Pelvic Floor Distress Inventory Questionnaire Research Articles

Association Between Physical Activity and Pelvic Floor Disorders in Parous Ugandan Women.

The aim was to assess the association between the degree of physical activity (PA) and the presence of pelvic floor disorders (PFDs) in a cohort of parous Ugandan women. In this cross-sectional study, PFDs were measured using symptom assessment, standardized questionnaires (Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire), and a standardized physical examination (POP-Q and cough stress test [CST]). Degree of PA was assessed using the International Physical Activity Questionnaire. Interquartile ranges were used to describe the age, parity, and body mass index (BMI) of participants. To examine the association between PA and PFDs, a log transformation was applied to the weekly minutes of PA variable and a logistic regression model was constructed with weekly minutes of moderate/vigorous PA, age, BMI, and parity as the predictors. A total of 159 women were enrolled. Median age was 35 (IQR 32-37), median parity 4 (IQR 3-5), and median BMI 29.0 (IQR 24-33). The prevalence of PFD as determined by symptom assessment was 28% (n=44). The most frequent stage of prolapse identified by POP-Q was stage II (57%, n=91). Thirty-six percent of the women (n=58) reported vigorous PA. Ninety-nine percent of the cohort (n=158) reported moderate PA. When controlling for age, parity, and BMI there was a significant positive association between PFD (defined as a combination of stage II prolapse, positive CST, and urinary incontinence (UI)) and moderate PA (OR 2.20, 95% CI 1.08-5.14, p value 0.045). Pelvic floor disorders are common among parous Ugandan women and are associated with moderate PA when controlling for age, BMI, and parity. Understanding the risk factors associated with PFD in this population may better equip providers to screen and care for individuals.

Reliability and Validation of the PFIQ-7 and PFDI-20 in the Luganda Language.

Pelvic floor disorders (PFDs) impact women worldwide and are assessed using instruments such as the Pelvic Floor Distress Inventory (PFDI-20) and Pelvic Floor Impact Questionnaire (PFIQ-7). There are no known valid PFD instruments in Uganda. This study's purpose was to translate and test the reliability and validity of the PFDI-20 and PFIQ-7 in Luganda. It was predicted that these instruments would be reliable and valid to assess the presence and impact of PFD in parous Luganda-speaking women. The translated PFDI-20 and PFIQ-7 were administered to parous Luganda-speaking women and readministered 4-8months after. The Pelvic Organ Prolapse Quantification (POP-Q) examination determined the presence of pelvic organ prolapse (POP) and a cough-stress test (CST) measured urinary leakage. Analysis was completed using Cronbach's α co-efficient for internal consistency and Spearman's correlation coefficients and Wilcoxon rank sum tests for construct validity. Of the 159 participants, 93 (58.3%) had stage II POP or higher. The PFDI-20 and PFIQ-7 demonstrated minimal bother and impact on activities of daily living respectively. The Urinary Distress Inventory 6 (UDI-6) scores on the PFDI-20 showed a strong positive association with the presence of urinary incontinence. When PFD was defined by responses to symptom assessment, the translated PFDI-20 and PFIQ-7 could differentiate between individuals with and without PFD. The UDI-6 section of the PFDI-20 was found to be valid in Luganda. The PFIQ-7 and the entirety of the PFDI-20 were not found to be reliable or valid, likely because of the low prevalence of PFDs in the study population.

Effect of Yoga in Pregnancy on Maternal Pelvic Floor Distress Symptoms-A Randomised Control Study.

Pregnancy is associated with an increase in pelvic floor dysfunction. Yoga, an ancient Indian practice involving asanas (physical postures), pranayam (breathing patterns) and meditation, can help women to control their pelvic floor muscles. However, the literature to support yoga as a remedy for pelvic floor dysfunction is lacking. We hypothesized that yoga could be an important method in improving pelvic floor dysfunction in pregnancy. In a randomised control study, 200 pregnant women matched for age, weight, parity and physical activity were randomised at the 13- to 20-week period of gestation into two groups: group I (n = 100, undergoing yoga therapy) and group II (n = 100, given usual antenatal care). A trained instructor provided two physical sessions, each lasting for 60min and further online sessions for 5 days a week for 3months. The Pelvic Floor Distress Inventory (PFDI-20) questionnaire was used to assess the primary outcome at recruitment, 32weeks (antenatal), 1week and 6weeks post-partum in both groups. In the 200 women randomised and matched for age and parity, there were no complications seen throughout the pregnancy and none of the patients was lost to follow-up in either group. The proportion of women exhibiting a decline in PFDI-20 scores was greater in group 1 (24%) than in group 2 (8%). The mean difference of scores between recruitment and 6weeks post-partum was statistically significant (p value = 0.0026). Yoga in pregnancy significantly improves pelvic floor dysfunction in an easy manner with no proven adverse effects.

