Female Pelvic Floor Dysfunction Research Articles

Female pelvic floor dysfunction in the Middle East: a tale of three factors—culture, religion and socialization of health role stereotypes

Female pelvic floor dysfunction in the Middle East: a tale of three factors—culture, religion and socialization of health role stereotypes

Female pelvic floor dysfunction in the Middle East: a tale of three factors—culture, religion and socialization of health role stereotypes

Female pelvic floor dysfunction in the Middle East: a tale of three factors—culture, religion and socialization of health role stereotypes

Preoperative and Postoperative Magnetic Resonance Imaging of Female Pelvic Floor Dysfunction: Correlation with Clinical Findings

AbstractObjective:To determine the role of magnetic resonance imaging (MRI) in surgical planning for females with pelvic floor dysfunction.Methods:This study included 29 females, 17 nulliparous females considered as control subjects and 12 patients with different varieties of pelvic floor dysfunctio

The use of ultrasound in the evaluation of pelvic organ prolapse

Pelvic organ prolapse is a common problem significantly affecting women's quality of life, particularly in later years. Transperineal, two-dimensional ultrasonography can be used for the assessment of female pelvic floor dysfunction for pelvic organ morphology, tissue biomechanics and in vivo properties of prosthetic implants. The role of transperineal ultrasound for the assessment of pelvic organ prolapse is still developing, but with the rapid development of three- and four-dimensional technology may allow dynamic assessment of anatomy in the axial plane. Three-dimensional ultrasound also permits the storage of data volumes for analysis at a later stage, which introduces the ability to independently review images in any plane offline. Further evaluation and research of this imaging tool is required to identify its place in the assessment of women for pelvic organ prolapse and its role in surgical audit.

Unspeakable women's problems and the hidden epidemic of female pelvic floor dysfunction

Unspeakable women's problems and the hidden epidemic of female pelvic floor dysfunction

Medical student exposure to female pelvic floor dysfunction

Medical student exposure to female pelvic floor dysfunction

Sacral neuromodulation: new applications in the treatment of female pelvic floor dysfunction.

The first sacral nerve stimulators implanted by Tanagho and Schmidt (1981) were performed for the indications of urinary urge incontinence, urgency-frequency, and nonobstructive urinary retention. Since that time, observations have been made for benefits beyond voiding disorders. These additional benefits have included re-establishment of pelvic floor muscle awareness, resolution of pelvic floor muscle tension and pain, decrease in vestibulitis and vulvadynia, decrease in bladder pain (interstitial cystitis), and normalization of bowel function. Therapy for fecal incontinence in patients with a structurally intact sphincter mechanism appears to be very promising. Investigators agree that there is a role for sacral nerve stimulation in patients with urge fecal incontinence that have failed conservative efforts. Objective manovolumetric testing shows an increase in resting pressure, an increase in voluntary contraction pressure, a decrease in rectal volumes which cause first urge, a decrease in rectal volume to initiate first urge to defecate, and an increase in duration of maximum squeeze pressure. Intractable interstitial cystitis is defined as patients that have failed conventional therapy. Historically, the only option remaining was extirpative surgery or diversion. Maher et al. reported on patients with intractable interstitial cystitis who had undergone sacral nerve stimulation. They found that 73% of these patients had a reduction in pelvic pain, daytime frequency, nocturnal urgency and an increase in average voided volumes. The final area of interest concerns refractory pelvic pain. Siegal et al. reported a decrease in severity, number of hours of pain, and improved quality of life measures in patients who underwent transforamenal sacral nerve stimulations. These patients had all failed conventional pain therapy. While the data are encouraging in these new arenas of pelvic floor disorders, investigators acknowledge the need for multicenter, statistically powered studies to evaluate the validity of these findings.

The assessment of female pelvic floor dysfunction

The assessment of female pelvic floor dysfunction

Female pelvic floor dysfunction and estrogen therapy

Female pelvic floor dysfunction and estrogen therapy

Prevalence and severity of urinary incontinence and pelvic genital prolapse in females with anal incontinence or rectal prolapse.

