Symptoms Of Pelvic Floor Dysfunction Research Articles

Effects of an 8-week pelvic core stability and nutrition community programme on maternal health outcomes.

Women, during the antenatal and post-partum period, report pelvic, low back pain, stress and urge urinary incontinence, colorectal dysfunction, and other co-morbidities that negatively affect health-related quality of life. Exercise and nutrition are important considerations for improving maternal health in this period. The purpose of this study was to examine the effects of a community-driven nutrition and exercise programme focused on pelvic floor and core stability, healthy nutrition, and breastfeeding counselling over an 8-week period on pelvic floor and urinary distress (UDI), prolapse and colorectal distress for antenatal and post-partum women with limited access to health care, and low socio-economic resources from a Midwestern Region of the United States. Purposive sample of 35 females, ages 18-44, were recruited for this prospective, preintervention to postintervention study, following ethical approval from Institutional Review Board and voluntary written consent from participants. The Health History Questionnaire, SF-36, Food Frequency Questionnaire, report of pelvic organ prolapse dysfunction (POPDI), colorectal-anal dysfunction (CRADI), and UDI as measured by the Pelvic Floor Distress Inventory (PFDI) were completed before and after intervention. Thirty-five women (n=35) 18 to 44years old (mean age of 22.72±3.45years) completed the study. A significant difference was found from preintervention to postintervention scores means for PFDI total scores, CRADI individual scores, and UDI individual scores (p<.05). POPDI scores decreased preintervention to postintervention but were not significant. A significant improvement in healthy nutrition and breastfeeding postintervention was also found (z=3.21, p=.001). Further analysis showed significant, but weak, correlation between parity and POPDI (r=.366, p=.033); between parity and UDI (r=.384, p=.03); and between parity and PFDI (r=.419, p=.014). Our study found a significant reduction in pelvic floor dysfunction, urinary, and colorectal-anal distress symptoms and improvement in breastfeeding and healthy nutrition following an 8-week community-driven nutrition and exercise programme focused on pelvic floor and core stability, healthy nutrition, and breastfeeding counselling.

Role of Radiofrequency (Votiva, InMode) in Pelvic Floor Restoration.

Postpartum pelvic floor disorders are estimated to impact 24% of women in the United States. This study describes the use of a radiofrequency device (Votiva, InMode) for postpartum pelvic floor restoration using an electrostimulator to objectively measure treatment effect. A retrospective evaluation was conducted between April 2017 and May 2018 of consecutive patients undergoing vaginal radiofrequency treatment. Inclusion criteria were patients at least 6 weeks postvaginal delivery with symptoms of pelvic floor dysfunction. Resting pelvic floor muscle tone and maximal pelvic floor contraction were measured. Fifty women were included in the study with an average age of 32 (29-40) years old, average of 2.6 pregnancies, and 1.8 vaginal deliveries. Two patients were lost to follow-up and excluded. Three complete radiofrequency treatments were performed in 31/50 patients, whereas 19 patients received 1-2 treatments. There were no adverse events from the radiofrequency treatment. No changes were found in resting pelvic muscle tone after Votiva treatment [Wilks' lambda = 0.98, F (1, 45) = 0.86, P = 0.36]. The quantity of treatments seemed to impact mean values of maximal pelvic floor contraction [F (1, 45) = 105.14, P < 0.001]. On the patient questionnaire, patients felt subjective improvement correlated to number of treatments. Radiofrequency is safe for the treatment of pelvic floor dysfunction. This study showed no changes in resting pelvic muscle tone but an improvement in maximal pelvic floor contraction. A prospective randomized study is being conducted to further evaluate the efficacy of this technology.

