Pelvic Floor Research Articles

Wearables for the Bladder: Stakeholder Perspectives on Moving Multiple Sclerosis Bladder Dysfunction Interventions Into the 21st Century.

Bladder dysfunction (BD) is common in people with multiple sclerosis (MS) and can reduce participation in daily life. Detecting BD early allows for effective prevention-focused treatments such as pelvic floor physical therapy. Pairing neurotechnology with patient-reported outcomes to remotely measure BD could significantly improve monitoring and treatment of BD. Therefore, we describe the process and findings of stakeholder engagement from a human-centered design process to assemble a wearables for the bladder (WeB) kit. Four people with MS with varying BD severity, and 5 MS clinical/research experts had 4 virtual meetings. Commercially available bladder tools were graded for ability to evaluate, monitor, or treat BD. The Health Information Technology Usability Evaluation Scale (utility, usability, feasibility) was used for evaluation. Scoring was performed individually and as a group. Of the 11 devices, 5 obtained mean scores of greater than 6 of 10 for likability, usability, and device utility. The 2 highest scoring (9/10) devices were selected for the pilot. One device measures bladder urine levels, reporting the number/frequency of voids/leaks; the other guides pelvic floor exercises by pairing games on an app with biofeedback from intravaginal sensors. We uncovered critical differences in experts' and patients' appreciation of the tools, and the collaborative engagement led to substantial revisions of initial tool scores. This process underscores the critical role of stakeholder engagement in the selection of digital tools, especially in sensitive domains like pelvic function. Ongoing clinical validation of the selected tools will yield a validated, user-friendly WeB kit that is able to fill gaps in our ability to evaluate BD treatments in people with MS, ultimately reducing the impact of BD on quality of life.

A simple four symptom-based BEDS score to predict dyssynergic defecation in patients with chronic constipation.

Dyssynergic defecation (DD) is a disorder of anorectal function characterized by impaired relaxation or inappropriate contraction of pelvic floor muscles on attempted defecation. Based on previous Indian studies, we devised a symptom score (bleeding per rectum, excessive straining for stools, digitation, sense of incomplete evacuation/blockage-BEDS) and tried to determine if it can identify which patients with chronic constipation are more likely to have DD. This is a prospective observational cohort study in which consecutive adult patients (> 18years) with chronic constipation who were referred to our centre for anorectal manometry (ARM) between 2019 and 2023 were included. Prior to tests, patients were asked in detail regarding their symptoms and scoring was done. ARM was done by a single observer. Diagnosis of DD was based on standard criteria. Statistical tests used were median, range and percentages, Chi-square test and Mann-Whitney U-test. The data was analyzed for sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Agreement of symptom-based scoring and DD diagnosis as per criteria was calculated using Cohen's κ coefficient. A p value of < 0.05 was considered statistically significant. As many as 244 patients (males 140, median age 42years) formed the study cohort. Of these, 104 (42.6%) have DD. Sense of incomplete evacuation/sense of blockage (72.1% vs. 40%, p < 0.0001), excessive straining (73.1% vs.22.1%, p < 0.0001) and digitation (28.8% vs. 13.5%, p 0.003) were more commonly reported in patients with DD. Taking a cut-off score of > / = 2, sensitivity of 69.2%, specificity 81.4% and positive likelihood ratio of 3.73 were noted. Similarly, if the score of > / = 3 was considered, the likelihood ratio increased to 4.71 with an increase in specificity (94.29%) and fall in sensitivity (26.92%). Symptom-based BEDS score of > / = 2 is useful in identifying patients with DD.

Prevalence of urinary incontinence in postpartum women and physiotherapy interventions applied: An integrative review.

This integrative review identified studies that reported the prevalence of physiotherapeutic interventions for urinary incontinence among postpartum women. This is an integrative literature review study. We used the integrative literature review framework proposed by Whittemore and Knafl to search for relevant literature. The search strategy for electronic databases was developed from the research question and definitions of key concepts, assisted by the librarian. Databases that were searched include Google Scholar, Medline (PubMed), CINAHL, and the Joanna Briggs Institute databases. Both qualitative and quantitative studies that met the inclusion criteria were included. We used the CASP tool to assess the quality of selected papers. The included articles were thematically analyzed. Thirty-six papers met the inclusion criteria for the review. Six themes emerged from the analysis: prevalence of postpartum UI; risk factors for postpartum UI; antenatal pelvic floor muscle training; conservative treatment and quality of life; experiences of postpartum women with UI; and possible coping strategies adopted by women. Most of the articles were quantitative studies (80.5%); 16.6% were qualitative and 2.7% adopted mixed methods. Urinary incontinence is common in postpartum women. Antenatal pelvic floor muscle training is protective against postpartum UI and should be the first-line treatment option.

