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OBJECTIVE: To develop evidence- and consensus-based clinical practice guidelines for management of high-tone pelvic floor dysfunction (HTPFD). High-tone pelvic floor dysfunction is a neuromuscular disorder of the pelvic floor characterized by non-relaxing pelvic floor muscles, resulting in lower urinary tract and defecatory symptoms, sexual dysfunction, and pelvic pain. Despite affecting 80% of women with chronic pelvic pain, there are no uniformly accepted guidelines to direct the management of these patients. METHODS: A Delphi method of consensus development was used, comprising three survey rounds administered anonymously via web-based platform (Qualtrics XM) to national experts in the field of HTPFD recruited through targeted invitation between September and December 2021. Eleven experts participated with backgrounds in urology, urogynecology, minimally invasive gynecology, and pelvic floor physical therapy (PFPT) participated. Panelists were asked to rate their agreement with rated evidence-based statements regarding HTPFD treatment. Statements reaching consensus were used to generate a consensus treatment algorithm. RESULTS: A total of 31 statements were reviewed by group members at the first Delphi round with 10 statements reaching consensus. 28 statements were reposed in the second round with 17 reaching consensus. The putative algorithm met clinical consensus in the third round. There was universal agreement for PFPT as first-line treatment for HTPFD. If satisfactory symptom improvement is reached with PFPT, the patient can be discharged with a home exercise program. If no improvement after PFPT, second-line options include trigger or tender point injections, vaginal muscle relaxants, and cognitive behavioral therapy, all of which can also be used in conjunction with PFPT. Onabotulinumtoxin A injections should be used as third line with symptom assessment after 2-4 weeks. There was universal agreement that sacral neuromodulation is fourth-line intervention. The largest identified barrier to care for these patients is access to PFPT. For patients who cannot access PFPT, experts recommend at-home, guided pelvic floor relaxation, self-massage with vaginal wands, and virtual PFPT visits. CONCLUSION: A stepwise approach to the treatment of HTPFD is recommended, with patients often necessitating multiple lines of treatment either sequentially or in conjunction. However, PFPT should be offered first line.

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

Objective: To determine the prevalence of pelvic floor dysfunction (PFD) among pregnant women, their clustering and their association with body image disturbance (BID) up to 1 year postpartum. Design: Monocentric prospective cohort study. Setting: University Hospitals Leuven. Population: Pregnant women attending for pregnancy care, first assessed prior to 14 weeks of gestation and agreeing to follow‐up until 1 year postpartum. Methods: Standardised questionnaires reporting on PFD and BID at 12–14 and 28–32 weeks of gestation, and again at 6–8 weeks and 1 year postpartum. We calculated the prevalence of PFD, how the cases clustered and how the cases correlated with BID using a linear mixed‐model analysis. A minimum of 174 women with complete follow‐up were required. Main Outcome Measures: The questionnaires used were the International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form (ICIQ‐UI SF), St. Mark's Incontinence Score (SMIS), Patient Assessment of Constipation Symptoms (PAC‐SYM), Pelvic Organ Prolapse Distress Inventory (POPDI), Pelvic Organ Prolapse/Incontinence Sexual Questionnaire IUGA Revised (PISQ‐IR) and the Body Image Disturbance Questionnaire (BIDQ). Results: Out of 208 women, 92.8% reported one or multiple symptoms of PFD at 28–32 weeks of gestation, dropping to 73.6% by 1 year postpartum. The most common symptoms were constipation (65.3% at 28–32 weeks of gestation and 42.8% at 1 year postpartum) and urinary incontinence (56.8% at 28–32 weeks of gestation and 35.1% at 1 year postpartum). After correcting for body mass index, parity and mode of delivery, the severity of BID was associated with the ICIQ‐UI SF score (β = 0.016, range 0.007–0.024), the PAC‐SYM score (β = 0.006, range 0.002–0.011) and the POPDI score (β = 0.009, range 0.005–0.012), but not with the SMIS score (β = 0.015, range −0.001 to 0.031) or the PISQ‐IR score, in sexually active women. Conclusions: Urinary incontinence, constipation and symptoms of prolapse have a measurable impact on BID. [ABSTRACT FROM AUTHOR]

