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Introduction: Patients without concurrent baseline stress urinary incontinence (SUI) can develop de novo SUI after transvaginal mesh surgery (TVM) for cystocele repair. Surgeons should be aware of de novo SUI risk factors after TVM. Methods: A total of 1124 women who were underwent TVM surgeries were recruited and assessed for eligibility from January 1, 2012 to April 30, 2021. All data related to patients and surgeries was collected, which included general conditions, clinical examination, surgery records, and follow‐up results. Patients were divided into three groups according to follow‐up results and data were compared with each group. The relative risk (RR) of de novo SUI with levator avulsion was also calculated. Results: Three hundred thirty‐six patients were included in this study. They were divided into no complication group (n = 249), de novo SUI group (n = 68), and other complications group (n = 19). It seemed elder or obese women had a higher risk of de novo SUI after TVM (p < 0.05). In de novo SUI group, incidence of levator avulsion before surgery were higher than the other two groups (p = 0.001). TVM can significantly change a prolapse to point Aa and Ba on POP‐Q quantification system (p < 0.05). RR ratios of de novo SUI with unilateral avulsion group is 2.60 (95% confidence interval [CI] 1.39–4.87), and 2.58 (95%CI 0.82–8.15) for bilateral group. Conclusion: Unilateral levator avulsion, instead of bilateral levator avulsion, is a risk factor of de novo SUI after cystocele repair surgery. [ABSTRACT FROM AUTHOR]

Objective: To analyze the scientific evidence on the association of physical activity with urinary incontinence in older women. Design: Searches were performed in MEDLINE, PubMed, CINAHL, Web of Science, SCOPUS, and ScienceDirect. Observational studies were included. The following search terms were used: urinary incontinence, older adult, and physical activity. Methodological quality was assessed using the checklist proposed by Downs and Black. Results: Ten articles were included. Sedentary lifestyle and <150 min/week of physical activity are at risk of developing urinary incontinence.Walking (at least 30 min) and physical activities (600-1,500 and 600METs/min per week) prevent urinary incontinence. Seven of the 10 studies indicated a good level of methodological quality. Conclusions: Sedentary lifestyle is at risk of urinary incontinence, and walking, moderate and vigorous physical activities are associated with prevention of urinary incontinence. [ABSTRACT FROM AUTHOR]

Background: Pelvic floor disorders are common, especially in pregnancy and after delivery, in the postmenopausal period, and old age, and they can significantly impact on the patient's quality of life. Methods: This narrative review is based on publications retrieved by a selective search of the literature, with special consideration to original articles and AWMF guidelines. Results: Pelvic floor physiotherapy (evidence level [EL] 1), the use of pessaries (EL2), and local estrogen therapy can help alleviate stress/urge urinary incontinence and other symptoms of urogenital prolapse. Physiotherapy can reduce urinary incontinence by 62% during pregnancy and by 29% 3-6 months post partum. Anticholinergic and β-sympathomimetic drugs are indicated for the treatment of an overactive bladder with or without urinary urge incontinence (EL1). For patients with stress urinary incontinence, selective serotonin-noradrenaline reuptake inhibitors can be prescribed (EL1). The tension-free tape is the current standard of surgical treatment (EL1); in an observational follow-up study, 87.2% of patients were satisfied with the outcome 17 years after surgery. Fascial reconstruction techniques are indicated for the treatment of primary pelvic organ prolapse, and mesh-based surgical procedures for recurrences and severe prolapse (EL1). Conclusion: Urogynecological symptoms should be specifically asked about by physicians of all relevant specialties; if present, they should be treated conservatively at first. Structured surgical techniques with and without mesh are available for the treatment of urinary incontinence and pelvic organ prolapse. Preventive measures against pelvic floor dysfunction should be offered during pregnancy and post partum. [ABSTRACT FROM AUTHOR]

Background/Aims: A vaginal balloon device for antenatal pelvic floor training may reduce the incidence of negative outcomes from vaginal birth on women's pelvic health. This study's aims were to investigate the effect of antenatal vaginal training on birth-induced levator ani muscle avulsion and to analyse the relationship between use of a balloon device for training and the duration of the second stage of labour, incidence of episiotomy and birth-induced perineal trauma. Methods: In this prospective cohort intervention study, 123 nulliparous women were divided into two groups: 64 training with the device antenatally (intervention) and 59 women receiving normal antenatal care (control). Clinical data were collected 10 weeks after birth and differences in the incidence of levator ani muscle avulsion, episiotomy, perineal tears and other birth injuries, as well as the duration of the second stage of labour, were assessed using two-tailed tests. Results: Training with the device was not associated with a reduction in the incidence of levator ani muscle avulsions (P=0.82), and the device did not shorten the duration of the second stage of labour (P=0.63). However, it was associated with a reduction in the frequency of episiotomies (cases: 34% vs controls: 59%; P=0.007). There was no significant difference in the incidence of perineal tears (P=1.00) or other birth injuries (P=0.50). An obstetric anal sphincter injury occurred in only one case, in a woman in the control group. Conclusions: The use of an antenatal training device in nulliparous women with cephalic vaginal birth at term is not associated with better pelvic health outcomes. However, it may reduce the frequency of episiotomies. [ABSTRACT FROM AUTHOR]

Aim: Patients with pelvic organ prolapse (POP) mostly have injury to the levator ani muscle (LAM). We aimed to assess LAM injury in POP patients by quantifying texture feature (TF) ratios between the LAM and the obturator internus muscle (OIM) using texture analysis. Methods: This study retrospectively enrolled 32 participants, including 24 patients with POP and eight people with normal pelvic floor muscles. TFs of the LAM and the OIM were extracted using LIFEx version 6.30, and an independent samples t‐test was performed to determine TF ratios characterizing LAM injury. After dimension reduction and binary logic analysis, the optimal TF ratio was obtained and the LAM injury quantitative evaluation was proposed. Spearman's correlation was performed to explore the correlations between TF ratios and clinical characteristics. We compared the diagnostic performance of quantitative evaluation and visual evaluation. Results: There were significant differences in 13 TF ratios between the POP and control groups. The area under the receiver operating characteristic curve of the integrated TF ratio was 0.948. Integrated TF ratio was significantly correlated with body mass index, pregnancies, and vaginal deliveries but had no correlation with LAM volume, hiatal area or abortions. Compared with the visual evaluation, the diagnostic accuracy of the quantitative evaluation had improved by 63.2% and 14.3% in the "minor defect" and "major defect" categories, respectively. Conclusion: The integrated TF ratio can be used as a new quantifiable index to characterize LAM injury. The TF evaluation provides a potential role in LAM injury noninvasive diagnostic. [ABSTRACT FROM AUTHOR]

The medical community has been focusing on gaining a deeper understanding of birth trauma, which affects millions of women worldwide. Maternal lesions can be challenging to diagnose and expensive to examine. To better comprehend the mechanism of injuries occurring in the pelvic floor muscles (PFM), biomechanical simulations can be a valuable tool. However, utilizing the finite element method (FEM) to conduct simulations can be a time-consuming process. To overcome this issue, the present study aims to develop a machine learning (ML) framework to predict stresses on the PFM during childbirth by training ML algorithms on FEM simulation data. To generate the dataset for the ML algorithm's training, childbirth simulations were performed using different material properties to characterize the PFM. Four ML algorithms were employed, namely Random Forest (RF), Extreme Gradient Boosting (XGBT), Support Vector Regression (SVR), and Artificial Neural Networks (ANN), considering two scenarios: (1) stress prediction for the maximum stretch level of the muscle, and (2) for multiple levels of fetal descent. Results showed that the ANN performed best in the former, with a mean absolute error (MAE) of 0.191 MPa. In the latter, XGBT provided lower errors for 20 and 35 mm of fetal descent, with MAE values of 0.002 and 0.028 MPa, respectively. Nevertheless, the ANN yielded better predictions for 50 and 65 mm, with MAE values of 0.214 and 0.187 MPa, respectively. The present work represents the first attempt to use FEM-based ML algorithms with childbirth simulations to obtain near-real-time predictions in routine clinical procedures. • Machine learning accelerates the results obtained from childbirth simulations. • Possibility of predicting pelvic floor muscles' mechanical behavior during labor. • Artificial neural networks yield lowest mean absolute error for stress prediction. • Real-time biomechanical analysis achievable and suitable for clinical applications. • Use of artificial intelligence tools contributes to reducing maternal morbidity. [ABSTRACT FROM AUTHOR]