Comparative study on the Impact of Transcranial Magnetic stimulation and Bio-feedback on overactive bladder in multiple sclerosis patients: a Randomized Clinical Trial.

Overactive bladder (OAB) is a common clinical presentation in patients with multiple sclerosis. The purpose of this study was to compare the effects of transcranial magnetic stimulation (TMS) and biofeedback on overactive bladder in patients with multiple sclerosis. This research included 45 individuals with multiple sclerosis of both sexes. We randomly divided them into three equal groups (A, B, and C). Patients in group A got biofeedback training and pelvic floor exercise (PFME); patients in group B had transcranial magnetic treatment and PFME; and patients in group C had PFME. Urodynamic measurements were utilized to determine bladder parameters (detrusor pressure at maximum flow rate, bladder volume at initial desire to empty, maximum cystometric capacity, detrusor pressure, and maximum flow rate) for all groups before and after a six-week training interval (the end of therapy). There was a statistically significant improvement in all urodynamic measurement parameters within the groups (Groups A, B and C). Except for the maximal cystometric capacity and detrusor pressure were non-significant improvement in B before and after therapy. However, there was no significant difference between the three groups following therapy. Transcranial magnetic stimulation and biofeedback improved bladder function in patients with multiple sclerosis. These approaches have a high level of safety and effectiveness, but EMG biofeedback has superiority.

Younger Age Is Associated With Pelvic Floor Muscle Dysfunction in Women With Urinary Symptoms.

Recent articles have highlighted the existence of pelvic floor myofascial dysfunction in women presenting with pelvic floor disorders. The aim of the study was to evaluate whether younger age is associated with pelvic floor muscle dysfunction in women with lower urinary tract symptoms, including urinary urgency, frequency, nocturia, and urinary incontinence. This retrospective cohort study included women seeking an initial outpatient urogynecology evaluation for urinary symptoms from 8/2018 to 2/2022. The primary outcome was the presence of pelvic floor muscle dysfunction, defined as a diagnosis of levator myalgia/spasm. Multivariable logistic regression was used to evaluate the association. Four hundred twenty-one women with lower urinary tract symptoms were included, and 115 (27.3%) were diagnosed with pelvic floor muscle dysfunction. Women with pelvic floor dysfunction were 13 years younger, less likely to report any incontinence (60% vs 71.9%, P = 0.026) and urgency incontinence (8.7% vs 17.3%, P = 0.04). There was no difference in reported urgency, frequency, or nocturia. Women with pelvic floor dysfunction were more likely to report dysuria (19.1% vs 9.5%, P = 0.012), dyspareunia (39% vs 7.5%, P < 0.001), vulvodynia (11.3% vs 2.3%, P < 0.001), and pelvic pain (25.2% vs 7.2%, P < 0.001). The odds of pelvic floor muscle dysfunction in women <40 years old was 2.34 times greater than women ≥40 years old, after adjusting for other factors (adjusted odds ratio 2.341, 95% confidence interval [1.102, 4.972]). Younger women with lower urinary tract symptoms were significantly more likely to have pelvic floor muscle dysfunction compared to older women with similar symptoms, even after controlling for other associated characteristics.

Influence of Transperineal Ultrasound on the POP-Q System in the Surgical Indication of Symptomatic Pelvic Organ Prolapse.

Background/Objectives: The diagnostic capacity of the preoperative pelvic organ prolapse quantification (POP-Q) system to define surgical pelvic organ prolapse (POP) is sometimes limited. On the other hand, pelvic floor ultrasound can influence the surgical indication for patients with symptomatic POP. Therefore, our objective is to determine how transperineal ultrasound can influence the surgical indication for symptomatic POP. Methods: This is a prospective observational study conducted over two years including patients who underwent corrective surgery for symptomatic POP. All patients underwent a preoperative examination using the POP-Q system to assess POP. Patients in whom the pelvic floor specialist had diagnostic doubts about the stage of POP underwent an ultrasound examination of the POP. Before the surgical procedure and with the patient anesthetized, a new clinical examination was performed using the POP-Q system and surgical correction of the POP was executed when the patient had a decline to stage II or higher. Cohen's kappa coefficient of agreement was used to assess the agreement. Results: Of the 180 patients who met the inclusion criteria, 167 were included (99 with preoperative clinical examination and 68 with preoperative clinical examination and ultrasound study). The kappa index for the diagnosis of surgical uterine prolapse of the preoperative clinical examination (moderate correlation) was lower than the ultrasound examination (very good correlation) (0.493 p < 0.001 and 0.924 p < 0.001). The kappa index for the diagnosis of cervical elongation without surgical uterine prolapse also showed differences between the preoperative clinical examination (good correlation) and the ultrasound examination (very good correlation) (0.749 p < 0.001 and 0.853 p < 0.001). Conclusions: Transperineal ultrasound has a higher concordance than presurgical clinical examination, based on the POP-Q system, for detecting POP with central compartment surgical indication.