• Australian Pelvic Floor Questionnaire (APFQ) as a comprehensive female pelvic floor questionnaire. Moreover, the APFQ was recently acknowledged as an attractive tool for patients, clinicians, and researchers. • There has been no study validating APFQ in Indonesia. • The translation and cross-cultural adaptation were conducted by forward translation to Bahasa Indonesia by two medical translators along with consultants of urogynecology, backward translation to English by another medical translator, comparison between the original and the translated version of the questionnaire, and debriefing of the new translation to the physicians and patients. • The Indonesian version of APFQ was administered consecutively to women aged ≥ 18 years old in two study groups. The urogynecology patient group consisted of urogynecology clinic patients with pelvic floor disorders and, the community (control) group consisted of similarly aged women without any pelvic floor disorders within the last 6 months prior to the recruitment. • The questionnaire can significantly discriminate between pelvic floor dysfunction patients and those without dysfunctions. The results of each domain of the questionnaire correlated with clinical examinations and another questionnaire. • The Indonesian version of the Australian Pelvic Floor Questionnaire (APFQ) is a valid and reliable questionnaire for assessing pelvic floor symptoms among women in Indonesia. To adapt and determine the validity and reliability of the Indonesian version of the Australian Pelvic Floor Questionnaire (APFQ). The original APFQ was translated and validated to obtain an Indonesian, physician-administered version on 41 urogynecology patients and 41 age-matched women without pelvic floor dysfunction. Missing answers never exceeded 2%. The questionnaire can significantly discriminate between pelvic floor dysfunction patients and those without dysfunctions. The results of each domain of the questionnaire correlated with clinical examinations and another questionnaire. Cronbach's alpha scores of all domains were 0.859 for bladder function, 0.829 for bowel function, 0.892 for prolapse symptoms, and 0.766 for sexual function. The Indonesian version of the Australian Pelvic Floor Questionnaire (APFQ) is a valid and reliable questionnaire for assessing pelvic floor symptoms among women in Indonesia. [ABSTRACT FROM AUTHOR]

Context: Athletes are almost 3 times more at risk of experiencing urinary incontinence (UI) than sedentary women, with prevalence rates varying from 10.9% in low-impact sports such as cycling to 80% when engaging in high-impact sports such as trampoline gymnastics. To treat UI, pelvic floor muscle (PFM) training (PFMT) is recommended as a first line of treatment. Objective: The aim of the present study was to perform a meta-analysis of the available literature on the efficacy of PFMT interventions in young, nulliparous female athletes. Data Sources: A literature research was conducted using PubMed, Sport Discus, and Web of Science. Study Selection: The inclusion criteria were studies with PFMT intervention in female athletes or recreationally active women. Interventions could be carried out for treatment or prevention of pelvic floor dysfunctions. Study Design: Systematic review with meta-analysis. Level of Evidence: Level 5. Data Extraction: A descriptive analysis of the articles included in the systematic review was carried out. Meta-analyses could be performed on 6 of the included articles, evaluating the maximal voluntary contraction (MVC) of the PFMs, the amount of urinary leakage (AUL), and the vaginal resting pressure (VRP). Random-effects model and standardized mean differences (SMD) ± 95% CI were reported. Results: The meta-analysis showed that PFMT produced a significant increase in MVC (SMD, 0.60; 95% CI, 0.11 to 1.08; P = 0.02) and a significant reduction of AUL (SMD, -1.13; 95% CI, -1.84 to -0.41; P < 0.01) in female athletes. No effects were shown in VRP (SMD, -0.05; 95% CI, -1.27 to 1.17; P = 0.93). Conclusion: PFMT is shown to be effective in increasing PFM strength and reducing urine leakage in female athletes, being a powerful tool to prevent and treat pelvic floor dysfunction in this population. [ABSTRACT FROM AUTHOR]

