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

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

Objective To compare the early effects on pelvic floor function of three modes of labor: natural delivery, cesarean section and forceps-assisted delivery. Methods Fifty-eight cases of women who underwent transperineal three-dimensional pelvic floor ultrasonography at 6 weeks postpartum at Obstetrics and Gynecology Hospital, Fudan University from Jan 2019 to Jan 2020 were collected and divided into three groups: the natural birth group (n=22), cesarean section group (n=9), and forceps group (n=27) . General data such as age, parity, birth order, neonatal weight, and pelvic floor ultrasonography findings were collected. Results The differences in age, gestational week at delivery, newborn weight and number of pregnancies among the three groups were not statistically significant. In pelvic floor ultrasonography, it was found that in the resting state, the cervix had a smaller vertical distance from the inferior border of the pubic symphysis and a smaller posterior vesicourethral angle in the forceps group compared with the cesarean section group. In the forceps group, the angle of urethral inclination was greater, and the area of the anorectal hiatus was smaller in the resting state compared with the natural birth group and cesarean section group. In the Valsalva state, the vertical distance of the bladder neck and the cervix from the lower edge of the pubic symphysis were smaller in the forceps group compared with the natural birth group and cesarean section group. In the transition from resting to Valsalva state, the angle of rotation of the urethra was greater in the natural birth group and the forceps group than in the cesarean section group. Cervical mobility and recto-pubic abdominal mobility were greater in the forceps group compared to the natural birth group and the cesarean section group. All these differences were statistically significant (P<0.05) . Conclusion In the early stage of labor, forceps-assisted delivery had a greater effect on the displacement of pelvic floor organs than natural labour and cesarean section. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the clinical efficacy of comprehensive nursing intervention in pelvic floor and bladder function recovery post-cervical cancer surgery. Method: This was a retrospective study. A total of 120 patients with cervical cancer undergoing radical surgery at Tangshan People's Hospital from June 2021 to June 2023 were randomly divided into two groups (n=60 cases each group). The control group received routine nursing intervention, while the study group was provided with comprehensive nursing intervention. Comparative analysis was conducted on clinical indicators, postoperative complications, bladder and pelvic floor function recovery, and patient satisfaction before and after intervention in both groups. Result: In the study group, ambulation time, gastrointestinal function recovery, duration of postoperative drainage tube placement, oral diet resumption time, duration of postoperative vaginal bleeding, and length of hospital stay were significantly shorter than in the control group (all p< 0.05). Bladder function recovery in the study group was superior to that in the control group (p< 0.05). The study group showed lower scores for anorectal disorders, urogenital disorders, and pelvic organ prolapse than the control group (p< 0.05, respectively). Patient satisfaction was 100% in the study group and 85% in the control group, suggesting a statistically significant difference between the two groups (p< 0.05). Conclusion: Comprehensive nursing intervention deserve to be promoted as it can accelerate postoperative clinical recovery, reduce the incidence of surgical complications, improve pelvic floor and bladder function post-cervical cancer surgery, and enhance patient satisfaction with care. [ABSTRACT FROM AUTHOR]

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Abstract To evaluate the effects of different delivery methods on the pelvic floor structure and function among primiparas by transperineal ultrasound, with a view to providing guidance for early postpartum intervention. Primiparas who underwent postpartum examination with transperineal ultrasound were recruited. Subjects were divided according to mode of delivery (vaginal and cesarean delivery). General information (including age, pre-pregnancy BMI and neonatal weight) were collected, and transperineal ultrasound was performed to measure such indicators as the levator hiatus areas in resting, constrictive anal and maximum Valsalva states, the posterior vesicourethral angles and distances between vesical neck and posterior inferior margin of pubic symphysis in resting and maximum Valsalva states, as well as the vesical neck mobility and urethral rotation angle in maximum Valsalva state. The inter-group differences in ultrasound indicators between the resting and Valsalva states were compared to analyze the postpartum incidences of pelvic floor dysfunctions like stress urinary incontinence, urethral funnel formation, bladder prolapse and uterine prolapse in primiparas. The levator hiatus areas in resting, constrictive anal and maximum Valsalva states were all larger in the vaginal delivery group than in the cesarean delivery group (P

Pelvic floor muscle exercise (PME), biofeedback, and electrical stimulation improve pelvic floor function, but the effect of their combination in patients with early-stage cervical cancer is unclear. This study intended to design a combined intervention encompassing these three interventions and explore its effect on pelvic floor function in postoperative patients with early-stage cervical cancer. Totally, 177 postoperative patients with early-stage cervical cancer were assigned to combination (N = 81) and PME (N = 96) groups according to actual interventions. Pelvic Floor Distress Inventory-Short Form 20 (PFDI-20), International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI-SF), and EORTC Core Quality of Life questionnaire (EORTC QLQ-C30) scores were assessed at the seventh day after surgery (W0), and at 4 (W4), 8 (W8), and 12 (W12) weeks after W0. PFDI-20 scores at W8 (P = 0.042) and W12 (P = 0.006), and ICIQ-UI-SF scores at W4 (P = 0.012), W8 (P = 0.024), and W12 (P = 0.003) were lower in the combination group versus PME group. PFDI-20 decline and ICIQ-UI-SF decline (W0-W12) were greater in the combination group versus PME group (both P = 0.007). Combined intervention (versus PME) was independently related to greater PFDI-20 decline (B = 5.548, P < 0.001) and ICIQ-UI-SF decline (W0-W12) (B = 1.544, P = 0.006). EORTC QLQ-C30 global health status scores at W12 were higher in the combination group versus PME group (P = 0.045), while EORTC QLQ-C30 function and symptom scores at any time points were not different between the two groups (all P > 0.05). Combined intervention achieves greater pelvic floor function improvement and better quality of life compared to PME in postoperative patients with early-stage cervical cancer. [ABSTRACT FROM AUTHOR]

Objective: To explore the effect of carbon dioxide (CO2) laser combined with biofeedback in female stress urinary in- continence (SUI). Methods: 106 SUI patients admitted to our hospital from January 2021 to December 2023 were selected and randomly divided into treatment group (54 patients) and control group (52 patients). The control group was given pelvic floor muscle rehabilitation training, and the treatment group was combined with CO2 laser treatment in the control group. Compare the two groups of relevant indicators. Results: Pelvic floor muscle strength grade, vaginal dynamic pressure, maximum sphincter pressure; bladder neck position, pro- longed pressure conduction time, maximum urinary flow rate, VHIS and FSFI, and quality of life score decreased (P<0.05), and more significant improvement in the treatment group (P<0.05). Conclusion: CO2 laser combined with biofeedback treatment of female SUI is effective, which can effectively improve pelvic floor function, correct urodynamic abnormalities, and improve the quality of life of patients, which is worthy of clinical promotion and application. [ABSTRACT FROM AUTHOR]

Objective To investigate the effect of rehabilitation training guided by information motivation behavior theory (IMB) based model on the effectiveness of postpartum pelvic floor function rehabilitation for primiparous women. Methods A total of 80 cases of primiparous women admitted to this hospital from March 2020 to March 2023 were selected as the study subjects, and were divided into two groups according to the randomized numerical table method. In the control group, 40 mothers were given rehabilitation training under conventional guidance, and in the observation group, 40 mothers were given rehabilitation training based on the IMB model. Pelvic floor muscle strength, pelvic floor function and quality of life were compared between the two groups. Results The grading of pelvic floor muscle strength of women in the observation group was better than that of the control group, and the difference was statistically significant (P <0. 05). In the observation group, the pelvic floor systolic blood pressure, and the affective functioning, mental health, somatic pain, general health, physical functioning, physiological functioning, emotional health, social functioning in the SF-36 were higher than those of the control group, the differences were statistically significant(P <0. 05). The resting pelvic floor pressure of the women in the observation group was lower than that of the control group, and the difference was statistically significant (P <0. 05). Conclusion Rehabilitation training based on the IMB model can promote postpartum pelvic floor function enhancement and improve pelvic floor muscle strength of primiparous women, thus improving their quality of life. [ABSTRACT FROM AUTHOR]

