returning to their average non-pregnant size three weeks postpartum. The newly developed methods for acquiring longitudinal in vivo MRI scans of the murine reproductive system can be extended to future studies that evaluate functional and morphological alterations of this system due to pathologies, interventions, and treatments. [ABSTRACT FROM AUTHOR]

Background: Untreated, urgency urinary incontinence (UUI) and overactive bladder (OAB) can precipitate a vicious cycle of decreasing physical activity, social isolation, fear of falling, and falls. Structured behavioral interventions and medications are common initial treatment options, but they elicit their effects through very different mechanisms of action that may influence fall-related outcomes differently. This study will determine the feasibility of conducting a comparative effectiveness, three-arm, mixed methods, randomized clinical trial of a behaviorally based pelvic floor muscle training (PFMT) intervention versus two recent drug options in older women with UUI or OAB who are also at increased risk of falling. Methods: Forty-eight women 60 years and older with UUI or OAB who screen positive for increased fall risk will be recruited through the urogynacology and pelvic health clinics of our university health system. Participants will be randomly assigned to one of three 12-week treatment arms: (1) a course of behavioral and pelvic floor muscle training (PFMT) provided by physical therapists; (2) the beta-3 agonist, mirabegron; and (3) the antimuscarinic, trospium chloride. Study feasibility will be established through objective metrics of evaluability, adherence to the interventions, and attrition. We will also assess relevant measures of OAB symptom severity, quality of life, physical activity, incident falls, and concern about falling. Discussion: The proposed research seeks to ultimately determine if linkages between reduction in UI symptoms through treatment also reduce the risk of falling in this patient population. Trial registration: NCT05880862. Registered on 30 May 2023. [ABSTRACT FROM AUTHOR]

Background: The primary aim of this study was to compare the quality of life between women with obstetric anal sphincter injury (OASI) and women with intact perineum or minor vaginal tears following their first vaginal birth through a validated urogynaecological questionnaire. As a secondary aim, we wanted to identify the specific symptoms for pelvic floor dysfunction after a vaginal birth. Methods: One hundred thirty-three cases (III- and IV-degree vaginal tears) and 133 controls (intact perineum or I- and II-degree vaginal tear) were asked to fill the PFDI-20 condition-specific and quality of life survey at three and 12 months after vaginal delivery. The survey evaluates pelvic floor dysfunction symptoms through three subsections: the Pelvic Organ Prolapse Distress Inventory (POPDI), the Colorectal-Anal Distress Inventory (CRADI), and Urinary Distress Inventory, (UDI). The scoring system ranges from 0 (no distress) to 100 (maximum distress) for each subsection, subsequently summed up to obtain the summary score (0 to 300). The patients recruited were asked to complete the survey at 3- and 12-months follow-up visit. Accordingly, data collection started. Categorical variables were subjected to Chi-square test or Fisher's Exact test. Quantitative variables were compared through Student's t-test or Mann-Whitney test. Results: All surveys have shown statistically significant differences when comparing the cases to the control group. Consequently, PFDI-20 has shown a strong correlation between III- and IV-grade lacerations and pelvic floor dysfunction persistence at 12 months after delivery. Intestinal symptoms were the most reported disturbances among women with previous OASI. Conclusions: Major vaginal tears have demonstrated to have a strong impact on women's quality of life up to a follow-up of 12 months. The use of PFDI-20 questionnaire is a useful and valid tool in the diagnosis and follow-up of genital prolapse, fecal and urinary incontinence in primiparous women with a history of OASI. Thus, its application in clinical practice can help offering the most adequate rehabilitative treatment. [ABSTRACT FROM AUTHOR]

Background: This study was designed to inspect the effectiveness of Hypopressive exercise and Kegels exercise for pelvic organ prolapse among patients with spontaneous vaginal delivery. Pelvic organ prolapse is when one or more organs of the pelvis slip down from their normal position and bulge into vagina. Hypopressive exercises help to rectify the prolapse and minimizes its severity. Kegels exercises are usually done for pelvic floor muscle training. Purpose: To compare the effectiveness of Hypopressive and Kegels exercise for pelvic organ prolapse among spontaneous vaginal delivery. Materials and Methods: Total of 42 participants were selected from C3 Care Cure Comfort clinic according to inclusion and exclusion criteria, and the participants were explained about the treatment and written consent were obtained. The subjects underwent study for a time period of 4 months from April 2023-July 2023 and results were obtained. The participating subjects were randomly allocated into two groups, Hypopressive exercise group "and" Kegels exercise group. All the subjects underwent pre-test measurement with modified oxford scale and pelvic floor impact questionnaire at the beginning of the treatment. Results: statistical analysis of data showed significant differences not only in the Hypopressive group but also in the Kegels exercise group. The Hypopressive group was significantly higher than Kegels exercise group, with a p value of <0.0001. Conclusion: Hypopressive exercise is more effective than Kegels exercise for pelvic organ prolapse among spontaneous vaginal delivery. The study was done for a short period of time with a small group of people. [ABSTRACT FROM AUTHOR]

Background: Menopause leads to a dramatic drop in ovarian function which lower the oestrogen in the circulating blood may cause atrophy of vaginal epithelium. Traditionally the atrophy of vaginal epithelium was managed by Kegels exercise but not attempted using reverse Kegels exercise. Purpose: This present study attempted the reverse Kegels exercise and compares the effectiveness with traditional Kegels exercise on vaginal atrophy and vaginal pH among postmenopausal women. Materials and Methods: 32 postmenopausal women in the age group between 40 to 60 years with vaginal atrophy were recruited and randomly assigned to one of the two groups: Traditional Kegels group (n=16) and Reverse Kegels group (n=16). The vulvovaginal symptom questionnaire (VSQ) and vaginal pH test kit were used as outcome measures to assess the vulvovaginal symptoms and vaginal pH level before and after the intervention. Results: The t-test analysis was used to analyse the comparison within and between the groups. The p value of the Vulvovaginal symptom questionnaire in post-test values between the groups was 0.0256 (p value < 0.05) which was statistically significant. Conclusion: Based on the outcome measures the participants in the traditional Kegels exercise found to be better in reliving the vulvovaginal symptoms. However, the vaginal pH level in both the groups after intervention does not show any changes. [ABSTRACT FROM AUTHOR]