Introduction: Postmicturition dribble (PMD) is common in males. Little is known about PMD etiology, but it is either secondary to urethral/prostatic surgery or primary (no previous surgery). Despite PMD's high prevalence, the effectiveness of its treatment modalities remains lacking. Objective: To undertake a systematic review of the available treatments for primary PMD in adult males and meta‐analysis of their effectiveness. Materials and Methods: We searched four electronic databases from inception to 2023 for original articles that evaluated PMD treatments in male adults without previous urethral/prostatic surgery (PROSPERO protocol CRD42023444591). Study quality and risk of bias were evaluated using established tools. We extracted a range of variables including treatment modality used and its effectiveness on PMD volume and patient complaint. Meta‐analysis was undertaken where feasible, and where this was not feasible, narrative synthesis was conducted. Results: Out of 335 studies, four were included (four clinical trials, n = 344 patients). Two trials used physical/behavioral therapy (pelvic floor muscle exercises [PFMEs], urethral milking); the other two employed phosphodiesterase (PDE5) inhibitors (tadalafil, Udenafil). All studies were of good quality, but physical/behavioral therapy studies had some risk of bias. As the two physical/behavioral therapy studies used heterogenous outcome measures, narrative synthesis showed PMD volume improvement with PFMEs more than with urethral milking, both modalities were more effective than counseling, and in one study, PFMEs were effective in reducing PMD self‐reported complaint than counseling. Meta‐analyses of the two PDE5 inhibitors studies showed a large effect size with high heterogeneity for decreased PMD volume favoring PDE5 inhibitors over placebo (g = −0.86, 95% confidence interval [CI] −1.75; 0.02, p = 0.05; I2 = 88%); and a significant improvement equivalent to −1.06 points on the Hallym PMD Questionnaire score with no discernable heterogeneity (95% CI −1.65; −0.47, p = 0.0004; I2 = 0%), favoring PDE5 inhibitors compared to controls. Conclusions: Physical/behavioral therapy and PDE5 inhibitors are effective primary PMD treatments. PMD management studies in males with no previous urethral/prostatic surgery are very scarce and lack the use of consistent/comparable outcome measures. Further studies addressing these deficiencies would benefit this very thin evidence base. [ABSTRACT FROM AUTHOR]