Background: Stress urinary incontinence (SUI) is prevalent and significantly impacts morbidity. While some risk factors for SUI have been identified, those specifically related to the severity of SUI have not been thoroughly investigated. Methods: This study recruited elderly female patients with SUI, aged over 60 years old, from Wuhan, Hubei, China, between October and November 2020. Data collection encompassed demographic information, clinical features (including obstetric history, chronic diseases, Urogenital Distress Inventory-6 (UDI-6), and International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) scores), as well as physical examinations (including assessments of pelvic floor muscle strength, pelvic organ prolapse quantification (POP-Q) system, and pelvic floor ultrasound imaging). Results: Univariate analysis revealed that a history of postpartum urinary incontinence and chronic constipation significantly influenced the severity of SUI symptoms in the elderly (p < 0.05). Additionally, age, the number of vaginal deliveries, and a history of chronic cough were correlated with the severity of SUI symptoms, with p-values of 0.05, 0.08, and 0.12, respectively. Factors such as pelvic floor muscle strength, vaginal wall prolapse, uterine prolapse, and the morphology of the largest urethral opening all significantly impacted the severity of SUI symptoms in this population (p < 0.05). Multivariate logistic regression analysis identified age, the number of vaginal deliveries, chronic constipation, anterior vaginal wall prolapse, a history of postpartum urinary incontinence, and the shape of the maximum urethral opening as independent factors influencing SUI severity in older women (p < 0.05). The results of the Hosmer-Lemeshow test indicate that the model fits well (p = 0.37). Conclusions: Age, the number of vaginal deliveries, anterior vaginal wall prolapse, a history of postpartum urinary incontinence, chronic constipation, and a funnel-shaped maximum urethral opening are associated with increased severity of SUI symptoms in elderly women. The severity of SUI escalates with advancing age and an increased number of vaginal deliveries.

Introduction: Long term effects after hysterectomy, such as a worsening of pelvic floor and sexual function, have been studied with diverse results. Therefore, we investigated the long‐term effects of hysterectomy for benign indication on pelvic floor and sexual function as well as differences in outcome depending on mode of hysterectomy. Material and methods: In a prospective clinical cohort study, we included 260 women scheduled for hysterectomy who answered validated questionnaires; pelvic floor impact questionnaire (PFIQ‐7), pelvic floor distress inventory (PFDI‐20) and female sexual function index (FSFI). Participants were followed up to 3 years after surgery. Nonparametric statistics and mixed effect models were used in analyses of the data. Results: After exclusions, 242 women remained in the study, with a response rate at the 3‐year follow‐up of 154/242 (63.6%) for all questionnaires. There was an improvement of pelvic floor function with a mean score of PFIQ‐7 at baseline of 42.5 (SD 51.7) and at 3 years 22.7 (SD 49.4), (p < 0.001) and mean score of PFDI‐20 at baseline was 69.6 (SD 51.1) and at 3 years 56.2 (SD 54.6), (p = 0.001). A deterioration of sexual function was seen among the sexually active women after 3 years with a mean score of FSFI at baseline 25.2 (SD 6.6) and after 3 years 21.6 (SD 10.1), (p < 0.001). However, this was not consistent with the unaltered sexual function for the whole cohort. No difference in pelvic floor or sexual function was detected when comparing robotic assisted laparoscopic hysterectomy, laparoscopic hysterectomy and abdominal hysterectomy. Conclusions: Three years after surgery robotic assisted laparoscopic hysterectomy, total laparoscopic hysterectomy and abdominal hysterectomy improve pelvic floor function to the same extent. Among the sexually active women, a decline of sexual function was seen after 3 years, not consistent with the entire cohort and independent of surgical methods. Whether this is a trend associated with aging or menopausal transition remains to be studied. [ABSTRACT FROM AUTHOR]

ObjectiveThis study aimed to investigate the efficacy of postpartum nursing guidance in the treatment of early pelvic floor dysfunction (PFD) in women of advanced maternal age.MethodsA total of 146 patients of advanced maternal age admitted to our hospital between January and December 2021 were enrolled in this study and randomly divided into two groups: the control group and the experimental group, with 73 patients in each group. Parturients in the control group received routine pelvic floor rehabilitation treatment, whereas those in the experimental group were given individualized postpartum nursing guidance alongside routine pelvic floor rehabilitation treatment. The recovery of pelvic floor muscle (PFM) strength, the incidence of PFD diseases and nursing satisfaction were compared between the two groups after 3 months of treatment.ResultsThe enhancement of PFM strength in the experimental group significantly surpassed that in the control group. Furthermore, the experimental group exhibited a notably lower overall occurrence of PFD and significantly greater maternal satisfaction compared with the control group, and the difference was statistically significant (p

Objective To explore the effect of TGF-β1/Smad signaling pathway regulated by total saponins of American ginseng on the functional recovery of pelvic floor in rats with stress urinary incontinence. Methods Sixty-five SD rats of SPF grade were selected, and 45 rats after modeling were randomly divided into model group, low-dose group and high-dose group with 15 rats each, and the remaining 15 rats without any treatment were used as control group. Rats in low-dose group and high-dose group were given total saponins of Panax quinquefolium according to the dosage of 50 mg/kg and 100 mg/kg respectively, while rats in control group and model group were given the same amount of physiological saline (15 mL) . The pathological histology, pelvic floor function related indexes, urodynamics related indexes, bladder internal pressure related indexes, pelvic floor muscle surface electrical signals and the relative expression of TGF-β1/Smad signaling pathway protein were compared in each group. Results Compared with those in the control group, urethra rotation angle, bladder neck motion, residual urine volume, urine output, Smad2 and Smad3 expression were increased in the model group, the low and high dose group；vaginal resting pressure, systolic pressure, LPP, MBC, ALPP, urinary efficiency, Class Ⅰ and Class Ⅱ pelvic floor muscle fiber potential, TGF- β1, and Smad7 level were decreased (P < 0.05) ; Compared with those in the model group, vaginal resting pressure, systolic blood pressure, LPP, MBC, ALPP, urinary efficiency, class Ⅰ and Class Ⅱ pelvic floor muscle fiber potential, TGF- β1, Smad7 expression increased in the low and high dose group；urethral rotation angle, bladder neck motion, residual urine volume, urine output, Smad2 and Smad3 levels were decreased (P <0.05) . Conclusion American ginseng total saponin could effectively improve pelvic floor function in rats with stress urinary incontinence, and the mechanism may be related to TGF- β1/Smad signaling pathway. [ABSTRACT FROM AUTHOR]

Copyright of Colo-Proctology is the property of Springer Nature 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: To explore the effect of hip muscle exercise combined with pelvic floor electrical stimulation biofeedback on pelvic floor function and stress response in patients with pelvic floor dysfunction disease (PFD). Methods: 120 patients with PFD who were treated in our hospital from January 2021 to December 2022 were selected as the study subjects. They were divided into control group and observation group according to random number table method, with 60 patients in each group. The patients in the control group received hip muscle exercise, and the patients in the observation group received pelvic floor electrical stimulation biofeedback therapy on the basis of the control group. The changes of pelvic floor function and stress response in the two groups were observed and analyzed. Results: The total clinical effective rates of the observation group after treatment were significantly higher than those in the control group (P＜0. 05), the PFDI-20, PISQ-12 and PFIQ-7 scores in the two groups were significantly better than those before treatment, and the above indexes in the observation group were significantly better than those in the control group (P＜0. 05), and the anterior pelvic floor muscle potential, dynamic muscle tone, static muscle tone and contractility of the two groups after treatment were significantly improved compared with those before treatment. Compared with the control group, the above indexes in the observation group were significantly improved (P＜0. 05), and the levels of norepinephrine (NE), prostaglandins (PGE2) and cortisol (COR) in the two groups were significantly increased after treatment, and the observation group was significantly better than that in the control group (P＜0. 05). Conclusion: Hip muscle exercise combined with pelvic floor electrical stimulation biofeedback can exercise muscle function, improve the level of pelvic floor muscle tension, promote the recovery of pelvic floor function and improve stress response, and significantly improve the quality of life of patients. [ABSTRACT FROM AUTHOR]

