Pelvic Floor Muscle Training Research Articles

Mechanisms for pelvic floor muscle training: Morphological changes and associations between changes in pelvic floor muscle variables and symptoms of female stress urinary incontinence and pelvic organ prolapse-A narrative review.

Today there is Level 1, recommendation A for pelvic floor muscle training (PFMT) to be effective in treatment of stress urinary incontinence (SUI) and pelvic organ prolapse (POP). However, the mechanisms of action are discussed. The aim of the present overview was to give an update of studies evaluating the effect of PFMT on pelvic floor morphology and associations between changes in PFM strength and symptoms of female SUI and POP. MATERIALS ANDMETHODS: This was a narrative review retrieving studies from systematic reviews of PFMT for SUI and POP. In addition, an open search on PubMed with the search terms PFMT and morphology was conducted. Both randomized controlled trials (RCTs) and pre-posttest design studies were included. PEDro rating scale (0-10) was used to assess risk of bias. Ten studies were found reporting on morphological changes after PFMT. The four RCTs had PEDro score between 5 and 8/10. The studies found significant higher bladder neck position and narrower levator hiatus dimensions, thicker external urethral sphincter, increased cross-sectional area of PFM, improvement in PFM tears and blood flow. Twenty studies analyzed associations between changes in different PFMT variables and SUI and POP. Eleven studies found a positive weak to moderate association and six studies reported no association. Studies comparing responders and nonresponders to PFMT found statistically significant better PFM variables in responders. PFMT can change pelvic floor muscle and external urethral sphincter anatomy. This contributes to the understanding on how PFMT can be effective in prevention and treatment of SUI and POP.

Pelvic floor muscle training vs radiofrequency for women with vaginal laxity: randomized clinical trial.

Vaginal laxity (VL) is a complaint of excessive vaginal looseness with a prevalence ranging from 24% to 38% across studies. The study sought to compare the effect of radiofrequency (RF) and pelvic floor muscle training (PFMT) on the treatment of women with VL. From February 2020 to December 2021, a prospective, parallel, noninferiority, randomized clinical trial was carried out in women ≥18years of age and complaining of VL in a tertiary hospital. Two groups (RF and PFMT) were evaluated at the beginning of the study and 30days and 6 months postintervention. A total of 42 participants per arm was sufficient to demonstrate a difference in sexual function on the Female Sexual Function Index at 90% power, 1-sided type 1 error of 0.025 with a noninferiority margin of 4 on the FSFI total score. Analysis was intention-to-treat and per-protocol based. The primary endpoint was the change of FSFI score after treatment, and the secondary outcomes were improvement in symptoms of VL and changes in questionnaire scores of sexual distress, vaginal symptoms, and urinary incontinence, in the quantification of pelvic organ prolapse, and pelvic floor muscle (PFM) contraction. Of 167 participants recruited, 87 were included (RF: n = 42; PFMT: n = 45). All questionnaires improved (P < .05) their total scores and subscales in both groups and during the follow-ups. After 30days of treatment, RF was noninferior to PFMT to improving FSFI total score (mean difference -0.08 [95% confidence interval, -2.58 to 2.42]) in the per-protocol analysis (mean difference -0.46 [95% confidence interval, -2.92 to 1.99]) and in the intention-to-treat analysis; however, this result was not maintained after 6 months of treatment. PFM contraction improved significantly in both groups (RF: P = .006, 30days; P = .049, 6 months; PFMT: P < .001, 30days and 6 months), with better results in the PFMT group. Sexual, vaginal, and urinary symptoms were improved after 30days and 6 months of treatment with RF and PFMT; however, better results were observed in the PFMT group after 6 months. The present randomized clinical trial used several validated questionnaires evaluating quality of life, sexual function and urinary symptoms, in addition to assessing PFM contraction and classifying the quantification of pelvic organ prolapse aiming at anatomical changes in two follow-up periods. The limitations were the lack of a sham-controlled group (third arm) and the difficulty of blinding researchers to assess treatments due to the COVID-19 pandemic. After 30days and 6 months of treatment, sexual, vaginal, and urinary symptoms improved with RF and PFMT; however, better results were observed in the PFMT group after 6 months. RF was noninferior to PFMT in improving FSFI total score after 30days; however, this result was not maintained after 6 months of treatment.