Many undergraduate students in kinesiology are interested in clinical careers and seek research opportunities for advanced study and unique learning experiences. This article describes a process of engaging undergraduate students in a multi-disciplinary, National Institutes of Health (NIH)-funded program project investigating factors that may affect pelvic floor support and symptoms in primiparous women during the first year postpartum. Students complete general and protocol-specific training prior to engagement, have specific tasks that reinforce skill development and require independence, and are invited to participate in additional opportunities with the investigative team. The topic of pelvic floor health is novel to most students and participation in this research expands their knowledge beyond a mainstream kinesiology curriculum. Institutionalizing this type of program could formalize undergraduate student research experiences and facilitate ongoing clinical research efforts with a kinesiology focus. [ABSTRACT FROM AUTHOR]

BACKGROUND Pelvic floor dysfunction (PFD) is mostly caused by childbirth levator ani muscle (LAM) trauma. We hypothesized that platelet-rich plasma (PRP) therapy could support the recovery of LAM in postpartum trauma. METHODS A prospective, single-blind, randomized control study was enrolled in primigravid women from November 2016 to July 2019 at 21 health facilities in Jakarta, Indonesia. Subjects were injected with autologous PRP or placebo at LAM during perineorrhaphy after childbirth. The primary outcome was regaining LAM strength and reducing levator hiatal area at 3 months postpartum. The LAM strength was examined by perineometer (cmH2O), and levator hiatal area was examined by transperineal ultrasound (cm²) at antenatal and 3 months after delivery. Mann--Whitney U test and Wilcoxon signed-rank test were used for analysis. The study was registered in clinicaltrials.gov: NCT03021954. RESULTS Among 240 women, 58 were eligible for analysis. There were no differences in LAM strength and levator ani hiatal area at 3 months postpartum between the two groups (p = 0.583 and p = 0.185, respectively). CONCLUSIONS PRP therapy did not show a difference in the muscle recovery healing process. [ABSTRACT FROM AUTHOR]

Introduction: Second‐degree perineal tears can vary widely as to the extent of trauma, which may be relevant for women's pelvic floor health postpartum. However, the short‐ and long‐term consequences of second‐degree perineal tears are poorly understood, likely due to the lack of a detailed classification system. Such a classification system for second‐degree tears has been suggested but the inter‐rater agreement has not yet been assessed. The aim of this study was to assess the inter‐rater agreement of the already established classification system for perineal tears recommended by the Royal College of Obstetricians and Gynaecologists (RCOG classification) among midwives. Further, we aimed to assess the inter‐rater agreement of a classification system that provides three sub‐categories for second‐degree perineal tears. Material and methods: This was an inter‐rater agreement study, conducted at Akershus University Hospital in Norway from 31 August to 29 November 2020. All midwives working in the delivery ward participated in the study. Midwives classified the integrity of the perineum of all women delivering vaginally within the study period. During the first month of the study, tears were classified by two midwives who were blinded to each other's findings, and the agreement of the RCOG classification was assessed. The following month, the detailed classification system was introduced to the midwifery staff. The last month, perineal tears were classified by two midwives using the detailed classification system, and the agreement was assessed. Inter‐rater agreement was measured using Fleiss multirater kappa (k) and Kendall's coefficient of concordance (KCCw). Results: The inter‐rater agreement for the RCOG classification was good to very good, with k = 0.705 (95% confidence interval [CI] 0.62–0.79, P < 0.001), KCCw = 0.928 (P < 0.001). The inter‐rater agreement for the detailed classification system was good to very good, with k = 0.748 (95% CI 0.67–0.83, P < 0.001), KCCw = 0.956 (P < 0.001). Conclusions: The inter‐rater agreement among midwives using both the RCOG classification and the detailed classification system among midwives was good to very good. The detailed classification system provides additional information about the extent of tissue trauma in second‐degree tears, warranted for future research on women's pelvic floor health postpartum. [ABSTRACT FROM AUTHOR]

Objective: Levator avulsion is a major etiological factor of pelvic organ prolapse (POP) and is primarily diagnosed on tomographic axial plane imaging. Two-dimensional imaging can also image the levator. The objective was to test reproducibility and validity of coronal plane assessment for diagnosis of levator trauma by assessing the coronal plane obtained on tomographic ultrasound imaging., Methods: A retrospective study of women who had undergone an interview, POPQ and four-dimensional translabial ultrasound at a tertiary urogynecological unit. Post-processing of archived volume data was performed for assessment; and levator muscle area and estimate of remnant muscle mass in the coronal plane. Interobserver reproducibility of the latter two measures and associations between various measures of levator trauma and POP were tested., Results: Interobserver agreement was good for percentage estimates (ICC 0.743), but fair for area measurements (ICC 0.482). Six hundred and twenty four women were seen, 468 (75%) had significant clinical prolapse. Full levator avulsions were diagnosed in 137 (22%). Mean TTS was 2.7 (range 0-12). On coronal plane assessment average muscle area was 1.47 (SD 0.76) cm 2 and 1.55 (SD 0.74) cm 2 on the right and left, respectively (P = .005). It was 76% and 79% for average estimates of muscle mass (P = .021). Both measures were strongly associated with POP; however, they were not superior to TTS in predicting POP., Conclusion: Coronal plane assessment in volume data is reproducible and valid for evaluation of levator trauma. Muscle mass estimate may be a better measure than muscle area., (© 2024 American Institute of Ultrasound in Medicine.)

Background and Objectives: This retrospective analysis investigated the impact of preparation of the pelvic floor for childbirth with stretching balloons and perineal massage on the risk of pelvic floor injuries. Materials and Methods : We analyzed 150 primiparous women who accessed private clinics in Padua (Italy) in the period 2019-2023 regarding the rate of perineal trauma and postpartum dysfunction across three groups: the balloon stretching group (BSG, N = 50, 33.3%), the perineal massage group (PMG, N = 39, 26.0%), and the control group (CG, 61, 40.7%). Results: Prenatal perineal training had a significant impact on reducing the rate of perineal injury and episiotomy (27.5% in BSG vs. 48.7% in PMG and 68.3% in CG, p = 0.008, respectively, 9.8% vs. 26% and 40%, p = 0.046) and the duration of the second stage of labor (BSG and PMG had a shorter duration compared to CG with a mean difference of -0.97892 h, p < 0.001, respectively, -0.63372 h, p = 0.002). Patients who carry out the preparation with the stretching balloon are less likely to develop urinary and anal incontinence and pain during intercourse. Specifically, the rate of urinary incontinence in BSG stands at around 23.5% compared to 43.6% in PMG ( p = 0.345) and 55% in CG ( p = 0.034). Dyspareunia in BSG was detected in 11.8% of cases compared to 35.5% in PMG ( p = 0.035) and 61.7% in CG ( p < 0.01). Symptomatology inherent to the posterior compartment was reported in 9.8% of cases in BSG vs. 23.11% in PMG ( p = 0.085) and 33.3% in CG ( p = 0.03%). Conclusions : Stretching balloons and perineal massage can be chosen as tools to prevent and reduce the rates of obstetric trauma during childbirth and to reduce the use of episiotomies as well as protect against the development of dysfunctions of the pelvic floor.