&lt;p&gt;Depression symptoms in women with pelvic floor dysfunction: a case-control study&lt;/p&gt;

PurposeIn this study, we aimed to estimate the prevalence of depression symptoms in women with pelvic floor dysfunction (PFD) and to assess their quality of life (QOL).Patients and methodsA case-control study assessing depression and its severity in women with PFD (urinary incontinence, pelvic organ prolapse, and fecal incontinence) was conducted. Patients attending the Urogynecology Department of the Women’s Specialized Hospital, King Fahad Medical City, were requested to complete the self-reported Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire, and Beck Inventory Scale for Depression. Women presenting with no PFD symptoms were recruited from other clinics as controls.ResultsData of 100 women diagnosed with PFD (mean age, 45.18±10.50 years) and 100 control participants (mean age, 45.14±13.03 years; P=0.644) were collected. Patients with PFD showed significantly higher (7.3%) body mass index (BMI) (32.59±6.22 kg/m2) than controls (30.37±8.08 kg/m2) (OR, 1.044, 95% CI: 1.001–1.091; P=0.043). Patients with PFD exhibited a threefold higher prevalence of depression symptoms than controls (43% vs 14%, respectively; P<0.001). QOL scores in patients with PFD were significantly higher in patients with depression (P-values, 0.024 to <0.001).ConclusionThere is a significant association between depression and PFD, and QOL scores in patients with PFD were significantly higher in patients with depression.

Pelvic Floor Dysfunction in the Female Athlete

Pelvic floor dysfunction (PFD) is a term used to describe a variety of disorders involving moderate to severe impairment of the pelvic floor muscles. It can be divided into two broad categories. Relaxing PFD is more common, presenting with urinary incontinence, fecal incontinence, or pelvic organ prolapse. Nonrelaxing PFD symptoms include impaired ability to evacuate urine or stool, sexual dysfunction, and pelvic pain. Unfamiliarity with this diagnosis among medical providers along with nonspecific symptoms often lead to a delayed or missed diagnosis for patients. Here, we present the case of a collegiate soccer player with PFD to illustrate the severity of presentation and progression of this disorder. We review the current literature regarding nonrelaxing PFD and all types of PFD in female athletes to raise awareness and recognition of this condition.

Urogynecology Service at a District General Hospital in the United Kingdom - Changing Needs or a Better Understanding?

Context:The urogynecological problems in women increase with age. The National Health Services (NHS) is experiencing an increase in the demand for and costs of health and social care for women in midlife. It is a relatively new subspecialty which requires a holistic approach to a patient symptoms and expert skills to overcome demands from aging female population and fulfilling patient expectations.Aims:The aim of the study was to analyze the referral pattern in relation to urogynecological symptoms referred to district general hospital in the United Kingdom and in turn to understand the gravity of the situation for improving the care of these women.Subjects and Methods:This was a retrospective study of case notes of women attending the gynecological outpatient clinic led by an urogynecology subspecialist at district general hospital in the United Kingdom having attended the clinic with symptoms suggestive of pelvic floor dysfunction.Results:We identified 777 women who attended the clinic with symptoms of pelvic floor dysfunction. The most frequently stated reason for referral was pelvic organ prolapse, followed by primary urinary incontinence. Majority of the patients (44%) had prolapse at diagnosis and 26% of the patients had multiple symptoms related to pelvic floor dysfunction after a urogynecologist's consultation, 5% of the patients had combined symptoms diagnosed at urogynaecology clinic. Majority of the referrals were from the general practitioners (43%).Conclusions:The study revealed that health practitioner referring the women needs better understanding of the urogynecological symptoms and with a better understanding and a thorough symptom treatment can be initiated for various symptoms at the same time. This allows patients' multiple symptoms improvement, avoids repeat referrals from primary care, avoids repeat visits to the clinics, avoids repeat interventions, and improves patients' satisfaction and therefore saves NHS resources.

