Pelvic Floor Function Research Articles

The Effect of Exercises Used in High Intensity and High Impact Training on Pelvic Floor Function: A Systematic Review

The Effect of Exercises Used in High Intensity and High Impact Training on Pelvic Floor Function: A Systematic Review

Research progress in female pelvic floor rehabilitation aids.

Pelvic floor dysfunction (PFD) is a common clinical problem that can lead to bladder and bowel dysfunction such as urinary incontinence, urinary retention, fecal incontinence, pelvic organ prolapse, and sexual dysfunction. Pelvic floor rehabilitation aids are essential tools in the treatment of PFD. However, there is limited understanding of the efficacy and mechanisms of these aids, and there is a lack of standardized guidelines for selecting appropriate aids for different types of PFD. To assist patients in choosing suitable pelvic floor rehabilitation aids to their needs, it is necessary to summarize the existing types, mechanisms, and applications of these aids. Based on their mechanisms and target functions, pelvic floor rehabilitation aids can be mainly categorized into 3 main types. The first type includes aids that improve pelvic floor function, such as vaginal dumbbells, vaginal tampons, and vaginal dilators, which aim to strengthen pelvic floor muscles and enhance the contractility of the urethral, vaginal, and anal sphincters, thereby improving incontinence symptoms. The second type consists of aids that mechanically block the outlet, such as pessaries, urethral plugs, incontinence pads, incontinence pants, anal plugs, and vaginal bowel control systems, which directly or indirectly prevent incontinence leakage. The third type includes aids that assist in outlet drainage, such as catheters and anal excreta collection devices, which help patients effectively expel urine, feces, and other waste materials, preventing incontinence leakage. By summarizing the existing pelvic floor rehabilitation aids, personalized guidance can be provided to patients with PFD, helping them select the appropriate aids for their rehabilitation needs.

Progress on treatment of acetabular quadrilateral plate injury

Acetabular quadrilateral plate injury has become a hot spot and focus in the field of orthopaedic trauma and pelvic floor function in recent years. Although there are five fracture types,they are all based on fracture morphology,without considering the pulling force of ligaments,joint capsular and muscles. A perfect classification needs to describe the displacement of bone mass in three-dimensional space to better guide reduction and fixation. The seven incision and exposure methods are still the traditional open-eye surgery,and how to protect the criss-crossing vascular neural network and pelvic organs is still the focus. Quadrilateral defect causes dislocation of artificial hip joint,and quantitative evaluation of quadrilateral defect volume and revision techniques are still a hot topic. In this paper,the viewpoints of three-dimensional network structure of acetabular pelvic vascular anatomy,anatomical surgical target channel and fixation anchor point of acetabular fracture reduction are proposed to design new techniques for accurate and minimally invasive surgical operations,in order to realize the requirements of rapid orthopedic rehabilitation.

(006) Can Vibrator Use Improve Well-Being?

Abstract Introduction In limited studies vibrators have been shown to improve sexual function and improve pelvic floor health; however, there are even less studies on the effect of vibrator use on overall genitourinary and mental health. Objective This study aimed to investigate the effect of regular vibrator use on sexual, genitourinary, and mental health in addition to quality of life. Methods We performed a prospective pilot study of women aged 18 to 99 years recruited from a urogynecology clinic. Study participants were instructed to use a vibrator for five to ten minutes, two to three times a week for three months on their external genitalia. Sexual function, pelvic floor function, mental health, and pelvic examination were assessed at the initial visit and at three months follow-up using validated questionnaires. Results Of the 79 participants enrolled in the study, 53 women (66%) completed the study. The mean age of the participants was 54.7 years (range 19 – 80 years), and the majority of participants were Caucasian (n=59, 74.7%), post-menopausal (n=48, 60.8%), and not receiving systemic (n=63, 79.7%) or local (n=63, 79.7%) hormone therapy. Sexual function significantly improved over time (p =0.002), while the rate of bothersome pelvic organ prolapse symptoms and pain scores significantly decreased (p=0.034 and 0.0008, respectively). Rates of urge urinary incontinence decreased although this was not statistically significant (p=0.059). There was a significant improvement in gross appearance of lichen sclerosus lesions (p=0.025) and in severity of vaginal atrophy (p=0.018). Rates of depression were significantly decreased (p=0.011). Patients who completed the study were more likely to report having partnered sexual activity (p=0.067), and significantly more likely to have vaginal penetration during intercourse (p=0.017). Conclusions Vibrator use was associated with improved sexual, genitourinary, and mental health. Disclosure No.

Type C1 radical hysterectomy and anatomical reconstruction of pelvic structures to enhance pelvic floor function in early-stage cervical cancer: surgical technique

Type C1 radical hysterectomy and anatomical reconstruction of pelvic structures to enhance pelvic floor function in early-stage cervical cancer: surgical technique

Evaluation of a new management approach using a mobile application in the treatment of stress urinary incontinence in women

Pelvic floor muscle training (PFMT) is effective in the treatment of stress urinary incontinence (SUI). The aim of this randomized controlled trial was to investigate a new management approach involving the use of a mobile application (app) along with standard pelvic floor physiotherapy. The study included 30 female participants with SUI who were aged between 30 and 60 years. The women in the intervention group performed exercises at home using an app connected to an intravaginal probe. Those in the control group performed the same exercises using paper-based instructions. The period of the intervention was 3 months, and five parameters were analysed: adherence, compliance, SUI symptoms, pelvic floor functionality and quality of life (QOL). All participants received physiotherapy sessions in parallel with PFMT. The intervention group showed improvements in incontinence symptoms (P = 0.002), QOL (P = 0.003) and pelvic floor functionality over the course of treatment. Improvements in symptoms (P = 0.021), QOL (P = 0.008), and the strength and speed of contractions were observed in the control group. Intergroup tests only identified a significant difference for the PERFECT speed parameter (P = 0.011). A decrease in motivation was noted in both groups. This study did not show that an app connected to a probe was superior to paper-based instructions for PFMT. However, it did confirm that a home exercise programme combined with physiotherapy has a positive impact on SUI symptoms and QOL.

