To evaluate long-term outcomes of open urorectal fistula (URF) repair, including URF recurrence, need for re-intervention, and patient-reported outcomes. This retrospective study included men undergoing open URF repair between 2014 and 2024. Data collected encompassed comorbidities, prostate cancer treatment history, prior URF interventions, and intraoperative details. Endpoints were: (i) URF recurrence-free survival, (ii) re-intervention-free survival (no further disease-related procedures), and (iii) validated patient-reported outcome measures (PROMs). Kaplan-Meier estimators were used for survival analyses; PROMs were scored according to standard protocols. A total of 29 patients underwent open URF repair. The median (interquartile range [IQR]) age was 68 (61-71) years, body mass index was 26 (23-28) kg/m2, and the time from prostatectomy to URF repair was 10 (4-13) months. Five patients (17%) had prior pelvic radiotherapy; 13 (45%) underwent redo repairs. Presenting symptoms included rectal urine leakage (48%), pneumaturia (24%), recurrent infections (21%), dysuria (21%), and faecaluria (10%). Transperineal repair was performed in 26 patients (90%) and transabdominal repair in three (10%). The median (IQR) operating time was 90 (80-107) min. The median follow-up was 50 months for recurrence and 58 months for re-intervention. The 5-year URF recurrence-free and any disease-related re-intervention-free survival estimates were 96% and 75%, respectively. The median (IQR) six-item lower urinary tract symptoms score from the Urethral Stricture Surgery PROM was 4 (2-8), International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form sum score was 11 (6-15), Wexner faecal incontinence score was 3 (1-9), International Consultation on Incontinence Questionnaire-Satisfaction outcome score was 21 (18-23), and Decision Regret Scale score was 0 (0-10), indicating restored voiding function, moderate urinary incontinence, mild faecal incontinence, high patient satisfaction, and negligible decisional regret. Open URF repair achieves durable URF closure with favourable long-term outcomes, even in complex cases. Patient satisfaction is high, while moderate urinary incontinence persists in some, likely reflecting underlying disease. Voiding and faecal continence remain largely preserved.

Survivors of pelvic cancer are at risk for pelvic floor dysfunction (PFD). This review is aimed at determining the pooled prevalence of PFD after pelvic radiotherapy and explore associations with treatment modalities. We included observational studies of women with urogynecological or anorectal cancer treated with radiotherapy, brachytherapy, or chemoradiotherapy, assessing PFD. Exclusion criteria were previous pelvic surgery or rehabilitation, reviews, case reports, conference abstracts, comments, letters, or inaccessible full texts. We searched PubMed, PubMed PMC, Cochrane library, EMBASE, Web of Science, and Scopus to 6 August 2024. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies. Meta-analyses were conducted in R software. Meta-regression explored potential covariates. A 5% level of statistical significance was established. Fifteen studies involving 1667 women were included. Pooled prevalence estimates were urinary incontinence (UI, 37%), stress UI (34%) and urgency UI (47%), overactive bladder (42%), anal incontinence (24%), defecatory urgency (20%), pelvic pain (30%), and sexual dysfunction (19%). Longer follow-up time was associated with increased defecatory urgency (p = 0.0054). Certainty of evidence was moderate for urgency urinary incontinence and overactive bladder, and low for the other outcomes. No publication bias was detected (Egger's test, p = 0.17). Radiotherapy for pelvic malignancies is associated with UI and overactive bladder symptoms. Bowel and sexual dysfunction were heterogeneous, but defecatory urgency increased over time. Limitations include heterogeneity in follow-up and study methods. Routine assessment and proactive multidisciplinary care are needed to mitigate morbidity and improve quality of life.