KNOWLEDGE AND BELIEFS TOWARDS PELVIC FLOOR MUSCLE TRAINING DURING PREGNANCY AND POSTPARTUM PERIOD; A CROSS-SECTIONAL OBSERVATIONAL STUDY IN THE URBAN POPULATION OF PAKISTAN

Background of the Study: This study aimed to assess knowledge and beliefs about pelvic floor muscle training to prevent urinary incontinence (UI) during pregnancy and postpartum in Karachi. Also, to determine the prevalence of urinary incontinence. Methodology: This cross-sectional study was conducted at the Department of Gynecology and Obstetrics, Dow University Hospital, Karachi. Non-probability sampling technique was done on N=380. QUID scale questionnaire and items to assess knowledge and beliefs were executed. Participants were invited either during their consultancy visit or post-delivery. The logistic regression analysis using SPSS Version 26.0 was performed to predict the knowledge level of PFMT, classification of gravida and parity, delivery type and other variables. Results: The study founded lack of awareness regarding pelvic floor muscle training and an inadequate level of knowledge during the antenatal period (n=168). It was found that 23.0% responded the question as they are currently “Doing Pelvic Floor Muscle Exercise” in the antenatal period. Logistic analysis showed that women with cesarean-section delivery have more probabilities of adequate knowledge (OR=1.65, 95% CI=1.03-2.64, p-value= 0.035). Women strongly believe that urine leakage is normal during pregnancy. Conclusion: The study concluded that stress incontinence and urge incontinence are most common among others. Lack of awareness regarding pelvic floor muscle training was found among both groups. In contrast, a high level of knowledge regarding pelvic floor muscles’ anatomy and function and urinary incontinence was found in the postpartum group.

Pelvic floor muscle training for urinary incontinence after radical prostatectomy. Literature review

Pelvic floor muscles training is the main method of treatment for urinary incontinence in prostate cancer patients after radical prostatectomy. For increasing the effectiveness of the method, the authors suggest starting the exercises before surgery and continuing them in the postoperative period. Other researchers modify the classic exercise program by adding exercises aimed at activating fast-twitch and slow-twitch muscle fibers, or combining with vibration therapy, electromyographic biofeedback. Pelvic floor muscles training in various combinations and modifications, as the literature review shows increases the effectiveness of recovery of urinary control function after radical prostatectomy in patients with prostate cancer.

Does Pelvic Floor Muscle Exercise Change the Hemodynamic Responses of the Inferior Vena Cava in Pregnant Women? A Prospective-Controlled Study.

This study was aimed at exploring the immediate impacts of pelvic floor muscle exercises (PFMEs) on various maternal physiological parameters in pregnant women. The study included a total of 52 women, 26 pregnant (Pregnant group: 28.04±6.01 years; 26.83±3.81 kg/m2) and 26 nonpregnant (Control group: 29.42±5.73 years; 25.41±3.03 kg/m2) individuals. All women received PFME as follows: PFME was performed for 5 min (6-s holding contraction, 10 s of relaxation, 3 rapid PFM contractions). Evaluations were conducted before, immediately after, and 5 min post-exercise, with measurements including inferior vena cava (IVC) diameters and pulsatility index, blood pressure, oxygen saturation, and heart rates. Two-way analysis of variance was performed for group and time comparisons in repeated measurements. In both groups, the IVC collapsibility index values were lower 5 min after exercise, although this decrease, although clinically significant, did not reach statistical significance (p= 0.057). Post-exercise systolic blood pressure significantly decreased in both groups, whereas diastolic blood pressure decreased significantly in the pregnant group (p= 0.001, p= 0.023). The study found no statistically significant changes in the collapsibility index of the IVC after PFME but observed a clinically suggestive decrease. The clinical decrease in the collapsibility index can be interpreted as PFME in the supine position increasing venous return. Additionally, PFME was found not to alter maternal and fetal heart rates but contributed to the decrease in maternal systolic and diastolic blood pressure. Our study supports the view that the acute effects of PFME neither induce fetal stress nor pose maternal risks.

Acute Effect of Transcranial Direct Current Stimulation in Pelvic Floor Muscle Function in Young Healthy Women: Initial Findings of a Randomized Controlled Trial.