Most women with endometrial cancer (EC) have an excellent prognosis and may be cured. However, treatment-related pelvic functional impacts may affect long-term quality of life. To better understand these concerns, we explored correlations between patient-reported outcomes and pelvic magnetic resonance imaging (MRI) features in women treated for EC. Women with histologic diagnosis of EC were consented preoperatively and completed the validated Female Sexual Function Index (FSFI) and Pelvic Floor Dysfunction Index (PFDI) questionnaires at preoperative, 6-week, and 6-month follow-up visits. Pelvic MRIs with dynamic pelvic floor sequences were performed at 6 weeks and 6 months. A total of 33 women participated in this prospective pilot study. Only 53.7% had been asked about sexual function by providers while 92.4% thought they should have been. Sexual function became more important to women over time. Baseline FSFI was low, declined at 6 weeks, and climbed above baseline at 6 months. Hyperintense vaginal wall signal on T2-weighted images (10.9 vs. 4.8, p =.002) and intact Kegel function (9.8 vs. 4.8, p =.03) were associated with higher FSFI. PFDI scores trended toward improved pelvic floor function over time. Pelvic adhesions on MRI were associated with better pelvic floor function (23.0 vs. 54.9, p =.003). Urethral hypermobility (48.4 vs. 21.7, p =.01), cystocele (65.6 vs. 24.8, p <.0001), and rectocele (58.8 vs. 18.8, p <.0001) predicted worse pelvic floor function. Use of pelvic MRI to quantify anatomic and tissue changes may facilitate risk stratification and response assessment for pelvic floor and sexual dysfunction. Patients articulated the need for attention to these outcomes during EC treatment. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effects of pelvic floor muscle training (PFMT) and perineal massage during late pregnancy on postpartum pelvic floor function in nulliparas. Design: Randomised controlled trial. Setting: The Peking University First Hospital, a teaching hospital in China. Participants: Two-hundred nulliparas were included. Interventions: Nulliparas were randomised into four groups in a 1:1:1:1 ratio. Group A, control; group B, perineal massage; group C, pelvic floor muscle training (PFMT); group D, perineal massage and PFMT. The intervention group received the corresponding intervention from 34 weeks of gestation until delivery. Measurements: Changes in pelvic floor function from 34 weeks of gestation to 6 weeks postpartum were assessed using pelvic floor electromyography (EMG), pelvic organ prolapse quantitation (POP-Q), and pelvic floor distress inventory-20 (PFDI-20). Results: Those with PFMT (groups C and D) had a smaller decline in pelvic floor EMG of fibre II than those without PFMT (groups A and B) [− 0.2 (− 7.1, 11.3) µV vs 6.1 (− 0.2, 15.2) µV, P = 0.040]. The same scenario was observed in the pelvic floor EMG of fibre I. The Aa point measurement differences of those with PFMT (groups C and D) were smaller than those without PFMT (groups A and B) [0.0 (0.0, 2.0) cm vs 1.0 (0.0, 3.0) cm, P = 0.006]. The same result was observed for point Ba. No difference was observed in EMG and POP-Q in nulliparas with (groups B and D) or without perineal massage (groups A and C). No differences were observed in PFDI-20 scores. Key conclusions: PFMT during late pregnancy enhanced pelvic floor EMG, while perineal massage alone or PFMT combined with perineal massage did not. Implications for practice: PFMT in late pregnancy enhances pelvic floor function.

Introduction and hypothesis: With the significant increase in its incidence, gestational diabetes mellitus (GDM) has received growing attention for its effect on pelvic floor function. This study was aimed at investigating the association of GDM with pelvic floor function and diastasis recti abdominis (DRA) in postpartum women. Methods: This is a retrospective cohort study. At 6 weeks postpartum, 1,133 postpartum women with vaginal delivery underwent routine examinations including measurement of the pelvic floor muscle (PFM) strength and endurance, determination of the stress urinary incontinence (SUI) by questionnaire, quantification of pelvic organ prolapse (POP) and assessment of DRA. Statistical analysis was performed using binary logistic regression and multiple linear regression analysis. Results: One hundred and seventy-six (176) of the 1,133 women were confirmed to be suffering from GDM, with a rate of 15.53% (176 out of 1,133). The age and pre-pregnancy body mass index of the GDM group were significantly higher than those without GDM (p < 0.05). The GDM group was more likely to have smaller gestational age and a higher chance of having to undergo a lateral episiotomy. No statistically significant differences are found in PFM endurance (B: −0.025, p = 0.462) or PFM strength (B: −0.001, p = 0.979) between women with and without GDM. And these two groups are not significantly different in terms of the prevalence of SUI (19.3% vs 20.4%), POP (35.8% vs 37.5%) and DRA (29.0% vs 25.8%; p > 0.05). Conclusions: Pelvic floor muscle function and SUI/POP/DRA prevalence of women at 6 weeks postpartum are not significantly affected by GDM. [ABSTRACT FROM AUTHOR]

Objective: To investigate associations of early and middle adulthood physical activity (PA) with symptoms of pelvic floor disorders (PFDs), i.e. stress urinary incontinence (SUI), urge urinary incontinence (UUI), faecal incontinence (FI), constipation or defecation difficulties (CDDs) and feeling of pelvic organ prolapse (POP) among middle‐aged women. Design: A cross‐sectional, observational study with retrospective PA assessment. Setting: University Research Laboratory. Sample A random population sample of 1098 Finnish women aged 47–55 years. Methods: Early adulthood PA, current PA, and demographic and gynaecological variables were assessed using self‐report questionnaires. Logistic regression analyses were applied to study associations of PA variables with symptoms of PFDs. Potential confounding effects of demographic and gynaecological variables were controlled in multiple logistic regression models. Main Outcome Measures: Structured questionnaire‐assessed retrospective PA assessment at the age of 17–29 years, current PA at middle age, and prevalence of symptoms of CDD, FI, POP, SUI and UUI. Results: Current PA was not independently associated with the occurrence of the symptoms of PFDs. Middle‐aged women with an early adulthood history of competitive sports were more likely to experience symptoms of UUI (OR 2.16, 95% CI 1.10–4.24, p = 0.025) but not symptoms of SUI, FI, CDD or POP, whereas women with a history of regular PA were more likely to experience symptoms of FI (OR 4.41, 95% CI 1.05–18.49, p = 0.043) but no other symptoms of PFDs. Conclusions: Competitive sports during early adulthood may increase the risk of UUI in middle age. Regular PA during early adulthood may increase the risk of FI. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of SLK triple therapy combined with epidural labor analgesia on pelvic floor function and perinatal outcome of primipara. Methods: 200 pregnant women who delivered singleton in Jiangyin People’s Hospital and its group hospitals from January 2022 to December 2022 were selected and randomly divided into control group, SLK triple therapy group,epidural delivery analgesia group and combined group according to random number table, with 50 cases in each group. The control group received routine training, the SLK triple therapy group received Sopfrology delivery training, Lamaze breath training and Kegel training,the epidural delivery analgesia group received patient controlled epidural analgesia, and the combined group received epidural delivery analgesia on the basis of SLK triple therapy. The pelvic floor function indexes were detected by ultrasonic diagnostic instrument(2) The pelvic floor electrophysiological indexes were detected by neuromuscular stimulation biofeedback therapeutic instrument, and the prenatal fever rate, midwifery rate, postpartum hemorrhage rate, cesarean section rate, labor process and Apgar score were recorded and compared in each group. Results: Compared with the control group, the pelvic floor ultrasonic examination △ y α, β, γ There was no significant difference among the parameters(P＞0.05); Pelvic floor ultrasonic examination △ y α, β, γ All the parameters were significantly lower than those in the control group(P＜0.05); However, there was no significant difference between SLK group and combination group in the above indicators(P＞0.05). The muscle strength of class Ⅰand class Ⅱ muscle fibers and fatigue of class Ⅰ and class Ⅱ muscle fibers in SLK group and combination group were significantly better than those in the control group(P＜0.05); However, there was no significant difference between SLK group and combination group in the above indicators(P＞0.05). The postpartum hemorrhage rate and cesarean section rate in SLK group, epidural analgesia group and combination group were significantly lower than those in the control group(P＜0.05), the first and second stages of labor in epidural analgesia group were significantly higher than those in the control group(P＜0.05), the first and second stages of labor in SLK group were significantly lower than those in the control group, and the first and second stages of labor in combination group were significantly lower than those in epidural analgesia group, Apgar score of SLK group and combined group was significantly higher than that of control group. Conclusion: SLK triple therapy combined with epidural labor analgesia can effectively improve the pelvic floor function and perinatal outcome of primipara, and make up for the shortage of epidural labor analgesia alone, which is worthy of clinical promotion. [ABSTRACT FROM AUTHOR]