Pelvic floor symptoms among premenopausal women with pelvic organ prolapse in the Democratic Republic of the Congo.

Most of the literature on pelvic organ prolapse (POP) has been generated from postmenopausal patients in high-income countries. In the Democratic Republic of the Congo (DRC), a significant proportion of patients who present for surgical management of POP are premenopausal. Little is known about the impact of POP on pelvic floor symptoms in this population. The objective was to describe pelvic floor symptoms and sexual function among premenopausal patients presenting for POP surgery in DRC. We performed a prospective cohort study of symptomatic premenopausal patients undergoing fertility-sparing POP surgery at a large referral hospital in the DRC. Pelvic floor symptoms were evaluated with the Pelvic Floor Distress Inventory Questionnaire and sexual function with the Pelvic organ prolapse/urinary Incontinence Sexual Questionnaire. Data are presented as means with standard deviations or counts with percentages. A total of 107 patients were recruited between April 2019 and December 2021. All had either stage III (95.3%) or stage IV (4.7%) prolapse. Ages were 34.2 ± 6.7 years; 78.5% were married. A majority of patients experienced low abdominal pain (82.2%), heaviness or dullness (95.3%), and bulging or protrusion of the prolapse (92.5%). Almost two-thirds of patients reported no longer being sexually active, and 80% stated that they were not sexually active because of POP. Of the 37 sexually active patients (34.6%), nearly all reported significant sexual impairment because of the prolapse, with only 4 reporting no sexual impairment. This study represents one of the largest prospective series of patients with premenopausal POP. Our results highlight the severity of pelvic floor symptoms and the negative effects on sexual function among this patient population with POP.

The Impact of Preoperative Pain on Outcomes After Vaginal Reconstructive Surgery and Perioperative Pelvic Floor Muscle Training.

The impact of preoperative pain on outcomes can guide counseling. The objective of this study was to compare outcomes after vaginal reconstructive surgery and pelvic muscle training between women with and without preoperative pain. This is a secondary analysis of the Operations and Pelvic Muscle Training in the Management of Apical Support Loss (OPTIMAL) trial, which randomized patients to a surgical intervention (sacrospinous ligament fixation versus uterosacral vaginal vault suspension) and a perioperative behavioral intervention (pelvic floor muscle training vs usual care). Preoperative pain was defined as a response of "5" or greater on the pain scale or answering "moderately" or "quite a bit" on the Pelvic Floor Distress Inventory question "Do you usually experience pain in the lower abdomen or genital area?" The OPTIMAL trial included 109 women with preoperative pain and 259 without pain. Although women with pain had worse pain scores and pelvic floor symptoms at baseline and postoperatively, they had greater improvement on pain scores (-2.3 ± 2.4 vs -0.2 ± 1.4, P < 0.001), as well as Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire scores. Among women with pain who underwent a sacrospinous ligament fixation, those who received pelvic floor muscle training had a greater reduction in pain compared with those in the usual care group (-3.0 ± 2.3 vs -1.3 ± 2.1, P = 0.008). Persistent or worsening pain was present at 24 months in 5 (16%) women with preoperative pain. Women with preoperative pain experience significant improvements in pain and pelvic floor symptoms with vaginal reconstructive surgery. Pelvic floor muscle training perioperatively may be beneficial for select patients.

Multimodal measurements of levator bowl volume in nulligravid asymptomatic women: endovaginal ultrasound versus MRI.

