Floor Function Research Articles

Ultrasonic Diagnosis and Analysis of the Effect of Labor Analgesia on Early Pelvic Floor Function and Pelvic Floor Dysfunction

Pelvic floor dysfunction disease (PFD) is a common pelvic organ dysfunction disease in the clinic of obstetrics and gynecology. Its cause is mainly the damage, defects and dysfunction of the pelvic floor support structure. Not only is the pathogenesis complicated, but also various symptoms coexist, which seriously affects the physical and mental health of female patients. Mechanical injury of the pelvic floor fascia tissue and levator ani muscles is the anatomical basis of PFD after birth; early postpartum pelvic floor examination and treatment can prevent and control the occurrence or development of PFD. Spinal canal anesthesia has good analgesic effect during labor and delivery, has little effect on mothers and infants, and is widely used. However, there are few domestic and foreign reports on the effect of labor analgesia on the pelvic floor. Labor analgesia relaxes the pelvic floor muscles, unblocks the birth canal, and the influence on the pelvic floor muscles is worth exploring. Based on the pelvic floor muscle strength screening to understand the changes in the function of the pelvic floor muscles, combined with the three-dimensional pelvic floor ultrasound examination, the pelvic floor structure and the levator ani muscle are clearly imaged, and the pelvic floor muscle structure is evaluated in the natural state and the analgesic muscle relaxation state. This study used a combination of the two to evaluate the effect of labor analgesia on pelvic floor function of primiparous women; provide individualized intervention treatment for high-risk groups screened; provide clinical basis for the prevention and treatment of PFD.

Can Supervised Pelvic Floor Muscle Training Through Gametherapy Relieve Urinary Incontinence Symptoms in Climacteric Women? A Feasibility Study.

To investigate the feasibility of pelvic floor muscle training (PFMT) through gametherapy for relieving urinary symptoms of climacteric women with stress or mixed urinary incontinence (UI). Randomized clinical trial, divided into two groups: Gametherapy (G_Game) and Control (G_Control). Both groups received recommendations about unsupervised PFMT, and G_Game also received supervised PFMT through gametherapy. After 5 consecutive weeks, the feasibility was investigated considering participant adherence, urinary symptoms (evaluated by the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form [ICIQ-UI-SF] questionnaire), and pelvic floor function (PERFECT Scheme: power, endurance, repetition and fast). The Fisher exact, Kruskal-Wallis, Wilcoxon sign paired, and Mann-Whitney U tests were used by intention-to-treat analysis, using STATA 15.1 (StataCorp, College Station, TX, USA) software. The present study included 20 women per group and observed a higher adherence in G_Game. In the intragroup analysis, a decrease in the ICIQ-UI-SF score was observed in both groups (14.0 to 10.0; 13.5 to 0), associated with increased endurance (2.5 to 3.5; 2.5 to 4.0) in G_Control and G_Game, respectively. Moreover, there was a concomitant increase in pelvic floor muscles (PFMs) power (2.0 to 3.0), repetition (3.0 to 5.0), and fast (10.0 to 10.0) in G_Game. In the intergroup analysis, a reduction of UI was observed (p < 0.001; r = 0.8), as well an increase in PFM power (p = 0.027, r = 0.2) and endurance (p = 0.033; r = 0.3) in G_Game. The feasibility of supervised PFMT through gametherapy was identified by observing participant adherence, relief of urinary symptoms, and improvement in PFM function.

BILANGAN DOMINASI LOKASI PADA LINE PAN GRAPH DAN MIDDLE PAN GRAPH

Let G is a simple, connected, and undirected graph. A set D is a subset of V. If every node of V adjacent to at least one node D, then D is a dominating set of the graph G . One of the topics from dominating set is locating dominating set. Locating dominating set is dominating set on condition if every two vertices u,v elements of V-D satisfy the intersection of N(v) and D not equal to the intersection of N(u) and D with u not equal to v. The locating domination number of a graph G is the minimum cardinality of a locating dominating set in a graph G . In this study discussed the locating domination number on line pan graph (L(Tn,1)) and middle pan graph (M(Tn,1)). Locating domination number was obtained by finding dominating set from some graph. Then, does the dominating set meet the condition of locating dominating set? If it meets locating dominating set condition, then we can find the locating domination number of the graphs. In the last procedure, we get pattern location domination number of line pan graph and middle pan graph. The results of the study obtained the locating domination number of (L(Tn,1)) and (M(Tn,1)) consecutive are floor function of (2n/5)+1 and floor function of ((2n+1)/3)+1.

