Pelvic Floor Dysfunction In Women Research Articles

49 - Prevalence of pelvic floor dysfunctions in women with endometriosis

49 - Prevalence of pelvic floor dysfunctions in women with endometriosis

(135) DYSORGASMIA IN A FEMALE PATIENT FOLLOWING TRAM RECONSTRUCTIVE SURGERY

Abstract Introduction Many women struggle with sexual dysfunction, either in desire, arousal, orgasm, and/or pain. Despite the incidence of dysorgasmia in the general population, there is a paucity of literature focusing on its causes and treatment, especially when attributed to medical conditions and surgery. Objective This case report describes an unusual presentation of post-orgasmic pain following breast reconstruction surgery using abdominal tissue. Methods A 73-year old woman presented with chronic orgasmic pain in the deep pelvic area following transverse rectus abdominal muscle (TRAM) flap reconstruction for a mastectomy in the setting of breast cancer treatment. The patient was diagnosed with ductal carcinoma breast cancer in 2011, where she received a lumpectomy with radiation. After 2 years, in 2013, she was diagnosed with a recurrence of breast cancer. She underwent a mastectomy with no complications, with a transverse rectus abdominal muscle flap reconstruction surgery conducted five days later. Following the TRAM reconstruction, the patient consistently began to observe pain with orgasm. Results Prior to this surgery, the patient had experienced normal sexual intercourse and orgasm throughout her life. The patient describes pain with orgasm associated with self-stimulation, manual stimulation, oral stimulation, and vaginal penetration. The patient describes the pain associated with orgasm as a “deep, dull pain” causing nausea and is often associated with abdominal spasms. The pain lasts 2-3 minutes following orgasm and is rated as a 5-6/10 on the pain scale. The pain is not associated with urinary incontinence, urinary fullness, or bowel dysfunction. Physical exam revealed a tense abdominal wall consistent with TRAM reconstruction, well healed incisions, a normal clitoris in terms of appearance and sensation and normal pelvic floor muscles. Conclusions An orgasm is a complex process which involves interplays between the clitoris, the glans pubis, and the sympathetic activation system. A four-phase model for orgasm has been explored, which separates the orgasm response into: desire (the urge to participate in sexual activities), arousal (increased genital blood flow and clitorial erection), orgasm (after the threshold for stimulation has been reached), and resolution. Dysorgasmia can be multifactorial, and while still unclear, etiologies include pelvic floor dysfunction and/or spasm. While the pathophysiology of how the pelvic floor is connected to orgasm is not exactly understood, it is theorized to be due to dysregulated coordination of pelvic floor muscles. A transverse rectus abdominis muscle (TRAM) flap is a common breast reconstructive procedure following mastectomy. The most common complications of a TRAM flap surgery are hernias/abdominal bulges, fat necrosis, and loco-regional occurance. Interestingly, TRAM surgeries have previously been associated with pelvic floor dysfunction in women due to an increase in abdominal pressure. Since the pelvic floor is tightly connected to the mechanism of an orgasm, it is possible that disruptions to the pelvic floor may lead to painful spasms during orgasms. This is also consistent with the patient’s sensation of abdominal “spasms” during/after orgasm. While not all TRAM surgeries cause dysorgasmia, this patient’s dysorgasmia may be postulated to be secondary to pelvic floor dysfunction. Disclosure No.

Squeeze-and-excitation-attention-based mobile vision transformer for grading recognition of bladder prolapse in pelvic MRI images.

Bladder prolapse is a common clinical disorder of pelvic floor dysfunction in women, and early diagnosis and treatment can help them recover. Pelvic magnetic resonance imaging (MRI) is one of the most important methods used by physicians to diagnose bladder prolapse; however, it is highly subjective and largely dependent on the clinical experience of physicians. The application of computer-aided diagnostic techniques to achieve a graded diagnosis of bladder prolapse can help improve its accuracy and shorten the learning curve. The purpose of this study is to combine convolutional neural network (CNN) and vision transformer (ViT) for grading bladder prolapse in place of traditional neural networks, and to incorporate attention mechanisms into mobile vision transformer (MobileViT) for assisting in the grading of bladder prolapse. This study focuses on the grading of bladder prolapse in pelvic organs using a combination of a CNN and a ViT. First, this study used MobileNetV2 to extract the local features of the images. Next, a ViT was used to extract the global features by modeling the non-local dependencies at a distance. Finally, a channel attention module (i.e., squeeze-and-excitation network) was used to improve the feature extraction network and enhance its feature representation capability. The final grading of the degree of bladder prolapse was thus achieved. Using pelvic MRI images provided by a Huzhou Maternal and Child Health Care Hospital, this study used the proposed method to grade patients with bladder prolapse. The accuracy, Kappa value, sensitivity, specificity, precision, and area under the curve of our method were 86.34%, 78.27%, 83.75%, 95.43%, 85.70%, and 95.05%, respectively. In comparison with other CNN models, the proposed method performed better. Thus, the model based on attention mechanisms exhibits better classification performance than existing methods for grading bladder prolapse in pelvic organs, and it can effectively assist physicians in achieving a more accurate bladder prolapse diagnosis.