Measurements of levator bowl volume using advanced imaging, may be predictive of pelvic floor muscle function. The aim of this study was to compare the volume of the levator bowl using both magnetic resonance imaging (MRI) and endovaginal ultrasound (EVU) of healthy asymptomatic women. All participants underwent a comprehensive interview including completion of the Pelvic Floor Distress Inventory Questionnaire-20 questionnaire, pelvic examination with a pelvic organ prolapse quantification evaluation, MRI, and EVU. The pelvic floor was segmented using Slicer and the MRI segmentations were trimmed using two methods: soft-tissue landmarks and the field of view (FOV) of the ultrasound volume. The levator bowl volume of the 3D segmented shapes was measured using Blender's 3D printing toolkit. Normality was tested using the Shapiro-Wilks test and comparisons were made using self-paired t tests. The final analysis included 19 patients. Levator bowl volume measured via MRI was larger than that measured in EVU (46.1 ± 7.9 cm3 vs 27.4 ± 5.9 cm3, p<0.001). Reducing the FOV of the MRI to that of EVU caused the MRI volume to be much closer to the EVU volume (35.5 ± 3.3 cm3 vs 27.4 ± 5.9 cm3, p<0.001); however, it remained significantly larger. Levator bowl volume measured using MRI was larger than that measured using EVU no matter the method of delineation of the levator muscles. Although EVU is safe, cheap, and easy to perform, it captures a smaller volume of levator bowel than MRI.

Long term surgical outcomes of vaginal colposuspension using the Uphold Lite™ mesh system vs. vaginal vault uterosacral ligament suspension for treatment of apical prolapse

ObjectiveThe aim of this study is to compare long-term outcomes (7–10 years) between vaginal hysterectomy with uterosacral ligament suspension (VHUSLS) and sacrospinous hysteropexy with the Uphold™ Lite mesh System (SHU) for management of apical prolapse. MethodsPatients undergoing VHUSLS or SHU from 2008 to 2012 at a single tertiary referral center were included. Patients were contacted, asked to return for physical examination, and to complete the Pelvic Floor Distress Inventory (PFDI-20) questionnaire. Our primary outcome was anatomic failure defined as Stage 2 POP or higher of any compartment. The secondary outcome was subjective changes in symptoms based upon PFDI-20 responses. ResultsTwo-hundred and two women were identified to have undergone the index surgeries from 2008 to 2012. Sixty-three agreed to return for follow up symptom evaluation and examination (30 VHUSLS and 33 SHU). Baseline characteristics were similar between groups. Clinical cure was high for both groups reaching 93.4 % and 94.0 % for the VHUSLS and SHU groups, respectively (p = 0.721). Anatomical success was lower with 44.7 % and 66.7 % of patients in the VHUSLS and SHU groups, respectively, meeting criteria for success (p = 0.138). There were no mesh complications among patients returning for exams. However, two patients who were contacted and were not interested in this study reported mesh complications and need for additional surgeries. Anterior vaginal wall support was noted to be significantly better supported for SHU (Ba −2.03 ± 0.75 vs −1.42 ± 0.92, p = 0.008). There were no differences between groups for overall PFDI-20 scores postoperatively. However, SHU patients reported higher rates of stress urinary incontinence compared to VHUSLS patients. ConclusionIn women with apical prolapse, VHUSLS and SHU afford similar long-term outcomes. SHU patients reported higher rates of stress urinary incontinence.

Translation, reliability, and validity of Amharic versions of the Pelvic Floor Distress Inventory (PFDI-20) and Pelvic Floor Impact Questionnaire (PFIQ-7).

Pelvic Floor Disorders (PFDs) affects many women and have a significant impact on their quality of life. Pelvic Floor Impact Questionnaire (PFIQ-7) and Pelvic Floor Distress Inventory (PFDI-20) help to assess PFDs; however, both are not culturally translated into the Amharic-language. Hence, we aimed to translate the English versions of short forms of the PFDI-20 and PFIQ-7 into Amharic-language and evaluate their psychometric properties in Amharic-speaking Ethiopian women with symptomatic PFDs. The PFDI-20 and PFIQ-7 were translated into Amharic language using standard procedures. The Amharic versions were completed by 197 patients (response rate 92%) with PFDs from University of Gondar specialized and comprehensive Hospital. Internal consistency and test-retest reliability were examined through Cronbach's alpha and Intraclass correlation coefficients (ICC). A relative criterion standard, POP-SS-7 score, was correlated with total PFDI-20 and subscale POPDI-6 scores using spearman's rank order correlation (SCC). Construct validity was evaluated by known group validity using the Mann-Whitney U test. Both instruments were successfully translated and adapted with an excellent content validity (&gt; 0.90). The Amharic versions of the PFDI-20 and PFIQ-7 showed excellent internal consistency and test-retest reliability in both summary and subscales (Cronbach's alpha: 0.92 for PFDI-20 and 0.91 for PFIQ-7; and ICC: 0.97 for PFDI-20 and 0.86 for PFIQ-7). Criterion validity was good for POPDI-6 (SCC = 0.71; p &lt; 0.001). Moreover, construct validity was acceptable, showing significant differences among groups of PFDs in the PFDI-20 and PFIQ-7 scores (Mann-Whitney U Test; p &lt; 0.001). The Amharic versions of the PFDI-20 and PFIQ-7 are comprehensible, reliable, valid, and feasible in Ethiopian Amharic-speaking women with PFDs to evaluate symptoms and its impact during research and clinical practice. However, further studies are needed to evaluate the responsiveness.