Correlation of Pelvic Organ Prolapse Quantification Technique with Pelvic Floor Dysfunction Symptoms

Introduction: Assessment of POP by POP-Q gives anatomical site-specific measurement, which helps in surgery, follow-up and reduces inter-observer variation. The Pelvic Floor Distress Inventory (PFDI) is condition-specific health-related quality of life questionnaires for women with pelvic floor disorders.&#x0D; Objective: To assess pelvic organ prolapse by POP-Q technique and to correlate pelvic floor distress inventory questionnaire with POP-Q segments. Methodology A prospective study was done from March 2014 to February 2015 after ethical approval from IRC, B.P. Koirala Institute of Health Sciences. All patients with pelvic organ prolapse were included after informed verbal consent. The patients were then asked questions as in pelvic floor distress inventory questionnaire (PFDI) and noted in performa. The patients were then examined by POP-Q technique and noted. The informations were entered in the MS excel chart and statistical analysis done using SPSS 11.5.&#x0D; Results: There were 72 patients enrolled. The mean age of patients was 53.65 years. Majority of patients were found to have stage 4 prolapse (43.1%). POP-Q examination showed majority of patients had anterior and apical compartment defect. Correlation between POP-Q points and urinary symptoms showed significant relation with points in anterior compartment, genital hiatus and perineal bodies. Correlation with POP-Q points with colorectal symptoms showed involvement of genital hiatus significantly with strain stool and incomplete bowel movement. Correlation with pelvic distress symptoms with POP-Q sites showed significant relation with bulging, push up vagina for urination and defecation.&#x0D; Conclusion: POP-Q site specific points showed significant correlation with symptoms from Pelvic Floor Distress Inventry (PFDI) questionnaires.

Распространенность симптомов дисфункции тазового дна у женщин репродуктивного возраста

Распространенность симптомов дисфункции тазового дна у женщин репродуктивного возраста

How Valid Is Tomographic Ultrasound Imaging in Diagnosing Levator and Anal Sphincter Trauma?

Three-/four-dimensional translabial ultrasound (US) is increasingly used to image the levator ani and anal sphincters, especially in the form of tomographic US. The aim of the study was to evaluate the validity of these published methods. This work was a retrospective analysis of datasets of 172 nulliparous women who attended 2 tertiary urogynecologic centers for symptoms of pelvic floor dysfunction between June 2012 and September 2016. All patients had a standardized interview, clinical examination, and 4-dimensional translabial US examination. An evaluation of volume data was performed by the first author, who was blinded against all clinical data, including parity. An assessment for levator avulsion and anal sphincter defects was performed using stored US volume data. Data sets of 162 and 153 nulliparous women were available for levator and anal sphincter assessments, respectively. On the assessment by the first author, a complete avulsion was diagnosed in 3 nulliparas. On a review by 2 senior authors, 1 was judged as positive and the other 2 as normal. On the sphincter assessment, 2 significant external anal sphincter defects were detected. On the review, 1 was judged as false-positive. The second was judged as highly abnormal by all authors. Therefore, 1 nullipara each was diagnosed with avulsion and a significant external anal sphincter defect. Published diagnostic criteria for levator avulsion and external anal sphincter trauma on tomographic US imaging are highly unlikely to result in false-positive findings. This finding supports the clinical validity of this method.

Does Patient Posture Affect the Ultrasound Evaluation of Pelvic Organ Prolapse?

Translabial ultrasound (US) imaging is an emerging method for the evaluation of pelvic organ prolapse (POP). Normative data to date are limited to imaging in the supine position. The purpose of this study was to evaluate the effect of posture changes on US pelvic organ mobility. This work was a retrospective study of 175 women seen in a tertiary urogynecologic center for symptoms of lower urinary tract and pelvic floor dysfunction. All underwent a standardized interview, POP quantification prolapse assessment, and 4-dimensional translabial US examination in supine and standing positions. Offline measurement of organ descent on the Valsalva maneuver was undertaken at a later date and was blinded against all other data. The mean age was 58 (SD, 13.5; range, 17 to 89) years, with a mean body mass index of 29 (SD, 6.1; range, 18 to 53) kg/m2 . In total, 58.9% (n = 103) presented with symptoms of prolapse. Clinically, 82.8% (n = 145) had substantial prolapse on the POP quantification assessment. On imaging, bladder, uterine, and rectal ampulla positions were significantly lower, and the hiatal area on the Valsalva maneuver was larger in the standing position (P < .03). On receiver operating characteristic statistics assessing correlations between POP symptoms and US pelvic organ descent, the area under the curve was higher in the standing position, but the difference was not statistically significant. Measurements of organ descent and hiatal dimensions are generally higher in the standing position. However, they are not reflected in a stronger association between symptoms and organ descent. Hence, imaging in the standing position can be limited to those patients in whom a false-negative assessment result is suspected.

