Pelvic Floor Dysfunction Research Articles

Differentiated approach to the choice of therapy for stress urinary incontinence in women with pelvic floor dysfunction

BACKGROUND: Among the symptoms of pelvic floor dysfunction, urinary incontinence is common in young patients. Stress urinary incontinence disrupts psychological health, sexual and social life. The effectiveness of modern conservative treatments for mild stress urinary incontinence in women of reproductive and perimenopausal age is being studied to prevent disease progression and improve the quality of life. AIM: The aim of this study was a comparative assessment of the effectiveness of pelvic floor muscle training using the Tyulpan laser vaginal simulator and paraurethral injections of a high-density hyaluronic biopolymer for the correction of stress urinary incontinence in women of reproductive and perimenopausal age with pelvic floor dysfunction. MATERIALS AND METHODS: We examined 82 patients aged 43.35 ± 6.25 years with mild to moderate stress urinary incontinence combined with grade I to II genital prolapse. After general clinical and special studies, including voiding diaries, Urgency Bother Visual Analogue Scale, cough test, ultrasound of the urethrovesical junction and pelvic floor, 41 women were prescribed a course of remote pelvic floor muscle training under medical supervision using the Tyulpan laser vaginal simulator (group I). 41 patients underwent paraurethral injection of 4.0 ml of high-density hyaluronic biopolymer crosslinked with 1,4-butanediol diglycidyl ether (group II). The effectiveness of therapy was evaluated one, six and 12 months after the start of treatment. RESULTS: After one month, the absence of stress urinary incontinence episodes based on voiding diaries was found in 29.4% of patients in group I and in 85.4% of patients in group II (2.9 times more often) (p 0.001); after 12 months, in 73.1% of patients in group I and in 36.4% of patients in group II (half as often) (p = 0.011). After one month, a negative cough test was detected in 65.0% of women in group I and in 92.1% of women in group II (1.4 times more often) (p = 0.023). After six months, the results of treatment for stress urinary incontinence based on the cough test were not different and amounted to 80.0% in group I and 71.9% in group II (p = 0.725). When assessing the pelvic floor muscle strength using the Oxford Scale and perineometry, an increase in strength after one and six months was detected in 100% of patients in group I (p 0.001). Both techniques equally reduced urethral mobility as measured by ultrasound over the one-month follow-up. Pelvic floor muscle training more significantly improved the quality of life of women 12 months after the start of therapy (p 0.05). CONCLUSIONS: The introduction of high-density hyaluronic biopolymer leads to a rapid and pronounced positive result in the treatment of stress urinary incontinence and an improvement in the quality of life in the short term; it is recommended for patients interested in quickly achieving results, informed about the limited duration of the effect. Regular training of the pelvic floor muscles in biofeedback mode under the remote control of a doctor contributes to better results in the long term. This method is recommended for women who are able to contract the pelvic floor muscles and are ready for regular exercise.

Transplantation of Mesenchymal Stem Cells Derived from Old Rats Improves Healing and Biomechanical Properties of Vaginal Tissue Following Surgical Incision in Aged Rats.

Pelvic floor dysfunction encompasses a group of disorders that negatively affect the quality of women's lives. These include pelvic organ prolapse (POP), urinary incontinence, and sexual dysfunction. The greatest risk factors for prolapse are increased parity and older age, with the largest group requiring surgical intervention being post-menopausal women over 65. Prolapse recurrence rates following surgery were reported to be as high as 30%. This may be attributed to ineffective healing in the elderly. Autologous stem cell transplantation during surgery may improve surgical results. In our previous studies, we showed that the transplantation of bone marrow-derived mesenchymal stem cells (MSCs) from young donor rats improved the healing of full-thickness vaginal surgical incision in the vaginal wall of old rats, demonstrated by both histological and functional analysis. In order to translate these results into the clinical reality of autologous MSC transplantation in elderly women, we sought to study whether stem cells derived from old donor animals would provide the same effect. In this study, we demonstrate that MSC transplantation attenuated the inflammatory response, increased angiogenesis, and exhibited a time-dependent impact on MMP9 localization. Most importantly, transplantation improved the restoration of the biomechanical properties of the vagina, resulting in stronger healed vaginal tissue. These results may pave the way for further translational studies focusing on the potential clinical autologous adjuvant transplantation of MSCs for POP repair for the improvement of surgical outcomes.