Occurrence and impact of pelvic floor dysfunction in women with and without breast cancer: a cross-sectional study

BackgroundOne of the sequalae of breast cancer treatments may be pelvic floor (PF) dysfunction such as urinary incontinence (UI), faecal incontinence (FI), and pelvic organ prolapse (POP). ObjectiveThe aim of this study was to compare the occurrence and related distress and impact of PF dysfunction between women with and without breast cancer. MethodsWomen with and without breast cancer participated in this cross-sectional study. The Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire were used to quantify the prevalence and related distress, and impact of PF dysfunction. Factors associated with PF outcomes were examined using logistic and linear regressions while controlling for known risk factors for PF dysfunction (age, body mass index, and parity). Results120 women with breast cancer, and 170 women without breast cancer responded. The occurrence of any type of UI was higher in women with breast cancer than women without breast cancer (percentage difference=17%; 95% CI: 7, 29). Women with breast cancer experienced higher impact of urinary symptoms (mean difference=18.2; 95% CI: 8.9, 27.7) compared to those without. Multivariable analysis indicated that having breast cancer (β 0.33; 95%CI: 0.08, 0.51) was the strongest predictor of greater impact of urinary symptoms. ConclusionWomen with breast cancer reported a higher occurrence and impact of urinary symptoms than women without breast cancer. While further studies are required to confirm our findings, routine screening and offering treatment for urinary symptoms may be indicated for women with breast cancer.

Does Partner Matter in Sexual Activity?

ABSTRACT Introduction A woman's sexual activity is a challenging topic to discuss for both provider and patient. Common questions about sexual activity imply that a woman is having partnered sexual activity with vaginal penetration. Discussion about masturbation or solo sexual experiences tend to be even more uncomfortable and considered a societal taboo. Nevertheless, solo sexual activity is an important part of physical and emotional health. Objective The aim of this pilot study is to examine the differences in sexual health, pelvic floor health and overall wellness among women with predominantly partnered sexual activity (PSA) compared to solo sexual activity (SSA). Methods This is a prospective pilot study of sexually active women with PSA and SSA age 18 to 99 years who presented for consultation to our Female Pelvic Medicine and Reconstructive Surgery clinic with a pelvic floor complain between May 2021 and August 2021. Participants were given validated questionnaires for 1) sexual health: Female Sexual Function Index (FSFI) and The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire International Urogynecological Association (IUGA) Revised (PISQ-IR); 2) pelvic floor function: The Pelvic Floor Distress Inventory Questionnaire (PFDI), Genitourinary Pain Index (GUPI), Interstitial cystitis/Painful bladder syndrome (IC/PBS), and 3) overall health: (Self-reported quality of life (SF-12), Patient Health Questionnaire (PHQ-9)). Physical exam and interview on sexual practices were performed. Demographics and health information were recorded. All data were analyzed with descriptive statistics, comparisons were made using Fisher Exact Test and Wilcoxson Rank Sum Tests. Results Among 23 women recruited in the pilot study, 13 had PSA and ten women had SSA. Among PSA, six women were also masturbating. Those who were sexually active with a partner were younger (p=0.021), and less likely to have neurologic disorders (p=0.022). No significant differences in demographics, comorbidities, hormonal therapies, pelvic floor disorders, or overall well-being were found between two groups. Women involved in PSA had significantly higher total FSFI score (p=0.035), sexual satisfaction (p=0.012). Interestingly, women with PSA had higher scores on ICSI (p=0.046) and less likely used a vibrator or sex toy ever in their lives (p=0.02). Conclusions No significant differences in pelvic health and overall wellness were noted between women with PSA and SSA. Satisfaction from sexual activity is higher among younger women involved in partnered sex, in spite of no significant differences present in desire and orgasm domains. Sexual activity is more than just vaginal penetrative intercourse thus solo sexual practices should be assessed by medical providers especially in older women who might not have available partners. Disclosure No