Background: We lack a comprehensive validated Danish questionnaire to evaluate symptoms and bother regarding anal incontinence (AI). The International Consultation on Incontinence Questionnaire‐Bowel (ICIQ‐B) is an internationally recommended questionnaire containing 21 items, of which 17 are scored in three subscales: bowel pattern, bowel control, and quality of life. Aims: To translate the ICIQ‐B into Danish and to validate the Danish version in pelvic floor disorder (PFD) patients with and without AI. Methods: The ICIQ‐B was translated by a panel of healthcare professionals followed by cognitive interviews with PFD patients attending an outpatient clinic. Revisions were undertaken using an iterative process, and a backward translation was performed for the final version. Pretesting and test‐retest of the ICIQ‐B were done online and administrated together with the St. Mark's score. Content, structural, convergent and discriminant validity were assessed, followed by an evaluation of relative and absolute reliability, including the smallest real difference (SRD). Results: Thirty cognitive patient interviews were performed, resulting in three revisions. The Danish ICIQ‐B was found to be comprehensible and relevant but lacked items addressing the psychological impact of bowel problems. The ICIQ‐B was completed online by 227 PFD patients with and without AI. The structural validity of the bowel pattern subscale could not be retrieved. Patients indicating AI had significantly higher ICIQ‐B and St. Mark's scores than patients without AI, and ICIQ‐B subscale scores correlated moderately with St. Mark's scores. Internal consistency was good except for the bowel pattern subscale. Seventy‐six patients completed test‐retest. Relative reliability was excellent for subscale scores and moderate or good for single items except for the item concerning stool consistency, which was weak. The SRD was found to be 2.8 for the bowel pattern subscale, 4.3 for bowel control subscale, and 3.6 for the quality‐of‐life subscale. Conclusion: The Danish version of the ICIQ‐B can be used for Danish patients with PFD, and discriminant validity is good. The structural validity and the internal consistency of the bowel pattern subscale are questionable, indicating that some items do not represent the underlying construct. Test‐retest reliability of the ICIQ‐B is acceptable, but the change needed to reflect a real change above the measurement error in each subscale is three to four points. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusions Our study aimed to investigate the association between maternal pre‐pregnancy body mass index (BMI), gestational weight gain (GWG), and impaired pelvic floor muscle (PFM) morphology and function during the early postpartum period.This retrospective cohort study was conducted at Shanghai First Maternity and Infant Hospital from December 2020 to December 2022. A total of 1118 primiparous women with singleton pregnancies who underwent vaginal deliveries and participated in postpartum PFM assessments were included. Maternal pre‐pregnancy BMI and GWG were considered as exposures. PFM morphology and function impairment were the primary outcomes. PFM morphology impairment, defined as levator ani muscle avulsion, was assessed using transperineal ultrasound. PFM function impairment, manifested as diminished PFM fiber strength, was assessed through vaginal manometry. Multivariable logistic regression analysis was employed to calculate adjusted odds ratios (aOR) with 95% confidence intervals (CI). Restricted cubic spline models were used to validate and visualize the relationship.Women with lower pre‐pregnancy BMI were at an increased risk of levator ani muscle avulsion (aOR = 1.73, 95% CI: 1.10–2.70, P = 0.017), particularly when combined with excessive GWG during pregnancy (aOR = 3.20, 95% CI: 1.15–8.97, P = 0.027). Lower pre‐pregnancy BMI was also identified as an independent predictor of PFM weakness (aOR = 1.53, 95% CI: 1.08–2.16, P = 0.017 for type I fiber injuries). Notably, regardless of the avulsion status, both underweight and overweight/obese women faced an elevated risk of reduced PFM strength (aOR = 1.74, 95% CI: 1.17–2.59, P = 0.006 for underweight women with type I fiber injuries; aOR = 1.67, 95% CI: 1.06–2.64, P = 0.027; and aOR = 1.73, 95% CI: 1.09–2.76, P = 0.021 for overweight/obese women with type I and type II fibers injuries, respectively).Both lower and higher pre‐pregnancy BMI, as well as excessive GWG, were strongly associated with PFM impairments. These findings highlighted the critical importance of comprehensive weight management throughout pregnancy to effectively promote women's pelvic health. [ABSTRACT FROM AUTHOR]

Background: Intravaginal electrical stimulation (IVES) has been explored as a potential treatment for pelvic floor disorders (PFDs), although its efficacy remains a subject of debate. We aim to conducted a comprehensive meta-analysis of relevant trials. Methods: This meta-analysis was performed under the PRISMA 2020 guideline. We meticulously searched for randomized controlled trial (RCT) studies in various databases, including PubMed, Cochrane Library, EMBASE, and ClinicalTrials.gov, spanning from inception to March 6, 2023. All studies included one treatment group of intravaginal electrical stimulation and the diseases spectrum of the studies involved different kinds of PFDs, including urinary incontinence, overactive bladder, etc. Risk of bias charts were used to assess the risk of bias in the studies and forest plots were used the demonstrate the overall effects. Results: Our analysis encompassed a total of 13 RCT studies. In most of the assessed PFD cure outcomes, the results demonstrated positive effects of IVES therapy, as indicated by the following findings: daily voiding frequency (MD = -1.57, 95% CI = -3.08 to -0.06, I² = 68%,), nocturia (MD = -1.07, 95% CI = -2.01 to -0.13,I² = 71%), Pad test, and Urinary incontinence. Nevertheless, the data concerning the impact of IVES therapy on the quality of life of individuals with PFDs did not confirm these positive results. Discussion: In light of the insufficiency in both the quality and quantity of the included studies, it is premature to draw a definitive conclusion regarding the efficacy of IVES therapy for treating PFDs. Nonetheless, our study does provide several pieces of evidence in support of the potential therapeutic effects of electrical stimulation therapy in this context. We recommend that further research in this area be conducted to provide more conclusive insights into the efficacy of IVES therapy for PFDs. [ABSTRACT FROM AUTHOR]