Aim: Sacral neuromodulation (SNM) is a minimally invasive treatment option for various lower urinary tract symptoms (LUTS) and bowel dysfunctions. Despite its widespread use, the exact mechanism of action and optimal patient selection remain unclear. This study aimed to report the outcomes of SNM in patients treated at tertiary health centers in Türkiye.Materials and Methods: A retrospective analysis was conducted on 16 patients who underwent SNM for LUTS, bowel dysfunction, or chronic pelvic pain between 2017 and 2022. Patient characteristics, primary diagnosis, implantation duration, complications, and symptom improvement were recorded. Urinary symptoms were assessed using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Statistical analyses were performed using SPSS Statistics 26.0.Results: The mean age of the patients was 42.4 ± 11.9 years, with a mean BMI of 25.5 ± 5.4 kg/m². The mean duration of symptoms was 12.6 ± 10.5 years, and the mean age at implantation was 40.2 ± 11.1 years. SNM was primarily performed for idiopathic lower urinary tract dysfunction (87.5% of patients) and faecal incontinence (12.5%). The mean ICIQ-SF score significantly decreased from 13.64 ± 7.61 before implantation to 7.50 ± 7.51 after implantation (p = 0.003). A complication requiring surgical intervention occurred in 12.5% of patients.Conclusion: This study demonstrates that SNM is effective in improving symptoms associated with LUTS and bowel dysfunction, as evidenced by the significant reduction in ICIQ-SF scores. However, a notable complication rate was observed, highlighting the importance of appropriate patient selection and ongoing follow-up. Further studies with larger cohorts and longer follow-up are warranted to evaluate the long-term outcomes and safety profile of SNM.

Role of Anorectal Autologous Fat Injection in Treatment of Fecal Incontinence in Children

Abstract Introduction Fecal incontinence (FI) characterized by uncontrolled passage of fecal material is a relatively common disorder. The Rome IV Criteria for Disorders of Gut-Brain Interaction (DGBI) define FI as a recurrent uncontrolled passage of fecal material in an individual with a developmental age of at least 4 years. The therapy for fecal incontinence comes with substantial number of hindrances and often result in disappointing results for patients. Therefore it should be individualized based on symptom presentation. Home electrical stimulation (HES) is a highly personalized method of therapy and when combined with voluntary sphincter training it could lead to significant improvement of the patient symptoms. However, there is a significant difference of protocols and device settings between these studies with lack of known evidence in real world clinical setting. Methods This a retrospective single center study based on real world data. Patients who had clinically distinctive urge or passive incontinence were considered for the study. The treatment duration was 12 weeks and patients used the manufacturer setting for stress incontinence. After the initial examination with 3D High definition anorectal manometry and filling the Wexner incontinence score questionary patients were thoroughly instructed about the use of the home stimulation device. The treatment protocol required to train once daily for 20 min six times a week. The control visit was performed 12 weeks after the initial visit with identical clinical evaluation protocol. Results Total number of evaluated patients was nineteen (19), ten (10) with passive and nine (9) wit urge incontinence . Both groups showed the improvement of sphincter function. These were significantly more prominent within the urge incontinence group. The total average increase in sphincter rest mean pressure was 22.53%, total average increase in sphincter rest maximum pressure was 25.69%, and total average increase during voluntary maximum pressure 36.13%. There overall improvement of Wexner score was significant (15 vs. 9 points, pre vs post therapy). Conclusion The home electric stimulation combined with voluntary sphincter training is effective in both clinical types of fecal incontinence, but substantially higher in urge incontinence. Further randomized studies should evaluate the additive effect of voluntary muscle contraction on the overall effect of therapy.

Background: Total proctocolectomy with ileal pouch anal anastomosis (IPAA) is a standard procedure for many diseases, including familial adenomatosis polyposis (FAP). This procedure can be achieved by different options. Objectives: To report and assess the outcome of a two-stage operation: Proctocolectomy with IPAA with diverting loop ileostomy followed by ileostomy reversal as a second stage using a stapled technique for J-pouch type. Methods: A prospective study conducted in Basrah Gastroenterology and Hepatology Hospital from March 2022 to June 2025. It involves 10 patients (two males and 8 females) diagnosed as FAP by colonoscopy and histopathological biopsies. All patients experienced two-stage operations. Laparotomies using the stapled technique were performed for all patients. The J-pouch type was created in all of them. Follow-up for all patients was achieved by scheduled visits. Results: No death was reported in this study. In addition, none of the patients developed anastomotic leakage, pouch loss, impotence, pulmonary embolism, bleeding, fecal incontinence, postoperative pneumonia, or intestinal obstruction. However, the following complications were reported as follows: Pouchitis (2/10), incisional hernia (2/10), wound infection (3/10), and peristomal dermatitis (10/10). Conclusions: This operation successfully achieved the primary treatment of FAP without serious complications, such as leakage, which encourages further studies involving larger sample sizes and the use of various staged surgical procedures for FAP or other patients with a broader range of underlying diseases.