Factors associated with pelvic floor dysfunction in women with breast cancer

Purpose:To determine the prevalence of pelvic floor (PF) dysfunction according to breast cancer characteristics and examine the association between breast cancer characteristics and the prevalence, distress and impact of PF dysfunction in women with breast cancer. Outcome measures:The Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire were used to quantify the prevalence, distress and impact of PF dysfunction. Results:Data from 120 women with breast cancer were included in this analysis. Women who underwent chemotherapy experienced the highest rates of UI (n=23/29; 79%) and FI (n=7/29; 24%). The associations between breast cancer characteristics and the presence of pelvic floor dysfunction were not statistically significant. Being older (β 0.25 95%CI 0.05, 0.44), and having stage IV breast cancer (β 0.83 95%CI 0.24, 1.42) were statistically significant predictors of reporting high distress of PF dysfunction. Being older (β 0.22 95%CI 0.01, 0.45), having breast irradiation (β 0.51 95%CI 0.08, 0.93) and more time since diagnosis (β 0.35 95%CI 0.16, 0.54) were also statistically significant predictors of experiencing higher impact of PF dysfunction. Implications:Our findings show that UI and FI are prevalent in women receiving breast cancer treatment, with increasing distress demonstrated in older women with more advanced disease. The impact of PF dysfunction appears to increase with more time after breast cancer diagnosis. A greater focus by health services and clinicians to assess and offer treatment for PF dysfunction may be warranted in women with breast cancer.

Autologous rectus fascia graft in the treatment of high-stage apical vaginal prolapse: preliminary results of a new surgical approach with native tissue.

Since vaginal meshes in pelvic organ prolapse have been associated with more complications in the last decades, native tissue vaginal repair is still the mainstay of prolapse surgery. This study introduces a new transvaginal approach with bilateral sacrospinous ligament fixation augmented by autologous rectus fascia graft to repair high-stage apical vaginal wall prolapse. Between December 2018 and June 2020, 13 patients with high-stage apical vaginal wall prolapse (point C ≥ + 1) accompanied by high-stage anterior vaginal wall prolapse (paint Ba ≥ + 1) were included. In this procedure, the central part of the anterior rectus fascia graft (6-8cm in length and 1-1.5cm in width) is sutured to the underlying tissue of the vaginal apex or cervix and the arms of the rectus graft augmented to the sacrospinous ligament with a Capio suture capturing device (Boston Scientific). The patients are evaluated by history taking, physical examination, Pelvic Floor Impact Questionnaire (PFIQ-7), and Pelvic Floor Distress Inventory (PFDI-20) Questionnaire. The patient's mean age was 61.2 ± 2.7years and they were followed up to 12months. The anatomical success rate was 92.3%. The PFDI-20 and PFIQ-7 were significantly improved (P < 0.001). There were no significant perioperative complications. Three patients complained of unilateral groin or buttock pain which resolved gradually at the first post-operative month. The transvaginal bilateral sacrospinous ligament fixation augmented by autologous rectus fascia graft is an effective and safe surgical approach in treating high-stage apical vaginal prolapse with short-term follow-up.

Perinatal Incontinence Assessment Tools: A Psychometric Evaluation and Scoping Review.

Background: Approximately 40% of women report incontinence during pregnancy and postpartum (known as the perinatal period). Due to the lack of an established measurement standard, this scoping review aimed to investigate the psychometric properties of tools, which assess incontinence-related symptoms and quality of life (QOL) during this period. Materials and Methods: Articles in English, which assessed psychometric properties of tools for perinatal incontinence-related symptoms or QOL, were included and evaluated by a 16-item checklist. Nine databases were searched from 2000 to 2020. Results: Four studies met the inclusion criteria, and five assessment tools were identified and included in this review. The modified Pelvic Floor Questionnaire (mPFQ), Leakage Index (LI), and International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) demonstrated internal consistency (Cronbach's α > 0.60, >0.70, and mean inter-item correlations >0.39, respectively). The mPFQ demonstrated moderate test-retest reliability (intraclass correlation coefficient >0.60). Construct validity of the ICIQ-UI SF was established by significant (p < 0.05) differences across age and obesity, whereas the mPFQ demonstrated significant (p < 0.001) discriminant validity in symptoms prepartum and postpartum. Convergent validity of telephone-administered Pelvic Floor Distress Inventory (PFDI-20) and Pelvic Floor Impact Questionnaire (PFIQ-7) was established with the written version (p > 0.05, correlation coefficient >0.90). Responsiveness to change was described for the ICIQ-UI SF and mPFQ. Conclusions: The mPFQ and ICIQ-UI SF demonstrated acceptable reliability, validity, and responsiveness to change, therefore suggesting good clinical utility. Since most studies included primiparous women, future research in heterogeneous samples of women with perinatal incontinence may be needed.