Transcranial direct current stimulation (tDCS) can enhance muscle function in healthy individuals. However, it is unknown if tDCS associated with pelvic floor muscle training (PFMT) can improve pelvic floor muscle function (PFMF) in healthy women. The aim of this study was to investigate the acute effect of a single session of tDCS in PFMF compared with sham-tDCS in healthy women. A double-blind, cross-over, randomized clinical trial was conducted with healthy, nulliparous and sexually active women. PFMF was assessed by bidigital palpation (PERFECT scale) and intravaginal pressure by a manometer (Peritron™). Participants randomly underwent two tDCS sessions (active and sham) 7 days apart. The electrode was positioned equal for both protocols, the anode electrode in the supplementary motor area (M1) and the cathode electrode in the right supraorbital frontal cortex (Fp2). The current was applied for 20min at 2mA in active stimulation and for 30s in sham-tDCS. The tDCS applications were associated with verbal instructions to PFMT in a seated position. After each tDCS session PFMF was reevaluated. Twenty young healthy women (aged 23.4 ± 1.7years; body mass index 21.7 ± 2.2kg/m2) were included. No difference was observed in power, endurance, and intravaginal pressure of PFMF (p > 0.05). The number of sustained contractions improved from 3.0 (2.0-3.5) to 4.0 (3.0-5.0) after active-tDCS (p = 0.0004) and was superior to sham-tDCS (p = 0.01). The number of sustained contractions of PFM improved immediately after a single active-tDCS session, with a difference compared with the post-intervention result of sham-tDCS in healthy young women.

The Prevalence of Urinary Incontinence, Knowledge and Practice of Pelvic Floor Muscle Training Among Female Recruits in Basic Training

OBJECTIVETo describe the prevalence, and severity of urinary incontinence (UI) among female recruits during basic training and their knowledge and practice of pelvic floor muscle training (PFMT). Furthermore, to determine if there is a relationship between the severity of UI and PFMT knowledge and practice. METHODSThis correlational study’s utilized a demographic and health questionnaire, a UI questionnaire [International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF)], and a PFMT questionnaire- Short version of the Patient-reported Outcome Measures (PFMT-P)]. RESULTSThe study included 349 female recruits with a mean age of 18.17 (± 0.390). The prevalence of UI was 26.7%, with a low mean of 2.03 (± 3.893) on the ICIQ-SF. PFMT knowledge level of was moderate, 1.46 (± 0.790), and the mean practice of PFMT was low, 2.51(± 1.180). No significant correlation was found between the ICIQ-SF score and the level of knowledge, rs=-0.09, p=0. 092. There was a weak but significant correlation between the ICIQ-SF score and PFMT practice, rs=0.170, p.= 0.003. CONCLUSIONSA little more than a quarter of the female recruits reported UI with a low severity. A relationship was found between UI and PFMT practice.

The Effect of Yoga and Pelvic Floor Muscle Exercise on Sexual Function and Sexual Self-esteem of Reproductive-age Women: A Randomized Clinical Trial.

Sexual function is a part of sexual health which is an important aspect of the quality of life. Physical activity is one of the healthiest activities that can effectively reduce the risk of sexual disorders. Therefore, this study was conducted with the aim of evaluating the effect of yoga and pelvic floor muscle exercises on the sexual function and sexual self-esteem of reproductive-age women. This randomized clinical trial study was conducted from September to December 2023 on 46 women of reproductive age working in the Shahrekord University of Medical Sciences and its affiliated health centers. Multi-stage cluster sampling was used to select the subjects; later, they were randomly divided into two intervention groups A (N=21) and B (N=25). Participants in intervention groups A and B performed pelvic floor muscle exercises at home using an educational pamphlet 3 times a week for 6 weeks, with 3 times a day repetition. In addition, women in the intervention group A participated in a yoga training program for 2 sessions per week for 6 weeks. Data collection tools included a demographic information form, the Female Sexual Function Index, and Sexual Self-Esteem Inventory for women. Questionnaires were completed by both groups before, immediately, and one month after the intervention. The data were analyzed using the chi-square test, fisher's exact test, independent two-sample t-test, repeated measures test, and analysis of covariance in SPSS software version 16. A significance level of less than 0.05 was considered. The results showed no statistically significant difference between the two groups in sexual function (P=0.21) and sexual self-esteem (P=0.22) scores before the intervention. Also, the results showed no statistically significant difference between the two groups in terms of sexual function (P=0.35) and sexual self-esteem (P=0.59) scores one month after the intervention. However, the mean score of the sexual function index immediately after intervention showed a statistically significant difference between the intervention groups A (31.43±3.76) and B (29.41±2.38) (P<0.001). The mean score of the sexual self-esteem immediately after the intervention showed a statistically significant difference between the intervention groups A (181.19±19.90) and B (171.32±15.02) (P<0.001). Adding yoga exercises to pelvic floor muscle exercises can improve the sexual function and sexual self-esteem of women at their reproductive age. Trial Registration Number: IRCT20100524004015N1.