The effectiveness of nursing interventions based on the self-efficacy in elderly patients receiving total laparoscopic hysterectomy was assessed. 100 senior patients undergoing total laparoscopic hysterectomy were committed to our hospital from January 2020 to February 2021. Patients were randomized into the study group (n = 51) and control group (n = 49), according to the time of surgery. The control group was given a conventional care plan, while the study group was given conventional care plus a nurse intervention based on a self-efficacy plan. The total post-operative disease uncertainty scores were relatively lower than before surgery both in the control group and the study group (p < 0.05). In particular, the disease uncertainty scale in the post-operative group was reduced in the study group as compared to that in the control group (p < 0.05). The post-operative self-efficacy scale scores of patients in the control group and the study group were increased than that in the pre-operative patients (p < 0.05). In particular, the post-operative self-efficacy scale scores of patients in the study group were higher than that in the control group. Patients in the study group had a lower incidence of post-operative complications than that in the control group. After one year of followup, the overall Pelvic Floor Distress Inventory-20 (PFDI-20) scores at 3 months and 12 months were statistically significant higher than pre-operative scores (p < 0.05). In particular, the post-operative patients' pelvic floor function in the study group were lower than that in the control group. It seems that a self-efficacy-based nursing intervention program applied to elderly patients after laparoscopic total hysterectomy was effective in improving patients' disease uncertainty and self-efficacy, shortening the length of hospital stay and reducing the incidence of postoperative complications, with little impact on pelvic floor function. [ABSTRACT FROM AUTHOR]

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This was an original article, and the objective of this study was to clarify the short-term effects of analgesic delivery on the pelvic floor function of primiparous women. Three hundred primiparas who delivered vaginally in The Affiliated Hospital of Kangda College of Nanjing Medical University from January 2022 to July 2022 were enrolled, and were divided into control and intervention groups. The control accepted traditional delivery without special analgesic intervention, while the intervention group accepted intraspinal block analgesia at the time of delivery. The results showed that related to the control group, the intervention group presented shorter first and second stages of labour, higher pelvic organ prolapse quantification (POP-Q) scores (0 and 1 degree) and hand-measured pelvic floor muscle strength scores, lower abnormal rate of muscle fatigue (class I and II), higher values of rapid contraction stage, tension contraction stage, and endurance contraction stage, lower values of pre-resting stage and post-resting stage, lower incidences of urinary retention and incontinence and higher VLQ and SSQ scores. We conclude that the implementation of analgesic delivery in primiparous women can effectively shorten the first and second stages of labor, suppress the damage to pelvic floor function, and elevate maternal satisfaction with sexual life., Competing Interests: The Authors declared no conflict of interest, (African Journal of Reproductive Health © 2024.)

Pelvic floor muscle exercise (PME), biofeedback, and electrical stimulation improve pelvic floor function, but the effect of their combination in patients with early-stage cervical cancer is unclear. This study intended to design a combined intervention encompassing these three interventions and explore its effect on pelvic floor function in postoperative patients with early-stage cervical cancer. Totally, 177 postoperative patients with early-stage cervical cancer were assigned to combination (N = 81) and PME (N = 96) groups according to actual interventions. Pelvic Floor Distress Inventory-Short Form 20 (PFDI-20), International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI-SF), and EORTC Core Quality of Life questionnaire (EORTC QLQ-C30) scores were assessed at the seventh day after surgery (W0), and at 4 (W4), 8 (W8), and 12 (W12) weeks after W0. PFDI-20 scores at W8 (P = 0.042) and W12 (P = 0.006), and ICIQ-UI-SF scores at W4 (P = 0.012), W8 (P = 0.024), and W12 (P = 0.003) were lower in the combination group versus PME group. PFDI-20 decline and ICIQ-UI-SF decline (W0-W12) were greater in the combination group versus PME group (both P = 0.007). Combined intervention (versus PME) was independently related to greater PFDI-20 decline (B = 5.548, P < 0.001) and ICIQ-UI-SF decline (W0-W12) (B = 1.544, P = 0.006). EORTC QLQ-C30 global health status scores at W12 were higher in the combination group versus PME group (P = 0.045), while EORTC QLQ-C30 function and symptom scores at any time points were not different between the two groups (all P > 0.05). Combined intervention achieves greater pelvic floor function improvement and better quality of life compared to PME in postoperative patients with early-stage cervical cancer.

The impairment of pelvic floor muscle functions and Lactobacillus-deficient vaginal microbiota is common in postpartum women. However, few studies have explored the correlation between pelvic floor muscle functions and vaginal microbiota. Given this research gap, our study aims to investigate any potential association between these two conditions of postpartum women (6–8 weeks after childbirth). A total of 230 women who required postpartum pelvic floor function examination at Peking University International Hospital from December 2021 to April 2022 were enrolled in this study. The collected questionnaire information included progestational weight, body mass index (BMI), weight gain during pregnancy, neonatal weight, delivery type, multiparity, postpartum time, and urinary incontinence (UI). A total of 187 samples of vaginal secretions were collected, and the vaginal microbiota was detected by 16S rRNA sequence analysis. Finally, 183 samples were analyzed in the trial. All individuals were divided into two groups according to the results of pelvic floor muscle assessment to explore the difference between the incidence of postpartum urinary incontinence and vaginal microbiota. We found that the prevalence of UI was higher in the group with weakened pelvic floor muscles. Vaginal delivery, overweight, age, neonatal weight, and weight gain during pregnancy were all risk factors for postpartum urinary incontinence. The vaginal microbiome was no longer Lactobacillus dominant of most postpartum women (91.8%), while the diversity of microbiota increased. The Lactobacillus-deficient community, commonly labeled as community state type (CST) IV, was sub-divided into four communities. The abundance of vaginal Lactobacillus decreased in the group with compromised pelvic muscle functions, while the species richness and diversity increased significantly. In conclusion, the decreased pelvic floor muscle functions of postpartum women 6–8 weeks after delivery may disrupt the balance of vaginal microbiota, and the restoration of pelvic floor functions may contribute to a healthy and balanced vaginal microbiota.

Objective: To observe the effects of suspension training therapy combined with biofeedback electrical stimulation on pelvic floor function and urodynamics in patients with postpartum stress urinary incontinence (PSUI). Methods: 96 patients with PSUI who were received in our hospital from July 2019 to August 2021 were selected. The patients who met the requirements were divided into control group (48 cases) and study group (48 cases) by envelope lottery. The patients in the control group received suspension training therapy, and the patients in the study group received suspension training therapy combined with biofeedback electrical stimulation. The curative effects, pelvic floor function indexes and urodynamic indexes of the two groups were compared. The leakage volume of urine pad test and the score of international consultation on incontinence questionnaire-urinary incontinence-short form (ICI-Q-SF) questionnaire of the two groups were observed. Results: The total clinical effective rate of the study group was higher than that of the control group (P<0.05). 1 month after treatment, the leakage volume of 24 h urine pad test and the score of ICI-Q-SF questionnaire of the two groups decreased, and the study group was lower than the control group (P<0.05). The improvement effect of pelvic floor muscle strength in the study group was better than that in the control group after one month of treatment (P<0.05). 1 month after treatment, the maximum urethral closure pressure (MUCP), functional urethral length (LES), abdominal pressure, leak point pressure (ALPP) and maximum urinary flow rate (Qmax) of two groups increased, and the study group was higher than the control group (P<0.05). Conclusion: The suspension training therapy combined with biofeedback electrical stimulation intervention in patients with PSUI can effectively improve clinical symptoms and promote the recovery of pelvic floor function and urodynamics, the effect is remarkable. [ABSTRACT FROM AUTHOR]