Trends of Pelvic Floor Disorders in Physically Active Women: A Cross-sectional Descriptive Study

Objetivo: Este estudio tuvo como objetivo determinar la prevalencia de trastornos de piso pélvico en mujeres físicamente activas en la provincia de Copiapó Chile. Además, explorar y analizar la posible correlación entre la presencia de trastornos del piso pélvico y el nivel de actividad física en esta población. Materiales y métodos: Se llevó a cabo un estudio descriptivo de corte transversal, para el cual se entrevistó a 233 mujeres mediante una plataforma en línea. La encuesta incluyó el Cuestionario Internacional de Actividad Física (IPAQ), el Pelvic Floor Distress Inventory short form (PFDI-20), el International Consultation on Incontinence Questionnaire short form (ICIQ-SF) y preguntas sobre disfunción sexual. Resultados: Se encontró una alta prevalencia de trastornos de piso pélvico en mujeres mayores de 18 años que realizan actividad física, destacando especialmente los síntomas urinarios. Sin embargo, solo un tercio de las mujeres consideró tener incontinencia urinaria. Además, no se halló una relación significativa entre la presencia de trastornos y el nivel de actividad física. La edad promedio fue de 32 años y la mayoría de las mujeres practicaba levantamiento de pesas y asistía al gimnasio, teniendo el 59,6 % de ellas un nivel alto de actividad física. Conclusiones: Se observó una alta prevalencia de trastornos de piso pélvico en mujeres mayores de 18 años que realizan actividad física. Sin embargo, no se evidenció una relación significativa entre la presencia de trastornos y el nivel de actividad física. Estos hallazgos resaltan la importancia de seguir investigando y abordando los factores que contribuyen a la aparición de trastornos de piso pélvico en mujeres con un estilo de vida activo.

Apical Suspension Repair for Vaginal Vault Prolapse

The optimal surgical repair of vaginal vault prolapse after hysterectomy remains undetermined. To compare the efficacy and safety of 3 surgical approaches for vaginal vault prolapse after hysterectomy. This was a multisite, 3-arm, superiority and noninferiority randomized clinical trial. Outcomes were assessed biannually up to 60 months, until the last participant reached 36 months of follow-up. Settings included 9 clinical sites in the US National Institute of Child Health and Human Development (NICHD) Pelvic Floor Disorders Network. Between February 2016 and April 2019, women with symptomatic vaginal vault prolapse after hysterectomy who desired surgical correction were randomized. Data were analyzed from November 2022 to January 2023. Mesh-augmented (either abdominally [sacrocolpopexy] or through a vaginal incision [transvaginal mesh]) vs transvaginal native tissue repair. The primary outcome was time until composite treatment failure (including retreatment for prolapse, prolapse beyond the hymen, or prolapse symptoms) evaluated with survival models. Secondary outcomes included patient-reported symptom-specific results, objective measures, and adverse events. Of 376 randomized participants (mean [SD] age, 66.1 [8.7] years), 360 (96%) had surgery, and 296 (82%) completed follow-up. Adjusted 36-month failure incidence was 28% (95% CI, 20%-37%) for sacrocolpopexy, 29% (95% CI, 21%-38%) for transvaginal mesh, and 43% (95% CI, 35%-53%) for native tissue repair. Sacrocolpopexy was found to be superior to native tissue repair (adjusted hazard ratio [aHR], 0.57; 99% CI, 0.33-0.98; P = .01). Transvaginal mesh was not statistically superior to native tissue after adjustment for multiple comparisons (aHR, 0.60; 99% CI, 0.34-1.03; P = .02) but was noninferior to sacrocolpopexy (aHR, 1.05; 97% CI, 0-1.65; P = .01). All 3 surgeries resulted in sustained benefits in subjective outcomes. Mesh exposure rates were low (4 of 120 [3%] for sacrocolpopexy and 6 of 115 [5%] for transvaginal mesh) as were the rates of dyspareunia. Among participants undergoing apical repair for vaginal vault prolapse, sacrocolpopexy and transvaginal mesh resulted in similar composite failure rates at study completion; both had lower failure rates than native tissue repair, although only sacrocolpopexy met a statistically significant difference. Low rates of mesh complications and adverse events corroborated the overall safety of each approach. ClinicalTrials.gov Identifier: NCT02676973.