A Prospective Feasibility Study to Differentiate Sacral Neuromodulation Lead Electrode Configurations Using Motor and Sensory Thresholds and Locations of Sensation.

Background Accurate positioning and effective programming of sacral neuromodulation (SNM) relies upon the use of several acute stimulation measurements. While the clinical utility of these acute measurements including pelvic floor motor thresholds (PFMT), toe/leg motor thresholds (TMT), and sensory thresholds (ST), are widely accepted, their usefulness in quantitative research remains unclear. The purpose of this prospective study was to test these measurements and gauge their utility in future research. Methods Eight participants received Axonics SNM, 6 Medtronic Interstim II, and 2 Medtronic Micro SNM. PFMT was measured after implantation. ST and the location of sensation (LOS) were measured immediately postoperatively (PO), at pre-release from the surgery center (PR), and during a follow-up clinic visit (FU). Thresholds were compared across contact and time using linear mixed-effects models. Results Significant differences in PFMT were found across electrode configurations, with stimulation through proximal contacts exhibiting lower PFMT than distal configurations. ST displayed no significant differences across electrodes and showed minimal changes over time. LOS exhibited substantial variability across patients and periods. Conclusions Results suggest that PFMT were able to differentiate differences across electrode configurations that may be useful for future quantitative research. The lack of differences in ST and LOS across electrode configurations was interesting given the focus on these measurements clinically. Future testing is to confirm these limitations.

Prevalence and Clinical Correlates of Endometriosis in Patients With IC/BPS.

Interstitial cystitis/bladder pain syndrome (IC/BPS) presents as a complex heterogeneous disorder that poses a significant clinical challenge both for diagnosis and treatment. The identification of patient subgroups with significant overlap in their nonurological associated symptoms, including endometriosis, may enable a more targeted therapeutic approach. This study investigated the prevalence, clinical correlates, and clinical sequelae associated with concurrent endometriosis in patients with IC/BPS. Demographic, clinical, surgical, and questionnaire data from female patients (n = 533) with a diagnosis of IC/BPS were evaluated in this retrospective cohort study. Surgical history was obtained from patient electronic medical records, using Current Procedural Terminology (CPT) and International Classification of Diseases (ICD) codes. Data from participants with and without concurrent endometriosis were compared using univariate analysis, followed by binary logistic regression to identify associated variables. Of 533 participants, 108 (20.3%) reported a history of endometriosis. Those with concurrent endometriosis were younger, had a larger bladder capacity, and had a higher number of nonurological associated symptoms. Patients with concurrent endometriosis were less likely to have a history of cystectomy (the surgical removal of the bladder) and report allergies but more prone to report comorbidities such as chronic pelvic pain, chronic fatigue, fibromyalgia, migraines, and pelvic floor dysfunction. Binary logistic regression identified a positive association between endometriosis and chronic pelvic pain, and a negative association between allergies and low bladder capacity for those with concurrent endometriosis. Endometriosis is common in younger female patients with IC/BPS and is associated with a non-bladder-centric (ie, systemic pain disorder) phenotype.

Application and clinical efficacy of comprehensive nursing intervention in pelvic floor and bladder function recovery post-cervical cancer surgery