Introduction: Second-degree perineal tears following vaginal birth are common and presumed to be of little clinical importance. However, the extent of damage to the perineal body varies widely, and there is reason to believe that larger second-degree tears may be associated with more pelvic floor symptoms, compared to lesser form. Therefore, the aim of this study was to assess differences in pelvic floor symptoms according to the severity of second-degree perineal tears up to 12 months post-partum, stratified by parity., Material and Methods: This was a prospective cohort study conducted at Akershus University Hospital, a tertiary referral hospital in Norway. The study sample consisted of 409 primiparas and 394 multiparas with vaginal births. Perineal tears were classified using the classification system recommended by the Royal College of Obstetricians and Gynecologists. Further, second-degree tears were subclassified as 2A, 2B, or 2C, depending on the percentage of damage to the perineal body. Episiotomies were analyzed as a separate group. Pelvic floor symptoms were assessed using the Karolinska Symptoms After Perineal Tear Inventory (KAPTAIN). A linear mixed model was estimated to assess the trend in pelvic floor symptom scores according to perineal tear category and stratified by parity. The primary and secondary outcome measures were the mean sum scores of the KAPTAIN-Inventory, measured in pregnancy (at 18 weeks of gestation), at 3- and 12 months post-partum, and the reported impact of genital discomfort on quality of life measured in pregnancy and at 12 months post-partum., Results: There were no significant differences in pelvic floor symptom scores over time, or at any timepoint, between no tear, first-degree tear, or second-degree tear subcategories, for primi-, and multiparas. Pelvic floor symptoms increased from pregnancy to 3 months post-partum and remained higher at 12 months post-partum compared to pregnancy in all perineal tear categories. Compared to primiparas, multiparas reported a significantly higher impact of genital discomfort on quality of life in pregnancy and at 12 months post-partum., Conclusions: There were no statistically significant differences in pelvic floor symptoms according to the severity of second-degree perineal tears., (© 2024 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).)

Objectives: To assess the evolution of levator ani muscle (LAM) avulsion from 1 year to 8 years after first delivery in women with and those without subsequent vaginal delivery. In addition, to assess whether women with full or partial avulsion 8 years after first delivery have larger LAM hiatal area and more symptoms of pelvic organ prolapse compared to women with normal LAM insertion., Methods: In this single-center longitudinal study, 195 women who were primiparous at the start of the study were included and underwent transperineal ultrasound examination 1 year and 8 years after first delivery. Muscle insertion was assessed by tomographic ultrasound imaging in the axial plane. Full LAM avulsion was defined as abnormal muscle insertion in all three central slices. Partial LAM avulsion was defined as abnormal muscle insertion in one or two central slices. Eight years after the first delivery, LAM hiatal area was assessed at rest, during maximum pelvic floor muscle contraction and on maximum Valsalva maneuver. To assess symptoms of pelvic organ prolapse, the vaginal symptoms module of the International Consultation on Incontinence Questionnaire was used., Results: At 1-year follow-up, 25 (12.8%) women showed signs of LAM avulsion, of whom 20 fulfilled the sonographic criteria of full avulsion and five of partial avulsion. Eight years after the first delivery, 35 (17.9%) women were diagnosed with avulsion, of whom 25 were diagnosed with full avulsion and 10 with partial avulsion. No woman with partial or full avulsion at 1 year had improved avulsion status at 8-year follow-up. Of the 150 women who had subsequent vaginal delivery, 21 (14.0%) women were diagnosed with partial or full LAM avulsion 1 year after first delivery, and 31 (20.7%) women were diagnosed with partial or full avulsion 8 years after first delivery. Of the 45 women without subsequent vaginal delivery, one woman with partial avulsion 1 year after first delivery was diagnosed with full avulsion at 8-year follow-up. All women with full avulsion at 1-year follow-up were diagnosed with full avulsion at 8-year follow-up regardless of whether they had subsequent vaginal delivery. At 8-year follow-up, women with full avulsion had statistically significantly larger LAM hiatal area compared to women with normal muscle insertion. Mean ± SD vaginal symptom scores ranged between 5.5 ± 5.7 and 6.0 ± 4.0 and vaginal symptom quality of life scores ranged between 0.9 ± 1.4 and 1.5 ± 2.2 and did not differ significantly between women with normal muscle insertion and women with partial or full avulsion at 8-year follow-up., Conclusions: More LAM avulsions were present 8 years compared with 1 year after first delivery in women with subsequent vaginal delivery. Except for one primipara, all women without subsequent vaginal delivery had unchanged LAM avulsion status between 1 year and 8 years after their first delivery. Larger LAM hiatal area was found in women with full avulsion compared to those with normal muscle insertion at 8-year follow-up. Vaginal symptoms scores were low and did not differ between women with normal muscle insertion and those with partial or full avulsion at 8-year follow-up. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology., (© 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.)

The article presents the case of a 36-year-old woman who has a history of delayed motor development and impaired social relatedness as a child and developed an anxiety about constipation as she grew older. It discusses the relationship between comorbid psychiatric disorders and sigmoid prolapze with de novo Pogo transposable element derived with ZNF domain (POGZ) gene mutation. The patient also has concomitant autism spectrum disorder (ASD).

Background: The anatomical location of the appendix in females determines its close contact with the internal genitalia, involving the latter in case of acute appendicitis (AA). The aim of this study was to evaluate the incidence of pelvic health impairment in adult women who underwent appendicectomy during childhood. Materials and Methods: A retrospective observational study was conducted including all female patients who underwent appendicectomy for acute appendicitis at our Center between January 1985 and December 1995. The patients were divided into two groups, i.e., complicated AA (Group A) and not complicated AA (Group B), and were asked to respond to a questionnaire investigating their general health status, fertility impairment, ectopic pregnancies, miscarriages, endometriosis, and chronic pelvic pain. The same questionnaire was administered to female volunteers with past medical history (PMH) negative for AA. The data were compared using chi-square test and Fisher exact test (a p value < 0.05 was considered for statistical significance). Results: In total, 75 patients operated for AA during childhood (22 in Group A and 53 in group B) and 44 female volunteers with PMH negative for AA (group C) were enrolled in the study. Seventeen patients (77.3%) in group A, 40 (75.4%) in group B, and 29 (65.9%) in group C (p > 0.05) had pregnancies. The number of miscarriages among women who became pregnant in their life was 5 in group A, 13 in group B, and 12 in group C (p > 0.05). Chronic pelvic pain was reported by 7 out of 22 (31.8%) patients in group A, 7 out of 53 (13.2%) in group B, and 5 out of 44 (11.4%) in group C (A vs. C: p = 0.04, OR = 3.64; A vs. B: p = 0.06 and B vs. C: p = 0.52). Conclusions: In our series, AA, complicated or not, neither determined repercussions on fertility, risk of miscarriages, and ectopic pregnancies nor increased the risk of developing endometriosis. However, women who experienced complicated AA showed a higher prevalence of chronic pelvic pain onset in adulthood compared to healthy women. [ABSTRACT FROM AUTHOR]

A pediatric robotic pyeloplasty has been performed with the Senhance® robotic system for the first time in January 2021 on a 1.5-year-old girl with symptomatic ureteropelvic junction stenosis. A Senhance® robotic system (Asensus Surgical® Inc., Durham, NC, USA) with three arms and 5 mm instruments was used, providing infrared eye tracking of the 5 mm camera and haptic feedback for the surgeon, facilitating suturing of the anastomosis and double-J stent insertion. The robotic surgery lasted 4.5 h, was uneventful and successful, without recurrence of the ureteropelvic junction obstruction after six months, and with normal development of the patient's growth and organ function. The use of the robotic system was shown to be safe and feasible; long term follow-up will be conducted subsequently in pediatric surgery. [ABSTRACT FROM AUTHOR]