The influence of pain presence on pelvic floor and sexual dysfunctions, and pain intensity-related variables in women using the menstrual cup: A cross-sectional survey

Objective: The aim was to assess the influence of pain during menstrual cup use on pelvic floor and sexual dysfunctions. In addition, we wanted to assess its impact on variables related to pain intensity during menstrual cup use such as insertion, removal, during menstruation, during sexual intercourse or the presence of pelvic pain. Methods: This study was a cross-sectional survey. The study included 566 women who fulfilled the inclusion criteria. Women were categorised into two primary groups: women with no pain and women with pain. Results: Regarding pelvic floor dysfunction, the independent samples t-test showed significant between-group differences ( t(564) = −3.50, mean differences (MD) = −8.86 (−13.8 to −3.89), p < 0.001). With respect to sexual dysfunction, no significant between-group differences were found with the exception of the pain subscale ( t(564) = 2.59, MD = 0.27 (0.48–0.06), p = 0.01. Regarding pain-related variables, we found statistically significant between-groups differences on all analysed variables. Conclusions: In conclusion, the results showed that women who use the menstrual cup and have pain showed worse scores on the pelvic floor dysfunction questionnaire, where it also seems that greater pain intensity was associated with worse questionnaire scores. However, we found no significant differences in sexual dysfunction except for the pain subscale between women who did and did not report pain in menstrual cup use. Finally, women who reported pain from menstrual cup use showed significantly greater pain intensity when inserting and removing the menstrual cup, during menstruation, during sexual intercourse and showed higher levels of pelvic pain although these differences are clinically slight.

European Board and College of Obstetrics and Gynaecology (EBCOG) position statement on the use of laser vaginal devices for treatment of genitourinary syndrome of menopause, vaginal laxity, pelvic organ prolapse and stress urinary incontinence

One in three women will experience pelvic floor disorders in her lifetime and nearly 60 percent of postmenopausal women are affected by vaginal dryness. Conservative management is recommended as first line treatment for pelvic organ prolapse and stress urinary incontinence. Also, vaginal estrogens are often prescribed for symptomatic vaginal atrophy. Lasers have been used in cosmetic industry for connective tissue remodeling and repair of skin. Their use in the last decade for treating genitourinary symptoms of menopause, pelvic organ prolapse and stress urinary incontinence has gained popularity but there is lack of robust evidence to support its use in routine practice. The European Board and College of Obstetrics and Gynaecology calls for high quality evidence with patient related outcome measures before adopting to routine clinical practice.

Pelvic Floor Disorders Among U.S. Military Active-Duty Females

Importance Women are a growing cohort within the U.S. military. Pelvic floor health is a component of health maintenance for which support needs vary by sex. The American Journal of Obstetrics & Gynecology reports that 1 in 4 women is affected by moderate to severe pelvic floor dysfunction (PFD). Understanding the specific experience of female service members is warranted for health care optimization and preservation of force readiness. Objective We aimed to identify the prevalence, incidence, and risk factors associated with incident PFD in active-duty females during an 11-year window. Study Design We used the Medical Assessment and Readiness System at Womack Army Medical Center, which includes medical record and personnel data from 2011 to 2022. Pelvic floor dysfunction diagnoses were identified using diagnosis codes and analyzed with respect to demographic parameters. Results Between 2011 and 2022, 32,996 of 550,303 active-duty females were diagnosed with PFD (period prevalence: 6.00%). Using 2011–2012 as a washout period, 27,046 of 486,558 participants were diagnosed during 1,879,990.90 person-years of follow-up (incidence rate: 14.39 cases per 1,000 person-years). The incidence rate of PFD increased in both new and established active-duty females. Increasing time since service entry was the strongest, statistically significant independent predictor of PFD. Three or more deployments and specific physical fitness scoring were also predictors of PFD. Conclusions The incidence rate of PFD among female service members is increasing, and multiple military-specific factors predict PFD. As the percentage of women in active-duty service continues to grow, additional investigation is needed to confirm PFD trends, illuminate other predictors, and prevent adverse outcomes.

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.

Symptomatology and knowledge regarding pelvic floor dysfunctions and influence of gender stereotypes in female athletes