Objective: To evaluate the clinical efficacy of comprehensive nursing intervention in pelvic floor and bladder function recovery post-cervical cancer surgery. Method: This was a retrospective study. A total of 120 patients with cervical cancer undergoing radical surgery at Tangshan People’s Hospital from June 2021 to June 2023 were randomly divided into two groups (n=60 cases each group). The control group received routine nursing intervention, while the study group was provided with comprehensive nursing intervention. Comparative analysis was conducted on clinical indicators, postoperative complications, bladder and pelvic floor function recovery, and patient satisfaction before and after intervention in both groups. Result: In the study group, ambulation time, gastrointestinal function recovery, duration of postoperative drainage tube placement, oral diet resumption time, duration of postoperative vaginal bleeding, and length of hospital stay were significantly shorter than in the control group (all p&lt; 0.05). Bladder function recovery in the study group was superior to that in the control group (p&lt; 0.05). The study group showed lower scores for anorectal disorders, urogenital disorders, and pelvic organ prolapse than the control group (p&lt; 0.05, respectively). Patient satisfaction was 100% in the study group and 85% in the control group, suggesting a statistically significant difference between the two groups (p&lt; 0.05). Conclusion: Comprehensive nursing intervention deserve to be promoted as it can accelerate postoperative clinical recovery, reduce the incidence of surgical complications, improve pelvic floor and bladder function post-cervical cancer surgery, and enhance patient satisfaction with care. doi: https://doi.org/10.12669/pjms.40.10.9271 How to cite this: Zhao Q. Application and clinical efficacy of comprehensive nursing intervention in pelvic floor and bladder function recovery post-cervical cancer surgery. Pak J Med Sci. 2024;40(10):2287-2292. doi: https://doi.org/10.12669/pjms.40.10.9271 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Ultrasound Evaluation of Onset Core Muscle Activity in Subjects with Non-Specific Lower Back Pain and Without Lower Back Pain: An Observational Case-Control Study.

Lower back pain (LBP) has been the leading cause of disability since 1990. Objectives: The main objective of this observational case-control study was to evaluate, using ultrasound, whether there were differences in the onset and ratio of core muscle contraction between subjects with non-specific chronic lower back pain and healthy subjects. Methods: A total of 60 participants (52% women), split between those with non-specific chronic lower back pain (n = 26) and healthy (n = 34) subjects, were recruited. Initial muscle contraction of the lateral abdominal wall, pelvic floor, lumbar multifidus, and respiratory diaphragm was measured using ultrasound. The abdominal drawing-in maneuver, contralateral arm elevation, the Valsalva maneuver, and voluntary contraction of the pelvic floor in seated and standing positions were performed. The muscle thickness of the lateral abdominal wall and lumbar multifidus and excursion of the pelvic floor and diaphragm at rest and during testing were also analyzed. Results: No differences were found between the groups in the initial contraction. Statistically significant differences were found in the following variables: diaphragm excursion (p = 0.032, r = 0.277) and lumbar multifidus ratio (p = 0.010, r = 0.333) in the standing-abdominal retraction maneuver; pelvic floor excursion (p = 0.012, r = 0.325) in the standing-contralateral arm raise; and transverse abdominis ratio (p = 0.033, r = 0.275) in the sitting-contralateral arm raise. A statistically significant interaction between the groups and body mass index was observed in resting diaphragm excursion (p = 0.018, partial eta squared = 0.096) during sitting-voluntary pelvic floor contraction. Conclusions: It cannot be concluded that there is a specific pattern of core activation in any of the groups. However, statistically significant differences were found in the contraction indexes of the lumbopelvic musculature.

To Study the Knowledge, Attitude and Practice of Postpartum Exercises in Nursing Mothers

Postpartum period has three distinct phases - immediate, early and remote.[1] First six weeks following childbirth known as puerperal period is a stressful for any women due to physiological and psychological adaptation which happens during this period and pelvic organ returns to pre pregnant state.[1] Breastfeeding starts immediately after the birth of the infant and as per the recommendation of WHO it is to be continued exclusively for 6 months.[2] During this period, Postpartum exercises like Kegel’s, abdominal and breathing exercises helps to improve the pelvic floor and abdominal muscle tone, bowel and bladder function and cardiovascular fitness which will have a positive influence on the health of the mother.[3] Two hundred and sixteen postpartum nursing mothers between the time period of six weeks to six months and Women who have given birth in hospitals and have been informed about post- natal exercises during the duration of hospitalization.In conclusion, the findings of this study provided an excellent insight on how many of the participants had knowledge about postnatal exercises and attitude is relatively positive which they were fully aware of the potential benefits of postnatal exercises but most of them did not practice postnatal exercises in their postpartum period regularly because majority of mothers were facing barriers because of household chores and baby care. Key Words: knowledge, attitude and practice of postpartum exercises, nursing mothers, postpartum health.