On the almost universality of $\lfloor x^2/a\rfloor +\lfloor y^2/b\rfloor +\lfloor z^2/c\rfloor $

In 2013, Farhi conjectured that for each $m\geq 3$, every natural number $n$ can be represented as $\lfloor x^2/m\rfloor+\lfloor y^2/m\rfloor+\lfloor z^2/m\rfloor$ with $x,y,z\in\Z$, where $\lfloor\cdot\rfloor$ denotes the floor function. Moreover, in 2015, Sun conjectured that every natural number $n$ can be written as $\lfloor x^2/a\rfloor+\lfloor y^2/b\rfloor+\lfloor z^2/c\rfloor$ with $x,y,z\in\Z$, where $a,b,c$ are integers and $(a,b,c)\neq (1,1,1),(2,2,2)$. In this paper, with the help of congruence theta functions, we prove that for each $m\geq 3$, Farhi's conjecture is true for every sufficiently large integer $n$. And for $a,b,c\geq 5$ with $a,b,c$ are pairwisely co-prime, we also confirm Sun's conjecture for every sufficiently large integer $n$.

The repeatability of measurements of male pelvic floor anatomy and function made from transperineal ultrasound images of healthy men and those before and after prostatectomy.

To investigate the inter- and intratester repeatability of measurement of the location and displacement of five pelvic landmarks related to pelvic floor muscles with transperineal ultrasound (TPUS) imaging recorded from healthy men and men before and after prostatectomy. TPUS images were selected from four different participant groups: healthy men, men awaiting prostatectomy, men 2 weeks after prostatectomy, and men 12 months after prostatectomy. On two separate occasions, two assessors with different levels of experience performed analysis of location and displacement of five pelvic landmarks in images made at rest and during voluntary contraction. A two-way mixed effects, single measurement, absolute agreement intraclass correlation coefficient (ICC) was used to investigate the repeatability. Intertester reliability of all locations at rest for all groups was excellent (ICCs > 0.8) except for the craniocaudal coordinate of the ventral urethrovesical junction for men 2 weeks postprostatectomy and the anorectal junction for men with a cancerous prostate. Intertester reliability of the measurement of landmark displacement was acceptable (>0.5) for the dorsoventral axis of motion but not for the craniocaudal axis of motion for all landmarks across all groups. The more experienced assessor was consistently more repeatable. More deeply placed landmarks were more often excluded from analysis and had poorer reliability. Analysis of TPUS images across clinical groups is repeatable for both location and displacement of pelvic landmarks related to pelvic floor muscles when measures are made twice. Analysis experience, landmark depth and optimization of ultrasound settings appear to be important factors in reliability.

Pelvic floor dysfunction one year after first childbirth in relation to perineal tear severity

The aims of this study were to evaluate pelvic floor dysfunction symptoms one year after delivery and investigate whether adverse functional outcomes after childbirth were related to the degree of perineal injury. A prospective cohort of 776 primiparas were included. Self-reported pelvic floor function data were obtained using a web-based questionnaire. Women with no/first-degree injuries, second-degree injuries, third-/fourth-degree injuries (obstetric anal sphincter injury, OASI) and cesarean section were compared. A total of 511 women (66%) responded. Second-degree tears were a risk factor for stress incontinence (aOR 2.6 (95% CI 1.3–5.1)). Cesarean section was protective against stress incontinence (aOR 0.2 (95% CI 0.1–0.9)). OASI was a risk factor for urge incontinence (aOR 4.8 (95% CI 1.6–15)), prolapse (aOR 7.7 (95% CI 2.1–29)) and pelvic pain (OR 3.3 (95% CI 1.1–10)). Dyspareunia was reported by 38% of women, 63% of women in the OASI group (aOR 3.1 (95% CI 1.1–9.0)). Women with OASI reported that the injury affected daily life (OR 18 (95% CI 5.1–59)). Pelvic floor dysfunction is common after childbirth, even in women with moderate injury. Women with OASI had significantly higher risks of symptoms of prolapse, urge urinary incontinence, pain, dyspareunia and impacts on daily life.