Pelvic floor dysfunctions (PFD) are highly prevalent among females who do athletics, a sport requiring jumping, strength, and running. Although educational approaches are useful options, the educational need for this particular population remains unknown. The objective of the present study was to describe the level of knowledge regarding PFD and its relationship with symptomatology and gender stereotypes in female athletes in Spain. A total of 255 female athletes completed an anonymous online survey to explore their knowledge regarding urinary incontinence (UI), pelvic organ prolapse (POP), anal incontinence (AI), and sexual dysfunction (SexD), as well as their PFD symptoms and gender stereotyped beliefs related to sport. Educational level and sports characteristics (training volume, experience, and athletic modality) were also explored. Participants demonstrated a low level of knowledge in terms of POP (52.5%), AI (64.0%), and SexD (40%), but not for UI (70.8%). The proportion of PFD complaints was 63.5% for dyspareunia, 51.8% for urine leakage, 42.4% for pelvic pain, 17.3% for AI, and 9.0% for POP, with no associations with knowledge (p > 0.05). Lower knowledge about UI and SexD was related to greater gender stereotypes (p < 0.05) and rejection of professional healthcare (p = 0.010). As a conclusion, the level of knowledge about PFD was low in female athletes who train and compete in athletics in Spain, mainly with regard to sexual dysfunction. Although 63.5% of athletes had dyspareunia and 51.8% urinary leakages, symptomatology was not associated with level of knowledge. However, a lower level of knowledge was associated with more stereotyped beliefs and rejection of professional healthcare for PFD. These findings confirm the need to design appropriate educational interventions to disseminate information on all the types of PFD, particularly sexual contents. The potential influence of gender stereotypes makes it appropriate to include the gender perspective in these interventions.

Pelvic Floor Dysfunction in People with Eating Disorders and the Acute Effect of Different Interventions – A Retrospective Cohort Study

Pelvic Floor Dysfunction in People with Eating Disorders and the Acute Effect of Different Interventions – A Retrospective Cohort Study

Biophysical Mechanisms of Vaginal Smooth Muscle Contraction: The Role of the Membrane Potential and Ion Channels.

The vagina is an essential component of the female reproductive system and is responsible for providing female sexual satisfaction. Vaginal smooth muscle contraction plays a crucial role in various physiological processes, including sexual arousal, childbirth, and urinary continence. In pathophysiological conditions, such as pelvic floor disorders, aberrations in vaginal smooth muscle function can lead to urinary incontinence and pelvic organ prolapse. A set of cellular and sub-cellular physiological mechanisms regulates the contractile properties of the vaginal smooth muscle cells. Calcium influx is a crucial determinant of smooth muscle contraction, facilitated through voltage-dependent calcium channels and calcium release from intracellular stores. Comprehensive reviews on smooth muscle biophysics are relatively scarce within the scientific literature, likely due to the complexity and specialized nature of the topic. The objective of this review is to provide a comprehensive description of alterations in the cellular physiology of vaginal smooth muscle contraction. The benefit associated with this particular approach is that conducting a comprehensive examination of the cellular mechanisms underlying contractile activation will enable the creation of more targeted therapeutic agents to control vaginal contraction disorders.

MR defecography in assessing stress urinary incontinence with or without symptomatic pelvic organ prolapse.

Utilize magnetic resonance defecography (MRD) to analyze the primary pelvic floor dysfunctions in patients with stress urinary incontinence (SUI) associated with pelvic organ prolapse (POP), and in SUI patients with asymptomatic POP. We performed MRD in both SUI and POP subjects. As a primary analysis, the functional MR parameters were compared between the isolated POP and POP combined SUI groups. As a secondary analysis, the functional MR data were compared between the POP combined SUI and the SUI with asymptomatic POP (isolated SUI) groups. MRD noted the main characteristics of SUI combined moderate or severe POP, including the shorter closed urethra length (1.87cm vs. 2.50cm, p < 0.001), more prevalent urethral hypermobility (112.31° vs. 85.67°, p = 0.003), bladder neck funneling (48.28% vs. 20.51%, p = 0.020), lower position of vesicourethral junction (2.11cm vs. 1.67cm, p = 0.030), and more severe prolapse of the posterior bladder wall (6.26cm vs. 4.35cm, p = 0.008). The isolated SUI patients showed the shortest length of the closed urethra (1.56cm vs. 1.87cm, p = 0.029), a larger vesicourethral angle (153.80° vs. 107.58°, p < 0.001), the more positive bladder funneling (84.85% vs. 48.28%, p = 0.002) and a special urethral opening sign (45.45% vs. 3.45%, p < 0.001). Patients with SUI accompanying POP primarily exhibit excessive urethral mobility and a shortened urethral closure. SUI patients with asymptomatic POP mainly show dysfunction of the urethra and bladder neck, characterized by the opening of the urethra and bladder neck and a shortened urethral closure.