Background: Vaginal laxity defined according to the International Urogynecological Association/International Continence society is excessive vaginal looseness; it is one of the most common symptoms of pelvic floor dysfunction, which refers to medical/functional disorders that can have a significant impact on a woman's sexual self‐esteem and sexual life. Aim: This study aimed to determine the impact of the Knack Technique on Pelvic floor muscle (PFM) and sexual function in women with vaginal laxity. Methods: Thirty females complaining of vaginal laxity were randomly chosen from the outpatient clinic at Deraya University. Their ages varied from 35 to 45 years, their body mass index was 25–30 kg/m2, and a number of parities ≤ three normal vaginal deliveries and at least two years from the last delivery complaining about vaginal laxity, water entrapment, and loss of friction during sexual intercourse. They were randomized into two equal groups at random (A, B). Group A (15 females) received (PSTES) and group B (15 females) received (PSTES) and Knack Technique. Both the groups received three sessions per week for 2 months. Evaluation: The outcome measures were evaluated through pre‐ and post‐interventions by using ultrasonography imaging to assess PFM function, Sexual Satisfaction Index, and Vaginal Laxity Questionnaires (VLQ) to assess sexual function. Results: Analysis indicated a significant improvement in vaginal laxity in the two groups. Comparison between groups pre‐ and posttreatment showed that there was no statistically significant difference between the groups B and A in SSI and VLQ, while there were significant differences between the groups A and B in PFM force. Conclusion: Combining Parasacral transcutaneous electrical stimulation (PSTES) and Knack Technique is more effective than PSTES alone in reducing vaginal laxity as well as improving PFM and sexual function in women with vaginal laxity. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The aim of this study was to determine the prevalence of Diastasis of the rectus abdominis muscles (DRAM) and pelvic floor muscle dysfunction (PFMD) in postpartum women. Design: The observational prospective study. MATERIAL: 150 of 180 women (83.3 %) from 6 weeks to 6 months postpartum, with a mean age of 33.1 years. METHODS: For diastasis examination, inter recti distance (IRD) was measured by a linear 2D ultrasound probe, 4.5 cm above the navel, in its area and 4.5 cm below the navel when lying on the back at rest and under a load test. The degree of DRAM was classified into four grades. Urinary leakage symptoms were assessed by the International Incontinence Consultation Questionnaire (ICIQ - UI SF). RESULTS: The first degree of diastasis during the load test was 38.1 % above the navel, 36.4 % in the navel area, and 23.7 % below the navel. The second degree of diastasis with load was 28.8 % above the navel, 21.2 % in the navel area, and 10.2 % below the navel. PFMD showed 31.3 % of women with mild symptoms of SUI, 32.2 % of women with grade 1 cystocele. CONCLUSION: The average IRD distance at rest and during the load test confirmed the first grade of DRAM out of four degrees of severity. Moderate and medium DRAM occurred according to location in an average of one-third of the cases. The highest percentage of DRAM was above the navel, and the lowest percentage below the navel. PFMD was detected in an average of one-third of cases. It is important to monitor these parameters with a view to improving the quality of life index in the future (Tab. 5, Ref. 22). [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The objective of this study was to identify the potential characteristics of pelvic floor muscles (PFM) in the preoperative assessment that could be associated with post-surgical prolapse severity. We hypothesized that the same variables, if identified, could be addressed in preoperative rehabilitation to improve surgical results. Methods: This was a single-center prospective observational study that included women who underwent surgical pelvic organ prolapse repair between 2020–2022. Genital prolapse was evaluated according to the Pelvic Organ Prolapse Quantification (POP-Q) system. All the participants underwent a PFM assessment, including a vaginal digital assessment and manometry (Peritron™ 9300 V) before surgery and at 1-, 3-, and 6-month follow-ups. Several PFM variables were recorded: vaginal resting pressure, vaginal pressure during maximal voluntary contraction (MVC), area under the curve during a 10-second MVC, ability to correctly contract the PFMs, and reflexive activation during cough and relaxation. The primary endpoint of the analysis was objective surgical success defined as POP-Q 0 or 1 at the 6-month follow-up. Additionally, a change in pelvic floor muscle function was recorded during postoperative visits. Results: A total of 106 females were included in the study. Fifty-one were lost during the 6-month follow-up, which is a major limitation of the study. None of the examined parameters evaluating PFM were associated with surgical success. No statistically significant difference was found in MVC and PFM endurance before and after surgery. Post-surgery, a significant change was observed in the vaginal resting pressure and the ability to correct PFM activation and relaxation. Conclusions: Preoperative PFM function is not associated with surgical success 6 months after surgery. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Women with central sensitisation syndrome (CSS) experience poorer subjective post-operative outcomes even after successful pelvic floor reconstruction. This study tests the hypothesis that women with pelvic floor symptoms (PFS) without relevant pelvic organ prolapse (POP), are more likely to have CSS. Methods: A questionnaire was sent to women who participated in the POP-UP study in 2017. The POP-UP study evaluated POP in 247 women 16 years after laparoscopic or vaginal hysterectomy. POP-Q data and Pelvic Floor Distress Inventory (PFDI-20) results were used and supplemented with CSS-specific questionnaires. A Central Sensitisation Inventory (CSI) score above 40 implicates CSS. Women were divided into groups based on POP beyond the hymen in relation to the PFDI-20 score. Outcomes of women with PFS and without POP (called 'group 1') were compared with the rest of the cohort (groups 2–4; women without PFS and/or with POP). Results: A total of 136 women were included in the analysis. A CSI score above 40 was present in 16 out of 42 women of group 1 (37%) versus 11 out of 93 women of groups 2–4 (12%), p < 0.0001. Passive coping was more prevalent in group 1 (p = 0.039), and more deviations in somatisation, depression, anxiety and distress were found in group 1 (p values of < 0.0001, 0.018, 0.003 and 0.002 respectively). Conclusions: This study suggests that CSS might be more prevalent in women with PFS without relevant POP. More awareness of CSS and valid individual counselling may overcome unnecessary surgery for POP and help in setting realistic expectations. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Pelvic floor myofascial pain (PFMP) is a common but underrecognized component of chronic pelvic pain and pelvic floor disorders symptoms with limited, well-studied treatment modalities. Our objective was to determine the effect of vaginal cryotherapy on PFMP with palpation. Methods: Following a standardized PFMP screening examination, individuals with a pain score ≥4/10 in ≥1 of four muscle groups were invited to participate in a randomized controlled trial comparing patients undergoing vaginal cryotherapy with controls. Participants in both arms could choose to participate in a single in-office treatment; a 2-week, at-home daily treatment; or both. Results: Between March 2019 and September 2021, a total of 163 participants were enrolled and randomized: 80 to cryotherapy, and 83 to the control group. Sixty-three (28 cryotherapy; 35 controls) completed in-office treatment and 56 (32 cryotherapy; 24 controls) completed at-home therapy. In the in-office comparison, mean pain scores decreased significantly in both arms: cryotherapy (5.13 vs 4.10; p=0.02) and controls (5.60 vs 4.72; p<0.01), with a similar magnitude of reduction between arms (p=0.75). In the at-home comparison, mean pain scores decreased significantly in the cryotherapy arm (6.34 vs 4.75; p<0.01), and nonsignificantly in the control arm (5.41 vs 4.66; p=0.07), resulting in a nonsignificant difference between arms (p=0.14). Conclusions: Pelvic floor myofascial pain with palpation improved following both a single cryotherapy session and 2 weeks of daily cryotherapy. Interestingly, pain scores also improved with room temperature therapy. Whether these findings reflect a therapeutic effect of both cold and room temperature intravaginal therapy or a placebo effect is unclear but should be explored in larger studies. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The aim of this study was to examine the impact of a single running session on pelvic floor morphology and function in female runners, and to compare those with and without running-induced stress urinary incontinence (RI-SUI). Methods: This cross-sectional, observational study involved two groups: female runners who regularly experienced RI-SUI (n = 19) and runners who did not (n = 20). Pelvic floor muscle (PFM) properties were assessed using intravaginal dynamometry during maximal voluntary contractions (MVC) and during passive tissue elongation. The morphology of the pelvic floor was assessed at rest, during MVC and during maximal Valsalva maneuver (MVM) using 2D and 3D transperineal ultrasound imaging before and after a running protocol. Mixed-effects ANOVA models were used to compare all outcomes between groups and within-groups, including the interaction between group and time. Effect sizes were calculated. Results: No changes in PFM function assessed using intravaginal dynamometry were observed in either group after the run. Significant and large within-group differences were observed on ultrasound imaging. Specifically, the area and antero-posterior diameter of the levator hiatus were larger after the run, the bladder neck height was lower after the run, and the levator plate length was longer after the run (p ≤ 0.05). At the peak MVM and MVC, the bladder neck height was lower after the run than before the run (p ≤ 0.05). No between-group differences were observed for any outcomes. Conclusions: Running appears to cause transient strain of the passive tissues of the female pelvic floor in runners both with and without RI-SUI, whereas no concurrent changes are observed in PFM contractile function. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Patients with chronic functional constipation have some problems such as weakness of pelvic floor muscles, and a lack of coordination of pelvic floor and abdominal muscles has been seen. The goal of this study was to investigate the lumbar proprioception and the core muscle recruitment pattern. Methods: The study type is a cross-sectional case–control study. There were 30 participants (case, n = 15, and control, n = 15). Electromyography of the core muscles was recorded while the subjects were getting up from the chair accompanied by lifting a weight, to check the pattern of muscle recruitment. Moreover, the lumbar proprioception was evaluated by an isokinetic device in both groups. The study was analyzed using independent t test and Mann–Whitney U test, and a nonparametric Friedman test was performed followed by Bonferroni pairwise comparison. Results: The comparison of muscle activity delay between the two groups showed that there was a significant difference between the two groups regarding the abdominal muscles, anal sphincter, and erector spinae (p < 0.05). However, there was no significant difference in the rectus femoris and gluteal muscles between the two groups (p > 0.05). Moreover, the proprioception of the lumbar region showed a significant difference (p < 0.05) between the two groups. Conclusions: The results of this study demonstrated that the lumbar proprioception sense was reduced in the case group. This result can be justified, based on the problems in constipation (lack of coordination of muscles, weakness of pelvic floor muscles). The coordination of core muscles changed in patients with chronic functional constipation during a functional task. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Most of the literature on pelvic organ prolapse (POP) has been generated from postmenopausal patients in high-income countries. In the Democratic Republic of the Congo (DRC), a significant proportion of patients who present for surgical management of POP are premenopausal. Little is known about the impact of POP on pelvic floor symptoms in this population. The objective was to describe pelvic floor symptoms and sexual function among premenopausal patients presenting for POP surgery in DRC. Methods: We performed a prospective cohort study of symptomatic premenopausal patients undergoing fertility-sparing POP surgery at a large referral hospital in the DRC. Pelvic floor symptoms were evaluated with the Pelvic Floor Distress Inventory Questionnaire and sexual function with the Pelvic organ prolapse/urinary Incontinence Sexual Questionnaire. Data are presented as means with standard deviations or counts with percentages. Results: A total of 107 patients were recruited between April 2019 and December 2021. All had either stage III (95.3%) or stage IV (4.7%) prolapse. Ages were 34.2 ± 6.7 years; 78.5% were married. A majority of patients experienced low abdominal pain (82.2%), heaviness or dullness (95.3%), and bulging or protrusion of the prolapse (92.5%). Almost two-thirds of patients reported no longer being sexually active, and 80% stated that they were not sexually active because of POP. Of the 37 sexually active patients (34.6%), nearly all reported significant sexual impairment because of the prolapse, with only 4 reporting no sexual impairment. Conclusions: This study represents one of the largest prospective series of patients with premenopausal POP. Our results highlight the severity of pelvic floor symptoms and the negative effects on sexual function among this patient population with POP. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The aim of the study was to perform a systematic review and meta-analysis of the impact of pregnancy and childbirth (vaginal delivery [VD]) or cesarean section (CS) on the recurrence of pelvic floor disorders in women who had previously undergone pelvic floor reconstructive surgery for pelvic organ prolapse (POP) or stress urinary incontinence (SUI), to facilitate future evidence-based counseling. Methods: PubMed, Cochrane, Embase, BJOG, Scopus, etc. were screened, from 1990 to date. Inclusion criteria included cohort studies, case–control studies, case series, and case reports that reported on the primary outcome measure of the review. Exclusion criteria included studies on surgical procedures whose outcomes are unlikely to be impacted by pregnancy and childbirth or are obsolete. Meta-analysis was performed using Review Manager 5.3. Results: Seven papers on midurethral slings (MUS; 181 women in both VD and CS groups respectively) and three papers on different hysteropexy techniques (47 and 29 women in the VD and CS groups respectively), were included in the meta-analysis. No difference was seen between the two groups regarding the recurrence of SUI in women who had previously undergone MUS surgery (OR: 1.18 [0.66, 2.09]; Z = 0.56; p = 0.58) or the recurrence of POP following hysteropexy using various apical suspension procedures (OR: 1.81 [0.04, 80.65]; Z = 0.31; p = 0.76). There are insufficient data to support meta-analyses for individual MUS sub-types or hysteropexy procedures. Conclusion: Current literature does not demonstrate a protective effect of CS in preventing recurrent SUI in women who had undergone MUS surgery for SUI. When hysteropexy is considered irrespective of the apical suspension procedure employed, the incidence of recurrent POP appears similar after CS and VD. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: How body mass index (BMI) affects pelvic floor function after a second-degree perineal laceration is unknown. The hypothesis of this study is that pelvic floor dysfunction and complications after an obstetric second-degree perineal laceration are more common in women with a higher BMI 8 weeks postpartum. Methods: This register-based cohort study includes 10,876 primiparous women with an obstetric second-degree perineal laceration between 2014 and 2021. Data were retrieved from the Swedish Perineal Laceration Registry. Outcomes in relation to maternal BMI were urinary incontinence (UI), anal incontinence (AI) and common complications attributable to the laceration. Uni- and multivariate logistic regressions were used for comparison between normal weight (BMI < 24.9, reference), overweight (25.0–29.9) and obese (≥ 30) women. Results: Multivariate analyses showed an increased risk for UI in both overweight and obese women compared to normal-weight women 8 weeks after a second-degree perineal laceration with an adjusted odds ratio (aOR) of 1.21 (CI 1.02–1.44) and 1.27 (CI 1.13–1.58) respectively. Overweight and obese women had a decreased risk for AI (aOR 0.81, CI 0.68–0.96; aOR 0.72, CI 0.57–0.90 respectively) compared with normal-weight women. No significant differences were found in the univariate analyses over BMI strata concerning complications after perineal laceration. Conclusions: Primiparous overweight and obese women report less AI and more UI than normal-weight women 8 weeks after a second-degree perineal laceration. No differences were found regarding complications. These findings are new and merit further study to find potential preventive factors and interventions after a second-degree perineal laceration. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The Variation in Surgical Technique study (VaST), demonstrated the large variation in surgical techniques used in native tissue (NT) anterior pelvic organ prolapse (POP) repairs. However, there are few comparative studies of different surgical techniques. This study was aimed at exploring whether surgical technique influenced the outcomes of NT anterior POP repairs. Methods: The surgical techniques of 22 consultant surgeons performing NT anterior POP repairs were filmed and categorised. These surgeons performed 809 anterior repairs within the PROlapse Surgery: Pragmatic Evaluation and randomised Controlled Trial (PROSPECT). Logistical regression models were used to determine the influence of the different surgical techniques on subjective and objective outcomes, using data collected during PROSPECT. Results: In adjusted multivariate linear regression models, fascial-flap repair was associated with an improved subjective outcome (POP-SS) compared with midline plication (β = −2.50 [−4.42 to −0.57]; p = 0.01). At 12 months, separate fascial defect repair was associated with a poorer objective outcome than midline plication (OR 6.06 [1.82–3.52], p = 0.006). At 24 months, deep dissection was associated with a poorer POP-SS than superficial dissection (0.32–2.60, p = 0.0). Continuous-locking closure of the skin was also associated with improved POP-SS compared with continuous non-locking closure (12 months: β = −1.94 [−3.42 to −0.45], p = 0.01). Conclusion: Surgical technique may influence the outcome of native tissue anterior POP repairs. Our results should not change practice but inform future research; to develop methods of explicitly recording surgical techniques and allow confirmation of the effect of these aspects of technique on outcome. [ABSTRACT FROM AUTHOR]