Postoperative Physiotherapy in Women Undergoing Pelvic Floor Reconstructive Surgery: A Randomized Controlled Clinical Trial.

Purpose: Postoperative physiotherapy in conjunction with pelvic organ prolapse (POP) surgery is still under-investigated and controversial. In this randomized controlled trial, pelvic floor muscle training (PFMT) and abdominal training were compared with a control condition (standard in-hospital treatment). Method: Eighty-one women were randomized to one of three groups. The Prolapse Quality of Life questionnaire, two-dimensional ultrasound, Pelvic Organ Prolapse Quantification System scale, the PERFECT (power, endurance, repetitions, fast contractions, every contraction timed) scheme, electromyography, Sahrmann scale, and pressure biofeedback unit (PBU) were used to measure quality of life (QOL), POP, and pelvic floor and abdominal muscle function. A mixed-model analysis of variance and the Kruskal-Wallis test was used for analysis. Results: Beneficial effects (p<0.05) were found for the PFMT group - increased power, number of fast contractions, amount of movement, endurance, and Sahrmann and PBU measures - compared with the control group. Abdominal training led to a significant (p<0.05) increase in bulging and discomfort, number of pelvic floor muscle contractions, and Sahrmann and PBU measures compared with the control condition; both groups showed significantly increased urinary frequency (p<0.05). Conclusions: Postoperative physiotherapy did not have a beneficial effect on QOL or POP symptoms. PFMT and abdominal training had beneficial effects on pelvic floor muscle function and abdominal muscle measures. Additional abdominal training led to increased symptoms.

High throughput resource efficient reconfigurable interleaver for MIMO WLAN application.

Demand for high-speed wireless broadband internet service is ever increasing. Multiple-input-multiple-output (MIMO) Wireless LAN (WLAN) is becoming a promising solution for such high-speed internet service requirements. This paper proposes a novel algorithm to efficiently model the address generation circuitry of the MIMO WLAN interleaver. The interleaver used in the MIMO WLAN transceiver has three permutation steps involving floor function whose hardware implementation is the most challenging task due to the absence of corresponding digital hardware. In this work, we propose an algorithm with a mathematical background for the address generator, eliminating the need for floor function. The algorithm is converted into digital hardware for implementation on the reconfigurable FPGA platform. Hardware structure for the complete interleaver, including the read address generator and memory module, is designed and modeled in VHDL using Xilinx Integrated Software Environment (ISE) utilizing embedded memory and DSP blocks of Spartan 6 FPGA. The functionality of the proposed algorithm is verified through exhaustive software simulation using ModelSim software. Hardware testing is carried out on Zynq 7000 FPGA using Virtual Input Output (VIO) and Integrated Logic Analyzer (ILA) core. Comparisons with few recent similar works, including the conventional Look-Up Table (LUT) based technique, show the superiority of our proposed design in terms of maximum improvement in operating frequency by 196.83%, maximum reduction in power consumption by 74.27%, and reduction of memory occupancy by 88.9%. In the case of throughput, our design can deliver 8.35 times higher compared to IEEE 802.11n requirement.