Up for the tackle? The pelvic floor and rugby. A review

AbstractThe pelvic floor and its associated disorders are a unique and often overlooked aspect of women's rugby. This review discusses relevant biopsychosocial considerations specific to the pelvic floor and rugby. Pelvic floor disorders can present at any time across the female lifespan but are more prevalent during pregnancy and postpartum. This is due to the substantial physiological and anatomical changes experienced during pregnancy and vaginal childbirth. Consequently, pelvic floor disorders can impact a player's ability to perform, maintain engagement with, or return to, rugby due to symptoms. Players need to be informed, supported, and guided through focused pelvic floor muscle training to condition the muscles and ‘ready’ them for the varied demands of rugby. Health and fitness professionals should understand the risk of pelvic floor disorders across the female lifespan and screen players for symptoms when supporting them to maintain or return to rugby. Rugby players who are symptomatic of pelvic floor disorders should be signposted to specialist services and/or resources to manage their symptoms. Once engaging in rugby training, ongoing evaluation of player load tolerance and implementation of individualized strategies to support managing rugby‐related loads to the pelvic floor should be considered. Finally, surveillance and research focusing specifically on rugby players and pelvic floor function are needed.

Epidemiology of Pelvic Floor Dysfunction in the Tacna Region of Peru, 2023

Introduction and hypothesisUrinary incontinence (UI) is highly prevalent in the general population, with numerous studies conducted in Europe and North America. However, there is a scarcity of data regarding its prevalence and sociodemographic factors in the southern region of Peru. There is an association between sociodemographic factors—such as age, educational level, body mass index, number of pregnancies, parity, mode of delivery, weight of the newborn—along with lifestyle factors such as physical effort, coffee and tobacco consumption with pelvic floor dysfunction (PFD). We anticipate that this association will negatively impact women’s quality of life.MethodsThis was a quantitative study, with a non-experimental, descriptive, cross-sectional correlational design. A sample consisting of 468 women between 30 and 64 years old. A previously tested survey was applied to explore prevalence, symptoms, associated factors, and quality of life.ResultsThe prevalence of PFD was 73.9%. UI was the most common. There is a significant association with overweight, obesity, parity, route of delivery, and physical effort. Even though a large percentage of participants presented with PFD, they reported that their quality of life was not affected (65.9% urinary discomfort, 96.5% colorectal–anal discomfort and 92.2% pelvic organ prolapse discomfort) and only in the case of urinary discomfort did they state that the impact was mild (28.6%) and moderate (5.5%).ConclusionsPelvic floor dysfunction in women is very common and it is strongly associated with overweight, obesity, parity, route of delivery, and physical exertion. The impact on quality of life was mild and moderate for those who had urinary discomfort.

Identifying Current Barriers in Patient Educational Content Surrounding Rectal Prolapse and Rectocele: Using Animation to Bridge the Gaps.