Aim: The role of colorectal surgeons in the management of acute obstetric anal sphincter injury (OASI) is an ongoing debate. Their expertise in operating in the anorectal region lends itself to assisting in OASI repair. The aim of this study was to establish the current involvement and recommended management of acute OASI by colorectal surgeons. Method: An online survey of consultant colorectal surgeons was sent to members of the Pelvic Floor Society to assess current involvement in acute OASI management and repair. Results: Forty completed surveys were collated and analysed. Sixty‐five per cent of respondents had seen an acute OASI since being a consultant and 50% stated they were involved in the repair of OASI less than once per year. 37.5% felt that a de‐functioning stoma was still necessary sometimes. Many agreed with current guidelines for OASI repair in terms of antibiotics, laxatives and follow‐up. Conclusions: Colorectal surgeons have varied opinions on the management of OASI. We suggest that multidisciplinary training of obstetricians and colorectal surgeons could lead to more collaboration regarding the management of women with acute OASI. [ABSTRACT FROM AUTHOR]

Introduction: The Sacroiliac joint (SIJ) serves as a crucial connection between the sacrum and ilium, playing a vital role in transferring forces during physical activity. Its biomechanical function is essential for stability, supported by ligaments and pelvic floor muscles. However, SIJ dysfunction can contribute to lower back pain, a condition affecting 70-85 % of Western society. Causes: SIJ dysfunction can stem from various factors, including abnormal motion or malalignment, triggered by arthritis, trauma, or atypical gait patterns. Diagnosis: Diagnosis SIJ dysfunction involves physical examinations such as FABER, compression, distraction, thigh thrust, and Gaenslen tests. Typically, three positive provocative test results are required for diagnosis, supplemented by imaging techniques like X-rays, MRIs, and joint injections. Misdiagnosis: Despite the availability of diagnostic methods, SIJ dysfunction is frequently misdiagnosed due to symptoms overlap with other conditions and overlooked etiology. Treatment: Upon diagnosis, SIJ dysfunction can be managed with conservative measures like physical therapy and NSAIDs, or more invasive interventions such as surgery. Conclusion: SIJ dysfunction is a prevalent yet often misdiagnosed condition, emphasizing the importance of raising awareness among both the public and clinicians to ensure accurate diagnosis and appropriate treatment. [ABSTRACT FROM AUTHOR]