Ensuring ethical maternal care: addressing episiotomy trends in Pakistan

Madam, The use of routine episiotomies, particularly those performed without consent, is a concerning and escalating trend during childbirth in Pakistan. An Episiotomy is a surgical incision in the pelvic floor to enlarge the vaginal opening during labour. The incision is performed under local anaesthetic with scissors. It is deemed necessary only under certain conditions: abnormal progression of labour, suspected foetal distress, vacuum or forceps childbirth, and shoulder dystocia.1,2 Despite the WHO’s recommendation of an episiotomy rate of less than 10% to be considered safe, the rates are disproportionately high in Pakistan. This prompts the need for improved maternal care that is responsible, accountable, and consensual.3 The need for respectful maternal care is crucial in Pakistan. A study conducted in Rawalpindi analysed data from 124798 deliveries and found an 80% incidence of routine episiotomies during normal vaginal deliveries in primigravida cases.3 Another cross-sectional study conducted in Karimabad on 235 patients, also revealed an alarming prevalence of episiotomies, with a rate of 78%.4 These rates differ significantly from those of other countries, such as 17% in New Zealand and 36.5% in Norway, underscoring the potential overuse of episiotomies beyond medical need in Pakistan. Cultural beliefs and a lack of adequately trained staff likely exacerbate this disparity.2,3 Furthermore, increasing episiotomy rates can adversely impact emotional well-being, cause perineal trauma, difficulty in breastfeeding, infection, and delayed healing.2 The intensity of these impacts and the high incidence of episiotomy highlight the need for comprehensive reforms in maternal care practices to ensure the safety and well-being of women. To address this issue, it is imperative to adopt a multifaceted approach that prioritizes informed consent and aims to curb the increasing trend of episiotomies. A commonly presumed benefit of an episiotomy is the prevention of advanced tears; yet, a randomized control trial on 676 patients found no association between decreased use of episiotomy and significant prevalence of severe tears.5 This stresses the need to shift to a policy of selective episiotomies like that implemented in Vietnam. The approach encompasses allocating a budget for routine training of staff, regularly recording rates of episiotomy/tears and including updated guidance about the use of episiotomies within the curriculum.2 Furthermore, when performing an episiotomy patients must be fully informed and individually consented, written or verbal. Opt-out consent may apply in emergencies.1 Such interventions can help ensure higher maternal care standards within Pakistan.

Convolution neural network based multi-class classification of rehabilitation exercises for diastasis recti abdominis using wearable EMG-IMU sensors

PurposeGlobally, postnatal women endure a prominent issue caused by midline separation of abdominal recti muscles, characterized by a sagging and pouch-like appearance of the belly termed as Diastasis Recti Abdominis (DRA). The necessity of ensuring the efficacy of rehabilitative workouts for individuals with DRA cannot be overstated, as inaccurate exercises can exacerbate the condition and deteriorate the health of affected women. The purpose of these exercises is to specifically focus on the rectus abdominis muscles to facilitate the reapproximation of the linea alba. The primary aim of this research work is to assess the effectiveness of rehabilitation exercises for DRA women obtained from Inertial Measurement Unit (IMU) and Electromyography (EMG) sensors.Design/methodology/approachConvolutional neural networks (CNN) employs convolutional activation functions and pooling layers. Recently, 1D CNNs have emerged as a promising approach used in various applications, including personalized biomedical data classification and early diagnosis, structural health monitoring and anomaly detection. Yet another significant benefit is the feasibility of a real-time and cost-effective implementation of 1D CNN. The EMG and IMU signals serve as inputs for the 1D CNN. Features are then extracted from the fully connected layer of the CNN and fed into a boosting machine learning algorithm for classification.FindingsThe findings demonstrate that a combination of sensors provides more details about the exercises, thereby contributing to the classification accuracy.Practical implicationsIn real time, collecting data from postnatal women was incredibly challenging. The process of examining these women was time-consuming, and they were often preoccupied with their newborns, leading to a reluctance to focus on their own health. Additionally, postnatal women might not be fully aware of the implications of DRA and the importance of rehabilitation exercises. Many might not realize that neglecting DRA can lead to long-term issues such as back pain, pelvic floor dysfunction, and compromised core strength.Social implicationsDuring our data collection camps, there were educational sessions to raise awareness about the DRA problem and the benefits of rehabilitation exercises. This dual approach helped in building trust and encouraging participation. Moreover, the use of wearable sensors in this study provided a non-invasive and convenient way for new mothers to engage in rehabilitation exercises without needing frequent visits to a clinic, which is often impractical for them.Originality/valueThe utilization of discriminating features retrieved from the output layer of 1D CNN is a significant contribution to this work. The responses of this study indicate that 1D convolutional neural network (1D CNN) and Boosting algorithms used in a transfer learning strategy produce successful discrimination between accurate and inaccurate performance of exercises by achieving an accuracy of 96%.