Wearing high heels with an appropriate height is protective for pelvic floor function

BackgroundWearing high-heeled shoes is a common phenomenon among women. However, the association between wearing high heels and pelvic floor function is largely unknown. Our aim was to evaluate the effects of wearing different height shoes on pelvic floor function and to analyze the influencing factors.MethodsThis was a population-based, cross-sectional study performed in general hospitals with a pelvic floor subspecialty in some cities of China. All participants completed a Urogenital Distress Inventory (UDI-6) questionnaire that consisted of demographic data, information about wearing shoes, and information about pelvic floor function (UDI-6). One-way ANOVA was carried out to compare the differences among 4 groups according to the heel height (<3, 3–5, 5–7, and >7 cm groups). Multivariate logistic regression was performed to identify the factors influencing the effect of wearing 3–5 cm high-heeled shoes on pelvic floor function.ResultsIn total, 1,263 participants finished the questionnaire and full data were collected. The 4 groups were comparable for clinical data, and participants who wore 3–5 cm high-heeled shoes had the lowest UDI-6 scores. Multivariate analysis revealed that the number of hours (≥8 h) wearing high heels per day and the thickness diameter (≥3 cm) of the heel were important factors affecting the protective effect of wearing 3–5 cm high-heeled shoes on pelvic floor function.ConclusionsWearing heeled shoes with a 3–5 cm heel height and ≥3 cm thickness for a long period of time is good for the pelvic floor function of women.

Cluster randomised control trial of the effect on attendance and outcomes of multi-disciplinary teams involving psychologists during pelvic floor muscle training for pelvic floor dysfunction

Pelvic floor muscle training (PFMT) is effective, acceptable to patients, and cost efficient as a treatment for Pelvic Floor Dysfunction (PFD). However, PFMT outcomes are mediated by patient variables, such as depression, anxiety, motivation, and health values. The current study examined whether multi-disciplinary provision of PFMT involving a psychologist would improve attendance and outcomes (Clinical Trial Registration: NCT02549157). 88 consecutively referred patients (age 28 − 85 years), with a variety of PFD, were randomised into two groups: PFMT treatment as usual (n = 47), and PFMT with a psychologist involved (n = 41). Patients received 6-month out-patient physiotherapy. More patients with the psychologist completed the course, and there were significantly greater improvements in subjective symptoms (Queensland scale), quality of life (EQ-5D), and anxiety (HADS), although not in objective measures (Oxford Grading) or depression (HADS). These results suggest that an MDT including a psychologist during PFMT intervention treatment may help some patients. IMPACT STATEMENT What is already known on this subject? Pelvic floor muscle training (PFMT) is effective, acceptable to patients, and cost efficient as a treatment for Pelvic Floor Dysfunction (PFD). However, PFMT outcomes are mediated by patient variables, such as depression, anxiety, motivation, and health values. The effectiveness of a multi-disciplinary team delivering both PFMT and psychological support simultaneously to women undergoing PFMT for PFD is unknown. What do the results of this study add? Psychological support delivered alongside PFMT increased patient attendance, improved subjective ratings of pelvic floor functioning, health-related quality of life, and reduced anxiety. This is one of the first demonstrations that this can be achieved through a multi-disciplinary team delivering their support simultaneously to the patients. What are the implications of these findings for clinical practice and/or further research? Improving subjective functioning and reducing attrition rates in PFD patients has cost implications in terms of reduced need for surgery, and making future surgery more effective. The inclusion of brief, easily delivered psychological support, integrated into the PFMT sessions in a multidisciplinary way may represent an extremely cost effective method of improving the service for these patients.

Pelvic floor function and morphological abnormalities in primiparas with postpartum symptomatic stress urinary incontinence based on the type of delivery: a 1:1 matched case-control study.