Urinary incontinence is still an underestimated problem due to its anatomical complexity and social taboo. Most of the time, it is believed to affect predominantly the elderly female population, and the literature still lacks data on its presence in the younger and male populations. Its relationship with other pelvic floor dysfunctions (PFDs) and sport activity remains an open topic. Thus, the present study surveyed 342 subjects of both genders, ranging from 18 to 39 y/o and with different sport activity levels, to understand the prevalence of PFDs (such as haemorrhoids, anal fissures, involuntary urinary/faecal leakage, and urgency). The results also showed a significative prevalence in younger, sporty, and male people. Approximately one third of the population had urinary incontinence mostly during stress activities (sport activity: 17%, cough/sneeze: 13%). The statistical analysis confirmed a higher prevalence in the cases of a light (32%) and intense (41%) sport activity level and a protective role of sport if practiced between 5 and 10 h/week, with bodybuilding/CrossFit and running seeming to be the riskiest sports. The relationship with the other PFDs showed a statistically significant dependence with most of them, confirming that urinary incontinence cannot be considered a separate problem from the other PFDs. [ABSTRACT FROM AUTHOR]

This study investigates the impact of pelvic floor muscle training (PFMT) on sexual function and distress in women with multiple sclerosis (MS), a prevalent chronic nervous system disorder associated with sexual dysfunction. This study's primary aim was to assess the effectiveness of PFMT at improving sexual function and alleviating sexual distress in this population. In a randomised controlled trial, 82 women with MS were divided into two groups: Group A (41 women) underwent 12 weeks of PFMT, while Group B (41 women) served as a control group with no intervention. Both groups were assessed at the beginning and end of this study using the Female Sexual Function Index (FSFI) and Female Sexual Distress Scale-Revised (FSDS-R). Statistical analysis, including Chi-square tests, was employed to compare the outcomes between the two groups, with a p-value of less than 0.05 considered significant. The results revealed no significant differences in baseline sexual function and distress between the groups. However, at the conclusion of the 12-week period, Group A exhibited statistically significant improvements in nearly all domains of FSFI and FSDS-R compared to Group B, except in the pain domain. This study concludes that PFMT can effectively enhance sexual function and reduce sexual distress in women suffering from MS. These findings underscore the potential of PFMT as a therapeutic intervention in managing sexual dysfunction associated with MS. [ABSTRACT FROM AUTHOR]

This study aimed to examine the impact of fractional CO2 laser treatment of pelvic symptoms in women who have undergone perineal trauma from vaginal delivery. It was a retrospective, monocentric analysis that encompassed all women assessed for pelvic discomfort or signs of vulvovaginal atrophy following vaginal delivery between 2013 and 2018. The severity of symptoms was assessed using the Visual Analogue Scale (VAS). Twenty-seven patients met the inclusion criteria and were sorted into two groups: (1) women who had undergone episiotomies during labor (n = 11); and (2) women who had experienced spontaneous tears during vaginal delivery (n = 16). For women with episiotomies, each treatment and subsequent evaluation consistently showed a significant reduction in dyspareunia intensity. A similar positive trend was observed regarding pain at the introitus (7.5 vs. 6.5 after the first treatment, p = 0.03; 6.5 vs. 3 after the second treatment, p = 0.01; 3 vs. 1 after the third treatment, p = 0.01). Among women experiencing spontaneous perineal tears during delivery, there was a notable decrease in dyspareunia following all treatments (8 vs. 7 after the first treatment, p = 0.01; 8 vs. 4 after the second treatment, p = 0.02; 3 vs. 1 after the third treatment, p = 0.03). The impact of laser treatment did not exhibit significant differences between women who underwent episiotomies and those who experienced spontaneous perineal tears. In conclusion, fractional CO2 laser can be regarded as a non-pharmacological option for managing pelvic floor symptoms in women who encountered perineal trauma during delivery, independently from the nature, spontaneity, or iatrogenesis of the perineal laceration. [ABSTRACT FROM AUTHOR]

Purpose: This study was conducted to evaluate the prevalence of perineal trauma during childbirth and to assess the correlations of the pelvic floor dimensions and fetal head station with obstetric trauma in a prospectively recruited cohort of women. Methods: The study included women with a gestational age of at least 37 weeks, who were carrying a single fetus in a cephalic presentation. Transperineal ultrasound (TPU) was performed prior to the onset of labor or labor induction. The purpose was to measure the anteroposterior diameter (APD) of the levator ani muscle (LAM) and the angle of progression, at both rest and maximum Valsalva maneuver. The head-perineum distance was assessed only at rest. Results: A total of 296 women were included. Of the 253 women who delivered vaginally, 19.0% (48/253) experienced no perineal trauma, 18.2% (46/253) received an episiotomy during childbirth, 34.4% (87/253) sustained a first-degree laceration, 25.3% (64/253) had a second-degree laceration, and 3.2% had a third- or fourth-degree laceration (8/253). Women with episiotomy had a significantly shorter median APD under Valsalva than women without perineal trauma. Furthermore, women with LAM coactivation (identified by a negative difference between the APD at Valsalva and the APD at rest) were approximately three times more likely to undergo an operative vaginal delivery and over five times more likely to sustain a third- or fourth-degree tear during childbirth than women who exhibited normal relaxation of the LAM during the Valsalva maneuver. Conclusion: TPU may predict the risk of perineal trauma in women with term pregnancy during childbirth. [ABSTRACT FROM AUTHOR]

The innervation of the pelvic wall muscles is not very clear. This study aimed to reveal the division of neuromuscular compartments and localize the surface position and depth of the center of the intramuscular nerve-dense region (CINDR) of the pelvic wall muscles based on Sihler's staining. Twenty-four adult cadavers were used. To localize the CINDR of the pelvic wall muscles, horizontal (H) and longitudinal (L) reference lines were drawn, and Sihler's staining was used to reveal the intramuscular nerve distribution. The CINDR projection points (P and P′ points) behind and in front of the body surface, the positions of the P points projected onto the H and L lines (PH and PL points), and the depth of CINDR were determined by spiral computed tomography scanning. The piriformis and obturator internus muscles can be divided into two and three neuromuscular compartments, respectively. The PH of CINDR of the piriformis muscle was located at 22.61 ± 2.66% of the H line, the PL was at 28.53 ± 6.08% of the L line, and the puncture depth of the piriformis muscle was at 24.64 ± 2.16% of the PP′ line. The PH of CINDR of the obturator internus muscle was at 16.49 ± 1.20% of the H line, the PL was at 10.94 ± 1.09% of its L line, and the puncture depth was 6.26 ± 0.38 cm. These findings may guide the design of the compartmentalized transplantation of the pelvic wall muscles and improve the target localization efficiency and efficacy for injecting botulinum toxin A to treat pelvic wall muscle spasm. [ABSTRACT FROM AUTHOR]