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Background: Pelvic Floor Dysfunction (PFD) is a global health problem affecting millions of women worldwide and comprises a broad range of clinical dysfunctions such as urinary incontinence (UI), fecal incontinence (FI), pelvic organ prolapse (POP) vaginal laxity (VL), vaginal wind (VW), and overactive bladder (OAB). This study aims to estimate the prevalence of PFD among Saudi women attending primary health care centers (PHCCs) across 13 regions of Saudi Arabia and their characteristics along with associated factors.Methods: A cross-sectional study was conducted on 2,289 non-pregnant women. The probability population proportional sampling technique was employed followed by a convenient sampling technique to recruit eligible women. Types of PFD were assessed using a self-administered electronic questionnaire. Pelvic Floor Distress Index (PFDI-20) was used to assess the primary study outcomes (FI, VL, POP, VW, and OAB). A multivariate logistic regression model was used to identify independent associated factors for PFD.Results: The findings showed that 830 women (36.3%) had any type of UI. Stress UI affected726 (31.7%) women, whilst 525 women (22.9%) had urge UI. VL occurred in 505 women (22.1%), whilst POP occurred in 536 women (23.4%). VW occurred in 733 participants and (32%) 1238 women (54.1%) had OAB. The multivariate analysis suggested that region, location, parity, and assisted birth were significantly associated with UI, VL, FI and PFD (P < 0.001).Conclusion: PFD is a common condition among Saudi women. UI, VL, VW, OAB, POP and FI increased consistently among urban women with increased age, greater parity, assisted birth, and post-menopausal status. [ABSTRACT FROM AUTHOR]

Background: Following obstetric anal sphincter injuries (OASISs), women commonly report symptoms of pelvic floor dysfunction such as fecal incontinence. Few studies have looked at pelvic health physical therapy (PHPT) as a treatment for women with OASIS and its associated symptoms. Objectives: To assess the outcomes of early PHPT on the presence and severity of symptoms in women with OASIS. Study Design: Retrospective cohort study. Methods: We assessed the records of 70 subjects with third- or fourth-degree OASIS who had undergone clinical evaluation and PHPT in the institution's pelvic health clinic between 2017 and 2019. PHPT assessment focused on pelvic and abdominal muscle strength, neuromuscular control, soft and connective tissue/scar mobility, and functional movement. Outcome measures assessed changes in the Pelvic Floor Distress Inventory-20 (PFDI-20), subjective symptom reports of pelvic floor dysfunction, and manual muscle testing of pelvic floor muscle strength. These changes were calculated using the t test, McNemar's test, and Wilcoxon rank sum test, respectively. Results: PHPT started within an average of 6.2 weeks resulted in a reduction across all subjective complaints. Pelvic floor muscle strength improved from an initial Modified Oxford Grading system (MOS) score of 1 (1-2) to 2 (1-3), (P <.01). Subjects who received PHPT within 2 months postpartum had a greater reduction in subjective symptoms than those who started after 2 months (2.4 ±1.7 vs 1.1 ± 1.3, P =.02). Conclusion: PHPT intervention is associated with a reduction in subjective complaints reported by women who experienced OASIS in a single tertiary center. Earlier initiation of PHPT may lead to a greater improvement in symptoms. [ABSTRACT FROM AUTHOR]

Bladder and bowel difficulties affect 20% and 10% of the UK population, respectively (Percival et al, 2021). This is most likely not an accurate reflection of the true scale of this often under-reported health issue. Pelvic floor dysfunction can cause symptoms relating to many different systems and its management involves numerous modalities. The management of bladder, bowel and pelvic floor dysfunction should be delivered in the community via general practitioners, pelvic health physiotherapists and bladder and bowel services. An effective multidisciplinary approach using pathways to reduce secondary care involvement unless required should be adopted. Post Covid, community bladder and bowel services are recovering from prolonged redeployment, a backlog of cancelled patients and a rising waiting list. Acute services are the same, with even bigger backlogs for benign lower urinary tract dysfunction and prolapse assessment. Scrutiny of current bladder and bowel services across new clinical commissioning group (CCG) collaborations will undoubtedly uncover the disparity in quality of service provision. [ABSTRACT FROM AUTHOR]

Background: Few electronic resources are available for new mothers with concerns about changes in their pelvic floor following childbirth. Patients may struggle when seeking authoritative information regarding pelvic floor conditions online given the sensitivity of the topic as well as the inadvertent connection to obscene or demeaning content found online. A health sciences librarian partnered with the Motherhood and Pelvic Health Study, an interdisciplinary research group, to provide expert searching skills for a particularly challenging health condition that patients struggle to find useful information on. Case Presentation: A custom rubric was developed to evaluate existing information products, which included criteria for cultural sensitivity, conflicts of interest, and other red flags. This evaluation process enabled the research team to identify top-tier evidence-based materials that were culturally congruent. This collaborative evaluation process led to the creation of a web-based toolkit resource for new mothers concerned about changes in their pelvic floor. The toolkit connects women to pertinent information on a national health organization's patient portal, supplemented by videos created by the team to serve as models of communication for women and health care providers. Conclusion: When developing a web-based resource, health sciences libraries can partner with research teams to find, evaluate, and disseminate information. Culturally congruent toolkits such as this one can improve access to health information and lead to improved health outcomes. To ensure that the information highlighted in toolkits is both culturally congruent and authoritative, research teams should form advisory committees and partner with relevant professional medical associations. [ABSTRACT FROM AUTHOR]

Background: Perineal massage, as a preventive intervention, has been shown to reduce the risk of perineal injuries and may have a positive impact on pelvic floor function in the early postpartum period. However, there is still debate concerning the best period to apply perineal massage, which is either antenatal or in the second stage of labor, as well as its safety and effectiveness. Meta-analysis was used to evaluate the effect of implementing perineal massage in antenatal versus the second stage of labor on the prevention of perineal injuries during labor and early postpartum pelvic floor function in primiparous women., Methods: We searched nine different electronic databases from inception to April 16, 2024. The randomized controlled trials (RCTs) we included assessed the effects of antenatal and second-stage labor perineal massage in primiparous women. All data were analyzed with Revman 5.3, Stata Statistical Software, and Risk of Bias 2 was used to assess the risk of bias. Subgroup analyses were performed based on the different periods of perineal massage. The primary outcomes were the incidence of perineal integrity and perineal injury. Secondary outcomes were perineal pain, duration of the second stage of labor, postpartum hemorrhage, urinary incontinence, fecal incontinence, and flatus incontinence., Results: This review comprised a total of 10 studies that covered 1057 primigravid women. The results of the analysis showed that perineal massage during the second stage of labor reduced the perineal pain of primigravid women in the immediate postpartum period compared to the antenatal period, with a statistical value of (MD = -2.29, 95% CI [-2.53, -2.05], P < 0.001). Additionally, only the antenatal stage reported that perineal massage reduced fecal incontinence (P = 0.04) and flatus incontinence (P = 0.01) in primiparous women at three months postpartum, but had no significant effect on urinary incontinence in primiparous women at three months postpartum (P = 0.80)., Conclusions: Reducing perineal injuries in primiparous women can be achieved by providing perineal massage both antenatally and during the second stage of labor. Pelvic floor function is improved in the postnatal phase by perineal massage during the antenatal stage., Trial Registration: CRD42023415996 (PROSPERO)., (© 2024. The Author(s).)