Conservative Treatment Options to Prevent and Manage Pelvic Floor Dysfunction in Women

Background: Pelvic floor dysfunction is a widespread, multifactorial disease that progresses slowly with age and occurs in 77% of postmenopausal women.Objective: To evaluate the effectiveness of conservative treatment of pelvic floor dysfunction in women and the possibility of preventing pelvic organ prolapse.Materials and methods: We analyzed literature data (PubMed, eLibrary, Scopus) on treatment and prevention of pelvic floor dysfunction in women using various conservative treatment options.Results: The conservative approach is the only preventive measure and a first-line treatment of pelvic organ prolapse, especially at the disease onset. It involves lifestyle changes, physical therapy, and pessary insertion. Physical therapy includes pelvic floor muscle training with or without biofeedback, vaginal cones, electrical stimulation, etc.Conclusions: Despite the large number of available conservative treatment options, their effectiveness should be further studied, and preventive measures aimed at strengthening pelvic floor muscles should be actively promoted and included in the routine medical use and daily life of women to prevent pelvic organ prolapse.

Pelvic floor dysfunction: prevalence and associated factors

BackgroundPelvic floor dysfunction in women encompasses a wide range of clinical disorders: urinary incontinence, pelvic organ prolapse, fecal incontinence, and pelvic-perineal region pain syndrome. A literature review did not identify any articles addressing the prevalence of all pelvic floor dysfunctions.ObjectiveDetermine the prevalence of the group of pelvic floor disorders and the factors associated with the development of these disorders in women.Material and methodsThis observational study was conducted with women during 2021 and 2022 in Spain. Sociodemographic and employment data, previous medical history and health status, lifestyle and habits, obstetric history, and health problems were collected through a self-developed questionnaire. The Pelvic Floor Distress Inventory (PFDI-20) was used to assess the presence and impact of pelvic floor disorders. Pearson's Chi-Square, Odds Ratio (OR) and adjusted Odds Ratio (aOR) with their respective 95% confidence intervals (CI) were calculated.ResultsOne thousand four hundred forty-six women participated. Urinary incontinence occurred in 55.8% (807) of the women, fecal incontinence in 10.4% (150), symptomatic uterine prolapse in 14.0% (203), and 18.7% (271) reported pain in the pelvic area. The following were identified as factors that increase the probability of urinary incontinence: menopausal status. For fecal incontinence: having had instrumental births. Factors for pelvic organ prolapse: number of vaginal births, one, two or more. Factors for pelvic pain: the existence of fetal macrosomia.ConclusionsThe prevalence of pelvic floor dysfunction in women is high. Various sociodemographic factors such as age, having a gastrointestinal disease, having had vaginal births, and instrumental vaginal births are associated with a greater probability of having pelvic floor dysfunction. Health personnel must take these factors into account to prevent the appearance of these dysfunctions.

Impact of childbirth on pelvic floor dysfunction in women who have undergone previous pelvic floor reconstructive surgery: systematic review and meta-analysis.