Effectiveness of Pelvic Floor Strengthening Exercises in Females with Stress Urinary Incontinence – A Systematic Review

Abstract Background: Urinary incontinence (UI) is an unpleasant and socially constrained disorder that affects one in three women. Stress UI (SUI) is the most prevalent type of UI and is identified in 50% of affected women. The main objective of this systematic review was to evaluate the updated literature exploring the effectiveness of pelvic floor strengthening exercises and their dosimetry in women with SUI. Methods: Randomized controlled trials published between January 2013 and February 2023 and in English were included in this review. Case reports, systematic reviews, meta-analyses, and studies published in languages other than English were excluded from the study. Databases such as PubMed, Cochrane Library, and Physiotherapy Evidence Database (PEDro) were used to locate the literature. The quality of the data included was evaluated using PEDro scoring, and the risk of bias in the included studies was evaluated using RoB 2, a modified Cochrane risk-of-bias tool. Results: After screening, 12 studies were selected and included for qualitative analysis for the review. The findings of this review showed that pelvic floor muscle training (PFMT) exercises are an effective intervention for treating symptoms of SUI and improving quality of life whether used in combination or isolation. It is also suggested that a minimum of 12 supervised sessions of PFMT with a frequency of three times a week is suggestive to be an effective intervention and can be seen as a first line of treatment of SUI. It can be concluded that the PFMT is an effective intervention to treat the symptoms of SUI in females. Registration and Protocol: The systematic review applied for registration in PROSPERO but declined the registration because of an excessive inflow of trials that needed to be registered in PROSPERO as it was not accepting trials other than COVID-19 trials.

Effect of Kegel Exercise and Prone Position on After Pain Among Postpartum Mothers

ABSTRACT Background: Afterpain is a common discomfort felt by most of the postpartum mothers which is occurred due to delayed involution. Kegel exercise and prone position enhance the involution. Aim: The aim of the study was to determine the effectiveness of Kegel exercise and prone position on afterpain among postpartum mothers. Material and Methods: A Quasi-experimental pretest post-test with control group research design was used. Using nonprobability purposive sampling technique recruited 60 postpartum mothers who met the criteria. The level of afterpain was assessed by using visual analog scale. Experimental group was educated to do Kegel exercise for 3 days and lie in prone position for 3–5 minutes, 3 times for 3 days. Control group follows routine postnatal care posttest was conducted. Results: The study results concluded that the afterpain mean difference was 0.53, 1.70, 1.80, and 4.03. The calculated paired t-test value of t = 5.757 between pretest and post-test 1, t = 12.420 between post-test 1 and post-test 2, t = 12.953 between post-test 2 and post-test 3, and t = 21.378 between pretest and post-test 3 was found to be statistically significant at P &lt; 0.001 level. Conclusion: Therefore, Kegel exercise and prone position was effective in reducing afterpain during postpartum period.

Comparison of Surgical Outcomes of Laparoscopic Ventral Mesh Rectopexy and Stapled Transanal Rectal Resection for Managing Obstructed Defecation Syndrome