Dutch translation and validation of the pelvic organ prolapse/incontinence sexual questionnaire-IUGA revised (PISQ-IR).

Condition-specific sexual questionnaires are important patient-reported outcome measures. The aim of this study was to translate and validate the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire-International Urogynecology Association Revised (PISQ-IR) into Dutch. The translated PISQ-IR was linguistically validated, followed by psychometrical validation among women presenting with symptoms of pelvic floor dysfunction in urogynecology clinics. For analysis of the criterion validity, the Pelvic Floor Dysfunction Inventory-20 (PFDI-20) and Female Sexual Function Index (FSFI) were used. Descriptive statistics, floor and ceiling effects, internal consistency using Cronbach's alpha coefficient and Pearson's and Spearman's correlations were calculated for all PISQ-IR subscales. The PISQ-IR was completed by 220 women, of whom 61 (27.7%) considered themselves not sexually active (NSA) and 159 (72.3%) sexually active (SA). The mean age of participating women was 57years; 49.5% reported symptoms of pelvic organ prolapse (POP), 66.8% urinary incontinence and 2.3% anal incontinence. The PISQ-IR subscales were analyzed separately for SA and NSA women with Cronbach's alpha coefficient ranging from 0.61 to 0.87. Moderate to high correlations were observed between PISQ-IR subscales and corresponding FSFI subscales and a moderate correlation between urinary distress and the condition impact (CI) subscale among NSA subjects. The Dutch PISQ-IR demonstrated a good internal consistency and criterion validity compared with the FSFI, but criterion validity compared with the PFDI-20 was poor except for urinary distress in NSA women and needs further attention.

Should Genital Hiatus/Perineal Body Be Measured at Rest or on Valsalva?

Genital hiatus (Gh) and perineal body (Pb) are part of the Pelvic Organ Prolapse Quantification assessment system, but it is unclear whether measurements should be taken at rest or on Valsalva. This study was designed to assess the predictive value of Gh and Pb measurements obtained at rest and on Valsalva for signs and symptoms of pelvic organ prolapse (POP). This is a retrospective study involving 416 women who presented to a tertiary urogynecology unit with symptoms of pelvic floor dysfunction. Genital hiatus and Pb were measured at rest and on maximal Valsalva. The strength of association between binary markers of POP and measurements of Gh/Pb was estimated using logistic regression analysis. Receiver operator characteristic statistics were used to compare predictive values of Gh and Pb measurements obtained at rest and on Valsalva. A total of 451 women were seen during the study period. Thirty-five were excluded owing to missing data, leaving 416. Fifty-four percent (n = 223) complained of POP symptoms. On examination, 80% (n = 332) had significant POP (stage 2+ in anterior or posterior compartments or stage 1+ in the central compartment). On imaging, significant POP was diagnosed in 66% (n = 275). Mean hiatal area was 22 cm (SD, 7; range, 5-49 cm) at rest and 30 cm (SD, 10; range, 11-69 cm) on Valsalva. Genital hiatus and Pb measured on Valsalva were consistently stronger predictors of prolapse symptoms and objective prolapse (by clinician examination and by ultrasound) than at Gh and Pb measured at rest. The corresponding area under the curve values were significantly larger for Gh/Pb measures on Valsalva after adjusting for multiple confounders. Genital hiatus/Pb measured on maximal Valsalva is a superior predictor of symptoms and signs of POP compared with Gh/Pb at rest.

Pelvic floor dysfunction in women with fibromyalgia and control subjects: Prevalence and impact on overall symptomatology and psychosocial function.