The aim of the study was to perform a systematic review and meta-analysis of the impact of pregnancy and childbirth (vaginal delivery [VD]) or cesarean section (CS) on the recurrence of pelvic floor disorders in women who had previously undergone pelvic floor reconstructive surgery for pelvic organ prolapse (POP) or stress urinary incontinence (SUI), to facilitate future evidence-based counseling. PubMed, Cochrane, Embase, BJOG, Scopus, etc. were screened, from 1990 to date. Inclusion criteria included cohort studies, case-control studies, case series, and case reports that reported on the primary outcome measure of the review. Exclusion criteria included studies on surgical procedures whose outcomes are unlikely to be impacted by pregnancy and childbirth or are obsolete. Meta-analysis was performed using Review Manager 5.3. Seven papers on midurethral slings (MUS; 181 women in both VD and CS groups respectively) and three papers on different hysteropexy techniques (47 and 29 women in the VD and CS groups respectively), were included in the meta-analysis. No difference was seen between the two groups regarding the recurrence of SUI in women who had previously undergone MUS surgery (OR: 1.18 [0.66, 2.09]; Z = 0.56; p = 0.58) or the recurrence of POP following hysteropexy using various apical suspension procedures (OR: 1.81 [0.04, 80.65]; Z = 0.31; p = 0.76). There are insufficient data to support meta-analyses for individual MUS sub-types or hysteropexy procedures. Current literature does not demonstrate a protective effect of CS in preventing recurrent SUI in women who had undergone MUS surgery for SUI. When hysteropexy is considered irrespective of the apical suspension procedure employed, the incidence of recurrent POP appears similar after CS and VD.

Prevalence of pelvic floor dysfunctions in women with endometriosis

Background: Endometriosis is a benign disease that has the potential for agressive tissue-invasion. Endometriosis and pelvic floor disorders (PFD) share common pathogenic mechanisms, but it is unknown whether endometriosis can cause them to develop or induce worsening PFD, including lower urinary tract symptoms, fecal incontinence and constipation. This study aimed to clarify the prevalence of symptoms of PFD in women with endometriosis.

Rate of Postoperative Urinary Retention after Anterior Compartment Prolapse Surgery: A Randomized Controlled Trial Comparing Early versus Conventional Transurethral Catheter Removal.

Pelvic organ prolapse is a common condition of pelvic floor dysfunction in women, especially in adult vaginally parous and elderly women. Because of its anatomy, the anterior compartment has a significant effect on urinary symptoms. Anterior colporrhaphy and colpocleisis are major anterior compartment prolapse-related surgeries. As we know, postoperative urinary retention (POUR) is one of the most common complications following pelvic floor surgery. To prevent this complication, indwelling bladder catheterization is routinely applied. In contrast, to minimize risk of infection and the patient's discomfort, the catheter should be removed as soon as possible. However, there is a lack of clarity regarding the optimal timing for catheter removal. Therefore, the aim of this trial is to compare the rate of POUR after anterior prolapse surgery between early transurethral catheter removal (24 h postoperatively) and our standard practice (on postoperative day 3). We conducted a randomized controlled trial among patients undergoing anterior compartment prolapse surgery between 2020 and 2021 at a university hospital. Women were randomized into two groups. After removal, if the second void residual urine volume exceeded 150 mL, POUR was diagnosed, and intermittent catheterization was performed. The primary outcome was the POUR rate. The secondary outcomes included urinary tract infection, asymptomatic bacteriuria, time to ambulation, time to spontaneous voiding, length of hospitalization, and patient satisfaction. Analysis was performed according to the intention to treat principle. The calculated sample size was 68 patients (34 patients in each group) for a 95% confidence interval, 80% power, 5% probability of type I error, and 10% data loss. This study demonstrated that early catheter removal was comparable in POUR rate to conventional treatment with shorter hospitalization among patients undergoing anterior compartment prolapse surgery. Additionally, we observed no re-hospitalization owing to POUR. Therefore, early transurethral catheter removal is preferable following anterior compartment prolapse-related surgery.

Prevalence of pelvic floor dysfunction in recreational athletes: a cross-sectional survey.

Pelvic floor dysfunction (PFD) affects many women and participation in elite sport and high-impact exercise has been reported as a potential risk. However, few studies have investigated the effects of exercising at recreational levels on PFD. Our aim was to investigate levels of PFD in women exercising at, or above, UK guidelines for health and compare them with levels in non-exercisers. Data on levels of PFD and potential risk factors (age, hormonal status, body mass index, constipation, parity, forceps delivery, and recreational exercise) were collected using a cross-sectional survey distributed via social media. The International Consultation Incontinence Questionnaire (ICIQ) Urinary Incontinence Short Form was used to estimate prevalence of urinary incontinence (UI). Selected questions from the ICIQ vaginal symptom and bowel symptom questionnaires were used to estimate prevalence of anal incontinence (AI) and pelvic organ prolapse (POP). Logistic regression analysis was used to compare exercisers and non-exercisers after adjusting for potential confounders. We recruited 1,598 adult women (1,141 exercisers and 457 non-exercisers). The majority were parous. High prevalence of UI (70%), AI (52%) and POP (18%) was reported. No significant association was found between recreational exercise and PFD despite adjustment for confounders, or further investigation regarding exercise involving impact, although some increased reporting of AI was seen in those exercising for over 10hoursper week. High levels of all PFD were reported but no significant association was found between recreational exercise and symptoms. However, data suggest that women modify their exercise regimes as required. Few symptomatic women sought professional help.