The aim of this study was to determine the prevalence, severity, and associations between urinary incontinence and genital prolapse in females after surgery for fecal incontinence or rectal prolapse. All patients who underwent surgery for fecal incontinence (Group I) or rectal prolapse (Group II) were compared with a control group of females (Group III) by 43 questions regarding demographic data, past medical and surgical history, and diagnosis and treatment of anal and urinary incontinence and genital and rectal prolapse. The type (stress, urge, and total) of urinary incontinence was determined and graded using an incontinence severity questionnaire (Individual Incontinence Impact Questionnaire). Overall response rate in the three groups of patients was 40.1 percent. The questionnaire was sent to 240 patients operated on for fecal incontinence or rectal prolapse, and 83 of them responded (34.5 percent). The patients were distributed into three groups: Group I consisted of 51 patients (mean age 56.7 +/- 14); Group II consisted of 32 patients (69.7 +/- 11); and Group III consisted of 40 patients (60.5 +/- 16). The prevalence of urinary incontinence in Group I was 27 (54 percent), in Group II was 21 (65.6 percent), and Group III was 12 patients (30 percent; P = 0.003). Genital prolapse was present in 9 (17.6 percent), 11 (34.3 percent), and 5 patients (12.5 percent), respectively (P = 0.03). The prevalence of coexistent urinary incontinence and genital prolapse in both study groups was 22.8 percent (19 patients). There were no statistically significant differences between Groups I and II relative to prevalence, type, and severity of urinary incontinence and genital prolapse, but there were significant differences between the two study groups and the control group. Of the patients in the study group, 67 percent had urinary incontinence before or at the time of surgery. There is a higher prevalence and severity of urinary incontinence and pelvic genital prolapse in females operated on for either fecal incontinence or rectal prolapse than in a control group. Therefore, female patients with fecal incontinence or rectal prolapse should be evaluated and treated by a multidisciplinary group of pelvic floor clinicians, including a gynecologist or urologist with special training in female pelvic floor dysfunction and a colorectal surgeon.

Female pelvic floor dysfunction and estrogen therapy

Female pelvic floor dysfunction may present as urinary incontinence, uterovaginal prolapse, or rectal incontinence or prolapse. Epidemiological studies for urinary incontinence show a prevalence of between 10 and 40% of the adult female population. The incidence of uterovaginal prolapse and fecal incontinence in women presenting with urinary incontinence is 40% and 20%, respectively. MacLennan and colleagues, in a cross-sectional population prevalence survey of 1546 interviewed women aged 15‐ 97 years, found that 46% were experiencing pelvic floor dysfunction defined as stress or urge incontinence, flatus or fecal incontinence, current symptoms of vaginal prolapse or previous pelvic floor repair 1 . Pelvic floor dysfunction was associated with significant physical and mental distress upon quality-of-life assessment and was described by the authors as an epidemic. In a study by Samsioe 2 , one in three women between 55 and 75 years of age had urogenital symptoms, with 58% seeking medical help and 11% taking medications for these symptoms. Pelvic floor dysfunction is therefore a common cause of morbidity and suffering in women, so any effective preventive or therapeutic measures will make a significant contribution to improving women’ s health generally. Pelvic floor dysfunction has a multifactorial etiology, with suggested causes being pregnancy and delivery, obesity, medications, pelvic surgery, neurological impairment, excessive heavy lifting or straining, and defective collagen. The role of the menopause and estrogen loss in causation is controversial, as even good prospective epidemiological studies have difficulty in separating the importance of the various confounding etiological factors, particularly aging and the menopause. As women age, they are more likely to be more overweight, be taking medications, have pelvic surgery and be menopausal. Urinary symptoms including incontinence and uterovaginal prolapse are common in women, and increase in the 40‐ 60-year-old. Estrogen and progesterone receptors are present in the urethra, bladder, vagina and pelvic floor. Menopausal loss of estrogen results in atrophy of the urogenital tract and connective tissue changes. Some of these can be prevented or reversed by estrogen supplementation. Clinicians frequently prescribe estrogens orally, transdermally or transvaginally for urinary symptoms of frequency, urgency and urge incontinence in postmenopausal women, sometimes with short-term clinical effect 3 . Drug trials have shown a high placebo effect in women with urge symptoms. This may in part be due to the bladderretraining effect of the use of the urinary diary in assessment. The real long-term clinical benefit of estrogens for these symptoms needs further clarification. Meta-analysis of randomized trials has shown no significant improvement in urinary incontinence with estrogens, compared with placebo 4 , although most trials have been small and of short duration. The Heart and Estrogen/ progestin Replacement Study (HERS) was a 4-year randomized trial to evaluate estrogen plus progestin therapy for the prevention of coronary heart disease in high-risk patients. In this study 5 , 1525 women (55%) reported at least one episode of urinary incontinence each week, and were randomly assigned to oral conjugated estrogen (0.625 mg) plus medroxyprogesterone acetate (2.5 mg) or placebo daily and followed for

The assessment of female pelvic floor dysfunction

The assessment of female pelvic floor dysfunction

The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction

This article presents a standard system of terminology recently approved by the International Continence Society, the American Urogynecologic Society, and the Society of Gynecologic Surgeons for the description of female pelvic organ prolapse and pelvic floor dysfunction. An objective site-specific system for describing, quantitating, and staging pelvic support in women is included. It has been developed to enhance both clinical and academic communication regarding individual patients and populations of patients. Clinicians and researchers caring for women with pelvic organ prolapse and pelvic floor dysfunction are encouraged to learn and use the system. (Am J Obstet Gynecol 1996;175:10-7.)