Introduction: Hysterectomy is one of the most common major surgical procedures in women. The effects of hysterectomy on pelvic floor and sexual function are uncertain. Our objective was to investigate the effects of hysterectomy for benign indications on pelvic floor and sexual function and to compare different modes of surgery.Material and Methods: We performed a prospective clinical cohort study. In all, 260 women scheduled for hysterectomy answered validated questionnaires (Pelvic Floor Impact Questionnaire, Pelvic Floor Distress Inventory and Female Sexual Function Index). Participants were followed 6 months and 1 year after surgery. Data were analyzed using nonparametric statistics and mixed effect models.Results: Women with subtotal hysterectomy, vaginal hysterectomy, laparoscopic assisted vaginal hysterectomy, and previous prolapse/incontinence surgery were excluded from further analysis, leaving the remaining cohort to 242 patients. The response rate at 6 months and 1 year follow-up was 180/242 (74.3%) and 169/242 (69.8%), respectively. There was an improvement of pelvic floor function at both follow-ups; mean score of Pelvic Floor Impact Questionnaire at baseline was 42.5 (51.7), at 6 months 19.9 (42.2) and at 1 year 23.7 (50.3) (p < 0.001). The mean score of Pelvic Floor Distress Inventory at baseline was 69.6 (51.1), at 6 months 49 (43.2) and at 1 year 49 (43.2) (p < 0.001). There was an improvement of sexual function after 6 months (mean score of Female Sexual Function Index at baseline 17.9 [SD 11.7] and at 6 months 21.0 [SD 11.7]) (p < 0.001). There was no difference in pelvic floor or sexual function when comparing surgical techniques.Conclusions: Robotic assisted laparoscopic hysterectomy, laparoscopic hysterectomy and abdominal hysterectomy improve pelvic floor function to the same extent at 6 months and 1 year after surgery. There was an overall improvement of sexual function 6 months after hysterectomy, but this did not persist after 1 year. [ABSTRACT FROM AUTHOR]

Purpose: Although pregnancy and childbirth are physiological processes they may be associated with pelvic floor disorders. The aim of this study was to evaluate the influence of pelvic floor muscle training on postpartum pelvic floor and sexual function of primiparous. Methods: This is a randomized prospective study including 300 primiparous women. Due to the dropout 200 women were analyzed. Inclusion criteria were the delivery of the first, mature baby, the ability to speak and understand German. The participants were evaluated by clinical examinations and questionnaires after 6 and 12 months postpartum. After 6 months, the women were randomized in two groups. Compared to the control group the intervention groups participated in 45-min pelvic floor muscle training and pelvic floor perception once a week over 6 weeks. Results: The results of the questionnaires showed no significant differences between the groups after 12 months. A significant stronger pelvic floor muscle strength was found for the intervention group after 12 months. The improvement of the pelvic floor and sexual function over the time showed a significant improvement in both groups. Conclusion: Supervised pelvic floor muscle training did not improve both the pelvic floor and the female sexual function in comparison to the control group. After 12 months, the pelvic floor and sexual function improved significant in all women. Trial registration: German Clinical Trials Register (DRKS00024725), retrospectively registrated. [ABSTRACT FROM AUTHOR]

Recently, pelvic floor muscle training has become popular not only in health magazines but also in women’s magazines, on television and on social networking services. The pelvic floor muscles are difficult to visually confirm movement of in a clothed situation, making it difficult to get a sense of muscle contraction; and, thus, there are many cases of incorrect training leading to pelvic floor dysfunction, including urinary incontinence and pelvic organ prolapse, and significant reduction of quality of life and healthy life expectancy. Therefore, the ability of instructors to teach appropriate pelvic floor muscle training is an important key to the prevention and improvement of pelvic floor dysfunction. The purpose of this review is to understand the functional anatomy and motor function of the pelvic floor muscles and to disseminate evaluation and training practices for preventing and improving pelvic floor dysfunction such as urinary incontinence and pelvic organ prolapse. [ABSTRACT FROM AUTHOR]

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

In our study, patients who had a second delivery were categorised into the following 4 groups. Pelvic floor ultrasound data were compared during the 6th week after the second delivery. The incidence of cystoceles was highest in group A and lowest in group D. In addition, groups A and B had a higher rate of rectoceles or perineum descent. Similarly, the areas of the levator hiatus were higher in Groups A and B during Valsalva manoeuvres. The area of the levator hiatus from the resting state to the Valsalva manoeuvre effect had the greatest change in Group A. A comparison of the PR thickening rates among the four groups did not reveal significant differences. All second delivery methods can cause varying degrees of pelvic organ prolapse and decreased pelvic floor function; however, vaginal delivery as the second delivery mode may have a more significant effect in Chinese women. What is already known on this subject? Different modes of delivery have significantly different effects on female pelvic floor function. Pregnancy beyond 35 weeks of gestation has an effect on female pelvic floor function, irrespective of the mode of delivery. What do the results of this study add? This study analysed the impact of different delivery modes on Chinese female pelvic floor function. Parous women who underwent different modes of second delivery all demonstrated different degrees of pelvic organ prolapse, as well as pelvic floor function decline. What are the implications of these findings for clinical practice and/or further research? Our study will provide basic research of Chinese female pelvic floor function after a second delivery, which will be of clinical significance around the world, as well as in China. China will keep promoting further delivery as the aging population is increasing. If the developing countries want to promote the second delivery around the women, they have basic research and data to instruct the females. [ABSTRACT FROM AUTHOR]

Purpose This study aimed to assess the feasibility of a rapid diffusion tensor imaging (DTI) for evaluation of the female urinary sphincter function based on differentiation between rest and muscle contraction. Methods Magnetic resonance imaging (MRI) of the lower pelvis was performed at 3 Tesla in 10 healthy female volunteers (21–36 years; body mass index, 20.8±3.6 kg/m2) between June and July 2019. High-resolution T1- and T2-weighted images were acquired for anatomical reference, and following DTI performed in 4 experiment phases: twice during rest (denoted rest-1, rest-2) and contraction (contraction-1, contraction-2). Manual segmentation of the urinary sphincter and the levator ani muscles were performed by 2 independent readers. Mean diffusivity (MD) and fractional anisotropy (FA) values derived from DTI volumes were compared in search for significant differences between the experiment phases. Interreader agreement was assessed by intraclass correlation coefficient (ICC). Results Kruskal-Wallis test showed significant differences between MD values among all the experiment phases, by both independent readers (1st: X2 [3,76]=17.16, P

BackgroundHysterectomy is one of the most frequently performed operations worldwide. However, postoperative complications and body image changes may induce psychological distress after hysterectomy. The study aimed to evaluate the effect of psychological intervention on pelvic floor function and psychological outcomes following hysterectomy among patients with benign indications.MethodsNinety-nine patients underwent hysterectomy were randomly divided into intervention group (n = 50) and control group (n = 49). Patients in the control group received routine postoperative nursing care, while extra psychological intervention was provided to patients in the intervention group, including psychological support, regular lectures and family support. After 6 months, patient's psychological statuses were assessed by Generalized Anxiety Disorder scale (GAD-7) and Patient Health Questionnaire-9 (PHQ-9). The pelvic floor function of patients was evaluated using Pelvic Floor Impact Questionnaire (PFIQ-7) and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Furthermore, the incidence of postoperative complications, including uracratia, pelvic organ prolapses, sexual dysfunction and chronic pelvic pain, was evaluated.ResultsAfter 6-month intervention, the GAD-7 and PHQ-9 scores were significantly decreased in the intervention group (p < 0.001 and p = 0.018 respectively). Both scored were significantly lower than that in the control group (p < 0.001 and p < 0.001). Compared with control group, the incidence of uracratia, pelvic organ prolapse, sexual dysfunction and chronic pelvic pain for intervention group was significantly lower (p = 0.003, p = 0.027, p = 0.001, p = 0.002 respectively) and the pelvic floor muscle strength was significantly stronger (p = 0.001). Besides, the postoperative Urinary Incontinence Impact Questionnaire (UIQ-7), Pelvic Organ Prolapse Impact Questionnaire (POPIQ-7), and Colorectal-Anal Impact Questionnaire (CRAIQ-7) scores were significantly lower (p = 0.025, p = 0.04, p < 0.001) and PISQ-12 score was significantly higher in intervention group (p < 0.001).ConclusionPsychological intervention could effectively improve the psychological condition of patients with hysterectomy, which may facilitate patients' postoperative recovery in pelvic floor function. These findings emphasized the necessity of psychological intervention in routine postoperative nursing care.