Surgical treatment of high anal fistulas is challenging and associated with a relatively high rate of complications and failure. Stem cell therapy has shown promising results for fistulas associated with Crohn's disease but remains less studied in cryptoglandular fistulas. This clinical trial is being performed to evaluate the outcome of treating complex cryptoglandular perianal fistulas (PAFs) using minimal surgical debridement combined with either non-cultured (autologous) or cultured (allogeneic) adipose-derived regenerative cells (ADRCs). The primary outcome is the clinical healing rate after 12months. Secondary outcomes include functional outcomes regarding quality of life and anal continence (measured by the 36-Item Short Form Health Survey [SF-36] and the Wexner Fecal Incontinence Score), risk factors for fistula recurrence, radiological healing assessed by magnetic resonance imaging, and comparison of autologous versus allogeneic ADRCs with respect to cell characterization, immune responses, and efficacy. This is a double-blinded, randomized interventional non-inferiority, phase I-II clinical trial using two approved investigational medicinal products. The study will be conducted at the surgical department, Odense University Hospital OUH, in Odense, Denmark. Inclusion criterion is an adult patient (≥ 18years) with complex PAF (high transsphincteric or suprasphincteric), involving more than 30% of the anal sphincter. Key exclusion criteria are ongoing suppuration, simple anal fistula, ano- or rectovaginal fistula, inflammatory bowel disease, body mass index (BMI) of < 18.5kg/m2, known allergy to penicillin or streptomycin, pregnancy, and verified syphilis, human immunodeficiency virus (HIV), or hepatitis on screening test. The primary investigator (PI) is responsible for participants' recruitment. Eligible patients will undergo 1-day surgery, including debridement of the fistula tract and closure of the internal orifice, liposuction from the anterior abdominal wall, injection of 30-40mL of autologous microfat around the fistula tract, and injection of 30 million stem cells (either autologous ADRCs or allogeneic ADRC001) according to randomization (1:1 allocation ratio). Patients who receive treatment will attend follow-up visits at 3, 6, and 12months postoperatively. Serious adverse events will be reported including large abscess formation, wound dehiscence causing fecal incontinence, sepsis, major bleeding, and serious allergic reactions. The trial has been approved by the European Medicines Agency EMA and is monitored by the Good Clinical Practice (GCP) Unit at OUH. A total of 75 patients will be included. Recruitment began in October 2024, with a planned duration of 3years. The trial intervention is designed as a minimally invasive treatment with the potential to shorten and ease recovery, enable a quicker return to daily activities and work, and avoid sphincter damage, thereby preserving function. The trial is expected to provide evidence on whether allogeneic ADRCs combined with microfat are a viable alternative to autologous ADRCs with microfat for the treatment of PAF. Clinical Trials Information System (CTIS) EU CT 2022-502659-73-01. Registered on 18 November 2023. org NCT06303752. Registered on 25 February 2024.

To observe the clinical efficacy of the loose-seton procedure combined with transanal opening of the intersphincteric space technique (LoSet-TROPlS) for complex anal fistulas. A retrospective analysis was conducted on the clinical data of 73 patients with cryptoglandular anal fistulas who underwent LoSet-TROPlS in our hospital from September 2020 to March 2021. The study evaluated the surgical healing rate, recurrence rate, time to seton removal, and postoperative anal incontinence. The median follow-up time was 34.0 (32.0, 38.0) months. The primary healing rate was 83.56% (61/73), with a failure rate of 16.44% (12/73). The recurrence rate was 9.84% (6/61), and the overall healing rate was 86.30% (63/73). The median time for seton removal was 27 (23, 30) days. No patients experienced formed stool incontinence. Two patients occasionally had anal gas or fluid leakage, which improved after biofeedback therapy. Two patients experienced occasional mucous discharge. There was no statistically significant difference in anal canal and rectal pressure before and after surgery (P > 0.05). The LoSet-TROPlS is an effective treatment for complex anal fistulas while preserving anal function. The procedure is not complicated and can be promoted for clinical application.

Association Between Constipation and Fecal Incontinence in Community-Dwelling Older Adults in Japan.