NONSURGICAL THERAPY FOR STRESS INCONTINENCE

This article discusses the therapies that have been developed for the treatment of stress incontinence due to female pelvic-floor dysfunction. A combination of pelvic muscle exercises, biofeedback, behavioral modification, and electrical stimulation are all treatment options that do not involve surgery. When physiotherapy proves successful, and surgery is avoided, it is necessary for the patient to be put on a maintenance program to avoid relapse. The authors also discuss the link between urinary stress incontinence and women involved in sports.

Neurophysiology of the female pelvic floor

The neurogenic theory of female pelvic floor dysfunction suggests a common thread for malfunction of pelvic visceral and support activities. Support for the neurogenic hypothesis has been promoted by recent literature showing that more central neuropathic processes, such as in the cauda equina or pelvic plexus, can be associated with the previously described peripheral neuropathies and are linked to pelvic floor disorders. Damage by vaginal dissection has been suggested as another etiologic factor. This concept has further been supported by studying the effects of pudendal nerve blockade. Methods for investigating pelvic floor neurophysiology are becoming more refined and widespread, and therapeutic horizons are described including nerve stimulation and surgical therapy of nerve compression.

The epidemiology of female pelvic floor dysfunction

Pelvic floor dysfunction, specifically urinary and fecal incontinence, is thought to be widespread. Prevalence figures for these disorders vary greatly. This review highlights the accepted prevalence and incidence figures for pelvic floor dysfunction and their relative age distribution in women. Remission and natural history is examined with an emphasis on gaps in our knowledge. The limited data on racial differences in the epidemiology of this disorder are also reviewed.

The psychiatric and emotional impact of female pelvic floor dysfunction

Urinary incontinence is cited as a distressing, depressing, and disabling condition. Recent research suggests that the impact of incontinence on psychological well-being may be less than previously assumed. However, personal reactions to incontinence are highly variable and need to be considered in the evaluation and management of incontinent women.

Physical therapy for female pelvic floor disorders

Non-surgical, non-pharmacological treatment for female pelvic floor dysfunction is represented by rehabilitation in urogynecology. Since Kegel, in 1948, who proposed the concept of functional restoration of the perineal muscles, no specific term has actually been established. Owing to the number of specialists involved in the management of female pelvic floor disorders (such as gynecologists, urologists, coloproctologists, and neurologists) and the different types of health care providers concerned (such as physicians, physical therapists, nurses, and midwives), it is difficult to make the proper choice between 'physical therapy for pelvic floor', 'pelvic floor rehabilitation', 'pelvic muscle re-education', and 'pelvic floor training'. Because muscle re-education is under the control of physical therapists, we have chosen the term of physical therapy for female pelvic floor disorders. Muscle re-education has an important role in the primary treatment of lower urinary tract dysfunction. A multidisciplinary collaboration may be of particular interest, and a thorough evaluation is useful for a proper selection of patients.

Female Pelvic Floor Functions, Dysfunctions, and Behavioral Approaches to Treatment

This article has reviewed normal pelvic floor function and the type of evaluation and treatment programs that should be offered to the woman who presents with pelvic floor dysfunction. Pelvic floor muscle contraction is an acquired function. It is not innate. Development of pelvic floor muscle strength requires specificity training and dedication to an exercise program. It is imperative that women be educated about the functions and dysfunctions of the pelvic floor complex in order to promote preventive rather than restorative benefits of pelvic floor exercise. Exercise programs should be specific to the type of pelvic floor muscle dysfunction and its causes. Behavioral treatment options focus on traditional physical therapy techniques of education, therapeutic exercise, and the use of physical modalities that aid in the restoration of muscle function. Exercises for the pelvic floor should be part of every woman's fitness regime. Health care providers, health educators, and fitness personnel need to ask women more questions about pelvic floor function, encourage women to exercise these muscles, and to seek medical care for their dysfunctions. Only then will the magnitude and prevalence of pelvic floor muscle dysfunctions receive the attention that they need.

Urogynecology: Introducing this Subspeciality for Managing Female Pelvic Floor Dysfunction in Nepal

DOI: http://dx.doi.org/10.3126/njog.v5i1.5051 NJOG 2010 Jul-Aug; 5(1): 1-2