The aim of this study was to assess pelvic floor muscle (PFM) morphology and function in primiparas with postpartum symptomatic SUI after different types of delivery. Retrospective analyses were carried out with individuals with postpartum symptomatic stress urinary incontinence (SUI). Among the women screened in our center from January 2018 to December 2019, participants were divided into elective cesarean section (eCS) and spontaneous vaginal delivery (sVD) groups, while being matched 1:1 on age (±5years), body mass index (BMI; ±0.5kg/m2), neonatal birth weight (±300g), gestational age (±1week), degree of pelvic organ prolapse quantification (POP-Q), International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) degree, Incontinence Impact Questionnaire short form (IIQ-7) score, and postpartum days (±10days); all participants had no sphincter defects or levator ani muscle avulsion. The bioelectrical activity of the PFM was collected using an endovaginal electrode with the Glazer protocol. For the assessment of PFM function, PFM morphometry was evaluated with 3D/4D transperineal ultrasound. A total of 78 matched pairs were recruited based on delivery mode. Regarding functional differences, both fast-twitch and slow-twitch fiber strengths in the eCS group were significantly higher than those in the sVD group, but PFMs were more hyperactive in the eCS group. Regarding morphometric differences, the retrovesical angle (RVA) and bladder neck position were not significantly different in the resting state between the two groups, nor was the RVA during the Valsalva maneuver (eCS group: 130.68 ± 17.08°, sVD group: 136.33 ± 23.93°), p >0.05. There were differences in bladder neck descent (BND; eCS group: 16.51 ± 7.55mm, sVD group: 23.92 ± 8.47mm) and urethral rotation angle (URA; eCS group: 37.53 ± 26.05°, sVD group: 59.94 ± 25.87°), all p < 0.05. BND showed a negative correlation with PFM strength, p < 0.05. URAs and RVAs showed no correlation with PFM strength, p > 0.05. Pelvic floor muscle function disorder, hyperactivity, and instability also occurred after eCS, which resulted in postpartum symptomatic SUI. The effects of sVD compared with eCS on abnormalities in the lower urinary tract were related to bladder neck and urethral hyperactivity, without an RVA increase.

Ultrasound analysis of the effect of second delivery on pelvic floor function in Chinese women

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. Impact Statement 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.

Essential Topics to Include in a Pelvic Floor Workshop for Physiotherapists

Pelvic floor dysfunction (PFD) is prevalent among women and can greatly impact quality of life. Pelvic floor physiotherapy (PFPT) has been shown to be the most effective treatment method for PFD, however, pelvic floor education is highly variable across physiotherapy (PT) programs. This study aims to develop and assess the effectiveness of a PFPT workshop for community PTs (CPT) with no formal training in pelvic floor health, which includes content deemed essential by PT experts (PTE) in the field. PTEs were asked to rank a variety of anatomical and PFPT topics. Those considered “essential” by the majority were included in the workshop. An online workshop was developed for CPTs based on these rankings, which included four asynchronous anatomy modules and one synchronous case-based session with two PTEs. The CPTs will be assessed for their knowledge of the essential topics prior to and following the workshop. Essential anatomy topics included not only the pelvic organs but also other musculature related to pelvic floor function, including those in the gluteal region, deep back muscles, and the diaphragm. Essential PFPT topics include assessment of pelvic floor muscle function and pain, diagnosing PFD based on clinical presentation, and treatment options for PFD such as pelvic floor muscle training and relaxation training. A PFPT workshop should not be limited to the anatomy of the pelvic floor and PFPT and should include the related anatomy that may be impacted in PFD. It is expected that following the workshop, CPTs will have a better understanding of PFD and its clinical presentations as it does not always clearly present in clients as pelvic floor issues.

Neural network approximation: Three hidden layers are enough

A three-hidden-layer neural network with super approximation power is introduced. This network is built with the floor function (⌊x⌋), the exponential function (2x), the step function (1x≥0), or their compositions as the activation function in each neuron and hence we call such networks as Floor-Exponential-Step (FLES) networks. For any width hyper-parameter N∈N+, it is shown that FLES networks with width max{d,N} and three hidden layers can uniformly approximate a Hölder continuous function f on [0,1]d with an exponential approximation rate 3λ(2d)α2−αN, where α∈(0,1] and λ>0 are the Hölder order and constant, respectively. More generally for an arbitrary continuous function f on [0,1]d with a modulus of continuity ωf(⋅), the constructive approximation rate is 2ωf(2d)2−N+ωf(2d2−N). Moreover, we extend such a result to general bounded continuous functions on a bounded set E⊆Rd. As a consequence, this new class of networks overcomes the curse of dimensionality in approximation power when the variation of ωf(r) as r→0 is moderate (e.g., ωf(r)≲rα for Hölder continuous functions), since the major term to be concerned in our approximation rate is essentially d times a function of N independent of d within the modulus of continuity. Finally, we extend our analysis to derive similar approximation results in the Lp-norm for p∈[1,∞) via replacing Floor-Exponential-Step activation functions by continuous activation functions.