To evaluate the prevalence, distress, and impact of pelvic floor dysfunction (PFD) symptomatology in women with fibromyalgia and control women. We also aimed to evaluate the impact of PFD symptomatology on several psychosocial measures such as mood, sleep, pain, and quality of life. We conducted a cross-sectional study in women with fibromyalgia and control women from the general population. Using a structured survey, we collected sociodemographic and clinical data, assessed the prevalence of PFD and evaluated the distress (PFDI-20) and the impact (PFIQ-7) caused by its symptomatology. Using Spanish-validated questionnaires, we also evaluated mood and sleep disturbances, bodily pain, and quality of life in subjects with and without PFD. In participants with fibromyalgia, we assessed the severity and impact of the disease using the Fibromyalgia Impact Questionnaire (FIQR). Two hundred and twenty-six patients with fibromyalgia and 222 control women completed the surveys. Two hundred and twenty patients (93%) and 140 controls (63%) reported PFD-related symptoms. Both the scores of distress (143.1 ± 5.7 vs 96.1 ± 4.8, P < 0.0001) and impact (122.4 ± 5.6 vs 100.6 ± 6.4, P < 0.0001) caused by PFD symptoms were significantly higher in women with fibromyalgia than in controls. There was a significant positive relationship between fibromyalgia severity and both PFDI-20 (r2 = 0.32, P < 0.0001) and PFIQ-7 scores (r2 = 0.375, P < 0.0001). Depression severity, sleep disturbances, bodily pain, and low quality of life were highest in women with fibromyalgia and PFD and lowest in control women without PFD. PFD-related symptoms were significantly more frequent in women with fibromyalgia than in controls. PFD symptomatology, when present, negatively influenced mood, sleep quality, and quality of life of both patients with fibromyalgia and controls.

Help-seeking behaviour for pelvic floor dysfunction in women over 55: drivers and barriers.

Our aim was to identify drivers of and barriers to help-seeking behaviour of older women with pelvic floor dysfunction (PFD) living independently in Australia . Women aged ≥55years were recruited to this cross-sectional study during July and August 2016. Bladder, bowel, pelvic organ prolapse (POP) and sexual dysfunction were assessed with the Australian Pelvic Floor Questionnaire (APFQ). Drivers and barriers were based on the Barriers to Incontinence Care Seeking Questionnaire. Univariate analyses were used to assess any significant relationships between PFD, age, education level, self-reported PFD, barriers and drivers. Of the 376 study participants [mean, standard deviation (SD) age 68.6 (10.5) years], 67% reported symptoms of PFD and 98.7% scored >0 on the APFQ. Women were more likely to seek help if they scored higher on the APFQ (p < 0.001). The main barrier to seeking help was the perception that PFD was a normal part of ageing (22.4%). Of those who did seek help (50%), the main factor was increased level of symptom bother (51.4%). There was no difference in age or education level between women who did and did not seek help. Women are more likely to seek help for PFD if scoring higher on the APFQ or symptoms are becoming more bothersome. They are less likely to seek help if they view their symptoms as normal. Future direction should be taken to raise awareness of normal pelvic floor function as well as the availability of help for PFD.

Impact of subsequent pregnancies on pelvic floor functional anatomy.

Vaginal childbirth clearly has an effect on pelvic floor anatomy, and pregnancy itself also likely plays a role. This study investigated the effects of consecutive pregnancies by comparing pelvic organ support and function in urogynecological patients delivered by cesarean section (CS) only. This was a retrospective study using 161 archived data sets of urogynecological patients delivered exclusively by CS presenting with symptoms of pelvic floor dysfunction between 2007 and 2015. Patients had undergone an interview, clinical examination using thePelvic Organ Prolapse Quantification (POP-Q) system, and 3D/4D translabial ultrasound (TLUS) using Voluson systems. Measures of functional pelvic floor anatomy were obtained from stored ultrasound (US) volumes at a later date, using proprietary software, and blinded against all other data. One hundred and sixty-one women delivered exclusively by CS were seen in a urogynecological clinic. Volume data analysis was possible in 151 patients. Mean age was 52 (26-82) years, with a mean body mass index (BMI) of 29.5 (18.4-48.7) kg/m2. Forty-three (28.5%) women had one CS, 67 (44.4%) had two, and 41 (27.1%) had three or more. On multivariate analysis, adjusting for age, BMI, history of hysterectomy, and incontinence or prolapse surgery, there were no significant differences between groups. On comparing women with one, two, or three or more CS, we found no significant differences in any measured sonographic parameters of pelvic organ descent and pelvic floor muscle function. This implies that subsequent pregnancies after the first are unlikely to exert significant additional effects on pelvic floor functional anatomy.