Pelvic physiotherapy in the rehabilitation of pelvic floor dysfunctions in women undergoing sexual reassignment: review

Background: Transsexuality is a gender incongruity, that is, there is a divergence between the gender at birth and the individual's identification, where in some cases surgeries may be required in order to provide sexual adequacy for which surgery can help. However, it is pointed out that such surgical procedures may lead to postoperative complications, negatively impacting the pelvic floor. Aims: to review the effects of pelvic physiotherapy on pelvic floor dysfunctions in the sexual reassignment postoperative period. Method: Integrative review of PubMed databases EMBASE, LILACS, Scielo, Cochrane Library and PEDro using the terms “sexual reassignment surgery”, “physiotherapy”, “transgender woman”, “vaginoplasty”. Results: Found 50 articles, 3 included. Pelvic physiotherapy has a significant impact on conditions such as stenosis, muscle weakness, intravaginal fibrosis, AP incoordination, pain and functionality. Conclusion: despite the scarcity of studies, pelvic floor muscle training showed benefits in the function of patients undergoing vaginoplasty. Patients treated from the preoperative period have a tendency to obtain more effective results.

Pelvic floor dysfunctions in women with fibromyalgia: A cross-sectional study

BackgroundFibromyalgia (FM) is a rheumatic syndrome that causes musculoskeletal disorders and is associated with several problems that affect quality of life. As the musculoskeletal system is affected, it can have an impact on the pelvic floor muscles, leading to pelvic floor dysfunction (PFD). ObjectiveInvestigate the occurrence of PFD, such as urinary incontinence (UI) and anal incontinence (AI), sexual problems, and pelvic organ prolapse (POP), in women with FM compared to a control group composed of women without FM; and investigate the association between FM and PFD. Study designThis was an online cross-sectional survey. Demographic and anthropometric data, the description of PFD (UI, nocturia, AI, genital-pelvic pain/penetration disorder, and POP), and previous obstetric history were collected through a web-based questionnaire. The groups were compared using the independent t-test for quantitative variables and the chi-square test for categorical variables. The association between FM and PFD was tested using logistic regression analysis. ResultsA total of 175 women answered the questionnaire (97 with FM and 78 healthy controls). The women with FM reported significantly more UI, mixed urinary incontinence, AI, POP, and vaginismus than the healthy controls (p ≤ 0.05). FM was associated with mixed urinary incontinence (OR: 2.6; 95 % CI: 1.1–6.4; p = 0.04), anal incontinence (OR: 2.9; 95 % CI: 1.3–6.1; p = 0.01), and flatus incontinence (OR: 2.6; 95 % CI: 1.2–5.4; p = 0.01). ConclusionThe prevalence of PFD was significantly higher in women with FM compared to healthy women. Indeed, the women with FM were 2.6-fold to 2.9-fold more likely to report mixed urinary incontinence, anal and flatus incontinence than those in the control group. The present findings show possible impairment of the pelvic floor musculature in women with FM.

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.

Pelvic floor dysfunctions in women with systemic lupus erythematosus: A cross-sectional study.

As a result of the impairment of the musculoskeletal system, the pelvic floor muscles are likely compromised in women with systemic lupus erythematosus (SLE). We hypothesized that women with SLE would report more symptoms of pelvic floor dysfunction (PFD) and there will be an association between SLE and PFD. An online cross-sectional survey was conducted. Data were collected on demographic and anthropometric characteristics, PFD (urinary incontinence, nocturia, anal incontinence, genital-pelvic pain/penetration disorder and pelvic organ prolapse) and obstetric history using a web-based questionnaire. The groups were compared using the Mann-Whitney test for quantitative variables and the chi-squared test for categorical variables. The association between SLE and PFD was tested using logistic regression analysis. A total of 196 women answered the questionnaire (102 with SLE and 94 healthy controls). Women with SLE reported significantly more urinary incontinence, nocturia, anal incontinence, pelvic organ prolapse and genital-pelvic pain/penetration disorder than the healthy controls (p ≤ 0.05). Women with SLE were 2.8- to 3.0-fold more likely to report genital-pelvic pain/penetration disorder than healthy women. The prevalence of PFD was significantly higher in women with SLE compared to healthy women. Thus, PFD seems to be an important problem in women with this disease. An in-depth investigation of these disorders could contribute to the understanding of how SLE impacts pelvic floor function.