Patient-centered educational resources surrounding rectal prolapse and rectocele can be difficult to locate and understand. Findings of video animation as patient-specific material for these conditions can help guide the creation of effective educational tools for patients. To identify female patient preferences for learning about rectal prolapse and rectocele and to obtain feedback on an animation developed to aid patient education on these conditions. This was a multiple-methods study. Participants received a 20-question survey about educational preferences and a 100-second video animation on rectal prolapse and rectocele. Respondents were invited for a semistructured interview to further express their thoughts regarding health education. This study was conducted from 2022 to 2023. Surveys were administered via e-mail, and interviews were held virtually. Female patients in the institutional review board-approved Stanford Rectal Prolapse Registry were included. Assess and describe the ability of short video animations to supplement patient education on rectal prolapse and rectocele. Forty-six female participants responded and 10 were interviewed. About 97% of participants indicated that the video animation explained the condition clearly and 66% felt comfortable explaining the condition. During feedback, participants recommended showing the animation during the first appointment and creating similar content for surgery preparation. Patient challenges while researching rectal prolapse and rectocele online included difficulty finding content (41.5%), complex language (18.8%), and uncertainty about source reliability (16.9%). Small sample size with little socioeconomic diversity and highly educated participants. Patient-centered resources surrounding specific pelvic floor disorder(s) are not always readily accessible online. This study demonstrated the value of a short video animation to enhance patients' understanding of rectal prolapse and rectocele. See Video Abstract . ANTECEDENTES:Los recursos educativos centrados en el paciente sobre el prolapso rectal y el rectocele pueden ser difíciles de localizar y comprender. Los hallazgos de la animación en vídeo como material específico para estos pacientes pueden ayudar a guiar la creación de herramientas educativas efectivas para los pacientes.OBJETIVO:Identificar las preferencias de las pacientes para aprender sobre el prolapso rectal y el rectocele y obtener retroalimentación sobre una animación desarrollada para ayudar a la educación del paciente sobre estas condiciones.DISEÑO:Este fue un estudio de métodos múltiples. Los participantes recibieron una encuesta de 20 preguntas sobre preferencias educativas y un vídeo de animación de 100 segundos sobre el prolapso rectal y el rectocele. Se invitó a los encuestados que respondieron a una entrevista semiestructurada para expresar sus opiniones sobre la educación sanitaria.ESCENARIO:Este estudio se realizó entre 2022 y 2023, las encuestas se administraron por correo electrónico y las entrevistas se realizaron virtualmente.PACIENTES:Se incluyeron pacientes mujeres en el Registro de Prolapso Rectal de Stanford aprobado por el IRB.PRINCIPALES MEDIDAS DE RESULTADO:Evaluar y describir la capacidad de animaciones de video corto para complementar la educación del paciente sobre el prolapso rectal y el rectocele.RESULTADOS:Respondieron 46 mujeres participantes y 10 fueron entrevistadas. Alrededor del 97% de los participantes indicaron que la video-animación explicaba la afección con claridad y el 66% se sentía cómoda explicando dicha afección. En los comentarios de retroalimentación sugirieron mostrar la animación durante la primera cita y crear contenido similar para la preparación de la cirugía. Los desafíos de los pacientes al investigar el prolapso rectal y el rectocele en línea incluyeron dificultad para encontrar contenido (41.5%), lenguaje complejo (18.8%) e incertidumbre sobre la confiabilidad de la fuente (16.9%).LIMITACIONES:Tamaño de muestra pequeño con poca diversidad socioeconómica y participantes con alto nivel educativo.CONCLUSIONES:Los recursos centrados en el paciente sobre trastornos específicos del piso pélvico no siempre son fácilmente accesibles en línea. Este estudio demostró el valor de un vídeo de animación breve para mejorar la comprensión de los pacientes sobre el prolapso rectal y el rectocele. (Traducción-Dr. Jorge Silva Velazco ).

Influence of pregnancy and mode of delivery on pelvic floor function: a review of literature.

Pelvic floor disorders (PFDs), such as pelvic organ prolapse (POP) and urinary incontinence (UI), severely affect women's quality of life. Among these, stress urinary incontinence (SUI) is the most common, impacting a significant proportion of women. In the US, the lifetime risk of undergoing surgery for UI or POP stands at 20%. Pregnancy-related factors, notably delivery method and UI occurrence during pregnancy, have a potent correlation with PFD onset. The pathophysiology of PFDs during pregnancy is complex, with factors like increased intra-abdominal pressure, changes in bladder neck mobility, and shifts in pelvic floor muscle strength and collagen metabolism playing pivotal roles. PFD risk factors span across pregnancy, labor, and the postnatal phase and include UI or fecal incontinence (FI) during pregnancy, advanced maternal age, elevated BMI, multiple births, instrumental and spontaneous vaginal deliveries, and newborns weighing over 4000 grams. Conversely, Cesarean deliveries are linked with a reduced long-term risk of UI and POP compared to vaginal births. Current prognostic models can predict the likelihood of PFD development based on variables such as delivery method, number of births, and familial history. Preventive measures encompass lifestyle changes like caffeine reduction and weight management, alongside pelvic floor muscle training (PFMT) during pregnancy. Thus, expectant mothers are advised to participate in physical activities, prominently including PFMT.

Effects of pelvic-abdominal mechanics exercises during pregnancy on improving perinatal pelvic floor function in primiparous women