The present study aimed to investigate the histopathological effects of obstetric gel (OG) on vaginal tissue. In this study, 21 female Wistar albino rats were divided into three groups, comprising seven animals in each group. The first group (group 1) was the control group, the second group (group 2) was the physiological saline (PS) group, and the third group (group 3) was the OG group. In group 1, dilatation was performed using Hegar dilators from Hegar 5 to Hegar 10 without any vaginal application. In group 2, the vagina was washed with a PS-filled applicator. In group 3, the vagina was washed with an OG-filled applicator and Hegar dilators were used to achieve vaginal dilatation. In the group of OG-applied rats, there was an increase in mast cell infiltration, tissue epithelial thickness, and fibrillin-1 levels of the mucosa in the vaginal tissue. The present study is the first to investigate the histopathological effects of OG used for vaginal tissue dilatation in rats. OGs have no early effectiveness in preventing the damage caused by compression of the vaginal wall; however, OGs may have a protective effect against pelvic floor pathologies. [ABSTRACT FROM AUTHOR]

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

Introduction and Hypothesis: Pelvic floor disorders (PFDs) impact women worldwide and are assessed using instruments such as the Pelvic Floor Distress Inventory (PFDI-20) and Pelvic Floor Impact Questionnaire (PFIQ-7). There are no known valid PFD instruments in Uganda. This study's purpose was to translate and test the reliability and validity of the PFDI-20 and PFIQ-7 in Luganda. It was predicted that these instruments would be reliable and valid to assess the presence and impact of PFD in parous Luganda-speaking women. Methods: The translated PFDI-20 and PFIQ-7 were administered to parous Luganda-speaking women and readministered 4–8 months after. The Pelvic Organ Prolapse Quantification (POP-Q) examination determined the presence of pelvic organ prolapse (POP) and a cough-stress test (CST) measured urinary leakage. Analysis was completed using Cronbach's α co-efficient for internal consistency and Spearman's correlation coefficients and Wilcoxon rank sum tests for construct validity. Results: Of the 159 participants, 93 (58.3%) had stage II POP or higher. The PFDI-20 and PFIQ-7 demonstrated minimal bother and impact on activities of daily living respectively. The Urinary Distress Inventory 6 (UDI-6) scores on the PFDI-20 showed a strong positive association with the presence of urinary incontinence. When PFD was defined by responses to symptom assessment, the translated PFDI-20 and PFIQ-7 could differentiate between individuals with and without PFD. Conclusions: The UDI-6 section of the PFDI-20 was found to be valid in Luganda. The PFIQ-7 and the entirety of the PFDI-20 were not found to be reliable or valid, likely because of the low prevalence of PFDs in the study population. [ABSTRACT FROM AUTHOR]