Abstract Background: Obstructed defecation syndrome has several underlying causes and is a prevalent but poorly understood condition. It is characterized by the inability to pass stool even when one experiences the urge to defecate. Initial therapy for ODS usually involves diet modifications, pelvic floor exercises, and biofeedback, which can considerably reduce symptoms. Surgical intervention may be recommended for individuals who present with certain anatomical anomalies and who do not respond to conservative therapies. Objectives: To assess and compare the surgical outcomes of laparoscopic ventral mesh rectopexy (LVMR) and stapled transanal rectal resection (STARR) for ODS management. Design: The study conducted a retrospective review of prospectively gathered data on the outcomes of 162 patients treated for ODS at our facility between January 2015 and January 2022 using either LVMR or STARR. Settings: The study was conducted at our facility between January 2015 and January 2022, evaluating 162 patients with ODS who underwent either LVMR (118 patients) or STARR (44 patients). Patient and Methods: The Modified Longo’s Scores (MLS) were used as the primary evaluation tool, determined preoperatively and postoperatively at 1 month, 6 months, and 12 months. Sample Size: A total of 162 patients were included in the study, with 118 patients who underwent LVMR and 44 patients who underwent STARR for the treatment of ODS at our facility between January 2015 and January 2022. Results: Preoperative MLS for LVMR patients averaged 23.41, which was similar to that of STARR patients (23.52), showing no statistically significant difference. After 1 month, the mean MLS showed a significant decrease of 93.3% among LVMR patients and that of 18.0% among STARR patients from the preoperative mean MLS, indicating a significantly greater change among LVMR patients than among STARR patients. Similarly, after 6 months, the preoperative mean MLS for LVMR patients and STARR patients revealed a substantial decline of 95.4% and 6.5%, respectively, with LVMR patients experiencing a considerably greater change than STARR patients. After 12 months, the mean MLS showed a significant decrease of 96.6% and 3.6% among LVMR and STARR patients from the preoperative mean MLS, respectively, with change being significantly more among LVMR patients than STARR patients. Conclusion: LVMR can be the preferred method because it outperforms STARR in terms of alleviating ODS symptoms. Limitations: This research involved a retrospective study using a small sample size and a short follow-up period. Conflicts of Interest: None.

Incidence of Urinary Incontinence During the Postpartum Period in Rajavithi Hospital: A Prospective Cohort Study.

The objective was to study the incidence of urinary incontinence (UI), associated risk factors and quality of life (QOL) in postpartum women. A prospective study was conducted with 406 postpartum women at Rajavithi Hospital and followed up over the phone between June 2020 and September 2021. Inclusion criteria were singleton pregnant women aged 18-45years, and gestational age ≥ 37weeks. Baseline characteristics (age, body mass index, birthweight, gestational age, parity, delivery type, smoking, and alcohol and caffeine intake) were recorded. UI was defined as a score ≥ 16.7% using the Urogenital Distress Inventory. Incontinence-related QOL was evaluated using the Incontinence Impact Questionnaire: a score of ≥ 70 indicated poor QOL. Outcomes were assessed during the postpartum period at 2days, 6weeks, 3 months, and 6months. Multivariate logistic regression was used to analyze risk factors for UI. The incidence of self-reported UI at 2days, 6weeks, 3 months, and 6months postpartum were 39%, 3%, 1%, and 0% respectively. Caffeine consumption during pregnancy was only a risk factor for UI (adjusted RR 1.61, 95%CI 1.27-2.05, p < 0.001) after adjusting for age, BMI, birthweight, parity, delivery type, alcohol, smoking, and pelvic floor exercise. Three women with UI had poor QOL, whereas all women without UI reported a good QOL. In our study sample, urinary incontinence was found in one-third of women during the early postpartum period, but for most women symptoms improved with the first 6weeks and all resolved at 6months. In this study, caffeine consumption during pregnancy was the only risk factor for UI.

The Effect of Kegel Exercises and Pelvic Floor Physiotherapy on the Improvements of Stress Urinary Incontinence and Urge Incontinence in Women with Normal Vaginal Delivery

Objectives: Pregnancy and normal vaginal delivery, are the main risk factors for urinary incontinence in women. A variety of treatments such as bladder training and pelvic floor exercises are effective for urinary incontinence. This interventional study has been conducted to compare the influence of Kegel exercises and pelvic floor physiotherapy on the improvements of urge and stress incontinence in women with first or second singleton pregnancies who have experienced normal vaginal delivery. Methods: One hundred fifty women with urinary incontinence in the postpartum period, who were divided randomly into 3 groups of 50 patients, participated in this prospective interventional study. The women were primigravida or it was their second labor. None of them complained of urinary incontinence before pregnancy. All of them had a normal vaginal delivery. The first group included females who were asked to perform Kegel exercises. The second group had 8 weekly physiotherapy appointments. The control group, included mothers who received routine care. We compared the prevalence of urge and stress incontinence between groups. Results: We found that the relative risk of urge and stress incontinence among mothers in the control group was more than in the intervention groups, but this difference was only statistically significant in the subject of stress incontinence between the Kegel and control groups. The reduction of urge incontinence prevalence among mothers in the Kegel and physiotherapy groups, was more than control group, although this reduction was not significant. Conclusion: There is a significant decrease in the prevalence of stress urinary incontinence at the end of the 8th and 12th weeks postpartum compared to the control group. Although the prevalence of urge incontinence among women in intervention groups was lower than in the control group, it was not significant. It seems the effect of Kegel exercises and pelvic floor physiotherapy, in reducing stress incontinence at the end of the 8th week, is almost equal.