This study aims to evaluate anorectal function through high-resolution anorectal manometry (HRAM) in patients with constipation and fecal impaction, considering the limited information available on this subject. HRAM conducted between January 2021 and November 2023 (785 procedures) were reviewed. Patients were identified as individuals who experienced at least one episode of hard stools in the last year that were unable to evacuate. They were compared with constipated patients without fecal impaction episodes (control group). HRAM was performed using solid-state equipment (Medtronic). Logistic regression analysis was done to identify demographic-clinical factors and manometric variables associated with fecal impaction. Fecal incontinence was independently associated with fecal impaction [adjusted odds ratio (aOR): 20.4, 95% CI: 2.5-167.8] after adjusting for demographic and clinical variables. Severe rectal hyposensitivity (no perception of urgency from a volume of 200mL) was present in 38.2% of patients with fecal impaction and 5.9% of controls ( P =0.001). Defecatory dyssynergia was diagnosed in 29.4% of patients with fecal impaction. Lower squeeze pressure and severe rectal hyposensitivity were independently associated with fecal impaction with an aOR of 0.98 (95% CI: 0.98-0.99) and aOR of 10.4 (2-54.1), respectively, and after adjusting for all manometric parameters. Hypotonia and hypo-contractility of the anal canal were found in 53.8% and 46.2% of patients with fecal impaction and incontinence, respectively. Patients with fecal impaction often show rectal hyposensitivity and anal hypo-contractility, which are independent risk factors for impaction. Fecal incontinence is linked to fecal impaction, and their coexistence is associated with reduced anal canal pressures.

ObjectiveThis study was designed to examine the relationship between fecal incontinence and accelerated aging, determine its association with mortality risk, and evaluate whether accelerated aging mediates the link between fecal incontinence and mortality.MethodsThis cohort study used data from the National Health and Nutrition Examination Survey. Accelerated aging was quantified using phenotypic age acceleration. Multivariable linear regression models, Cox proportional hazards models, and mediation analysis were employed to assess the associations between fecal incontinence, phenotypic age acceleration, and mortality.ResultsAmong 12,581 United States adults, the overall prevalence of fecal incontinence was 8.38%. Fecal incontinence was positively associated with phenotypic age acceleration (β: 0.98, 95% confidence interval: 0.43, 1.58) and increased risks of all-cause mortality (hazard ratio: 1.24, 95% confidence interval: 1.07, 1.44) and cardiovascular mortality (hazard ratio: 1.28, 95% confidence interval: 1.01, 1.63). Mediation analysis indicated that phenotypic age acceleration accounted for 9.56% of the effect of fecal incontinence on all-cause mortality.ConclusionAccelerated aging partially mediated the association between fecal incontinence and all-cause mortality in the United States population. These findings suggest new pathways for mitigating the broader health impacts of fecal incontinence.

The effect of a short interpregnancy interval (IPI) on pelvic floor disorders is unknown. We investigated the relationship between a short IPI and the development of stress incontinence (SUI), pelvic organ prolapse (POP), and anal incontinence (AI) in the decade after the first delivery. We performed a secondary analysis of the Mothers' Outcomes After Delivery study-a prospective cohort of women recruited 5-10 years following their first delivery and followed annually between 2008 and 2018. A short IPI was defined as ≤18 months, calculated as the number of months between deliveries minus the length of the second pregnancy. SUI, POP, and AI were identified by annual validated questionnaires, examination, or history of treatment. Data were analyzed in SAS. Variables significant on bivariate analysis were entered into multivariable logistic regression models predicting each outcome using the generalized estimating equations approach for repeated measures. Of 1,127 women, the majority (671, 59%) never had a short IPI, 395 (35%) had 1 short IPI, and 61 (6%) had 2 or more. Within 10-15 years, 219 women (19%) reported SUI, 156 (14%) reported POP, and 251 (22%) reported AI. We found that a short IPI was not associated with SUI ( P =0.69), POP ( P =0.71), or AI ( P =0.95). When restricting the cohort to women with only nonoperative vaginal deliveries (n=440), there remained no difference in the presence of SUI, POP, or AI ( P = 0.88, 0.84, 0.78, respectively). A short IPI is not associated with pelvic floor disorders in the decade following the first delivery. This should be reassuring to women at risk of PFDs who elect to become pregnant within 18 months of childbirth.

Prevalence of Fecal Incontinence in Older Adults: A Systematic Review and Meta-Analysis.