Objective: To explore the effects of pelvic-abdominal mechanics exercises during pregnancy on improving pelvic floor function in primiparous women during the perinatal period. Methods: A single-center prospective study selected 200 primipara of singleton pregnancies with prenatal care and delivery established at Shanghai Tongren hospital from June 2022 to June 2023 as the study subjects. Participants were divided into two groups: the exercise group (100 cases) and the control group (100 cases) by using a random number table method, five participants dropped out of the study due to reasons such as follow-up failure. Ultimately, the exercise group consisted of 97 cases, while the control group consisted of 98 cases. Participants who engaged in pelvic-abdominal mechanics exercises for at least 3 months, exercising once a week, were included in the exercise group. Those who did not engage in exercise were included in control group. Comparing the two groups in terms of pregnancy discomfort symptoms, delivery outcomes, postpartum pelvic floor electromyography results, postpartum quality of life, and pelvic floor disease incidence. The statistical methods utilized included independent t-test, Pearson chi-square test, Fisher's exact test, and Mann-Whitney U test. Results: In the late stage of pregnancy, the VAS score for low back pain was 5.05±1.22 in the exercise group and 5.47±1.55 in the control group, with a statistically significant difference (t=2.090, P<0.05). The PFDI-20 score was 23.33±8.41 in the exercise group and 25.76±8.34 in the control group, with a statistically significant difference (t=2.026, P<0.05). The PFIQ-7 score was 19.21±7.69 in the exercise group and 26.66±6.19 in the control group, with a statistically significant difference (t=6.851, P<0.05). There was no statistically significant difference in sleep quality and incidence of urinary incontinence between the two groups in late pregnancy (t=1.252, P=0.396, P>0.05). In terms of childbirth outcomes, the exercise group had a vaginal delivery rate of 81.44% (79 cases), while the control group had a rate of 64.28% (63 cases), with a statistically significant difference (χ2=9.022, P<0.05). The duration of the second stage of labor was (42.68±21.38) minutes in the exercise group and (50.54±21.33) minutes in the control group, with a statistically significant difference (t=2.178, P<0.05). At 42 days postpartum, the evaluation of pelvic floor function showed that the vaginal pressure in the exercise group was 62.19±10.04, while in the control group it was 52.68±15.55, with a statistically significant difference (t=-5.074, P<0.05). The MOS grading in the exercise group was 3.82±1.26, whereas in the control group it was 2.34±1.55, with a statistically significant difference (t=-7.355, P<0.05). In terms of the incidence of postpartum pelvic floor disorders, the occurrence of pelvic organ prolapse was 7.22% in the exercise group and 12.24% in the control group, with no statistically significant difference (χ2=1.402, P>0.05). The occurrence rate of stress urinary incontinence was 13.4% in the exercise group and 30.61% in the control group, with a statistically significant difference (P=0.015, P<0.05). Conclusion: Pelvic-abdominal mechanics exercises may have some advantages in reducing symptoms related to perinatal pelvic floor dysfunction, enhancing pelvic floor function, and preventing the occurrence of pelvic floor disease.

Effect of Cox’s Interaction Model of Client Health Behavior Combined with Huangqi and Dangshen Decoction on Female Pelvic Floor Dysfunction

Huangqi and Dangshen have significant medicinal and medical value as natural bio-based materials, but there are few studies on female pelvic floor dysfunction. We aimed to explore the effect of the Cox’s interaction model of client health behavior (Cox-IMCHB) combined with Huangqi and Dangshen decoction on female pelvic floor dysfunction. 166 postpartum patients with Qi-deficiency syndrome of pelvic floor dysfunction were selected from Tongren Hospital of Wuhan University hospital and divided into two groups, Group A and Group B, each consisting of 83 cases. The allocation was done using the random number table method. Patients in Group A received routine nursing and biofeedback electrical stimulation treatment, while patients in Group B received Cox-IMCHB combined with Huangqi and Dangshen decoction based on Group A. We compared the clinical efficacy, syndrome efficacy, pelvic floor muscle strength scores, sexual life quality scores, VAS score, pelvic floor functional exercise compliance score, and the incidence of urinary incontinence and pelvic organ prolapse between the two groups. The results showed that Group B had better clinical efficacy and syndrome efficacy, as well as a higher total effective rate (clinical efficacy: 91.57% vs. 72.29%; syndrome efficacy: 95.18% vs. 74.70%). Moreover, compared to Group A, Group B had higher scores of pelvic floor muscle strength and sexual life quality, a lower proportion of mild pain (85.54% vs. 71.08%), and higher scores of pelvic floor functional exercise compliance. The scores of pelvic floor functional exercise compliance in both groups tended to increase with time, and there was an interactive effect between groups and time (intergroup effect: F = 322.900, time effect: F = 186.200, interaction effect: F = 27.410). The incidence of urinary incontinence (2.41% vs. 14.46%, ϰ2 = 6.319) and pelvic organ prolapse (3.61% vs. 16.87%, ϰ2 = 9.608) in group B was lower (all P &gt; 0.05). The combination of Cox-IMCHB with Huangqi and Dangshen decoction can improve the pelvic function and exercise compliance of patients with pelvic floor dysfunction, relieve pain, and have significant clinical effects, which are worthy of promotion and application.

Regenerative Medicine in Urogynecology: Where We Are and Where We Want to Be.