MODERN VIEWS OF USE OF TELEREHABILITATION IN URINARY TRACT DYSFUNCTION IN PATIENTS WITH MULTIPLE SCLEROSIS

Multiple sclerosis is a chronic disease of the nervous system that often leads to various disorders, including urinary tract dysfunction. This significantly affects the quality of life of patients, causing physical and psychological complications. The term "bladder rehabilitation" summarizes treatment options aimed at restoring its function in patients with neurourological symptoms. A strong contraction of the sphincter of the urethra and/or pelvic floor, as well as anal dilatation, manipulation of the genital area, and physical activity reflexly inhibit urination. A comprehensive physical therapy program for patients with pelvic disoders includes pelvic floor vibration massage, training in proper breathing patterns, pelvic floor muscle relaxation and stabilization exercises and should last several months, during which the patient regularly visits the doctor. The pandemic and war have created barriers that affect almost every aspect of life, treatment and rehabilitation, especially for people with chronic neurological conditions. Traditional rehabilitation methods used to correct urinary tract dysfunction have their limitations, including difficulties in accessing specialists, especially in remote areas. This stimulates the development and implementation of telerehabilitation as an alternative approach. Telerehabilitation involves the use of digital technologies for the remote provision of medical services and patient monitoring. It allows doctors to monitor the condition of patients, provide recommendations and adjust treatment without the need for personal visits. Considering the existing data and our own clinical experience, we consider it appropriate to use telerehabilitation for the correction of disorders of the lower urinary tract, especially in the conditions of war, when access to rehabilitation centers may be difficult. In the department of medical rehabilitation of the University Clinic of the Kharkiv National Medical University, we successfully conducted telerehabilitation using Google Meet video conferencing for 10 patients with urinary incontinence on the background of multiple sclerosis, whose EDSS was no more than 4.0. When conducting online classes under the guidance of a physical therapist, patients noted a desire to strictly follow the recommendations and perform regular exercises. All patients kept a urination diary, according to which the frequency of urination was reduced by an average of 20-25%, which had a positive effect on their quality of life. Although our observations are not representative, in combination with existing studies, we consider telerehabilitation to be a promising direction in complex therapy and rehabilitation of this pathology. Conclusion The use of telerehabilitation for urinary tract dysfunction in patients with multiple sclerosis is a promising direction that requires further research. This approach can significantly improve the quality of life of patients, reduce the burden on the health care system and provide a more affordable and convenient treatment. A multidisciplinary team should be involved, including a neurologist, a urologist, a gynecologist, and a physical therapist to select the optimal tactics of drug treatment and physical therapy. A promising direction of further research is the development of standard protocols for conducting telerehabilitation for patients with lower urinary tract dysfunction against the background of multiple sclerosis and other pathologies.

Antenatal Anovaginal Distance, a Potential Indicator of Perineal Damage during Pregnancy.

Perineal injuries, including episiotomies and spontaneous tears, are common complications during childbirth, often leading to significant discomfort and prolonged recovery for women. This retrospective observational cohort study aimed to explore the relationship between antenatal anovaginal distance (AVD) and the incidence of perineal injuries in a cohort of pregnant women evaluated for pelvic floor health at 28 to 32 weeks of gestation. Conducted at the University Hospital of Padua over 18 months, the study included 416 women who underwent vaginal delivery at term. Based on AVD, the study participants were divided into two groups: AVD-N group, which included 252 patients with AVD ≥ 2 cm, and the AVD-R group, which included 164 with AVD < 2 cm. The results of the pelvic floor assessment and those related to childbirth were then examined in relation to AVD (reduced vs. normal). The study found that women with reduced AVD were more likely to experience perineal injuries. Specifically, the incidence of episiotomy and severe perineal tears (3rd and 4th degree) was significantly higher in the reduced AVD group (p < 0.05). Furthermore, a lower AVD was associated with increased perineal muscle hypertonicity and a higher likelihood of operative delivery with episiotomy. Logistic regression analysis confirmed that reduced AVD was an independent risk factor for perineal injuries, regardless of other maternal or neonatal characteristics. These results suggest that AVD measurement during pregnancy may help identify women at higher risk of perineal trauma, enabling more personalized obstetric care to mitigate these outcomes.