Purpose: Despite the establishment of radical surgery for therapy of cervical cancer, data on quality of life and patient-reported outcomes are scarce. The aim of this retrospective cohort study was to evaluate bladder, bowel and sexual function in women who underwent minimally invasive surgery for early-stage cervical cancer. Methods: From 2007–2013, 261 women underwent laparoscopically assisted radical vaginal hysterectomy (LARVH = 45), vaginally assisted laparoscopic or robotic radical hysterectomy (VALRRH = 61) or laparoscopic total mesometrial resection (TMMR = 25) and 131 of them completed the validated German version of the Australian Pelvic Floor Questionnaire (PFQ). Results were compared with controls recruited from gynecological clinics (n = 24) and with urogynecological patients (n = 63). Results: Groups were similar regarding age, BMI and parity. The TMMR group had significantly shorter median follow-up (16 months versus 70 and 36 months). Postoperatively, deterioration of bladder function was reported by 70%, 57% and 44% in the LARVH, VARRVH and TMMR groups, respectively (p = 0.734). Bowel function was significantly worse after TMMR with a higher deterioration rate in 72 versus 43% (LARVH) and 47% (VARRVH) with a correspondingly higher bowel dysfunction score of 2.9 versus 1.5 and 1.8, respectively and 1.8 in urogynaecological patients. Sexual dysfunction was common in all surgical groups. 38% considered their vagina too short which was significantly associated with deep dyspareunia. Compared with controls, surgical groups had significantly increased PFQ scores. Conclusion: Pelvic floor dysfunction commonly deteriorates and negatively impacts on quality of life after minimally invasive radical hysterectomy, especially bowel function after TMMR. Pelvic floor symptoms should routinely be addressed pre- and postoperatively. [ABSTRACT FROM AUTHOR]

Objectives: Our study aimed to evaluate the quality of life (QoL) and pelvic floor function of cervical cancer (CC) patients after treatment. Design: This was a cross-sectional observational cohort study. Participants: The participants included in this study were CC patients who underwent radical hysterectomy (RH) from 2012 to 2018 at 18 medical centers across China. Methods: The validated versions of the Pelvic floor Distress Inventory-Short Form 20, Overactive Bladder Symptom Score, and Euro Qol Five-Dimension questionnaires were used to evaluate postoperative pelvic floor dysfunction (PFD) and QoL. Results: A total of 689 CC patients were enrolled. The incidence of stress urinary incontinence (SUI), incomplete urinary emptying, and constipation were 32.7, 27.7, and 28.6%, respectively. Multivariate analysis confirmed that laparoscopic RH (LRH) and vaginal wall resection greater than 3 cm were risk factors for lower urinary tract symptoms (LUTS). LRH and chemotherapy were risk factors for SUI. Chemoradiotherapy and LRH were risk factors for overactive bladder (OAB). A high body mass index and LRH were risk factors for more severe defecation symptoms. ARH and large amount of operative blood loss were risk factors for poor QoL. Conclusion: PFD is common in CC patients after treatment. LRH seems to increase the postoperative distress, including LUTS and defecation symptoms. Postoperative urinary incontinence and OAB are more bothersome for patients undergoing chemotherapy and radiotherapy. We recommend evaluating pelvic floor function as a standard assessment during follow-up. [ABSTRACT FROM AUTHOR]

Objective: To investigate the Effects of vaginal and open surgery on pelvic floor function, inflammatory stress response and sexual quality of life in patients with uterine benign tumor. Methods: The clinical data of 78 patients with uterine benign tumor from March 2017 to January 2019 were analyzed retrospectively, the patients were divided into group A (n=38, treatment by open surgery) and group B (n=40, treatment by vaginal surgery) according to the different operative plans, the indexes of perioperative period, inflammatory stress indexes [Interleukin-6 (IL-6), C-reactive protein (CRP), Cortisol Cor ], pelvic floor dysfunction, complications and sexual quality of life were compared between the two groups. Results: The time of exhaust, operation, hospitalization and getting out of bed in group B were shorter than that in group A, and the amount of bleeding was less than that in group A (P<0.05). The levels of IL-6, CRP and cor were all increased in two groups, but the level in group B was lower than that in group A (P<0.05). The incidence of pelvic floor dysfunction in group B was 12.50% (5 / 40), lower than 36.84% (14 / 38) in group A (P<0.05). The score of Female sexual function index scale FSFI in the two groups was higher than that before operation, and the score in group B was higher than that in group A (P<0.05). The incidence of postoperative complications in group B was lower than that in group A (P<0.05). Conclusions: Compared with laparotomy, vaginal surgery can effectively improve the perioperative indicators, inflammatory stress response, pelvic floor function and sexual quality of life, and reduce the incidence of complications. [ABSTRACT FROM AUTHOR]

Purpose: Obstetric anal sphincter injuries (OASIS) increase the risk for pelvic floor dysfunctions. The goal of this study was to examine the long-term outcomes after OASIS on pelvic floor functions and quality of life. Material and methods: Between 2005 and 2013, 424 women had an OASIS at the Women University Hospital Ulm. Out of these 71 women completed the German pelvic floor questionnaire, which includes questions regarding prolapse symptoms as well as bladder, bowel and sexual function. In addition, 64 women were physically examined, including a speculum examination to evaluate the degree of prolapse, a cough test to evaluate urinary stress incontinence (SI) and an evaluation of both pelvic floor sphincter (modified Oxford score) and anal sphincter contraction. Results: A high rate of pelvic floor disorders after OASIS was found, as 74.6% of women reported SI, 64.8% flatus incontinence and 18.3% stool incontinence, respectively. However, only few women stated a substantial negative impact on quality of life. The clinical examination showed that a positive cough test, a weak anal sphincter tone and a diagnosed prolapse correlated with the results of the self-reported questionnaire. Conclusion: On one hand, OASIS has an influence on pelvic floor function going along with lots of complaints, while on the other hand, it still seems to be a taboo topic, as none of the participants spoke about the complaints after OASIS with a doctor. Therefore, the gynecologist should actively address these issues and offer therapy options for the women with persisting problems. [ABSTRACT FROM AUTHOR]

Objective: Vaginal childbirth is an established main aetiological factor in the pathogenesis of female pelvic floor dysfunction. However, pregnancy itself is also likely to have an effect. This study investigated the effect of pregnancy on pelvic floor functional anatomy.Study Design: This was a retrospective observational study involving vaginally nulliparous women who presented to a tertiary urogynaecology unit with symptoms and signs of pelvic floor dysfunction between 2006 and 2014. Nulliparous women were compared with those who delivered exclusively by Caesarean Section (CS). All had undergone a standardised clinical interview, ICS POP-Q assessment and 3D/4D translabial pelvic floor ultrasound. Main outcome measures included sonographically determined pelvic organ position and hiatal dimensions on Valsalva and pelvic floor muscle contraction (PFMC).Results: Of 2930 women seen during the study period, 242 had never given birth vaginally. One hundred and twenty-nine (53 %) were nulliparous, and 113 (47 %) were delivered by CS only. The CS group demonstrated significantly higher pelvic organ mobility in the anterior compartment (all P < 0.05) and a larger hiatal area on Valsalva (P = 0.004). All sonographic measures of pelvic floor muscle function demonstrated greater tissue displacement on PFMC in the CS group (all P < 0.05).Conclusions: Compared to nulliparas, women who delivered exclusively by CS showed increased pelvic organ descent on Valsalva and tissue displacement on PFMC, implying increased tissue elasticity/ compliance or reduced stiffness, consistent with a small permanent hormonal and/or mechanical effect of pregnancy. [ABSTRACT FROM AUTHOR]

Introduction: One of the functions of the pelvic floor muscles (PFM) is to support the pelvic organs and continence. This continence mechanism tends to change when PFM are exposed to high-impact exercises. Objetives: To describe the dynamic changes in the pelvic floor (PF) in elite nulliparous athletes. Methods: Translabial two and three-dimensional ultrasound was used to assess PF anatomy and function in athletes (n=8). This ultrasonography was performed after voiding and in the supine position, using a vaginal probe. The descent of the pelvic organs was assessed on a maximum Valsalva maneuver, whilst the volume datasets were acquired at rest, during maximum voluntary contraction (MVC) and during a Valsalva maneuver. The athletes performed each maneuver at least 3 times, with the most effective being used for evaluation. Results: The bladder neck descent was 14 mm for the javelin thrower, being the highest value when compared to the remaining participants. Three athletes featured the rectocele (swimming, gymnastics and javelin throw) and 4 participants presented a paravaginal defect (volleyball, horsemanship, javelin throw and printer). The volleyball athlete had the highest value of the levator hiatal area in MVC value. Conclusions: The athletes present minimal differences in the evaluated parameters. The sample is small to generalize the results, but there is a tendency for athletes of high-impact exercises to have a lower CMV value. Further studies are needed to corroborate these results.