Experiences of pelvic floor dysfunction and treatment in women with breast cancer: a qualitative study.

PurposeTo explore the experiences of women with breast cancer and pelvic floor (PF) dysfunction and the perceived enablers and barriers to uptake of treatment for PF dysfunction during their recovery.MethodPurposive sampling was used to recruit 30 women with a past diagnosis of breast cancer and PF dysfunction. Semi-structured interviews were conducted, and data were analysed inductively to identify new concepts in the experiences of PF dysfunction in women with breast cancer and deductively according to the capability, opportunity, motivation and behaviour (COM-B) framework to identify the enablers and barriers to the uptake of treatment for PF dysfunction in women with breast cancer.ResultsParticipants were aged between 31 and 88 years, diagnosed with stages I–IV breast cancer and experienced either urinary incontinence (n = 24/30, 80%), faecal incontinence (n = 6/30, 20%) or sexual dysfunction (n = 20/30, 67%). They were either resigned to or bothered by their PF dysfunction; bother was exacerbated by embarrassment from experiencing PF symptoms in public. Barriers to accessing treatment for PF dysfunction included a lack of awareness about PF dysfunction following breast cancer treatments and health care professionals not focussing on the management of PF symptoms during cancer treatment. An enabler was their motivation to resume their normal pre-cancer lives.ConclusionParticipants in this study reported that there needs to be more awareness about PF dysfunction in women undergoing treatment for breast cancer. They would like to receive information about PF dysfunction prior to starting cancer treatment, be screened for PF dysfunction during cancer treatment and be offered therapies for their PF dysfunction after primary cancer treatment. Therefore, a greater focus on managing PF symptoms by clinicians may be warranted in women with breast cancer.

Perineometer- An equipment used for measuring the strength of voluntary contractions of pelvic floor muscles- A Review

Pelvic floor dysfunction (PFD) is an umbrella term used for disorders like, Urinary Incontinence, Pelvic Organ Prolapse, Urgency etc. There are many evaluation and treatment tools available for pelvic floor assessment. The purpose of this review was to know the effectiveness and usage of perineometer for the evaluation and treatment of PFD in women, with focus on the usage in current clinical practice.
 Electronic databases searched- PubMed, Google scholar and Cochrane
 Search Terms used- Perineometer, pressure manometer, pelvic floor muscle trainer, clinical application
 Method and Methodology- Inclusion criteria- Studies used Perineometer as evaluation/treatment method for any PFD in female population, Full text articles, ­ case study, case control study, cross sectional, RCTs paper published between 2000-2022.
 Exclusion criteria- Articles published in other than English.
 Conclusion- Perineometer is an effective tool for evaluation and treatment of PFD but it’s usage in clinical practice needs to be enhanced for better objectivity of evaluation and treatment.
 Keywords- Pelvic Floor Dysfunction, pressure manometer, pelvic floor muscle trainer

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.

When does oasis cause de novo pelvic floor dysfunction? role of the surgeon's skills.

Introduction and hypothesisMinorly skilled gynecologists are less likely to repair obstetric anal sphincter injuries (OASIS), and this can lead to higher rate of de novo onset of pelvic floor dysfunction (PFD). The aim of this study was to understand the impact of surgeon skills in OASIS repair on de novo incidence of PFDs.MethodsAn observational prospective cohort study performed between January 2019 and December 2020. We included 116 women with OASIS. At 6-weeks from delivery, women were divided into two groups in relation to the onset of PFDs. Characteristics were compared; categorical and continuous variables were assessed with chi-squared test and the Mann–Whitney rank-sum test respectively. Factors involved in PFDs development were analysed with explorative univariate analysis; significant (p<0.05) or approaching significance (p≤0.10) variables were included in multivariable analysis.ResultsSeventy-six women (76/116; 65.5%) reported at least one PFD symptom and anal incontinence was the most prevalent (44.73%; 34/76). OASIS management by a skilled gynaecologist resulted protective for PFDs [aOR 0.33 (0.13-0.61)]. Skilled surgeon reported fewer PFDs than less skilled surgeon (4% vs 82.4%; p<0.0001). Operative delivery was more performed (32.5% vs 15.8%; p= 0.03) and severe OASIS resulted more prevalent (60% vs 17.1%; p<0.0001) among women without PDFs, even if these didn’t affect the incidence of de novo PFDs [aOR 1.03 (0.23-1.45) and 0.83 (0.13-1.45), respectively].ConclusionsSurgeons skilled in OASIS repair resulted the only protective factor for incidence of de novo PFDs in women with OASIS at 6 weeks of follow up. Improvement of training in OASIS repair is necessary.