Sexual function in women with unexplained infertility

Background. The problem of infertility, including unexplained infertility (UEI), does not lose its relevance. It is known that infertile women are prone to emotional disorders. Such psychological changes can contribute to the development of sexual dysfunction. Aim. To study the characteristics of sexual function in women with unexplained infertility. Materials and methods. A comparative study of sexual function was conducted in 60 women with UEI aged 20–40 years (group 1). Group 2 consisted of 75 fertile women with at least one living healthy child and no history of infertility. Group 3 included 75 healthy nulliparous women who do not plan pregnancy and do not have a diagnosis of “Infertility”. The questionnaire “Index of Female Sexual Function” (FSFI) was used to assess sexual function. The following parameters were assessed: “desire”, “arousal”, “lubrication”, “orgasm”, “satisfaction”, “pain”, and the final score. Results. The lowest values were in group 2. In this group, statistically significant differences were obtained with groups 1 and 3 in the parameters “Attraction”, “Arousal”, “Lubrication”, “Satisfaction”, “Orgasm”. In group 1, the final score was significantly higher than in groups 2 and 3 – 30.2 (26.3–31.7), 26.6 (23.7–28.8) and 28.3 (27.5–29.9); p0.001, respectively. The highest proportion of women with sexual dysfunction (FSFI26.55) was in group 2 – 37 (49.33%). In groups 1 and 3, the number of women with sexual dysfunction was 13 (21.66%) and 9 (12%), respectively (the differences between groups 1 and 3 were not significant). Conclusion. The quality of sexual function was not associated with reproductive disorders. The lowest rates were in group 2. This is probably due to psychological aspects and anatomical changes in the pelvic floor after childbirth. Many women, regardless of the presence of children, need therapeutic and preventive sexological care. In the case of sexual dysfunctions that impair a woman's quality of life, qualified sexological and psychological assistance should be provided regardless of her fertility.

Functional and postoperative outcomes in ideal pouch-anal anastomosis in patients with parkinson disease and multiple sclerosis.

Patients with multiple sclerosis and Parkinson's disease may experience pelvic floor dysfunction and constipation which can affect ileoanal pouch emptying. This can lead to complications such as pouchitis, pouch dysfunction, and failure. We hypothesized that patients with neurological diseases have a higher rate of pouch failure and complications than healthy controls. Data were sourced from the institutional ileoanal pouch database. Patients with multiple sclerosis or Parkinson's disease, diagnosed before or after pouch construction, were matched to a control group of patients without neurological disease using propensity score-optimal matching. Demographics, postoperative and functional outcomes, and quality of life were analyzed. Twenty-six patients (38%) with multiple sclerosis and 16 (62%) with Parkinson's disease were matched with 42 healthy controls. The overall median age was 39 years, median BMI was 25.3kg/m2, and most patients were female (61.9%). Preoperative colorectal diagnoses included ulcerative colitis (83.3%), indeterminate colitis (9.5%), and Crohn's disease (7.1%). Patients with neurological diseases had higher ASA scores (class III, 57.1% vs. 21.4%; p < 0.01), fewer nocturnal bowel movements (median 0 vs. 2; p < 0.001), fewer bowel movements over 24h (median 6 vs. 8; p = 0.01), and were less likely to recommend IPAA construction (72.7% vs. 97%; p = 0.01) than the controls. Other surgical, functional, and quality-of-life outcomes were similar. Patients with multiple sclerosis or Parkinson's disease might differ in pouch function compared with healthy controls. These neurological diseases might affect pouch function. The rate of pouch failure was similar, showing its feasibility despite multiple sclerosis and Parkinson's disease.

Clinical value of transperineal ultrasound in evaluating the effects of different delivery methods on the primipara pelvic floor structure and function

To evaluate the effects of different delivery methods on the pelvic floor structure and function among primiparas by transperineal ultrasound, with a view to providing guidance for early postpartum intervention. Primiparas who underwent postpartum examination with transperineal ultrasound were recruited. Subjects were divided according to mode of delivery (vaginal and cesarean delivery). General information (including age, pre-pregnancy BMI and neonatal weight) were collected, and transperineal ultrasound was performed to measure such indicators as the levator hiatus areas in resting, constrictive anal and maximum Valsalva states, the posterior vesicourethral angles and distances between vesical neck and posterior inferior margin of pubic symphysis in resting and maximum Valsalva states, as well as the vesical neck mobility and urethral rotation angle in maximum Valsalva state. The inter-group differences in ultrasound indicators between the resting and Valsalva states were compared to analyze the postpartum incidences of pelvic floor dysfunctions like stress urinary incontinence, urethral funnel formation, bladder prolapse and uterine prolapse in primiparas. The levator hiatus areas in resting, constrictive anal and maximum Valsalva states were all larger in the vaginal delivery group than in the cesarean delivery group (P < 0.05). Compared to the cesarean delivery group, the vaginal delivery group exhibited larger posterior vesicourethral angles in resting and maximum Valsalva states (P < 0.05). The distances between vesical neck and posterior inferior margin of pubic symphysis were greater in the cesarean delivery group than in the vaginal delivery group at both resting and maximum Valsalva, with that at maximum Valsalva showing significant inter-group difference (P < 0.05). The vaginal delivery group exhibited greater vesical neck mobility and urethral rotation angle at maximum Valsalva compared to the cesarean delivery group (P < 0.05). The incidences of stress urinary incontinence, urethral funnel formation, bladder prolapse and uterine prolapse were all higher in the vaginal delivery group than in the cesarean delivery group, with the stress urinary incontinence and bladder prolapse incidences showing significant inter-group differences (P < 0.05). With transperineal ultrasound, various pelvic floor indicators of primiparas can be clearly measured and, through these ultrasound indicators, the effects of different delivery methods on the pelvic floor function can be evaluated, which is conducive to early clinical detection and intervention of postpartum pelvic floor dysfunctions, thus facilitating the early postpartum treatment.