Pelvic floor disorders (PFDs) constitute a major public health issue given their negative effect on quality of life for millions of women worldwide and the associated economic burden. As the prevalence of PFDs continues to increase, novel therapeutic approaches for the effective treatment of these disorders are urgently needed. Regenerative medicine techniques, including cellular therapies, extracellular vesicles, secretomes, platelet-rich plasma, laser therapy, and bioinductive acellular biomaterial scaffolds, are emerging as viable clinical options to counteract urinary and fecal incontinence, as well as pelvic organ prolapse. This brief expert review explores the current state-of-science regarding application of these therapies for the treatment of PFDs. Although regenerative approaches have not been widely deployed in clinical care to date, these innovative techniques show a promising safety profile and potential to positively affect the quality of life of patients with PFDs. Furthermore, investigations focused on regeneration of the main constituents of the pelvic floor and lower urinary tract improve our understanding of the underlying pathophysiology of PFDs. Regenerative medicine techniques have a high potential not only to revolutionize treatment of PFDs but also to prevent these complex conditions.

Defining Architectural Changes in Mouse Pelvic Floor Muscles During Pregnancy to Withstand Physiological Distension Associated with Parturition

Pelvic floor disorders (PFDs), which are present in ~25% of women, profoundly impact quality of life. During childbirth, pelvic floor muscles (PFMs) endure substantial mechanical strain, which can lead to PFM dysfunction. As such, vaginal childbirth is a major risk factor for PFDs. Previous studies in rats demonstrate important structural adaptations in the PFMs that help to withstand the mechanical strain of childbirth, including muscle fiber lengthening by sarcomerogenesis. However, it is diffcult to establish a comprehensive understanding of the molecular mechanisms underlying PFM dysfunction during childbirth in rat models. Here, our objective was to determine if mouse PFMs undergo similar adaptations to rats during pregnancy and vaginal distension. We hypothesized that, akin to rats, PFMs in mice would undergo muscle fiber elongation through sarcomerogenesis during pregnancy. The PFMs (coccygeus [C], iliocaudalis [ICa], pubocaudalis [PCa]) and a non-pelvic floor muscle (tibialis anterior [TA]) were collected from late-pregnant (E16.5) and non-pregnant C57BL/6NJ (3 months old) mice. These animals were subjected or not subjected to physiological vaginal distension to mimic vaginal parturition (N = 4/group); in anesthetized mice, a 6F transurethral catheter was inserted into the vagina, and it was inflated with 0.3 mL (which best approximated fetal head circumference), and a 13 g weight was attached to the catheter creating circumferential and downward strains similar to parturition. Following this, the animals were euthanized, and the pelvis was fixed in situ for assessment of muscle architectural parameters; muscle fibers length was determined using digital calipers and sarcomere length was measured by light microscopy. Pregnancy induced a significant increase in normalized muscle fiber length in all PFMs compared to non-pregnant animals (Pregnant vs. not pregnant — C: 4.71±0.06 mm vs. 3.37±0.15 mm, p&lt;0.0001; ICa 8.74±0.14 mm vs. 7.50±0.27 mm, p=0.004; PCa 7.13±0.09 mm vs. 6.28±0.34 mm, p=0.04); TA muscle fiber length was unchanged (6.92±0.17 mm vs. 6.73 ± 0.19 mm, p=0.28). Sarcomere length was not affected by pregnancy in any muscle (C: 2.44±0.002 μm vs. 2.45 ± 0.003 μm, p=0.55; ICa: 2.26±0.003 μm vs. 2.26±0.004 μm, p=0.64; PCa: 2.16±0.01 μm vs. 2.16±0.003 μm, p=0.74; TA: 2.55±0.004 μm vs. 2.54±0.003 μm, p=0.28). Balloon-mediated vaginal distention resulted in significantly longer sarcomere lengths in non-pregnant compared to pregnant animals in all PFMs (C: 2.98±0.01 μm vs. 2.43±0.01 μm, p&lt;0.0001; ICa: 2.54±0.004 μm vs. 2.24±0.005 μm, p&lt;0.0001; PCa: 2.85±0.001 μm vs. 2.17±0.001 μm, p&lt;0.0001), indicating protection against sarcomere elongation in pelvic floor muscles of pregnant animals. This study shows that, similar to rats, pregnancy causes architectural changes in mouse pelvic floor muscles, which prevent excessive sarcomere stretching during physiologic vaginal distension that is comparable to fetal delivery. This work was funded by NIH grant #K12 HD000849 (Reproductive Scientist Development Program) to LAB and UC San Diego Senate Grant to LAB. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.