Introduction and Hypothesis: Risk factors for pelvic floor disorders (PFDs) are not well understood in lower resource settings. The objective of this study is to determine the risk factors associated with stress urinary incontinence (SUI), urge urinary incontinence (UUI), and pelvic organ prolapse (POP) among women of reproductive age in rural Nepal. Methods: This is a case–control study nested within a community-based cross-sectional survey of parous women of reproductive age with PFDs in the Sarlahi District of Nepal. The presence of PFDs was confirmed by clinical assessment. Detailed sociodemographic information and histories were captured. Results: We examined 406 women; the mean (SD, range) age was 32.7 (8.5, 16–49) years, mean BMI (SD) was 19.7 (3.3) kg/m2, and median (range) number of pregnancies was 4 (1–11). Two hundred and three women (50.0%) had either SUI or UUI, 85 (17.8%) had both SUI and UUI, and 71 (17.5%) had POP at or beyond the hymen. After controlling for other variables significant on bivariate analysis, age (adjusted odds ratio [aOR] 1.06 [95% CI 1.03–1.09]), illiteracy (aOR 2.24 [95% CI 1.04–4.80]), and presence of upper gastrointestinal issues (aOR 3.30, [95% CI 1.77–6.16]) were independently associated with SUI/UUI. Age (aOR 1.05 [95% CI 1.02–1.09]), bispinous diameter (aOR 2.88 ([95% CI 1.11–7.47]), and subpubic angle (aOR 2.78 [95% CI 1.55–5.03]) were independently associated with POP. Conclusion: Risk factors for PFDs in a homogenous community of parous women of reproductive age in rural Nepal are similar to those found in parous women in higher income countries. [ABSTRACT FROM AUTHOR]

Purpose/Objective: Mixed urinary incontinence (MUI) is the coexistence of stress urinary incontinence (SUI) and urge urinary incontinence (UUI). MUI can be a challenging condition to treat, and there continues to be a demand for successful nonsurgical interventions if possible. This study evaluates the efficacy of combining bipolar radiofrequency (RF) energy to the vaginal canal, electrical muscle stimulation (EMS) of the pelvic floor, and patient education in the treatment of MUI in females. Methods: A prospective study that evaluates RF and EMS in female patients with moderate MUI. RF and EMS treatments were administered three times, 2 weeks apart. Patients were also educated on exactly what MUI is and how to appropriately utilize their pelvic floor muscles. Outcome measures assessed included both objective (cough stress test to measure pad weight) and subjective (Incontinence Quality of Life [iQOL]; Medical, Epidemiological, and Social Aspects of Aging [MESA] Urge Incontinence [UI], MESA Stress Incontinence [SI], Female Sexual Function Index [FsFI]; and Urogenital Distress Inventory-6 [UDI-6]). Results: In total, 31 women underwent the combination of RF, EMS, and patient education, resulting in significant improvement in MUI symptoms (PGI: 82% indicated feeling improvement) after 3 months of treatment in all measures. Conclusion: RF and EMS in conjunction with patient education via a three-treatment protocol was found to be efficacious and safe for treating women with MUI. Future studies should be done to further elucidate optimal treatment protocols for MUI and patients followed up for longer periods of time to determine the durability of this regimen. [ABSTRACT FROM AUTHOR]