A Randomized Controlled Trial to Evaluate the Effect of Abdominal Electrical Muscle Stimulation on Abdominal Wall Restoration in Postpartum Women

Background: Diastasis of recti abdominis muscle (DRAM) is a common condition occurring postpartum and thought to be a cause for back pain and pelvic instability. Electrical muscle stimulation (EMS) had been used in abdominal muscle rehabilitation in combination with exercises in DRAM. This study looks at the effect of EMS in treating DRAM in comparison to a control group receiving no treatment. Methods: This is a prospective randomized clinical trial. A total of 51 patients were included in the study, including group A (28 patients) that was treated with EMS, and a control group B (23 patients) that did not receive any treatment. Pre-treatment baseline, 1-, 3-, and 6-month follow-up data were collected. Results were evaluated through ultrasound measurements of inter-rectal distance (IRD), investigator assessments, patient subjective improvement and satisfaction and Pelvic Floor Distress Inventory (PFDI) questionnaire. Results: Ultrasound IRD measurements demonstrated improvement from baseline to the 3-month and 6-month follow-up in the treatment group. Investigator assessment favored the treatment group with significant difference at all study points. Subjective assessments by patients demonstrated a significant difference between the two groups at 1-month while continued to show improvement at 3- and 6-months follow-up. PFDI questionnaire favored the treatment group over the control group in three PFDI subscales at all study points. Progress of the EMS effect over time was shown. Conclusions: The current study supports potential efficacy of the EMS device as a stand- alone treatment modality for the improvement of DRAM in postpartum women. J Clin Gynecol Obstet. 2021;10(3):59-66 doi: https://doi.org/10.14740/jcgo755

The impact of preoperative pelvic pain on outcomes after vaginal reconstructive surgery

Pelvic pain is a debilitating condition that is common among women with pelvic floor disorders. Limited information is known about the impact of preoperative pelvic pain on outcomes after vaginal reconstructive surgery. This study aimed to compare the outcomes after vaginal reconstructive surgery between women with and without preoperative pelvic pain. Baseline and postoperative data were analyzed from the "Outcomes Following Vaginal Prolapse Repair and Midurethral Sling trial." The multicenter trial involved women with anterior prolapse without symptoms of stress incontinence randomized to receive either a midurethral sling or sham incisions during a vaginal reconstructive surgery. Participants completed the visual analog scale adapted for suprapubic pain and Pelvic Floor Distress Inventory at baseline, 3 months, and 12 months. Preoperative pelvic pain was defined as a response of "5" or greater on pain on the visual analog scale or answering "moderately" or "quite a bit" on the Pelvic Floor Distress Inventory question, "Do you usually experience pain in the lower abdomen or genital area?" Outcomes and complication rates were compared between women with and without pelvic pain. The "Outcomes Following Vaginal Prolapse Repair and Midurethral Sling trial" participants included 112 women with pelvic pain (58 had a midurethral sling and 54 had sham incisions) and 212 women without pelvic pain (105 had a midurethral sling and 107 had sham incisions). Women who had a midurethral sling and pelvic pain were younger than women without pelvic pain (60.3±12.1 vs 65.1±8.6; P=.004). Women who had sham incisions and pelvic pain were more likely of Hispanic ethnicity than women without pelvic pain (27.8% vs 9.4%; P=.002). Patient improvement based on the Patient Global Impression of Improvement scale did not differ between arms. Women with pelvic pain had greater improvement on the visual analog scale pain scores after a surgical procedure at 3 months (-3.1±2.9 vs-0.4±1.6; P<.001) and at 12 months (-3.4±3.0 vs-0.6±1.6; P<.001) than women without pain, although their pain scores remained higher than those without preoperative pelvic pain at all time points (P<.001 for all). Similar improvements were found on the Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire. The differences observed were not affected by whether women were in the midurethral sling or sham arm of the trial. Postoperative urinary tract infection and incomplete bladder emptying did not differ between the groups. Women with preoperative pelvic pain experienced significant improvements in pain and pelvic floor symptoms with vaginal reconstructive surgery and had similar subjective improvement postoperatively compared with women without preoperative pelvic pain. Reassuringly, the performance of a midurethral sling did not have an impact on the results.