Objectives: Women have a 11% lifetime risk of undergoing surgery for vaginal prolapse. Levator ani muscle (LAM) avulsion is one etiological factor associated with primary and recurrent pelvic organ prolapse. Pelvic organ prolapse has been shown to greatly affect the quality of life and well-being of women. Conduct a meta-analysis identifying risk factors associated with LAM avulsion recognised on transperineal ultrasound (TPUS) or magnetic resonance imaging (MRI) in primiparous women after vaginal birth., Study Design: OVID Medline, Embase and the Cochrane Library from inception to January 2021 were searched. Review Manager 5.3 (The Cochrane Collaboration) was used to analyse data. Odds ratios (OR) with 95% confidence intervals (95% CIs) were calculated. The heterogeneity among studies was calculated using the I 2 statistic., Results: Twenty-five studies were eligible for inclusion (n = 9333 women). Major LAM avulsion was diagnosed in an average of 22 % (range 12.7-39.5 %) of cases. Twenty-two studies used TPUS and three used MRI to diagnose avulsion. Modifiable and non-modifiable risk factors were identified. Significant predictors identified were forceps (OR 6.25 [4.33 - 9.0]), obstetric anal sphincter injuries (OR 3.93 [2.85-5.42]), vacuum (OR 2.41 [1.40-4.16]), and maternal age (OR 1.06 [1.02-1.10])., Conclusions: This is the first meta-analysis of both modifiable and non-modifiable risk factors associated with LAM avulsion. This information could be used to develop a clinically applicable risk prediction model to target postnatal women at risk of LAM avulsion with a view to prevent the onset of pelvic floor organ prolapse., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Importance: Pelvic floor translabial ultrasound (TLUS) can identify levator ani muscle (LAM) avulsion and ballooning, which some studies have shown to be possible risk factors for prolapse recurrence. Our group uses TLUS to counsel patients preoperatively. If any of these risk factors exist, we offer sacrocolpopexy over vaginal repair. However, some patients, even though they have these possible risk factors, prefer to undergo vaginal surgery., Objective: The objective of this study was to determine if TLUS LAM avulsion and/or ballooning are risk factors for composite outcome recurrence in patients undergoing sacrospinous ligament fixation for pelvic organ prolapse., Study Design: This was a retrospective observational study. All patients with vaginal apical repair with sacrospinous ligament fixation with preoperative TLUS were included. Demographics, clinical characteristics, and follow-up were analyzed. Multivariable logistic regression analysis was performed for composite outcome that included TLUS risk factors, age, Pelvic Organ Prolapse Quantification System measurements and stage, and variables with P < 0.1 in the univariate analysis., Results: Eighty-two patients were included. All patients had symptomatic vaginal bulge; 65.4% had stage III prolapse. Concomitant hysterectomy was performed in 54.3%. Median follow-up was 20 months (interquartile range, 8-35 months); 19.8% had LAM avulsion, and 43.2% had ballooning. Anatomic recurrence rate was 23.5%, symptomatic was 22.2%, and reoperation was 1.2%. The composite recurrence rate was 29.6%. In the multivariable logistic regression analysis, unilateral/bilateral avulsion in TLUS was found to be a significant risk factor for composite outcome with an odds ratio of 4.33 (confidence interval, 1.219-15.398; P = 0.023)., Conclusions: Composite outcome of recurrence in our study was 29.6%. Avulsion on TLUS increased the risk of recurrence of pelvic organ prolapse by fourfold., Competing Interests: The authors have declared they have no conflicts of interest., (Copyright © 2023 American Urogynecologic Society. All rights reserved.)

Introduction and Hypothesis: The objective was to evaluate the prevalence of levator ani avulsion (LAA) among primiparous women with obstetric anal sphincter injury (OASI) and how this association could affect future pelvic floor dysfunction., Methods: Three electronic databases (MEDLINE/PubMed/EMBASE) were searched in December 2018 and again in October 2022. Nine full-text articles were included in the analysis. The exclusion criteria were language other than English, studies not based on primiparous women only, conference abstracts, and evaluation without ultrasound or MRI., Results: The overall prevalence of LAA was 24% (95% CI: 18-30%). Those with OASI, were at a higher risk of LAA, OR 3.49 (95% CI: 1.46 to 8.35). In women with LAA + OASI versus OASI alone, Three of Five studies showed worsened AI symptoms. Three of Five studies assessing urinary incontinence (UI) reported no significant difference in UI, whereas two reported increased UI. All studies that looked at pelvic organ prolapse reported a higher incidence of symptomatic prolapse and reduced pelvic floor muscle strength in women with LAA + OASI compared with those without LAA., Conclusion: Levator ani avulsion is prevalent following vaginal birth and is strongly associated with OASI. Incidence of AI does not increase in women with LAA and OASI, but they had greater symptom bother. OASI with LAA appears to increase the incidence of pelvic floor weakness and pelvic organ prolapse. There is no consensus agreement on the effect of LAA + OASI on UI., (© 2024. Crown.)

Pelvic floor dysfunction (PFD) is common to be associated with pregnancy and birth. To date, no research has been done to understand whether the perineal massage and warm compresses technique has an impact on pelvic floor dysfunction. To assess the impact of perineal massage and warm compresses technique during the second stage of labor in pelvic floor dysfunction at 3 and 6 months postpartum. Of the 800 women recruited to randomised controlled trial to prevent perineal trauma, 496 were included in the study, with 242 (48.8%) assigned to the Perineal Massage and Warm Compresses (PeMWaC) group and 254 (51.2%) to the control group (hands-on). Used the Pelvic Floor Distress Inventory-20 (PFDI-20). The questionnaire is divided into three subscales: Urinary (UDI), Colorectal-Anal (CRADI), and Pelvic Organ Prolapse Distress Inventory (POPDI). The PeMWaC group had a significantly higher frequency of intact perineum (p < 0.001) and low-severity vaginal tears (tears without any other degree of perineal trauma) (p = 0.031) compared to the control group, while the control group had significantly more patients who suffered high-severity vaginal/perineal trauma (second degree perineal tears) (p = 0.031) and patients without spontaneous perineal trauma or vaginal tears who underwent episiotomy (p < 0.001). In addition, at 3 months postpartum, women in the control group had a higher Urinary Distress Inventory (UDI) score and global score, compared to the PeMWaC group, and after controlling for confounding variables, the perineal massage and warm compresses technique was associated with lower UDI scores at 3 months postpartum compared to control group. At 6 months postpartum, there were no differences in the UDI or global scores, indicating general recovery from perineal trauma. In addition to reducing perineal trauma during birth, the perineal massage and warm compresses technique was associated with a lower prevalence of early PFD symptoms, mainly urinary distress, at 3 months.Trial registration http://www.ClinicalTrials.gov NCT05854888, retrospectively registered., (© 2023. The Author(s), under exclusive licence to Society for Reproductive Investigation.)