Objectives: The aim of this study was to evaluate current education and training of student and registered midwives across the UK and Spain; analysing both pelvic floor teaching and practical experience.Study Design: A cross-sectional survey was carried out by 711 student and 384 registered midwives across different universities and regions in the UK and Spain.Results: The vast majority (91.5 % n = 382) of UK students complete training without ever cutting or repairing an episiotomy. This compares to 39.4 % (n = 85) of registered midwives who did not cut an episiotomy during training. Only 20 % (n = 9) of Spanish and 10 % (n = 45) of UK registered midwives felt confident undertaking these techniques. In Spain just 15 % (n = 6) of students, compared to 54.8 % (n = 80) of registered midwives had received teaching on longer-term pelvic floor complications.Conclusion: There is a considerable deficit in the current training practices for midwives regarding episiotomies. This lack of practice and confidence may be impacting on the increased rates of perineal tears and pelvic dysfunction in post-partum women. Across registered midwives there are gaps in education regarding longer-term pelvic floor complications. Our study was limited by a smaller sample size from Spain compared to the UK. Our results show practical assessment of skills during training is desirable and could improve both the confidence and competence of midwives upon registration. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to assess the feasibility of a rapid diffusion tensor imaging (DTI) for evaluation of the female urinary sphincter function based on differentiation between rest and muscle contraction. Methods: Magnetic resonance imaging (MRI) of the lower pelvis was performed at 3 Tesla in 10 healthy female volunteers (21-36 years; body mass index, 20.8±3.6 kg/m²) between June and July 2019. High-resolution T1- and T2-weighted images were acquired for anatomical reference, and following DTI performed in 4 experiment phases: twice during rest (denoted rest- 1, rest-2) and contraction (contraction-1, contraction-2). Manual segmentation of the urinary sphincter and the levator ani muscles were performed by 2 independent readers. Mean diffusivity (MD) and fractional anisotropy (FA) values derived from DTI volumes were compared in search for significant differences between the experiment phases. Interreader agreement was assessed by intraclass correlation coefficient (ICC). Results: Kruskal-Wallis test showed significant differences between MD values among all the experiment phases, by both independent readers (1st: X²[3,76]=17.16, P<0.001 and 2nd: X²[3,76]=15.88, P<0.01). Post hoc analysis revealed differences in MD values by both readers between: rest-1 vs. contraction-1 (least P<0.05), rest-1 vs. contraction-2 (P<0.01), rest-2 vs. contraction- 1 (P<0.03), rest-2 vs. contraction-2 (P=0.02) with overall mean 'rest' to 'contraction' ΔMD=20.6%. No MD or FA differences were found between rest-1 vs. rest-2 and contraction-1 vs. contraction-2 among all the experiment phases, and interreader agreement was ICC=0.85 (MD) and ICC=0.79 (FA). Conclusions: Rapid DTI might prospectively act as a supporting tool for the evaluation of female pelvic floor muscle function, and incontinence assessment. [ABSTRACT FROM AUTHOR]

To explore the evaluation value of two-dimensional perineal ultrasound on three-compartment movement and early pelvic floor function of postpartum women with natural delivery. 284 women who gave birth naturally in our hospital from February 2019 to July 2019 were selected as the study group, and 200 women who did not give birth to gynecological diseases during the same period were selected as the control group. Transperineal two-dimensional ultrasound examination was performed between the two groups,the position and movement changes of anorectal junction (ARJ), cervical mouth outside (CV), urethral vesica junction (UVJ) during resting period, tension period and anal contraction period were compared between the two groups. The pelvic floor ultrasound parameters under resting state and maximum Valsaval action were compared between the two groups. The vertical length of CV distance from horizontal reference line (CV-VD) and UVJ distance from horizontal reference line (UVJ-VD) in the study group during resting period, tension period and anal contraction period were lower than those in the control group (all P＜0.05). The vertical lengths of △ r-sCV-VD and △ r-sUVJ-VD in the study group during tension period corresponds to resting period were higher than those in the control group, while the vertical lengths of △ r-sCV-VD and △ r-sUVJ-VD in the study group during anal contraction period corresponds to resting period were lower than those in the control group (all P＜0.05). The bladder neck position (BNP) in the study group in resting state was lower than that in the control group, but the posterior urethravesical angel (PUA) was higher than that in the control group (all P＜0.05). The maximum Valsaval movement of bladder neck descent (BND), PUA and urethral rotation angel (URA) in the study group were all higher than those in the control group (all P＜0.05). Transperineal two-dimensional ultrasound can effectively observe the postpartum pelvic floor movement and early pelvic floor function of women in natural delivery. It is helpful to evaluate the changes of pelvic floor structure and function, and it has certain clinical application value. [ABSTRACT FROM AUTHOR]

Pelvic floor dysfunction (PFD) is a common clinical problem that can lead to bladder and bowel dysfunction such as urinary incontinence, urinary retention, fecal incontinence, pelvic organ prolapse, and sexual dysfunction. Pelvic floor rehabilitation aids are essential tools in the treatment of PFD. However, there is limited understanding of the efficacy and mechanisms of these aids, and there is a lack of standardized guidelines for selecting appropriate aids for different types of PFD. To assist patients in choosing suitable pelvic floor rehabilitation aids to their needs, it is necessary to summarize the existing types, mechanisms, and applications of these aids. Based on their mechanisms and target functions, pelvic floor rehabilitation aids can be mainly categorized into 3 main types. The first type includes aids that improve pelvic floor function, such as vaginal dumbbells, vaginal tampons, and vaginal dilators, which aim to strengthen pelvic floor muscles and enhance the contractility of the urethral, vaginal, and anal sphincters, thereby improving incontinence symptoms. The second type consists of aids that mechanically block the outlet, such as pessaries, urethral plugs, incontinence pads, incontinence pants, anal plugs, and vaginal bowel control systems, which directly or indirectly prevent incontinence leakage. The third type includes aids that assist in outlet drainage, such as catheters and anal excreta collection devices, which help patients effectively expel urine, feces, and other waste materials, preventing incontinence leakage. By summarizing the existing pelvic floor rehabilitation aids, personalized guidance can be provided to patients with PFD, helping them select the appropriate aids for their rehabilitation needs.

Introduction and hypothesis: Pelvic floor muscle (PFM) function plays a role in pelvic organ support, and estrogen deprivation is commonly seen as a risk factor for pelvic floor dysfunction. This study investigated the association between estrogen deprivation and PFM contractility. Methods: This was a retrospective study on women attending a tertiary urogynecological unit. The assessment included an interview, POPQ assessment, Modified Oxford Scale (MOS) score, and 4D translabial ultrasound (US) on PFM contraction (PMFC). Hormonal status and details on hormone replacement therapy (HRT) were recorded. Corrected menopausal age was defined as the duration of systemic estrogen deprivation. Offline analysis of stored US volumes was performed to measure the reduction in anteroposterior hiatal diameter and bladder neck elevation on PFMC at a later date. Results: Seven hundred thirty-nine women were seen during the study period. Fifty-three were excluded for missing data, leaving 686. Mean age was 56 (17–89, SD 13.3) years; average BMI was 29 (16–66, SD 6.6) kg/m²; 60.6% (n = 416) were menopausal at a mean duration of 16 (1–56, SD 10.2) years. Forty-nine (7.1%) were currently on systemic HRT, while 104 (15.2%) had used it previously. Mean corrected menopausal age (menopausal age - systemic HRT duration) was 7.4 (0–56, SD 10.0) years. Current local estrogen use ≥ 3 months was reported by 31 (4.5%). Mean PFM contractility measured by MOS was 2 (0–5, SD 1.1,). On multivariate analysis there was no association between menopausal age and PFM contractility. Conclusions: Estrogen deprivation may not be an independent predictor of pelvic floor muscle contractility. [ABSTRACT FROM AUTHOR]