Evaluation of Pelvic Floor Dysfunction for Patient with History of Total Vaginal Hysterectomy at Dr Sardjito General Hospital Yogyakarta

Introduction: Uterine prolapse is the herniation of the uterus into or beyond the vagina as a result of failure of the ligamentous and fascial supports. It often coexist with prolapse of the vaginal walls, involving the bladder or rectum. A surgical treatment for uterine prolapse is hysterectomy. Changes in pelvic anatomic structure due to hysterectomy can result in impaired pelvic function because of nerve or pelvic muscle structure damage during surgery. Objective: This study aims to evaluate the presence of pelvic floor dysfunction in uterine prolapse patients who have undergone Total Vaginal Hysterectomy (TVH) surgery at Dr Sardjito General Hospital, from November 2018 to September 2019. Evaluations were carried out using Pelvic Floor Distress Inventory (PFDI) questionnaire. Methods: This study is an analytical descriptive research, using secondary data taken from patient’s medical records at Dr. Sardjito General Hospital Yogyakarta. It uses The Pelvic Floor Distress Inventory (PFDI) questionnaire, which consisted of 3 assessment groups, those are Pelvic Organ Prolapse Distress Inventory 6 (POPDI-6), Colorectal-Anal Distress Inventory 8m(CRADI 8), and Urinary Distress Inventory 6 (UDI- 6). The inclusion criteria of this study were patients with diagnoses of uterine prolapse, cystocele and rectocele, who could be contacted and gave consent to conduct telephone interview. Results: There were 14 patients that met the inclusion criteria, they are uterine prolapse, cystocele and rectocele patients with a history of TVH procedure, were assessed using PFDI questionnaire. All patients did not have any pelvic floor dysfunction either from the POPDI-6, CRADI-8 or UDI-6 assessment groups. The weakness of this evaluation is that the PFDI postoperative value cannot be compared with before surgery, so it cannot be proven that the absence of pelvic floor dysfunction in the patient concerned is a positive result of the surgery performed, or not give significant changes. Conclusion: There is no pelvic floor dysfunction in patients with a history of TVH procedure on the indication of uterine prolapse, which was performed at Dr Sardjito General Hospital Yogyakarta.

Sacrospinous ligament fixation: medium and long-term anatomical results, functional and quality of life results

BackgroundTo evaluate the medium and long-term anatomical results of sacrospinous ligament fixation (SLF) and its impact on quality of life (QoL).MethodsWe conducted a retrospective and observational single centre study. Fifty-nine patients were interviewed using the Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire and underwent physical examination using POP-Q several years after SLF. Primary outcome was the comparison of anatomic results of SLF at medium-term (group 1: 1–5 years after surgery) and long-term (group 2: more than 5 years after surgery). The secondary outcome was QoL evaluation.ResultsThe overall recurrence and complication rates were respectively 22% and 10%, with no significant differences between groups 1 and 2. The recurrence rate was similar in both groups [twelve (35%) in group 1 and nine (20%) in group 2, p = 0.09]. Two patients (12%) in the recurrence and none in the no recurrence group had clinical symptoms (p = 0.08). Two patients (12%) in the recurrence and one patient (2%) in the no-recurrence group had a significant impact on their quality of life (p = 0.12).ConclusionThis study showed sustainable anatomic and functional results of SLF in medium and long-term analysis with overall low morbidity.

The relationship between diastasis rectus abdominus, pelvic floor trauma and function in primiparous women postpartum.

A functional interaction exists between the pelvic floor and the abdominal wall. The study was aimed at investigating the clinical and morphological relationships between diastasis rectus abdominus (DRA) and pelvic floor trauma in primiparous women. Eighteen women suffering from DRA and 18 women without DRA (non-DRA group), all primiparous with pelvic floor trauma, were enrolled in the study. Ultrasound was performed on the 36 women examining the inter-rectus distance, pelvic floor morphology, abdominal muscle force (MMT), Static Abdominal Flexion Endurance Test (SFET), and Dynamic Abdominal Flexion Endurance Test (DFET), abdominal circumference, visual analog scale, and responses to the Oswestry Low Back Pain Questionnaire and the Pelvic Floor Distress Inventory questionnaire (PFDI). A significant increase in the urinary symptoms portion of the in PFDI-20 questionnaire was found in the DRA group (non-DRA = 12.5 ± 22.8, DRA = 26.8 ± 18.2, p = 0.01). A significant reduction in abdominal force and endurance was observed in the DRA2-3 group compared with the DRA0-1 group (0.025 < p < 0.04). DFET (average repetitions) in the DRA0-1 group measured 13.4 ± 11.8 and 6.46 ± 4.59 in the DRA2-3 group (p = 0.025). SFET was 20.48 ± 14.46s in the DRA0-1 group and 10.62 ± 10.6s in the DRA2-3 group (p = 0.031). MMT was 4 in the DRA0-1 group and 3 in the DRA2-3 group (p = 0.04). Diastasis rectus abdominus does not correlate with morphological changes in the pelvic floor, but does correlate with higher scores in the urinary symptoms portion of the PFDI-20. Women suffering from DRA do not endure more pain or greater lumbar disability than non-DRA women. In extended DRA, the abdominal muscles are significantly compromised and weaker.