Transperineal ultrasound imaging of the pelvic floor muscles in women with pelvic floor dysfunction symptoms: A cross-sectional study

Abstract Objective Transperineal ultrasound (TPUS) assessment of the pelvic floor muscle (morphological and dynamic function) in women with pelvic floor dysfunction symptoms. Study design A cross-section study, 73 women complaining of any of the pelvic floor disorder symptoms. Digital palpation of the puborectalis muscle using modified Oxford score grading system (MOS), 2 D and 3 D TPUS were done at rest, maximum contraction, and at valsalva. Levator ani defects, and/or avulsion were identified. Levator urethral gap (LUG) was measured. Ultrasound measurements were correlated to MOS, and presence of symptoms Results The mean percentage decrease in the antro posterior hiatal diameter (LHap) during contraction was significantly lower in women with UpfmC than those with NpfmC as assessed by MOS. A cut-off percentage decrease in LHap at contraction 2% predicted UpfmC; area under the curve 0.81, sensitivity 38.5%, specificity 81% and accuracy 50.6%. LUG was significantly longer in UpfmC. All cases of ultrasound diagnosed avulsion had an UpfmC by MOS. MOS had a strong positive correlation with percentage decrease LHap (contraction), and a strong negative correlation with the percentage increase in LHap (Valsalva), and LUG. Conclusion Ultrasound is clinically valuable, reasonable, allows morphological and dynamic evaluation of the function of PFM in women with pelvic floor dysfunction symptoms, and correlated well with MOS. LUG increased its validity for diagnosis of levator avulsion.

971: Diabetes mellitus in pregnancy does not delay postpartum pelvic floor recovery

Pelvic floor dysfunction (PFD) symptoms are prevalent during pregnancy, however they are mostly reversible postpartum. Diabetes mellitus (DM) and pre-diabetic conditions, such as insulin resistance and impaired fasting glucose, have been found to be a risk factor for PFD in non-pregnant women. Therefore, it has been hypothesized that PFD symptoms may be more prevalent in women with gestational or pre-gestational DM and that there may be a slower spontaneous postpartum recovery of PFD symptoms. We aimed to determine the impact of DM on PFD symptoms recovery. We conducted a prospective cohort study of women who gave birth at a tertiary medical center in Israel. Women who have consented completed the “Pelvic Floor Distress Inventory-20” (PFDI-20), a condition specific questionnaire developed to measure quality-of-life and the extent of pelvic floor injury. The PFDI-20 was completed during the third trimester of pregnancy or immediately after delivery, and again three months postpartum. Clinical and obstetrical characteristics were retrieved from the participants' medical records. A total of 192 women have completed both questionnaires and were divided into DM group (n=66) and control group (n=126). We found a significant difference between PFD during pregnancy, and PFD three months postpartum (P<0.001). This difference remained consistent in all components of the PFDI-20: pelvic organ prolapse distress (P<0.001), colorectal and anal dysfunction (P=0.01) and urinary dysfunction (P<0.001). No significant difference was noted in the extent of recovery of PFD symptoms between women with DM and the control group (P=0.31). There is a clinical and statistically significant spontaneous recovery of PFD symptoms in the postpartum period. Diabetes mellitus in pregnancy does not delay the pelvic floor recovery postpartum.

385: Is there a correlation between pelvic floor dysfunction symptoms during pregnancy and the duration of the second stage of labor?

385: Is there a correlation between pelvic floor dysfunction symptoms during pregnancy and the duration of the second stage of labor?