Neuromodulation has become a valid therapeutic option for patients with various lower urinary tract disorders. In clinical practice, the most used and recommended neuromodulation techniques are sacral neuromodulation (SNM), pudendal neuromodulation (PN), and percutaneous tibial nerve stimulation (PTNS). There are many theories concerning the mechanism of action of neuromodulation. Although SNM, PN, and PTNS show their activities through different nerve roots, all provide central and peripheral nervous system modulations. SNM has been approved for the treatment of overactive bladder (OAB), nonobstructive urinary retention, and fecal incontinence, while PTNS has been approved for OAB treatment. However, they are also used off-label in other urinary and nonurinary pelvic floor disorders, such as neurogenic lower urinary system disorder, interstitial cystitis, chronic pelvic pain, and sexual dysfunction. Minor and nonsurgical reversible complications are usually seen after neuromodulation techniques. In addition, in the last few years, there have been various developments in neuromodulation technology. Some of the examples of these developments are rechargeable batteries with wireless charging, improvements in programing, less invasive single-stage implantation in outpatient settings, and lower-cost new devices. We performed a literature search using Medline (PubMed), Cochrane Library, EMBASE, and Google scholar databases in the English language from January 2010 to February 2021. We included reviews, meta-analyses, randomized controlled trials, and prospective and retrospective studies to evaluate the activities and reliability of SNM, PN, and PTNS and the developments in this area in the last decade based on the current literature. [ABSTRACT FROM AUTHOR]

Pelvic floor muscle dysfunction and symptoms of incontinence may affect any gender and age. Incontinence is embarrassing and socially limiting for patients and is not the result of normal aging. This health issue can successfully be treated with surface electromyography (sEMG) biofeedback when this modality is used by a knowledgeable and skilled provider. In combination with sEMG, behavioral intervention regarding fluid intake, normalized toileting patterns, and education on muscle function empower patients to overcome their symptoms. This article describes two patient cases, one with stress incontinence and fecal incontinence, the other with urge incontinence. [ABSTRACT FROM AUTHOR]

The third part of the JCN continence clinical skills series identifies what conservative therapies and treatments are available to treat bladder and/or bowel dysfunction. This includes a range of treatment options which can be provided by practitioners/clinicians from a multitude of healthcare professional disciplines. It highlights simple interventions, such as lifestyle changes, i.e. from diet, fluid, smoking and weight loss advice, up to the more complicated treatment options such as pelvic floor rehabilitation, bladder retraining and use of medication. [ABSTRACT FROM AUTHOR]

Since hysterectomy could be performed with low risk, it has been part of the standard of surgical prolapse therapy for decades. This has not been scrutinized for a long time. In this review, we describe the development of this issue in recent years. The current literature suggests that hysterectomy requires its own indication. The article describes the various options for a uterine-preserving surgical technique and the available data. [ABSTRACT FROM AUTHOR]

Our study aimed to assess the knowledge and awareness regarding pelvic floor disorders (PFDs) among pregnant women. We additionally evaluated whether the knowledge of PFDs was different in relation to gestational age, parity, the attendance to an antenatal education (ANE), and history of urinary incontinence (UI) and/or pelvic organ prolapse (POP). A cross-sectional descriptive study was conducted in pregnant women from all trimesters of pregnancy. The Prolapse and Incontinence Knowledge Questionnaire (PIKQ) and three questions were used for knowledge and awareness. Two hundred and forty-one women participated in the study. Of them, 18.6% (n = 46) and 3.6% (n = 9) had UI and POP, respectively. The median of the PIKQ-UI and the PIKQ-POP scores were 6 (min-max: 0–11) and 5 (min-max: 0–12), respectively. The median PIKQ-UI and PIKQ-POP scores were higher in women who had attended ANE. There was no significant difference in terms of gestational age, parity, the attendance to ANE, and the history of pelvic floor disorder (p >.05). Knowledge and awareness were low among the women in all trimesters. Education programs involving pelvic floor training should be organized for pregnant women. [ABSTRACT FROM AUTHOR]

Among women who have participated in group-based education about the pelvic floor, what are their perceptions of the program and the group format? Exploratory longitudinal qualitative study. Community-dwelling women aged ≥ 18 years who participated in three or four sessions of pelvic floor education in a group format at a university clinic. Semi-structured group or individual interviews were conducted at three time points: 1 week, 3 months and ≥ 5 months after the education activity. Data were inductively content analysed and independently coded, with iterative theme development. Women considered the content and delivery appropriate and useful. New knowledge was assimilated and shared with others, and many tried to adopt pelvic floor muscle training in daily life. The women felt that the education sessions might benefit other women, with and without pelvic floor dysfunction symptoms, and that such education would ideally be more widely available. A perception of the value of the education persisted over time, even though maintenance of some health-promoting behaviours, such as pelvic floor muscle training, decreased. The pelvic floor group education sessions appeared to fulfil the purpose of increasing knowledge about pelvic floor (dys)function and applying this in daily life. Overall, the participants, who had completed three or four of the four sessions, found the program to be useful. A unique feature of this study was longitudinal data collection and it seemed that the perception of value persisted over time. [ABSTRACT FROM AUTHOR]

Background: A large proportion of patients with interstitial cystitis have concomitant pelvic floor muscle dysfunction. Objective: To assess voiding dysfunction in patients with interstitial cystitis who have varying degrees of pelvic floor dysfunction. Study Design: A retrospective cohort study. Methods: Women with interstitial cystitis who underwent cystoscopy/bladder hydrodistension and urodynamic testing from November 2015 to February 2019 were divided into 2 cohorts based on severity of pelvic floor dysfunction (nonsevere and severe). The primary outcome was voiding dysfunction (bladder outlet obstruction and/or pelvic floor muscle dyssynergia by electromyography during voiding). Symptom severity, cystoscopy findings, and urodynamic findings were compared. Results: Fifty-one patients were included—36 in the severe and 15 in the nonsevere cohort. The mean age was 48 years. Those in the severe cohort showed higher rates of voiding dysfunction than those in the nonsevere cohort (89.7% vs 64.3%, respectively, P =.045). Seventy-three percent of subjects had glomerulations and 12% had Hunner's lesions. The presence of Hunner's lesions was associated with a lower first urge volume on urodynamic testing compared with non-Hunner's lesions (75.8 vs 148 mL, P =.046). Modest negative correlations were obtained between interstitial cystitis symptom severity and most urodynamic volumes. Conclusion: Patients with interstitial cystitis with more severe pelvic floor dysfunction demonstrated higher rates of dysfunctional voiding than those with nonsevere dysfunction, and may benefit from advanced pelvic floor therapy. [ABSTRACT FROM AUTHOR]

Urinary incontinence is linked to pelvic floor dysfunction; the delicate balance between bones, muscles, tendons, and nerves is fundamental for continence and can be altered for numerous reasons, also linked to anatomical areas other than the pelvis. The assessment of the patient is at the basis of treatment choices; the literature reports the need to assess the patient's postural, respiratory, muscular and neurological components. To date, however, there are no studies that provide the nurse with a compendium of evidence in the form of a practical guide to assessment. To present literature evidence regarding the assessment of patients with urinary incontinence, undergoing pelvic conservative rehabilitation and to discuss the practical implications. This evaluation refers to the first contact with the patient and aims to understand how to set up the rehabilitation pathway and whether specific investigations or consultations are needed before starting rehabilitation. Narrative reviews of the literature on the PubMed, CINAHL, Cochrane Library, EMBASE, Scopus, Web of Science, PEDro database. We included studies published in the last 10 years, with no design restrictions, on the topic of assessment criteria for patients with urinary incontinence undergoing pelvic floor conservation rehabilitation, with regard to the role of the nurse. Thirty‐two references were retrieved including two systematic reviews. Assessment should focus on physical activity, bowel habits, spine and posture, nutrition and food habits, breathing and clinical history. Physical examination is aimed at (1) collecting data for establishing the correct rehabilitation programme and (2) excluding the need for evaluation/intervention by other healthcare professionals. Nurses play a key role in pelvic rehabilitation teams. Assessment and decision making about rehabilitation methods are complex tasks which require specialistic education. This paper summarizes the key points of both areas. Conservative rehabilitation of urinary incontinence requires a complex assessment in order to correctly set up the rehabilitation pathway. Aspects to be assessed include muscular, postural, respiratory, neurological and medical history. There are no works in the literature offering a compendium of the information to be considered. A complete overview of the evaluation phases and their characteristics including a practical description of the nursing assessment of the patient undergoing pelvic rehabilitation for urinary incontinence. [ABSTRACT FROM AUTHOR]