English

This paper presents formulas (together with their proofs) determining 3 and 4 part partitions of any integer. These formulas were derived using the properties of the floor function and Bernoulli formulas for various powers of finite sums of the floor function series. This made it possible to obtain above formulas in a much simpler way than most traditional methods.

Deep Network With Approximation Error Being Reciprocal of Width to Power of Square Root of Depth.

A new network with super-approximation power is introduced. This network is built with Floor (⌊x⌋) or ReLU (max{0,x}) activation function in each neuron; hence, we call such networks Floor-ReLU networks. For any hyperparameters N∈N+ and L∈N+, we show that Floor-ReLU networks with width max{d,5N+13} and depth 64dL+3 can uniformly approximate a Hölder function f on [0,1]d with an approximation error 3λdα/2N-αL, where α∈(0,1] and λ are the Hölder order and constant, respectively. More generally for an arbitrary continuous function f on [0,1]d with a modulus of continuity ωf(·), the constructive approximation rate is ωf(dN-L)+2ωf(d)N-L. As a consequence, this new class of networks overcomes the curse of dimensionality in approximation power when the variation of ωf(r) as r→0 is moderate (e.g., ωf(r)≲rα for Hölder continuous functions), since the major term to be considered in our approximation rate is essentially d times a function of N and L independent of d within the modulus of continuity.

Reliability of ultrasound imaging of pelvic floor morphology and function among females who have undergone pelvic radiotherapy.

To investigate the intra- and inter-rater reliability of two-dimensional (2D) transperineal ultrasound imaging (USI) measures of bladder wall thickness (BWT), urethral length (UL), and parameters related to levator plate length (LP) and transient changes in LP during pelvic floor muscle (PFM) contraction, and on Valsalva in women who received radiation therapy (RT) for treatment of pelvic cancer. Twenty women with a history of RT for the treatment of pelvic cancer were assessed independently by two raters on the same day. Five outcomes were assessed for reliability:BWT,UL, and LP at rest (LP-R), during a maximal voluntary contraction of the PFMs (LP-MVC), and during a maximal-effort Valsalva maneuver (LP-MVM). Reliability was determined using intra-class correlation coefficients (ICC) and Bland-Altman analyses. Measurement error was determined using standard error of the measurement (SEM) and minimal detectable difference. Intra-rater reliability was very good for LP-R, LP-MVC, LP-MVM, and UL(ICC: 0.97 [0.93-0.99], 0.95 [0.88-0.98], 0.84 [0.59-0.94], and 0.96 [0.89-0.98], respectively). Inter-rater reliability was very good for LP-R (ICC: 0.82 [0.55-0.93]), and good for LP-MVC, LP-MVM, and UL (ICC: 0.79 [0.46-0.92], 0.79 [0.49-0.92], and 0.75 [0.36-0.90], respectively). BWT had poor intra- and inter-rater reliability. The variability between measurements was the smallest for LP-R, LP-MVC, and UL for intra-rater assessments, and for LP-Rand UL for inter-rater assessments. SEM values for intra-rater assessments were LP-R: 1.5 mm, LP-MVC: 1.84 mm, LP-MVM: 4.33 mm, and UL: 1.16 mm. Althoughthese results support the reliability of 2D-transperineal USI for the evaluation of UL and PFM parameters, they do not support its use for the assessment of BWT.

Short-term effects of delivery methods on postpartum pelvic floor function in primiparas: a retrospective study.