386: Recovery from pelvic floor dysfunction symptoms in the postpartum is correlated with the duration of the second stage of labor

386: Recovery from pelvic floor dysfunction symptoms in the postpartum is correlated with the duration of the second stage of labor

Psychological consequences of pelvic floor trauma following vaginal birth: a qualitative study from two Australian tertiary maternity units

Vaginal birth may result in damage to the levator ani muscle (LAM) with subsequent pelvic floor dysfunction and there may be accompanying psychological problems. This study examines associations between these somatic injuries and psychological symptoms. A qualitative study using semi-structured interviews to examine the experiences of primiparous women (n = 40) with known LAM trauma was undertaken. Participants were identified from a population of 504 women retrospectively assessed by a perinatal imaging study at two obstetric units in Sydney, Australia. LAM avulsion was diagnosed by 3D/4D translabial ultrasound 3-6months postpartum. The template consisted of open-ended questions. Main outcome measures were quality of information provided antenatally; intrapartum events; postpartum symptoms; and coping mechanisms. Thematic analysis of maternal experiences was employed to evaluate prevalence of themes. Ten statement categories were identified: (1) limited antenatal education (29/40); (2) no information provided on potential morbidities (36/40); (3) conflicting advice (35/40); (4) traumatized partners (21/40); (5) long-term sexual dysfunction/relationship issues (27/40); (6) no postnatal assessment of injuries (36/40); (7) multiple symptoms of pelvic floor dysfunction (35/40); (8) "putting up" with injuries (36/40); (9) symptoms of post-traumatic stress disorder (PTSD) (27/40); (10) dismissive staff responses (26/40). Women who sustain LAM damage after vaginal birth have reduced quality of life due to psychological and somatic morbidities. PTSD symptoms are common. Clinicians may be unaware of the severity of this damage. Women report they feel traumatized and abandoned because such morbidities were not discussed prior to birth or postpartum.

Role of Magnetic Resonance Imaging in the Diagnosis and Management of Pelvic Floor Dysfunction

ABSTRACT Aim To study the effect of age and parity in pelvic floor anatomy in women with pelvic floor dysfunction and the changes in pelvic floor anatomy after a course of pelvic floor exercises. Design A prospective study at Government Kilpauk Medical College (KMC), Chennai. Materials and methods Patients with pelvic floor dysfunction are subjected to clinical examination and magnetic resonance imaging (MRI). The changes in anatomy are analyzed in terms of levator hiatus dimension and descent of the pelvic organs. Substratified analysis is done and mean diameters in each degree of prolapse are identified (Chi-square tests using cross tables). Patients with cystocele, rectocele, or enterocele are also compared in both clinical examination and MRI and the degree of correlation is measured (inter-rater kappa). The changes in pelvic floor anatomy in terms of H line, M line, and levator plate angle with respect to age and parity are studied. In patients with lower degrees of prolapse, the changes in anatomy in terms of H line, M line, and levator plate angle are studied after a course of pelvic floor exercises (post hoc tests and paired t-tests). The area under curve of receiver-operating curve in each degree of prolapse is seen and the critical cut-off value of the various anatomical parameters above which a patient develops a prolapse is calculated. Results Ninety patients with symptoms of pelvic floor dysfunction were studied with clinical examination and MRI. Levator hiatus width cut off at rest above 5 cm and at straining above 5.8 cm develops clinical first-degree prolapse. Levator plate angle of more than 44.4° develops a clinical first-degree prolapse. With increasing age there is an increase in mean values of levator hiatus width at straining, levator plate angle, and descent of various organs. With increasing parity, there is an increase in mean values of levator hiatus width at rest and straining and increase in descent at straining. Conclusion Magnetic resonance imaging should be considered as a pretreatment planning tool when the physical findings are equivocal. How to cite this article Shankar P, Gunasingh S. Role of Magnetic Resonance Imaging in the Diagnosis and Management of Pelvic Floor Dysfunction. J South Asian Feder Obst Gynae 2017;9(3):250-254.