Purpose: Sigmoidocele, which is a type of obstructed defecation syndrome (ODS), is a peritoneal hernia of the pelvic floor that has been seldom studied individually. This study investigated the anatomic characteristics of sigmoidocele based on imaging features. Methods: This retrospective cohort population comprised adult patients with ODS who underwent defecography between December 2017 and July 2020. Sigmoidocele was classified based on existing criteria. Novel radiological parameters including the vertical distance descended by the sigmoid colon from rest to maximum straining (RMS) and from the inferior border of the sigmoid colon to the superior border of the rectum at maximum straining (MSR) were measured. Results: Among 275 patients with sigmoidocele, 251 (91.6%) were female. The mean age was 51.53±12.99 years. We classified 26, 205, and 44 cases as grades I, II, and III, respectively. Patients with more severe sigmoidocele had greater sigmoid colon mobility (RMS: 19.13±8.54 mm, 34.45±14.51 mm, and 48.70±20.05 mm for grades I, II, and III, respectively; p < 0.001) and more pronounced compression of the rectum by the sigmoid colon at maximum straining (MSR: 35.23±8.44 mm, 26.33±13.29 mm, and 15.18±18.00 mm, respectively; p < 0.001). We regrouped the patients based on sigmoid colon alignment. Type L patients had the most severe constipation. Conclusion: Our study presents a novel sigmoidocele classification. The anatomic appearance and location of the herniated sigmoid colon observed using fluoroscopy during defecation may help improve the clinical awareness of ODS caused by sigmoidocele. [ABSTRACT FROM AUTHOR]

Background Anismus is a functional disorder characterized by dyssynergia and incoordination of pelvic floor muscular contractions at defecation. Despite normal propulsive power used when attempting to defecate, a hypertonic pelvic floor dysfunction results in nonrelaxation or even paradoxical contraction of puborectalis muscle, resulting in failure to straighten the anorectal angle, hence impaired stool evacuation. This study aims at evaluating the outcome of injection of botulinum toxin type-A (BTX-A) in puborectalis muscle in patients with anismus. Patients and methods The study included 50 patients who were presented with symptoms of obstructed defecation (OD) and were diagnosed as anismus and failed conservative treatment and biofeedback training. Ultrasound-guided BTX-A injections into puborectalis muscle were done. All patients were followed up for 6 months for OD symptoms and manometric findings. Results The current study included 50 patients with a mean age of 36.6±11.9 years presented with anismus for a mean duration of 6.8±2.64 months. There was a statistically significant improvement in the Longo score of OD at 1, 3, and 6 months when compared with the initial values (P<0.001), while there was no statistically significant difference noticed in the defecation frequency at 3 and 6 months when compared with the initial records. There was a statistically significant decrease in both resting and squeeze pressures after 3 and 6 months when compared with the initial records (P<0.001). The overall satisfaction significantly increased to 68 and 64% after 3 and 6 months, respectively, when compared with 0% satisfaction reported at the initial assessment. Conclusion According to the current results, injection of BTX-A therapy in puborectalis muscle in patients with anismus is assumed to be effective for short term with good overall satisfaction. [ABSTRACT FROM AUTHOR]

Overactive bladder is a prevalent problem faced by American women and is associated with social, psychological, and financial burdens. Despite a high prevalence of risk factors, no current data exist examining the risk of this disorder in Native American women. [ABSTRACT FROM AUTHOR]

Background: The literature is inconclusive when comparing health-related quality of life following restorative anterior resection (AR) compared with abdominoperineal resection (APR). Consideration of functional outcomes may explain this inconsistency. The aim of this study was to compare health-related quality of life in patients post-anterior resection, stratified by low anterior resection syndrome score, and post-abdominoperineal resection patients. Methods: A cross-sectional study of consecutive patients post APR and AR for rectal or sigmoid adenocarcinoma at a tertiary centre in Sydney, Australia (Jan 2012- Dec 2021) was performed. HRQoL outcomes (SF36v2 physical [PCS] and mental component summary [MCS] scores) were compared between APR and AR patients, with subgroup analyses stratifying AR patients according to LARS score (no/minor/major). Age- and gender-adjusted comparisons were performed by linear regression. Results: Overall, 248 post-AR patients (57.3% male, mean age 70.8 years, SD 11.6) and 64 post-APR patients (62.5% male, mean age 68.1 years, SD 13.1) participated. When stratified by LARS, ‘major LARS’ had a similar negative effect on age-and sex-adjusted PCS scores as APR. ‘No LARS’ (p < 0.001) and ‘minor LARS’ (p < 0.001) patients had higher PCS scores compared to post-APR patients. ‘Major LARS’ had a similarly negative effect on MCS scores compared with post-APR patients. MCS scores were higher in ‘no LARS’ (p = 0.006) compared with APR patients. Conclusions: Postoperative bowel dysfunction significantly impacts health-related quality of life. Patients with ‘major LARS’ have health-related quality of life as poor as those following APR. This requires consideration when counselling patients on postoperative health-related quality of life, especially where poor postoperative bowel function is anticipated following restorative surgery. [ABSTRACT FROM AUTHOR]