Objective: Although multiple pathophysiologic changes develop within the gastrointestinal (GI) system in the setting of malnutrition, the etiology of the reported multitude of symptoms in those with anorexia nervosa and avoidant restrictive intake disorder, as well as their contribution toward disordered eating, remain poorly understood. This systematic review seeks to better understand how these physiologic changes of malnutrition of the esophagus, stomach, intestines, and pancreas contribute toward the reported GI symptoms, as well as better understand how celiac disease, inflammatory bowel disease, pelvic floor dysfunction, and Ehlers–Danlos syndrome contribute toward disordered eating. Methods: Studies of any design exploring the pathogenesis of complications and treatment strategies were included. Preferred Reporting Items for Systematic Reviews and Meta‐Analysis guidelines were used to structure and complete the review. Results: A total of 146 articles were used for the review. The majority of studies were observational or case reports/case series. Discussion: Pathophysiologic changes of the esophagus, stomach, and intestines develop with malnutrition, although these changes do not consistently correlate with expressed GI symptoms in patients with restrictive eating disorders. Celiac disease and inflammatory bowel disease also contribute to disordered eating through the associated somatic GI complaints, while pelvic floor dysfunction and Ehlers–Danlos syndrome contribute through both somatic symptoms and functional symptoms. Indeed, functional GI symptoms remain problematic during the course of treatment, and further research is required to better understand the extent to which these symptoms are functional in nature and remit or remain as treatment ensues. [ABSTRACT FROM AUTHOR]

• Convergent validity between PFM tenderness and central pain mechanisms. • Poor agreement between pelvic floor muscle tenderness and self-reported symptoms. • When PFM tenderness on digital palpation is present, screen for central pain mechanisms. Tenderness on palpation of the pelvic floor muscles (PFMs) is a clinical assessment tool used alongside other tests to identify PFM involvement in pelvic complaints including pelvic pain. Although reliability of PFM tenderness has been determined, validity has yet to be established. To assess convergent validity of PFM tenderness on digital palpation with the presence of central pain mechanism, as determined by a score of greater than 40 on the Central Sensitization Inventory (CSI). A secondary objective was to assess the agreement between PFM tenderness and self-reported symptoms of PFM sensitivity. Participants completed a battery of self-report questions, the CSI, and various physical assessments (blinded assessors). Convergent validity was assessed between tenderness on palpation and the CSI. Kappa statistics were used to determine agreement between tenderness on palpation and self-reported perineal pain, urinary urgency, dyspareunia, and dysmenorrhea. Ninety-nine female participants with hip or back pain and at least one self-reported symptom of pelvic floor dysfunction were included in the study (mean age 40.56 ± 12.72 years). Convergent validity was found between PFM tenderness on palpation and scores greater than 40 on the CSI (X 1 2 = 4.2 , p = 0.04). There was poor agreement between tenderness on palpation with dyspareunia (agreement 62.83%, Kappa = 0.27), dysmenorrhea (agreement 55.75%, Kappa = 0.14), or perineal pain (agreement 53.04%, Kappa = 0.10). PFM tenderness on digital palpation confirmed convergent validity with CSI scores, suggesting central pain mechanisms. Clinicians may need to consider the role of central pain mechanisms in their clinical decision making when treating PFM dysfunction. [ABSTRACT FROM AUTHOR]

Copyright of Fisioterapia Brasil is the property of Atlantica Editora and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective More than one-half of gynecological cancer survivors are affected by pain during sexual intercourse, also known as dyspareunia. Oncological treatments may result in pelvic floor muscle (PFM) alterations, which are suspected to play a key role in dyspareunia. However, to our knowledge, no study has investigated PFM function and morphometry in this population. The aim of the study was to characterize and compare PFM function and morphometry between gynecological cancer survivors with dyspareunia and asymptomatic women. Methods Twenty-four gynecological cancer survivors with dyspareunia and 32 women with a history of total hysterectomy but without pelvic pain (asymptomatic women) participated in this comparative cross-sectional study. PFM passive forces (tone), flexibility, stiffness, maximal strength, coordination, and endurance were assessed with an intra-vaginal dynamometric speculum. Bladder neck position, levator plate angle, anorectal angle, and levator hiatal dimensions were measured at rest and on maximal contraction with 3D/4D transperineal ultrasound imaging. Results Compared with asymptomatic women, gynecological cancer survivors showed heightened PFM tone, lower flexibility, higher stiffness, and lower coordination and endurance. At rest, they had a smaller anorectal angle and smaller levator hiatal dimensions, indicating heightened PFM tone. They also presented fewer changes from rest to maximal contraction for anorectal angle and levator hiatal dimensions, suggesting an elevated tone or altered contractile properties. Conclusions Gynecological cancer survivors with dyspareunia present with altered PFM function and morphometry. This research therefore provides a better understanding of the underlying mechanisms of dyspareunia in cancer survivors. Impact Our study confirms alterations in PFM function and morphometry in gynecological cancer survivors with dyspareunia. These findings support the rationale for developing and assessing the efficacy of physical therapy targeting PFM alterations in this population. [ABSTRACT FROM AUTHOR]

Background: Breastfeeding women struggle to achieve recommendations of obtaining 150 minutes of moderate activity per week or more. Pelvic floor dysfunction may be hindering postpartum physical activity. However, the severity and type of dysfunction remain poorly understood. Objective: This study had the following objectives: (1) to determine the severity of symptoms of pelvic floor dysfunction among breastfeeding women, with a secondary objective (1a) to determine whether this varied on the basis of exclusive breastfeeding versus supplementation of solids foods and/or formula and (2) to determine what breastfeeding women perceive they need in a physical activity intervention and (2a) how their activity levels change from before to after pregnancy. Study Design: This was a concurrent embedded mixed-methods cross-sectional survey. Methods: A survey consisting of demographic questions, physical activity experiences, the Pelvic Floor Distress Inventory (PFDI-20), and open-ended questions was disseminated to currently breastfeeding mothers. Results: Survey findings conclude that breastfeeding women are primarily sedentary or engage in light physical activity and experience greater symptom severity related to urinary incontinence than anal or pelvic organ prolapse distress. Symptoms are not influenced by breastfeeding exclusivity. Many women are hindered from being active by time constraints associated with feeding their infant. Women would like a combination of in-person/online pelvic floor and general exercise resources. Conclusion: A large proportion of breastfeeding women are sedentary or engaging only in light activity. Furthermore, breastfeeding women report urinary incontinence symptoms and these symptoms are not influenced by breastfeeding exclusivity. Breastfeeding women desire increased education and resources to support their physical activity. [ABSTRACT FROM AUTHOR]

Postpartum pelvic floor dysfunction (PFD) has been identified as a significant public health issue. The study aimed to (a) identify the impact of PFD on parous women's occupations, (b) explore how PFD impacts daily life, and (c) determine the level of awareness regarding availability of PFD treatment. The preliminary study utilized a mixed-methods descriptive design. In total, 255 participants completed the Mothers and Children (MAC) survey, distributed electronically throughout the United States. Results indicated that PFD symptoms limit parous women's occupational performance, specifically sexual activity and exercise. Despite results indicating PFD significantly detracted from participants' daily life, 66.8% of participants reported having no awareness of pelvic floor rehabilitation to address PFD. Findings suggest that further research and increased advocacy within the field of occupational therapy are necessary to increase the awareness of PFD rehabilitation and mitigate the impact on women's lives after childbirth. [ABSTRACT FROM AUTHOR]