Urinary and fecal incontinence following childbirth

Onabotulinumtoxin A Injections for Patients With Pelvic Floor Dysfunction.

Pressure injury (PI) is considered a widespread public health problem despite the advancement of technology in the field of health, the increase in the level of medical knowledge, newly introduced treatments and precautions. Traditional methods are capable of recognising only 20%-40% of cases of PI development. To evaluate the feasibility of using an Infrared Thermal Imaging Camera (IRTC) to prevent the development of pressure injury. This study is a cross-sectional study. Delta-T (ΔT) temperature differences measured by IRTC were determined to be high risk, with differences above -1°C detected in the pressure areas. ΔT risk status was compared with the Braden Risk Assessment Scale (BRAS). The study was completed with the participation of 30 patients and using 1755 thermography measurements. A statistically significant correlation was noted between Braden Risk Assessment Scale (BRAS) measurements and age (95% Cl [-0.704, -0.045] p = 0.025), albumin level (95% Cl [0.262, 0.710] p = 0.006), haemoglobin level (95% Cl [0.225, 0.740] p = 0.005), systolic blood pressure (95% Cl [0.212, 0.728] p = 0.005), faecal incontinence (95% Cl [-2.120, -0.858] p = 0.000) and Glasgow Coma Scale (GCS) (95% Cl [0.708, 0.929] p = 0.000). Statistically significant differences were identified between the ΔT temperature differences measured with IRTC and the variables of gender (95% Cl [-0.907, -0.204] p = 0.002), age (95% Cl [0.290, 2.380], p = 0.008), Glasgow coma scale (95% Cl [0.123, 0.388] p = 0.000), body mass index (95% Cl [-0.512, -0.027] p = 0.011), albumin level (95% Cl [0.009, 0.372] p = 0.037), haemoglobin level (95% Cl [-0.459, -0.057] p = 0.019), body temperature (95% Cl [-0.301, -0.009] p = 0.027), SPO2 (95% Cl [-0.305, 0.025] p = 0.030), systolic blood pressure (95% Cl [-0.359, -0.095] p = 0.001) and oedema (95% Cl [0.205, 1.155] p = 0.002). A statistically significant difference was observed between IRTC measurements and BRAS scores in identifying the pressure injury development risk (OR = 0.164, 95% Cl [0.032, 0.834] p = 0.024). Considering the period throughout which the IRTC measurements were followed, a significant difference was found in terms of PI development after the third day (95% Cl [6.994, 10.000] p = 0.017). The findings indicate that the Infrared Thermal Camera can detect pressure injury risk earlier and more objectively compared to the Braden Risk Assessment Scale and therefore may serve as an effective tool for preventing pressure injuries in patients in tertiary intensive care units. In this study, the Infrared Thermal Camera was found to be more effective than the Braden Risk Assessment Scale in evaluating the risk of pressure injuries. In this context, the use of the Infrared Thermal Camera by critical care nurses in intensive care practice provides an important clinical application for the early detection of pressure injuries and the development of preventive care strategies. The post hoc study was registered on https://clinicaltrials.gov/ (January 12, 2024) with the registration number NCT06219954.

To describe the incidence, prevalence, and prognostic factors for gastroenterological disorders and hepatic disease in adults with cerebral palsy (CP), and to examine the effectiveness of any screening or interventions. Six databases were searched for articles published in any language since 1990 meeting eligibility criteria, defined for each of five objectives. Two independent reviewers screened study titles, abstracts, and full texts for inclusion. Thirty-two reports of 30 unique samples, including 10 to 16 818 adults, were identified. Twenty-five reported prevalence of at least one of the following: gastroesophageal reflux disease (GERD) (prevalence 3%-42%; seven studies), constipation (4%-67%; seven studies), dysphagia (6%-77%; 12 studies), fecal incontinence (6%-29%; three studies), dental/oral cavity disorders (25%-53%; five studies), and aggregated hepatic diseases (1%-6%; seven studies). The prevalences of GERD, dysphagia, and hepatic disease were higher in adults with CP than in those without. The prevalence of fecal incontinence was greater in people classified as having CP in higher Gross Motor Function Classification System levels. No incidence studies were identified. Four intervention studies addressing oral/dental health or dysphagia were found, but certainty of evidence was low to very low. The prevalence of specific gastroenterological disorders and hepatic disease varies across studies in adults with CP. Evidence for intervention efficacy in their management is of very low quality to absent.