The present study sought to investigate the short-term effects of different delivery methods on postpartum pelvic floor function in Chinese primiparas. Primiparous women who delivered a full-term, cephalic, singleton infant at our hospital between January 1, 2018 and August 15, 2019 were recruited into this study. All women underwent pelvic floor function screening at 6-8 weeks postpartum. Tests included postpartum Pelvic Organ Prolapse Quantification (POP-Q) score, incidence of urinary incontinence, pelvic floor muscle (PFM) strength, and Pelvic Floor Distress Inventory Questionnaire-Short Form 20 (PFDI-20) score. A total of 284 postpartum women were recruited into the study. Of the participants, 147 had undergone vaginal delivery, 37 had undergone intrapartum cesarean delivery (ICD), and 100 had undergone elective cesarean delivery (ECD). Points Aa, Ba, Ap, and Bp showed a greater degree of prolapse in the vaginal delivery group than in the ECD group (P≤0.05). UI was less prevalent in ECD group relative to the vaginal delivery group (P≤0.05). Tonic PFM contraction was weaker in the vaginal delivery group than in the ECD and ICD groups (P≤0.05). Significant differences were also observed between the vaginal delivery group and the ECD group with respect to PFDI-20 scores (P≤0.05). Compared with vaginal delivery, ECD was strongly linked to a lower risk of pelvic organ prolapse (POP) and UI, stronger tonic PFM strength, and lower PFDI-20 scores. ECD confers relatively better protection against pelvic floor dysfunction (PFD) than does ICD.

Vaginal palpation versus transabdominal ultrasound in the comprehension of pelvic floor muscle contraction after vaginal delivery: a randomised controlled trial

BackgroundPelvic floor muscles support the pelvic organs and control voiding. The first choice in the repair of pelvic floor function that is damaged during pregnancy and delivery is pelvic floor muscle training, which involves repeated muscle relaxation and contraction. However, as muscle contractions cannot be visualised, it is difficult to assess whether patients understand how to contract them. Therefore, we assessed patients’ comprehension of pelvic floor muscle contraction by comparing two teaching methods, vaginal palpation and transabdominal ultrasound, following vaginal delivery. We hypothesised that vaginal palpation is better than transabdominal ultrasound in this regard.MethodsThis randomised controlled trial conducted in facilities in Tokyo, Japan between July 2018 and January 2019 included women aged ≥ 20 years at 4–6 weeks after vaginal delivery. The randomisation involved website-based centralised allocation. The primary outcome was a change in bladder base displacement during pelvic floor muscle contraction before and after training, which was measured using transabdominal ultrasound. Participants performed three contractions for 3 s, and the mean value was used for statistical analysis. The secondary outcome was a change in understanding the contraction before and after training, which was measured using a five-point Likert scale questionnaire. Outcomes were analysed using Welch’s t-test.ResultsSixty-five participants were randomly allocated to the vaginal palpation group (n = 32) and transabdominal ultrasound group (n = 33). Baseline characteristics were similar between the groups. Changes in bladder base displacement were not significantly different between the groups (p = 0.181). Within-group analyses showed that bladder base displacement was large in both groups after the respective intervention. There were no significant differences in any of the outcomes between the two groups before and after the intervention.ConclusionsVaginal palpation and transabdominal ultrasound might be useful for comprehending pelvic floor muscle contraction after vaginal delivery.Trial registration: UMIN 000032304. Registered 18 April 2018, https://upload.umin.ac.jp/cgi-open-bin/icdr_e/ctr_view.cgi?recptno=R000036820.

Is Cycling Practice Related to Men's Pelvic Floor Dysfunctions? A Hypothesis-Generating Observational Study.

Background: There is a lack of consensus with regards to the consequences of cycling practice on urogenital and sexual problems in men. The aim of the study was to analyse the relationship between intensity of cycling practice and urinary tract symptoms, erectile dysfunction, and urinary incontinence. Methods: Observational hypothesis-generating design. Cyclists, men, between 25 and 70 years who had been cycling for more than one year were included. During the statistical analysis, a multiple linear regression model, partial correlation and Spearman’s correlation were carried out. Results: Fifty-eight men participated in the study. Results showed that there is a correlation between years of cycling and prostate symptoms (p = 0.041), and between age and erectile dysfunction (p = 0.001). The multiple linear regression model and the partial correlation analysis showed a correlation between the years of cycling and prostate symptoms (p = 0.007 and p = 0.018). Conclusions: The results have shown that there is a slight correlation between the years of cycling and the presence of lower urinary tract symptoms, independently of the man’s age. Therefore, the results display that high-intensity cycling practice might impact negatively in some men’s pelvic floor functions. Further research is needed to analyse the impact of cycling on urogenital problems in this population group.