Pelvic floor dysfunction in women: current understanding of the problem

Here we review the recent literature on pelvic floor dysfunction, which is increasingly common in women of reproductive age and represents a significant medical problem occurring as a result of injured pelvic floor ligaments. Pelvic floor dysfunction is largely associated with vaginal delivery and might lead to urinary and fecal incontinence as well as pelvic organ prolapse. Intraabdominal hypertension, nerve damage, obesity, and genetic predisposition are among the major contributors to pelvic floor dysfunction. Being asymptomatic at the early stage, pelvic floor dysfunction gradually leads to the irreversible alterations in pelvic floor anatomy, ultimately deteriorating quality of life. Surgery remains a gold standard in the treatment of pelvic organ prolapse, yet POP-Q stage I-II prolapse should be treated conservatively. Currently, there are no specific treatment regimens and no evidence-based opinion regarding Kegel exercises and laser therapy. Biofeedback pelvic floor muscle training is the treatment of choice for urinary incontinence. Use of pessaries represents another efficient approach to conservative treatment.

Effect of conservative treatment of pelvic floor dysfunctions in women: An umbrella review

Due to their high worldwide prevalence, pelvic floor dysfunctions (PFD's) are a public health problem. There is high heterogeneity in the types and effectiveness of conservative treatment. The objective was to analyze the scientific evidence on conservative treatment of PFDs in women. Umbrella review, covering MEDLINE (1950-2019), Scopus (1960-2019), Web of Science (1980-2019), and Cochrane Library (2000-2019). Inclusion criterion: review on conservative treatments about pelvic floor disorders in the adult women, in Spanish or English; exclusion criterion: studies about other urological, gynecological, and coloproctological pathologies, among others. Thirty-two reviews (2000-2019) and 12 meta-analyses were included. 53.1% showed an improvement on urinary incontinence. Pelvic floor muscle training worked on 70.6% of them, followed by electrical stimulation and estrogen (11.7%), and weight loss (5.9%). 6.3% of reviews and meta-analyses fulfilled all items in PRISMA, and 93.7% of them fulfilled more than 60% of the checklist. 60% de los ítems. PFMT and weight loss are the most effective treatments for UI, but there is no evidence for other PFDs. The methodological quality of conservative treatments must be improved for a more effective treatment of PFDs in women. Pelvic floor muscle training and weight loss are the most effective treatments for urinary incontinence. Only 6.3% of the reviews fulfilled all PRISMA ítems.

The Influence of Obstetric Factors on the Occurrence of Pelvic Floor Dysfunction in Women in the Early Postpartum Period.

BackgroundThis study aimed to analyze the effect of obstetric factors on the development of pelvic floor dysfunction (PFD) in women in the early postpartum period.MethodsClinical data of 300 women who were reviewed in our outpatient clinic from July 2016 to December 2019 in the postpartum period were retrospectively analyzed. The occurrence of pelvic organ prolapse (POP) and stress urinary incontinence (SUI) was assessed using the Pelvic Organ Prolapse Quantification System and International Consultation on Incontinence Questionnaire Short Form. Factors affecting the occurrence of PFD in women in the early postpartum period were analyzed using univariate and multifactorial logistic regression models.ResultsA total of 46 cases of POP (15.33%) and 82 of SUI (27.33%) occurred in 300 women at 6–8 weeks after birth. Unconditional logistic regression confirmed that age ≥35 years, vaginal delivery, BMI before delivery ≥ 25 kg/m2, perineal tear, protracted or prolonged second stage of labor, and fetal macrosomia were risk factors influencing the occurrence of POP (OR > 1, P < 0.05), whereas age ≥ 35 years, vaginal delivery, perineal tear, protracted or prolonged second stage of labor, fetal macrosomia, and SUI during pregnancy were risk factors influencing the occurrence of SUI (OR> 1, P< 0.05).ConclusionObstetric factors such as age, mode of delivery, perineal tear, protracted or prolonged second stage of labor, and fetal macrosomia may increase the risk of developing PFD in women in the early postpartum period; hence, these risk factors should be correctly identified and promptly addressed to prevent the development of PFD.