The Effect of Pelvic Floor Muscle Exercises on Urinary Incontinence and Leisure Time activities of Women with Multiple Sclerosis

The Effect of Pelvic Floor Muscle Exercises on Urinary Incontinence and Leisure Time activities of Women with Multiple Sclerosis

The Prevalence and Related Risk Factors of Urinary Incontinence Among Adult Women in Al Medina Al Munawara, Saudi Arabia.

Introduction Urinary incontinence (UI) is a common clinical problem. It has an impact on an individual's social, professional, psychological, and physicalelements of life. The present study aimed to identify the prevalence of UI and associated risk factors among Saudi women in Al Medina Al Munawara, Saudi Arabia. Methods A cross-sectional study was conducted using an online questionnaire among 430 women aged 18-60 in Al Medina Al Munawara. The participants completed the validated Arabic version of the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) to assess the prevalence of UI and its associated factors. Results Among the participants, 64.8% did not experience urine incontinence, while 17.8% reported slight, 14.0% reported moderate, and 3.3% reported severe incontinence. Stress incontinence caused by coughing or sneezing was the most common cause (48.6%), followed by before reaching the toilet (urge incontinence) (34.5%) and after urination (15.5%). Significant associations were found between age, marital status, number of children, diabetes mellitus, urinary tract diseases, previous abdominal or pelvic surgery, obesity, constipation, and menopausal symptoms. However, no significant association was found between pregnancy and urine incontinence. Conclusions This study reveals a moderate prevalence of UI among Saudi women in Al Medina Al Munawara. The findings highlight the importance of early detection, treatment, and education on pelvic floor exercises to address UI. Factors such as age, marital status, number of children, and various medical conditions are associated with this condition, emphasizing the need for comprehensive management strategies.

The Effect of Eight-Week Kegel Exercise on Quality of Life in Postmenopausal Females with Urinary Incontinence

Introduction: Urinary incontinence (UI) is the leakage of urine which is often uncontrollable and can negatively impact on the quality of life (QoL). The aim of this study was to determine the effects of an eight-week of Kegel exercise as a complementary therapy on QoL in postmenopausal females with UI. Methods: The study design was a quasi-experimental pre-test post-test with a control group trial. The participants were Iranian women aged between 60 to 95 years with UI problems referring to medical centers in Najafabad city in Isfahan Province, Iran. Twenty four female UI patients were recruited and randomly divided into Kegel exercise (n = 12) and control group (n = 12). The Kegel group received exercise three times a week for eight-week, and the control group continued their routine life. The Questionnaire for Urinary Incontinence Diagnosis and the World Health Organization Quality of Life questionnaire were used for data collection. The variables were measured before and after the Kegel protocol in both groups. Descriptive statistics and analysis of covariance were used to assess variable differences between groups (p &lt; 0.05). Results: The mean age of UI patients was 70.83 ± 7.61 years old. Analysis of variance demonstrated a significant decrease in stress urinary incontinence symptoms (F = 61.88, p = 0.01), urge urinary incontinence symptoms (F = 111.56, p = 0.01), and UI symptoms (F = 88.20, p = 0.01), and significant increase in physical health (F = 28.93, p = 0.01), psychological health (F = 15.35, p = 0.01), social relationships (F = 18.83, p = 0.01), environment health (F = 155.51, p = 0.01), QoL (F = 132.07, p = 0.01) in Kegel exercise group. Conclusion: Kegel exercise can be an effective complementary therapy for improving QoL in postmenopausal female suffering from UI. Healthcare providers should consider recommending Kegel exercise as part of comprehensive treatment approach for postmenopausal female with UI to help alleviate symptoms and enhance their overall QoL.