The Association Between Gastrointestinal Symptoms andTransvaginal Ultrasound Findings in Women Referred forEndometriosis Evaluation: A Prospective Pilot Study.

To evaluate the relationship between gastrointestinal (GI) symptoms and transvaginal ultrasound (TVUS) findings suggestive of endometriosis. A prospective design. Women referred for a diagnostic ultrasound due to suspicion of endometriosis completed a Rome III and Pelvic Floor Distress Inventory (PFDI-20) questionnaire for clinical, GI symptoms, before undergoing TVUS. Endometriosis was diagnosed in the presence of endometriomas and/or deeply infiltrative endometriotic (DIE) lesions. Association between lesion sites and GI symptoms was evaluated by univariate and multivariate analysis. The study included 241 women who presented with: dysmenorrhea (89.6 %), dyspareunia (76.3 %), chronic pelvic pain (77.2 %), dyschezia (66 %), hematochezia (15.4 %), subfertility (24.5 %). GI symptoms were present in 25.3-76.8 % and 5.4-55.6 % of Rome III and PFDI-20 questionnaire responses, respectively. TVUS findings were endometriomas (23.2 %), peritoneal adhesions (46.5 %), uterosacral ligament (26.7 %), retrocervical (11.2 %), rectosigmoid (11.2 %), intestinal (4.6 %), and bladder (0.8 %) involvement, and pouch of Douglas (POD) obliteration (15.4 %). There was a high prevalence of peritoneal adhesions, uterosacral ligament involvement, and rectosigmoid and intestinal nodules on TVUS in women with GI symptoms, up to Chi2 = 9.639 (p = 0.013) onunivariate and Chi2 = 8.102 (p = 0.005) on multivariate analysis. We observed an almost 10-fold increase in DIE lesions in women with GI symptoms. We suggest that the presence of GI symptoms should prompt a referral for endometriosis evaluation and performance of a dedicated TVUS before invasive gastrointestinal procedures.

Responsiveness of Pelvic Floor Distress Inventory (PFDI-20) and Pelvic Floor Impact Questionnaire (PFIQ-7) after pelvic floor muscle training in women with stress and mixed urinary incontinence

ObjectiveTo evaluate the responsiveness of Brazilian-Portuguese version of Pelvic Floor Distress Inventory-20 (PFDI-20) and Pelvic Floor Impact Questionnaire-7 (PFIQ-7) after pelvic floor muscle training (PFMT) in women with stress urinary incontinence (SUI) and mixed urinary incontinence (MUI). Study designThis is an observational study with 72 women (51.8 ± 11.9SD years) with SUI (n = 33) and MUI (n = 39). Participants answered PFDI-20 and PFIQ-7 before and after PFMT, which consisted of a 12 weeks protocol supervised by a physiotherapist once a week with 30 min of a duration. Wilcoxon test, effect size (ES) and standardized response mean (SRM) were performed on baseline and after three months. ResultsWe found a significant reduction in PFDI-20 and PFIQ-7 after PFMT (p < 0.001), except for Pelvic Organ Prolapses Distress Inventory (POPDI-16), Colorectal–Anal Impact Questionnaire (CRAIQ-7) and Pelvic Organ Prolapse Impact Questionnaire (POPIQ-7). The responsiveness of both questionnaires was considered moderate for PFDI-20 (ES = 0.49; SEM = 0.61; p < 0.0001) and PFIQ-7 (ES = 0.51; SEM = 0.52; p < 0.0001). ConclusionsPFDI-20 and PFIQ-7 Brazilian Portuguese version presented moderate responsiveness in women with SUI and MUI who performed a PFMT.