BACKGROUND: Stress urinary incontinence is prevalent among women and the incidence increases with age. OBJECTIVE: To explore the effect of intelligent pelvic floor muscle rehabilitation on elderly female patients with incontinence. METHODS: A total of 209 patients with urinary incontinence who were treated with pelvic floor muscle rehabilitation at Peking University International Hospital from September 2020 to January 2022 were selected by convenient sampling. All subjects were divided into the 50–60 year old patient group (n = 51) and over 60 years old patient group according to age (n = 158). The subjects of different age group were divided into an experimental group and a control group. The patients in the control group received routine nursing and health education, and the patients in the observation group received a combination of mobile application use and smart dumbbells. Based on this, we constructed an intervention model for intelligent, continuous pelvic floor rehabilitation. After 7 and 12 weeks, pelvic floor muscle function knowledge and exercise compliance in the two groups were evaluated. The improvement of urinary incontinence symptoms, pelvic floor muscle strength grades and quality-of-life scales were evaluated. RESULTS: The results showed that pelvic floor knowledge and exercise compliance in the experimental group were better than in the control group at 7 and 12 weeks after intervention (P < 0.05). There was no significant difference in pelvic floor muscle strength and quality of life between the two groups at 7 weeks after intervention (P > 0.05). However, there was a significant difference in pelvic floor muscle strength and quality of life between the two groups at 12 weeks after intervention (P < 0.05). There was no significant difference between different age groups. CONCLUSION: The intelligent pelvic floor rehabilitation model that combines a mobile application with smart dumbbells can maintain and strengthen the clinical treatment effect for elderly patients with urinary incontinence. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To systematically review the literature on use of botulinum toxin to treat pelvic floor tension myalgia and persistent pelvic pain. DATA SOURCES: The ClinicalTrials.gov, PubMed, EM-BASE, and Scopus databases were searched from inception to November 2022 by two independent assessors (B. L.K. and F.G.L.). Identified studies were screened by title and abstract and included after full-text review. Data extraction was subsequently performed and recorded in Microsoft Excel. METHODS: This study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines after registration in PROSPERO (CRD42022289132). All randomized studies, prospective studies with more than five participants, and retrospective studies with more than 10 participants published in English or French and assessing the use of botulinum toxin for the treatment of pelvic floor tension myalgia and persistent pelvic pain in women were included. Meta-analyses were performed on randomized data. TABULATION, INTEGRATION, AND RESULTS: Of 4,722 articles identified, 24 satisfied inclusion criteria. A meta-analysis of five randomized controlled trials totaling 329 participants demonstrated no differences in patient- and clinician-reported outcome measures, including pain, dyspareunia, sexual function, and vaginal manometry. Mean duration of follow-up was 6 months. A qualitative analysis of 14 prospective and four retrospective studies including 804 participants is supportive of botulinum toxin; however, the quality of data is low, and there is marked heterogeneity between studies. CONCLUSION: Meta-analyses of randomized data do not support the use of botulinum toxin to treat pelvic floor tension myalgia and persistent pelvic pain. Failure of these data to confirm the findings of nonrandomized prospective studies that suggest a treatment benefit may be attributable to the absence of placebo control and confounding outcomes obtained from an active comparator group. Further randomized controlled trials with true placebo are strongly recommended. [ABSTRACT FROM AUTHOR]

This study investigated the effect of WeChatguided Kegel exercises on compliance and selfefficacy in preventing postpartum urinary incontinence and aiding pelvic floor muscle recovery. Employing one-group and two-group pretest-posttest designs, the research evaluated the impact of a postpartum exercise intervention on new mothers. The control group received routine postpartum education, while the experimental group received Kegel exercise guidance through WeChat. Maternal feelings were also explored using various questionnaires, including the Demographic Information Questionnaire, Compliance Questionnaire, Selfefficacy Questionnaire, and Kegel Knowledge Level Test. Data were analyzed using percentage distribution, mean ± standard deviation (x±S), and both paired and independent sample t-tests. Results indicated significant compliance and self-efficacy scores differences between the experimental and control groups post-intervention. The experimental group showed notable improvements in these scores compared to their pre-test results. First-time mothers often struggle with pelvic floor muscle recovery postchildbirth due to inexperience. WeChat-guided Kegel exercises provide reminders, address concerns, and boost confidence, effectively enhancing exercise compliance and selfefficacy. This convenient method proves beneficial in supporting new mothers through postpartum recovery, highlighting the potential of digital health interventions in maternal care. [ABSTRACT FROM AUTHOR]

Aims: To determine the impact of a multi‐component exercise intervention on the cure rate of urinary incontinence (UI) among older women living in the community. Method: A systematic search was conducted of five databases (Medline, Cumulative Index to Nursing and Allied Health Literature [CINAHL], Academic Search Complete, PubMed and Web of Science), grey literature and reference lists of relevant studies in December 2021– January 2022 and again between January 2023 and February 2023 when no additional new studies were identified. Key inclusion criteria were studies with female older adults above the age of 60, with any type of UI, residing in the community, addressing the effects of a multi‐component exercise intervention combining pelvic floor muscle training (PFMT), strength and balance exercises. The primary outcome of interest was the cure rate of UI in community‐dwelling older women (%). Studies underwent quality appraisal using the RevMan Risk of Bias tool and the Evidence‐based Librarianship tool, identifying significant biases. A narrative synthesis presents results for all outcomes; a meta‐analysis was also performed for secondary outcomes. Results: Following the PRISMA 2020 guidelines, a total of 596 records were identified from the systematic search. Five studies met the inclusion criteria. Participants receiving the intervention had a statistically significant mean cure rate of 44.0% (p < 0.05), which decreased at follow‐up, except for participants with stress UI. Participants receiving the intervention had significantly decreased frequency of UI episodes (p < 0.00001) and increased maximum walking speed (p < 0.0003) at a 3‐month follow‐up. Conclusion: A multi‐component exercise, combining PFMT, strength and balance exercises, is effective in improving and curing UI, especially stress UI, in community‐dwelling older women. [ABSTRACT FROM AUTHOR]

Objectives: To explore the therapeutic effect of the temperature-controlled radiofrequency technology in female sexual dysfunction (FSD). Material and methods: From July 2020 to June 2021, patients with FSD who visited the Gynecology Clinic of Peking University Shenzhen Hospital were treated with the temperature-controlled radiofrequency technology once every two weeks, for a total of five times. The therapeutic effect was objectively evaluated with pelvic floor dysfunction (PFD) indicators (FSFI score, pelvic floor muscles surface electromyography, sexual function test). The pre- and post-treatment (2 weeks)/follow-up (3 months) results were compared to evaluate the feasibility of this technology for treating FSD, as well as using PFD-related indicators in objective evaluation of FSD patients. Results: Fifty patients completed treatment; 31 patients completed follow-up. The mean FSFI score for post-treatment/follow-up was significantly higher than pre-treatment (p < 0.05). There were no significant changes in the mean pelvic floor resting surface myoelectric potential and its variability and mean myoelectric potential of sexual function test between pre- and post-treatment/follow-up. The mean surface myoelectric potential of the patients' type I and II muscle fibers of the pelvic floor for post-treatment/follow-up was significantly higher than pre-treatment (p < 0.05). The mean peak myoelectric potential for post-treatment was significantly higher than pre-treatment (p < 0.05). Conclusions: Temperature-controlled radiofrequency technology has a certain therapeutic effect on FSD. Pelvic floor surface electromyography and sexual function test can be used as an objective indicator for PFD in FSD patients. Subsequent studies may involve a larger size sample and evaluate the effect over a consecutive time-point, to develop a better therapeutic approach. [ABSTRACT FROM AUTHOR]