Objective: To compare the effects and complications of caesarean section (CSD) and vaginal delivery (VD) for pelvic floor function of parturients.Methods: Multiple databases were searched for full-text articles regarding the clinical effects and complications of CSD and VD. Review Manager 5.0 was used for meta-analyses, sensitivity analysis and bias analysis.Results: In total, 4491 patients were included in nine studies that met the eligibility criteria. Of these, 1527 women underwent CSD and 2944 women had a VD. The meta-analyses suggested significant differences in pelvic floor muscle strength [mean difference (MD) -11.94, 95% confidence interval (CI) -12.48 to -11.39, p < 0.00001, p for heterogeneity <0.00001, I² = 93%], vaginal muscle voltage (MD -9.45, 95% CI -9.73 to -9.16, p < 0.00001, p for heterogeneity <0.00001, I² = 94%), maximum urinary flow rate (MD -5.67, 95% CI -5.94 to -5.39, p < 0.00001, p for heterogeneity <0.00001, I² = 96%), stress urinary incontinence [odds ratio (OR) 0.45, 95% CI 0.37-0.55, p < 0.00001, p for heterogeneity = 0.79, I² = 0%] and pelvic organ prolapse (OR 0.59, 95% CI 0.50-0.70, p < 0.00001, p for heterogeneity = 0.24, I² = 23%) between the CSD group and the VD group.Conclusion: This study demonstrated that CSD is the preferred mode of delivery for pregnant woman in terms of pelvic floor function. [ABSTRACT FROM AUTHOR]

Objective: To study possible associations between pelvic floor muscle contraction, levator ani muscle (LAM) trauma and/or pelvic organ prolapse (POP) ≥ Stage 2 in parous women recruited from a general population.Methods: This was a secondary analysis of data from a cross-sectional study of 608 parous women from a general population examined using the POP quantification system (POP-Q) and three-dimensional/four-dimensional transperineal ultrasound for identification of LAM macrotrauma (avulsion) and microtrauma (distension of levator hiatal area > 75th percentile on Valsalva maneuver). Muscle contraction was assessed using the modified Oxford scale (MOS), perineometry and ultrasound measurement of proportional change of anteroposterior hiatal diameter and levator hiatal area at rest and on pelvic floor muscle contraction. The Mann-Whitney U-test was used to study associations between pelvic floor muscle contraction, LAM trauma and POP.Results: Women with macrotrauma (n = 113) had significantly weaker median pelvic floor muscle contraction, as measured using MOS and perineometry, than did women with an intact LAM (n = 493) (contraction strength was 1.5 (range, 0.0-5.0) vs 3.5 (range, 0.0-5.0) on MOS, and vaginal squeeze pressure was 15.0 (range, 0.0-78.0) cmH2 O vs 28.0 (range, 0.0-129.0) cmH2 O on perineometry; P < 0.001). This was also demonstrated by ultrasound measurement, with a proportional change in hiatal area of 19.9% (range, 4.1-48.0%) vs 34.0% (range, 0.0-64.0%) (P < 0.001) and proportional change in anteroposterior diameter of 16.2% (range, -5.7 to 42.6%) vs 26.0% (range, -3.4 to 49.4%) (P < 0.001). No statistically significant difference between women with (n = 65), and those without (n = 378), microtrauma was found after excluding women with macrotrauma. Women with POP had weaker muscle contraction than those without; in those with POP-Q ≥ 2 (n = 275) compared with those with POP-Q < 2 (n = 333), muscle contraction strength was 3.0 (range, 0.0-5.0) vs 3.5 (range, 0.0-5.0) on MOS, vaginal squeeze pressure was 21.0 (range, 0.0-98.0) cmH2 O vs 28.0 (range, 3.0-129.0) cmH2 O on perineometry, proportional change in hiatal area was 29.6% (range, 0.0-60.9%) vs 33.8% (range, 0.0-64.4%) and proportional change in anteroposterior diameter was 22.8% (range, -5.7 to 49.4%) vs 25.7% (range, -3.4 to 49.4%) (P < 0.001 for all).Conclusions: LAM macrotrauma was associated with weaker pelvic floor muscle contraction measured using palpation, perineometry and ultrasound. Women with POP had weaker contraction than did women without POP. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Purpose: To compare the short- and long-term perineal consequences (at 6 months postpartum) and short-term neonatal consequences of instrumental rotation (IR) to those induced by assisted delivery (AD) in the occiput posterior (OP) position, in case of manual rotation failure.Methods: A prospective observational cohort study; tertiary referral hospital including all women presenting with persistent OP position who delivered vaginally after manual rotation failure with attempted IR or AD in OP position from September 2015 to October 2016. Maternal and neonatal outcomes of all attempted IR deliveries were compared with OP operative vaginal deliveries. Main outcomes measured were pelvic floor function at 6 months postpartum including Wexner score for anal incontinence and ICIQ-FLUTS for urinary symptoms. Perineal morbidity comprised severe perineal tears, corresponding to third and fourth degree lacerations. Fetal morbidity parameters comprised low neonatal Apgar scores, acidaemia, major and minor fetal injuries and neonatal intensive care unit admissions.Results: Among 5265 women, 495 presented with persistent OP positions (9.4%) and 111 delivered after manual rotation failure followed by AD delivery: 58 in the IR group and 53 in the AD in OP group. The incidence of anal sphincter injuries was significantly reduced after IR attempt (1.7% vs. 24.5%; p < 0.001) without increasing neonatal morbidity. At 6 months postpartum, AD in OP position was associated with higher rate of anal incontinence (30% vs. 5.5%, p = 0.001) and with more urinary symptoms, dyspareunia and perineal pain.Conclusions: OP operative deliveries are associated with significant perineal morbidity and pelvic floor dysfunction at 6 months postpartum. [ABSTRACT FROM AUTHOR]

The objective of this narrative review is to study the impact of pregnancy and childbirth on pelvic floor function as assessed by objective measurement techniques with quantitative data carried out during pregnancy and after childbirth. A literature search in MEDLINE and relevant and up-to-date journals from 1960 until April 2017 was performed for articles dealing with the impact of pregnancy and childbirth on pelvic floor function as assessed by objective measurement methods. Only studies describing objective measurement techniques. i.e., urodynamics, ultrasound (US), magnetic resonance imaging (MRI), Pelvic Organ Prolapse Quantification (POP-Q) system, and neurophysiologic tests carried out throughout pregnancy and after childbirth are included. Relevant studies presenting objective quantitative data are analyzed and briefly summarized. The number of studies meeting selection criteria was relatively few. Pregnancy, especially first pregnancy, is associated bladder neck lowering, increased bladder neck mobility, pelvic organ descent, decreased levator ani strength, and decreased urethral resistance. These changes are accentuated after vaginal delivery. Data on the impact of obstetrical and neonatal variables are transient and seem of less importance. Cesarean delivery is not completely protective. In most women, pelvic floor muscle function recovers in the year after delivery. Objective measurement techniques during pregnancy may allow identification of women susceptible to pelvic floor dysfunction later in life and offer the opportunity for counseling and preventive treatment strategies. [ABSTRACT FROM AUTHOR]

To evaluate the effects of pelvic floor muscle training (PFMT) and perineal massage during late pregnancy on postpartum pelvic floor function in nulliparas. Randomised controlled trial. The Peking University First Hospital, a teaching hospital in China. Two-hundred nulliparas were included. Nulliparas were randomised into four groups in a 1:1:1:1 ratio. Group A, control; group B, perineal massage; group C, pelvic floor muscle training (PFMT); group D, perineal massage and PFMT. The intervention group received the corresponding intervention from 34 weeks of gestation until delivery. Changes in pelvic floor function from 34 weeks of gestation to 6 weeks postpartum were assessed using pelvic floor electromyography (EMG), pelvic organ prolapse quantitation (POP-Q), and pelvic floor distress inventory-20 (PFDI-20). Those with PFMT (groups C and D) had a smaller decline in pelvic floor EMG of fibre II than those without PFMT (groups A and B) [− 0.2 (− 7.1, 11.3) µV vs 6.1 (− 0.2, 15.2) µV, P = 0.040]. The same scenario was observed in the pelvic floor EMG of fibre I. The Aa point measurement differences of those with PFMT (groups C and D) were smaller than those without PFMT (groups A and B) [0.0 (0.0, 2.0) cm vs 1.0 (0.0, 3.0) cm, P = 0.006]. The same result was observed for point Ba. No difference was observed in EMG and POP-Q in nulliparas with (groups B and D) or without perineal massage (groups A and C). No differences were observed in PFDI-20 scores. PFMT during late pregnancy enhanced pelvic floor EMG, while perineal massage alone or PFMT combined with perineal massage did not. PFMT in late pregnancy enhances pelvic floor function. • The effect of pelvic floor muscle training and perineal massage in the last trimester on nulliparas. • Pelvic floor muscle training alone enhances pelvic floor electromyography. • Perineal massage alone or combine with pelvic floor muscle training don't. [ABSTRACT FROM AUTHOR]