Evaluating the effectiveness of early urethral catheter removal combined with intermittent catheterization for promoting early recovery of bladder function after laparoscopic radical hysterectomy: a study protocol for a randomized controlled trial

BackgroundBladder dysfunction, notably urinary retention, emerges as a significant complication for cervical cancer patients following radical hysterectomy, predominantly due to nerve damage, severely impacting their postoperative quality of life. The challenges to recovery include insufficient pelvic floor muscle training and the negative effects of prolonged postoperative indwelling urinary catheters. Intermittent catheterization represents the gold standard for neurogenic bladder management, facilitating bladder training, which is an important behavioral therapy aiming to enhance bladder function through the training of the external urethral sphincter and promoting the recovery of the micturition reflex. Nevertheless, gaps remain in current research regarding optimal timing for intermittent catheterization and the evaluation of subjective symptoms of bladder dysfunction.MethodsCervical cancer patients undergoing laparoscopic radical hysterectomy will be recruited to this randomized controlled trial. Participants will be randomly assigned to either early postoperative catheter removal combined with intermittent catheterization group or a control group receiving standard care with indwelling urinary catheters. All these patients will be followed for 3 months after surgery. The study’s primary endpoint is the comparison of bladder function recovery rates (defined as achieving a Bladder Function Recovery Grade of II or higher) 2 weeks post-surgery. Secondary endpoints include the incidence of urinary tract infections, and changes in urodynamic parameters, and Mesure Du Handicap Urinaire scores within 1 month postoperatively. All analysis will adhere to the intention-to-treat principle.DiscussionThe findings from this trial are expected to refine clinical management strategies for enhancing postoperative recovery among cervical cancer patients undergoing radical hysterectomy. By providing robust evidence, this study aims to support patients and their families in informed decision-making regarding postoperative bladder management, potentially reducing the incidence of urinary complications and improving overall quality of life post-surgery.Trial registrationChiCTR2200064041, registered on 24th September, 2022.

Real-World Evidence From a Digital Health Treatment Program for Female Urinary Incontinence: Observational Study of Outcomes Following User-Centered Product Design.

Urinary incontinence (UI) affects millions of women with substantial health and quality-of-life impacts. Supervised pelvic floor muscle training (PFMT) is the recommended first-line treatment. However, multiple individual and institutional barriers impede women's access to skilled care. Evidence suggests that digital health solutions are acceptable and may be effective in delivering first-line incontinence treatment, although these technologies have not yet been leveraged at scale. The primary objective is to describe the effectiveness and safety of a prescribed digital health treatment program to guide PFMT for UI treatment among real-world users. The secondary objectives are to evaluate patient engagement following an updated user platform and identify the factors predictive of success. This retrospective cohort study of women who initiated device use between January 1, 2022, and June 30, 2023, included users aged ≥18 years old with a diagnosis of stress, urgency, or mixed incontinence or a score of >33.3 points on the Urogenital Distress Inventory Short Form (UDI-6). Users are prescribed a 2.5-minute, twice-daily, training program guided by an intravaginal, motion-based device that pairs with a smartphone app. Data collected by the device or app include patient-reported demographics and outcomes, adherence to the twice-daily regimen, and pelvic floor muscle performance parameters, including angle change and hold time. Symptom improvement was assessed by the UDI-6 score change from baseline to the most recent score using paired 2-tailed t tests. Factors associated with meeting the UDI-6 minimum clinically important difference were evaluated by regression analysis. Of 1419 users, 947 met inclusion criteria and provided data for analysis. The mean baseline UDI-6 score was 46.8 (SD 19.3), and the mean UDI-6 score change was 11.3 (SD 19.9; P<.001). Improvement was reported by 74% (697/947) and was similar across age, BMI, and incontinence subtype. Mean adherence was 89% (mean 12.5, SD 2.1 of 14 possible weekly uses) over 12 weeks. Those who used the device ≥10 times per week were more likely to achieve symptom improvement. In multivariate logistic regression analysis, baseline incontinence symptom severity and maximum angle change during pelvic floor muscle contraction were significantly associated with meeting the UDI-6 minimum clinically important difference. Age, BMI, and UI subtype were not associated. This study provides real-world evidence to support the effectiveness and safety of a prescribed digital health treatment program for female UI. A digital PFMT program completed with visual guidance from a motion-based device yields significant results when executed ≥10 times per week over a period of 12 weeks. The program demonstrates high user engagement, with 92.9% (880/947) of users adhering to the prescribed training regimen. First-line incontinence treatment, when implemented using this digital program, leads to statistically and clinically substantial symptom improvements across age and BMI categories and incontinence subtypes.