Fourier-transform infrared (FTIR) spectroscopy was used to investigate molecular differences among peritoneal, ovarian, bowel endometriosis phenotypes and control tissues. Peritoneal lesions showed the most pronounced spectral changes in CH-stretching (2800-3000 cm-1) and 1000-1500 cm-1 regions, indicating protein and lipid alterations. Bowel lesions exhibited moderate but significant deviations, particularly in protein- and nucleic acid-associated bands, while ovarian lesions displayed subtler differences with increased lipid-related CH-stretching. Principal component analysis distinguished all phenotypes from controls, with peritoneal clustering most distinct, bowel intermediate, and ovarian partially overlapping. Key discriminative regions included phosphate vibrations (1080-1100, 1240-1250 cm-1), CH2 bending (~1450 cm-1), amide I (~1650 cm-1), and amide II (~1540 cm-1). Decision tree analysis identified phenotype-specific markers: 988 cm-1 (ovarian), 1101 cm-1 (bowel), 1544 cm-1 (peritoneal). Marker intensity correlated with tumor size and clinical scores, strongest in ovarian lesions. These findings highlight phenotype-specific FTIR fingerprints, offering diagnostic and prognostic potential in endometriosis.

Perineal and perianal lipomas with and without anorectal malformations (ARM) are rare. This retrospective study evaluated records from patients with congenital perianal and perineal fatty-tissue growths with and without anorectal abnormalities in two tertiary centres. To contextualize the findings, an updated review of the literature spanning 2019 to 2023 was conducted. Eleven patients (m:f = 4:7) from two tertiary care centres were included over eight years; five (m:f = 2:3) had concomitant ARM. Other malformations included heterotaxy syndrome and urogenital malformations. Preoperative MRI was essential for diagnosis and surgical planning. Complete excision was performed in all cases (0-12 months of age) with only one minor wound infection and no recurrence of the lipoma. A posterior sagittal anorectoplasty was performed in cases of concurrent anorectal malformation. Malignancy was ruled out histopathologically in all cases. Postoperative bowel control seems to correlate with the severity of concurrent anorectal or spinal malformation: There was no postoperative fecal incontinence in patients without anorectal malformation. Perineal and perianal lipomas are rare congenital anomalies that can occur in isolation or in combination with ARM. Preoperative imaging, particularly high-resolution pelvic MRI, is essential for accurate diagnosis and optimal surgical planning. Surgical excision is both safe and curative, even when performed alongside corrective procedures for ARM. Perineal or perianal lipomas do not influence postoperative functional outcome; postoperative continence is primarily determined by the severity of associated anomalies, such as ARM or spinal malformations. The familial cases in our series suggest a potential genetic component, highlighting the need for further research into the underlying embryological and genetic mechanisms.

A recent study found that young power and weightlifters reported a high prevalence of pelvic floor disorders (PFDs) with urinary incontinence (UI) 50%, anal incontinence 80% and pelvic organ prolapse 23%. Performing "the knack", a voluntary pre-contraction of the pelvic floor muscles (PFMs), before and during stressful events, can prevent UI during coughing and daily activities. However, the effect of this manoeuvre has not been investigated during strenuous exercises. This study was aimed at investigating the feasibility of using the femfit® to measure intra-abdominal pressure (IAP) and PFM pressure during strength exercises and at discovering if a voluntary pre-contraction of the PFMs can exceed increases in IAP during strength exercises. This was a short-term, cross-sectional, experimental study. Eleven participants were tested in squat, deadlift, leg press and curl up, performed in a random order with and without voluntary pre-contraction of the PFMs. Assessment of the ability to contract the PFMs was conducted by suprapubic 2D ultrasound. IAP and PFM pressure were measured with the femfit®. Wilcoxon Signed Rank Test was used to estimate differences in change between IAP and PFM pressure with and without voluntary pre-contraction during the strength exercises. No participants reported displacement or discomfort from the femfit® device. Voluntary pre-contraction of the PFMs did not exceed the rise in IAP during squat, deadlift, leg press and curlup. The PFM pressure was not significantly higher than the IAP during strength exercises. Further longitudinal studies are warranted to investigate if systematic PFM training can improve the strength of the voluntary pre-contraction.