Copyright of Fisioterapia Brasil is the property of Atlantica Editora and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: To evaluate the morphology and biometry of pelvic floor structures 3 months after birth in women experiencing first- or second-degree perineal tears or undergoing episiotomy during labor.Material and methods: Prospective observational study including nulliparous women delivering at term with a clinical diagnosis of first- or second-degree perineal tears after birth or undergoing episiotomy. The role of Kristeller maneuver during labor in affecting pelvic structure and function is also explored. All women underwent 2D trans-perineal and 3D endovaginal or endoanal ultrasound 3 months after birth.Results: 115 women assessed 3 months after delivery were enrolled in the study. Compared with controls, women who experienced first-degree perineal tears had higher bladder neck-symphysis (versus 20.9 ± 4.9 versus 16.1 ± 4.9 mm, p = .017), bladder wall-pubic symphysis (22.4 ± 7.4 versus 14.2 ± 9.5 mm, p = .02) and anorectal angle-symphysis distance (12.5 ± 4.7 versus 9.3 ± 4.3 mm, p = .018). Furthermore, they have thicker internal and external anal sphincter. The incidence of partial right and left pubo-rectalis muscle avulsion was higher in women experiencing first-degree vaginal tear during labor (16.2 versus 0%, p = .004 for both). In women affected by second-degree tears, the occurrence of partial avulsion of the right and left pubo-rectalis muscle was 16.2%, while Oasis was detected in 10.8% of the cases. Women receiving Kristeller maneuver during labor had a higher incidence of either right or left puborectalis muscle avulsion.Conclusion: Women who had either first- and second-degree perineal tears or episiotomy show signs of abnormal pelvic morphometry on 3D rotational ultrasound 3 months after birth. [ABSTRACT FROM AUTHOR]

Background: Pelvic floor dysfunction (PFD) is a common problem in both men and women. Despite the high prevalence and negative effects on quality of life, there is still a lack of research in this area which translates into clinical practice and education. Objectives: My study discusses how gaps and controversies in current research and evidence on PFD might be addressed by positioning PFD within a contemporary biopsychosocial model of care (BPSM). Method: Various databases were searched for relevant studies published between 2010 and 2020 to support hypotheses and statements. Results: My study focuses on the available evidence of PFD in both men and women as related to the themes and sub-themes of the BPSM, and how this available evidence might translate into education and clinical practice. It highlights areas of research, education and clinical practice that need to be explored and how the different components of healthcare may influence one another. Conclusion: Biomedical aspects regarding pelvic health are mostly investigated and taught, whilst psychological, cognitive, behavioural, social and occupational factors, individualised care, communication and therapeutic alliances are still under-investigated and not integrated or translated at a sufficient level into research, education and clinical practice. Clinical implications: Incorporating the integration of all factors of the BPSM into research is important for effective knowledge translation and enhancement of a de-compartmentalised approach to management. The interaction between the different components of the BPSM should be investigated especially in a South African population. [ABSTRACT FROM AUTHOR]

To evaluate the effectiveness of pelvic floor muscle training (PFMT) on perimenopausal women with pelvic floor dysfunction (PFD). A two-group longitudinal experimental design with multiple comparisons. The intervention group (n = 37) received a 3-month intervention combining Kegel and yoga exercise. The control group (n = 37) received Kegel exercise. The combined training alleviated PFD symptoms, improved life quality and increased pelvic floor muscle strength of perimenopausal women. Women with PDF symptoms can integrate PFMT and yoga exercise to promote rehabilitation and improved outcomes. Combined exercise should be taught and practiced under supervision by qualified health professionals. [ABSTRACT FROM AUTHOR]

Background: A growing female workforce within military forces internationally necessitates comprehensive consideration of this population's unique health requirements within a wide range of military contexts Pelvic floor health is a key area where support needs vary between sexes because of differences in pelvic anatomy and function Purpose: To explore what is known about the pelvic floor health of women working in military contexts, specific risk factors and relationships between pelvic floor problems and military occupational health, safety and performance Methods: Searches of multiple health and Defence databases identified published studies of relevance to this review's aims Findings of relevance were extracted and synthesised to provide a narrative overview of the topic Findings: From the available studies, genitourinary infections and urinary incontinence were both found to affect up to one-third of serving women Some self-management strategies used by servicewomen, particularly when deployed, may have negative health consequences Serving women also identified environmental, equipment and cultural factors that challenged their ability to manage their pelvic health in occupational contexts Conclusion: A sizeable proportion of military women experience pelvic floor conditions Consideration of how to optimise and support the pelvic floor health of female military personnel is required [ABSTRACT FROM AUTHOR]

Background. Pelvic Floor Disorders (PFDs) include a wide range of diseases. According to biomechanical concepts and previous studies, it can be assumed that there are relations between posture and PFDs but there have been many controversial results. This study aimed to find out if there is any postural change in women with and without common PFDs. Methods. In this descriptive cross-sectional study, a total of 47 women with PFDs and 47 matched controls (aged 25-45), participated. Static standing posture was measured by photo-grammetry and flexible ruler for spinal curvature. Results. In the case group, the lumbar lordosis (p = 0.002) and Q angle (p < 0.001) significantly decreased while the thoracic kyphosis (p = 0.002), foot pronation angle (p < 0.001) and sagittal shoulder angle (p = 0.002) increased significantly in comparison with the control. Conclusions. This study showed that some of the postural changes in the spine, shoulder, pelvis, and lower limbs were prone to be associated with common PFDs (urinary incontinence, fecal incontinence, pelvic organ prolapses, and chronic pelvic pain syndrome). [ABSTRACT FROM AUTHOR]

Objective: Obstructed defecation syndrome (ODS) is a group of symptoms that are mainly caused by pelvic floor dysfunction concerning bowel symptoms. It is challenging in clinical practice. Acupuncture has advantages in the treatment of complex symptoms because of its multitarget and bi-directional regulation of the human body. Since, 2,500 years ago, acupuncture has been applied empirically to the treatment of constipation. Does acupuncture have any effect on ODS? By showing the clinical thoughts, methods, and achievements of acupuncture series in ODS in recent ten years by the author's team, and two scientific papers published in English on acupuncture treatment of chronic intractable constipation and stress urinary incontinence, it is proved that the core scheme of acupuncture treatment of ODS is flexible. In order to raise awareness of the therapeutic effect of acupuncture in ODS, it can be integrated into existing practice to get opportunities for multi-disciplinary cooperation and further research and development. Materials and Methods: By summarizing the diagnosis and treatment of ODS, the first-line selection of pelvic floor rehabilitation and the minimally invasive sacral neuromodulation were reviewed, and it was pointed out that there was a gap between the high demand of patients and the expectation of cost-effectiveness. Then, on the basis of modern eastern and western medical achievements, the holistic concept was introduced into the treatment of pelvic floor dysfunction, and an acupuncture scheme suitable for ODS was proposed. Results: Acupuncture is based on the idea of improving the patients' central nervous system, autonomic nervous system, and intestinal nervous system, and is effective in treating ODS. The acupoints were set in two groups when the patient in a supine position, which includes ST 25 (Tian Shu), SP 15 (Da Heng), SP 14 (Fu Jie), CV 6 (Qi Hai), CV 4 (Guan Yuan), ST 36 (Zu San Li), ST 37 (Shang Ju Xu); When a patient is in the prone position, it includes BL 20 (Pi Shu), BL 23 (Shen Shu), BL 25 (Da Chang Shu), BL 33 (Zhong Liso), BL 34 (Xia Liao), and GV 20 (Bai Hui). The key was the technique of deep needling of the ST 25 (Tian Shu) and deep needling of the BL 33 (Zhong Liso) & BL 34 (Xia Liao). It needs 2-15 Hz sparse-dense wave electrical stimulation, 30 minutes each time, a total of 20 times, which was a scheme that could achieve satisfactory short-term and long-term effects. Conclusion: At present, clinical and basic experimental studies have proved that acupuncture plays a role in treating ODS in a multi-target way. This is a very promising research direction of pelvic floor integrated medicine. In the future, further study on optimizing the protocol and meeting the patient's gap individually and cost-effectively. [ABSTRACT FROM AUTHOR]