Urogynecological symptoms and pelvic floor muscle tender points in women with and without fibromyalgia

Aims: To compare the urinary, sexual and vaginal symptoms frequency, pelvic floor muscles (PFM) tender points and pain severity in women with and without fibromyalgia. Methods: Cross-sectional study composed by women with fibromyalgia (FMG) and without it (control group, CG) assessed by: (a) sexual (Female Sexual Function Index - FSFI); (b) vaginal (International Consultation on Incontinence Questionnaire ICIQ-Vaginal Symptoms); (c) urinary (ICIQ: Urinary Incontinence Short Form ICIQ-UI SF and ICIQ-Overactive Bladder ICIQ-OAB); (d) quality of life (King’s Health Questionnaire - KHQ), as well as digital palpation assessment of: tone (normal, increased or decreased); tender points (position by clock-face); and pain severity (numeric rating scale - NRS). Statistical analysis included Student’s t-test, Wilcoxon-Mann-Whitney’s, logistic Regression and Spearman’s Correlation (significance level: 5%). Results: Of the 84 women enrolled, 39 FMG and 39 CG completed the study. No differences in urinary or vaginal symptoms were found. FMG presented lower FSFI (FMG: 7.2; CG: 21.6; p&lt;0.001), more PFM tender points (FMG: 10 (25.6%); CG: 1 (2.6%); p=0.03), greater quality of life impairment (FMG: 5, CG: 4; p=0.01) and sleep/energy (FMG: 5, CG: 2, p&lt;0.01) both KHQ domains. The pain severity was FMG: 4 (1-6); CG: 7(7); p=0.05. Conclusion: More PFM tender points, greater impairment in sexual function, as well as in quality of life were all more frequent in women with fibromyalgia when compared to healthy controls. However, the correlation between sexual function and PFM pain was low.

Cough-Induced Detrusor Overactivity—Outcome after Conservative and Surgical Treatment

Background/Objectives: The most common variant of mixed urinary incontinence is stress-induced urge urinary incontinence with the correlating urodynamic findings of cough-induced detrusor overactivity (CIDO). This prospective study assessed the clinical outcomes and leakage improvement among patients with CIDO following conservative or surgical treatment. Methods: We included patients with CIDO treated at our tertiary referral center from January 2018 to July 2021 in this prospective cohort study. The detection of a detrusor contraction after a cough was diagnosed as CIDO by urodynamic multichannel testing. All the patients in our study received personalized care, with behavioral therapy and anticholinergic/betamimetic treatment as a first step. If leakage persisted, patients were given a choice between pelvic floor muscle exercises (PFMEs), periurethral bulking or a midurethral sling. The primary outcome was the mean difference in urine leakage in the pad test before and six months after treatment. Results: Thirty-five patients met the inclusion criteria for CIDO and all presented a positive pad test at baseline (mean: 27 g). All 35 patients participated in behavioral therapy and anticholinergic/betamimetic treatment. Twenty-two patients (62.9%) underwent PFME, twelve patients (34.2%) received periurethral bulking, and nine patients (25.7%) received a midurethral sling. After all the treatments, our cohort showed a significant improvement in the pad test (mean: 5.7 g, p &lt; 0.001). The result was more favorable after periurethral bulking than the midurethral sling (p &lt; 0.001). Conclusions: This study shows the effectiveness of conservative treatment as a first step. In cases needing further treatment, bulking agents may be superior to PFME and midurethral propylene slings, offering new perspectives in the field of urogynecology and urinary incontinence.