Background: Bladder prolapse is a common clinical disorder of pelvic floor dysfunction in women, and early diagnosis and treatment can help them recover. Pelvic magnetic resonance imaging (MRI) is one of the most important methods used by physicians to diagnose bladder prolapse; however, it is highly subjective and largely dependent on the clinical experience of physicians. The application of computer‐aided diagnostic techniques to achieve a graded diagnosis of bladder prolapse can help improve its accuracy and shorten the learning curve. Purpose: The purpose of this study is to combine convolutional neural network (CNN) and vision transformer (ViT) for grading bladder prolapse in place of traditional neural networks, and to incorporate attention mechanisms into mobile vision transformer (MobileViT) for assisting in the grading of bladder prolapse. Methods: This study focuses on the grading of bladder prolapse in pelvic organs using a combination of a CNN and a ViT. First, this study used MobileNetV2 to extract the local features of the images. Next, a ViT was used to extract the global features by modeling the non‐local dependencies at a distance. Finally, a channel attention module (i.e., squeeze‐and‐excitation network) was used to improve the feature extraction network and enhance its feature representation capability. The final grading of the degree of bladder prolapse was thus achieved. Results: Using pelvic MRI images provided by a Huzhou Maternal and Child Health Care Hospital, this study used the proposed method to grade patients with bladder prolapse. The accuracy, Kappa value, sensitivity, specificity, precision, and area under the curve of our method were 86.34%, 78.27%, 83.75%, 95.43%, 85.70%, and 95.05%, respectively. In comparison with other CNN models, the proposed method performed better. Conclusions: Thus, the model based on attention mechanisms exhibits better classification performance than existing methods for grading bladder prolapse in pelvic organs, and it can effectively assist physicians in achieving a more accurate bladder prolapse diagnosis. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of vacuum extraction (VE) or caesarean section (CS), compared with expectant management, on pelvic floor dysfunction (PFD) 1–2 years postpartum in primiparous women with a prolonged second stage of labour. Design: A population‐based questionnaire and cohort study. Setting: Stockholm, Sweden. Population: A cohort of 1302 primiparous women with a second stage duration of ≥3 h, delivering from December 2017 to November 2018. Methods: The 1‐year follow‐up questionnaire from the Swedish National Perineal Laceration Register was distributed 12–24 months postpartum. Exposure was VE or CS at 3–4 h or 4–5 h, compared with expectant management. Main outcome measures: Pelvic floor dysfunction was defined as at least weekly symptoms of urinary incontinence, pelvic organ prolapse or a Wexner score of ≥4. The risk of PFD was calculated using Poisson regression with robust variance estimation, presented as crude and adjusted relative risks (RRs and aRRs) with 95% confidence intervals (95% CIs). The implication of obstetric anal sphincter injury (OASI) on pelvic floor disorders was investigated through mediation analysis. Results: In total, 35.1% of women reported PFD. Compared with expectant management, the risk of PFD was increased after VE at 3–4 h (aRR 1.33, 95% CI 1.06–1.65) and 4–5 h (aRR 1.34, 95% CI 1.05–1.70), but remained unchanged after CS. The increased risk after VE was not mediated by OASI. Conclusions: Pelvic floor dysfunction was common in primiparous women after a prolonged second stage, and the risk of PFD increased after VE but was unaffected by CS, compared with expectant management. If a spontaneous vaginal delivery eventually occurred, allowing an extended duration of labour did not increase the risk of PFD. [ABSTRACT FROM AUTHOR]

Background: Telehealth utilization, largely spurred by the COVID‐19 pandemic, has become popular due to convenience and access. We assessed the effectiveness of telehealth for delivering pelvic health physical therapy (PHPT) in patients with pelvic floor disorders (PFD). Methods: In this IRB approved, cross‐sectional study, 812 patients who underwent PHPT treatment by telehealth or in combination with in‐person visits were surveyed. Post intervention effectiveness was analyzed using Patient Global Impression of Change (PGIC) and short form Pelvic Floor Impact Questionnaire (PFIQ‐7). Results: One hundred and forty‐one patients, 80% female, mean (SD) age of 52 (17) completed the study. The mean number of encounters was 4.55 (4.25) with 2.81 (2.08) telehealth visits. A total of 42 (30%) patients reported no change/worse, 27 (19%) minimal, and 72 (51%) moderate/much improvement of symptoms consistent with a lower PFIQ‐7 scores. Patients who reported improvement were significantly younger (p < 0.002). Age was the only independent factor that could predict response to PHPT. Patients <50 years old reported significantly more symptom improvement (p < 0.02), symptom resolution (p < 0.002), meeting personal goals (p < 0.0001), improved muscle strength, coordination, and relaxation (p < 0.05), greater satisfaction with bowel movements, and less negative impact of bowel on quality of life (p < 0.005) than older patients. Regardless of age, 89 (64%) patients preferred hybrid telehealth visits. Conclusion & Inferences: Utilizing telehealth alone or in a hybrid format combined with in‐person visits for PHPT appears to be preferred by patients and associated with subjective report of improvement of symptoms. However, efficacy of telehealth interventions in older adults warrants further studies. [ABSTRACT FROM AUTHOR]