Mediating Effects of Self-Efficacy and Illness Perceptions on Mental Health in Men with Localized Prostate Cancer: A Secondary Analysis of the Prostate Cancer Patient Empowerment Program (PC-PEP) Randomized Controlled Trial.

Understanding how interventions reduce psychological distress in patients with prostate cancer is crucial for improving patient care. This study examined the roles of self-efficacy, illness perceptions, and heart rhythm coherence in mediating the effects of the Prostate Cancer Patient Empowerment Program (PC-PEP) on psychological distress compared to standard care. In a randomized controlled trial, 128 patients were assigned to either the PC-PEP intervention or standard care. The PC-PEP, a six-month program emphasizing daily healthy living habits, included relaxation and stress management, diet, exercise, pelvic floor muscle exercises, and strategies to improve relationships and intimacy, with daily activities supported by online resources and live sessions. Participants in the intervention group showed significant improvements in self-efficacy and specific illness perceptions, such as personal control and emotional response, compared to the control group. These factors mediated the relationship between the intervention and its psychological benefits, with self-efficacy accounting for 52% of the reduction in psychological distress. No significant differences in heart rhythm coherence were observed. This study highlights the critical role of self-efficacy and illness perceptions in enhancing psychological health in prostate cancer patients through the PC-PEP. The results underscore this program's effectiveness and the key mechanisms through which it operates. Given the high rates of distress among men undergoing prostate cancer treatments, these findings emphasize the importance of integrating the PC-PEP into clinical practice. The implementation of the PC-PEP in clinical settings can provide a structured approach to reducing psychological distress and improving overall patient well-being.

Factors influencing engagement in pelvic floor muscle exercise following radical prostatectomy: A scoping review

AbstractInconsistent engagement in pelvic floor muscle exercise (PFME) among patients with prostate cancer (PC) following radical prostatectomy may have contributed to varying effectiveness in improving urinary incontinence across studies. Identifying factors influencing engagement can help develop effective interventions to maximize participation, enhance urinary function and improve quality of life (QoL). This scoping review aims to systematically search for factors influencing PFME engagement among post radical prostatectomy patients managing urinary incontinence. Eligible publications in English were identified from various databases, including PubMed, CINAHL, ProQuest, PsycINFO and Scopus. A health science librarian was consulted to assist in formulating search terms, encompassing PC, PFME terms and influencing factors terms. We employed Colandrapp™ for data extraction, focusing on key themes such as study characteristics, PFME education and training, recommended sessions, engagement rates and factors influencing PFME engagement following radical prostatectomy. Results were presented in tables and supplemented by a narrative discussion addressing gaps in research knowledge. The synthesis drew from a diverse body of literature, blending quantitative and qualitative approaches, to contribute to a comprehensive understanding of PFME engagement factors. Twelve papers, based on 10 studies published between 2011 and 2018, met our inclusion criteria. The reviewed studies primarily employed longitudinal quantitative designs, except for one study that utilized a mixed‐method design. Only three studies incorporated theories to guide the selection of potential factors influencing PFME engagement. The factors examined across the reviewed studies encompassed aspects related to the patient–partner relationship, patient's action control, planning (dyadic or individual), self‐efficacy, perceived urinary incontinence and the patient–provider relationship. We observed conflicting findings regarding the factors influencing PFME engagement across studies. Our review underscores the importance of theory‐informed studies using rigorous methodology and precise theoretical and operational definitions of potential factors. Such studies can help pinpoint the most influential factors to enhance PFME engagement and, ultimately, improve symptoms and QoL for PC patients. The scoping review also showed critical implications for nursing practice. Nurses should develop individualized and culturally sensitive interventions, integrate health behaviour change theories, assess patient–partner relationships and action control and consider intention's mediating role in the enhancement of PFME engagement following radical prostatectomy.