Objectives: Urinary incontinence (UI) is a prevalent health issue affecting women's quality of life and sexual function. This study investigates the impact of different types of UI on sexual function using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire short form (PISQ-12). Methods: A total of 123 sexually active women with stress, urge, or mixed-type UI, who presented to the Urogynecology clinic of Etlik City Hospital between May 2023 and September 2023, were included in the study. Patients with a history of pelvic floor surgery or pelvic organ prolapse were excluded. The PISQ-12 short form, validated in Turkish, was administered. Statistical analysis was performed using SPSS 21 software. Results: The study population had a mean age of 48.2±10.5 years and a mean BMI of 30.0±4.6 kg/m². The average duration of UI was 5.4±3.8 years. Mixed-type UI was the most common (46.3%), followed by stress UI (36.5%) and urge UI (17.2%). The mean total PISQ-12 score was 27.1±6.7, with the lowest scores observed in the mixed-type UI group (25.1). Coital incontinence was reported in 46% of the patients. Statistically significant differences were observed in coital incontinence and coital incontinence anxiety between groups with poor and better sexual function (p<0.05). However, there were no statistically significant differences in PISQ-12 scores between the types of UI. Additionally, no significant difference in sexual dysfunction was found between premenopausal and postmenopausal groups. Conclusion: Urinary incontinence significantly impacts women's physical, psychosocial, and sexual health, necessitating thorough evaluation and treatment to improve quality of life and sexual function. Addressing UI and its associated sexual dysfunctions in clinical practice is crucial, despite the challenges in diagnosing these conditions. [ABSTRACT FROM AUTHOR]

Background One of the most well-known physiological effects of menopause is hormonal changes. Women's hormone levels decrease year by year during menopause, following which they are more likely to experience many changes as a result of this hormonal imbalance. Estrogen reacts directly and indirectly over muscle and results in condition leading to muscle loss, that brings about which in turn results in restrictions in physical abilities, muscle strength, and balance accelerating their risk of falling. Therefore this study compared fall prevention techniques in postmenopausal women by incorporating proprioceptive neuromuscular facilitation (PNF) and exercises utilizing elastic bands. OBJECTIVES - To find out effect of pelvic PNF and lower limb strengthening to improve balance and strength for fall prevention. METHOD- It is a control group experimental study with a pre-test and post-test design. total no. of 24 postmenopausal women of age 45 to 65 were included in the study, Pelvic PNF along with lower limb PNF was administered to Experimental Group whereas lower limb strengthening was given to Control group. Along with the above intervention, home based exercises was also provided. All the subjects in the study underwent a basic assessment and then they were randomly assigned into one of two groups, the 4-week treatment plan of 3 sessions per week for 30-35 minutes was given. RESULT After the 4 week PNF and elastic band exercise, both the experimental group and control groups showed statistically significant differences within the groups, except for POMA in the control group that showed no significant results. FTSTS in experimental group with p value (0.008*) and in control group with p-value (0.000*). POMA with p value (0.02*) within experimental group showed significant results and POMA with p value (0.152) within control group showed no significant results. EFST with p value (0.005*) and (0.005*) showed significant result with in experimental and control group respevtively. There was no significant difference between the two groups in the scores of EFST, POMA and FTSTS (p>0.05). CONCLUSION Given the findings of the present study, Pelvic PNF and elastic band exercise should be recommended as a practical approach in order to improve strength, balance and reduce fall in postmenopausal women. [ABSTRACT FROM AUTHOR]

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Background and Objectives: Endometriosis is a chronic and recurrent disease defined as the presence and proliferation of endometrial glands and stroma outside the uterine cavity. It affects up to 6–10% of women of reproductive age and can be classified into superficial, ovarian, and deep infiltrating endometriosis (DIE). Deep infiltrating endometriosis can be associated with pain symptoms and pelvic floor muscle hypertone. Moreover, it may be responsible of bowel, urinary, and sexual dysfunctions with impairment of women's quality of life. Few studies have investigated the role of physiotherapy in women with DIE. Here, we aimed first to evaluate the effects of pelvic floor physiotherapy (PFP) on urinary, bowel, and sexual functions. Secondly, we aimed to evaluate the effects of ultrasound visual feedback during PFP on pelvic floor and subjective modifications in the frequency of sexual intercourse. Materials and Methods: This randomized controlled trial was conducted between June 2018 and December 2019 at our tertiary center. Nulliparous women with DIE and superficial dyspareunia were enrolled. At first examination, levator hiatal area (LHA) assessed with 3D/4D transperineal ultrasound, pain symptoms, urinary, bowel, and sexual functions were evaluated. Then, women were randomly assigned to no intervention (control group) or treatment with five individual sessions of PFP (experimental group), and after four months women underwent a second examination. Urinary, bowel, and sexual functions were assessed with validated questionnaires at first and second examinations. In particular, the Bristol Female Lower Urinary Tract Symptoms questionnaire was used to evaluate urinary symptoms, the Knowles–Eccersley–Scott–Symptom questionnaire to assess the presence of constipation, and the Female Sexual Function Index to investigate sexual function. Study outcomes were the comparisons among groups in terms of differences in actual changes in median of questionnaire scores between first and second examinations. Results: Thirty women (17 in the experimental group and 13 in the control group) completed the study. No significant differences were found between the two groups regarding urinary, bowel, and sexual functions, although women in the experimental group showed a tendency towards an improvement in constipation symptoms. Conclusion: In women with DIE, PFP does not appear to affect urinary, bowel, and sexual functions. Therefore, despite the improvement in superficial dyspareunia, chronic pelvic pain, and PFM relaxation with high treatment satisfaction, women should be informed about the unclear impact of PFP on urinary, bowel, and sexual functions. Larger studies are necessary to further investigate the impact of PFP on these functions. [ABSTRACT FROM AUTHOR]