Volumetric segmentation analysis of the levator ani muscle using magnetic resonance imaging in pelvic floor function assessment

In this case-control study, we aimed to evaluate how muscle volume affects pelvic floor function by analyzing the levator ani muscle (LAM) using volumetric segmentation in addition to standard magnetic resonance (MR) defecography assessments. We enrolled 85 patients with varying degrees of pelvic floor dysfunction (PFD) and 85 age- and gender-matched controls in this retrospective study. All patients had MR defecography images, while all controls had pelvic MR images obtained for other reasons. Group comparisons were performed using independent samples t-tests and Mann-Whitney U tests. The receiver operating curve (ROC) was constructed to establish a cut-off value for a normal LAM volume. Interrater reliability was assessed by calculating the intraclass correlation coefficient. A P value of less than 0.05 was considered statistically significant. Volumetric measurements revealed that the control group had higher LAM volumes, and the ROC curve analysis indicated a cut-off value of 38934.3 mm3 with a sensitivity of 0.812 and specificity of 0.8 for PFD assessment using LAM volumetric measurement. Gender did not significantly affect LAM volume in the control group. Alongside the useful structural and functional information acquired from MR defecography images, volumetric analysis, and three-dimensional reconstructions of LAM may help to improve the accuracy of the diagnosis.

Assessment of Involuntary PFM Contractions in Comparison with Existing Literature and IUGA/ICS Terminology Reports

Introduction and HypothesisInvoluntary pelvic floor muscle (PFM) contractions are thought to occur during an increase in intra-abdominal pressure (IAP). Although no studies have assessed their presence in women with normal pelvic floor (PF) function, existing literature links the absence of involuntary PFM contractions to various PF dysfunctions. This study rectifies this lacuna by evaluating involuntary PFM contractions during IAP in healthy nulliparous women with no PF dysfunction, using visual observation and vaginal palpation. Results were compared with the literature and the IUGA/ICS Terminology Reports.MethodsNulliparous (n=149) women performed three sets of three maximal coughs. Visual observation and vaginal palpation were conducted in the standing and supine positions. The women were not instructed to contract their PFMs. Occurrence rates were calculated for each assessment method and position; differences between positions were analyzed using the Chi-squared test.ResultsRates of occurrence of involuntary PFM contraction were low across both assessments and positions (5–17%). Significant differences were found between standing (5%) and supine (15%) positions for visual observation, but not vaginal palpation (15%, 17% respectively). Occurrence rates also differed compared with the literature and terminology reports.ConclusionsContrary to clinical expectations, rates of occurrence of involuntary PFM contraction among our cohort of nulliparous women were extremely low. Digital palpation results showed high agreement with the terminology reports, but only partial agreement was observed for the visual observation results. Our study underscores the need for more research aimed at defining normal involuntary PF functions, a review of our understanding of involuntary PFM contractions, and better standardized guidelines for involuntary PFM assessment methods.

Management of stress urinary incontinence associated with perimenopause

Pelvic health physiotherapy is recommended as first-line treatment for those with lower urinary tract symptoms and pelvic floor dysfunction. Pelvic health physiotherapists treat a number of genitourinary conditions conservatively, including stress urinary incontinence, overactive bladder, pelvic organ prolapse and vaginal atrophy. When physiotherapy management alone does not fully resolve symptoms, medication may be required. Independent prescribing enables the physiotherapist to maintain continuity of care, allowing a smoother, more effective patient journey. This offers quicker access to medicines and helps avoid delays in commencing appropriate treatment, reducing waiting times across other services. In this article, the role of the pelvic health physiotherapy independent prescriber is detailed in a case study of a patient referred with symptoms of stress urinary incontinence associated with impaired pelvic floor function and episodic constipation, in addition to perimenopausal vaginal dryness causing dyspareunia.

Delivery Mode and the Pelvic Floor Function of Primiparous Women at Early Postpartum: An Observational Retrospective Cohort Study

Delivery Mode and the Pelvic Floor Function of Primiparous Women at Early Postpartum: An Observational Retrospective Cohort Study

Pubococcygeal Line Versus H-line as MR Defecography Reference for Bladder Descent.

Magnetic resonance defecography imaging techniques have been used widely to study pelvic floor function and diagnose pelvic organ prolapse (POP). The aim of this study was to investigate the diagnostic accuracy of the H-line to detect bladder descent compared with the current landmark, the pubococcygeal line (PCL). In this retrospective cohort study, patients who underwent MR defecography in our medical center and were diagnosed with moderate to severe cystocele by radiological measurements were recruited. One rest image and one maximum evacuation image for each subject were used for the following measurements: bladder base perpendicular distance from the genital hiatus (GH), indicative of clinically significant bladder descent, PCL as the current radiological reference line, and the H-line, or minimal levator hiatus line, indicative of pelvic floor muscle and connective tissue support.Subjects were categorized as having clinically significant cystocele if the "bladder base" reached within 1 cm or lower of the GH (stage II or higher cystocele). A comparison was performed to assess differences and predictive capabilities of the reference lines relative to the GH measure. Seventy subjects were included, 30 with clinically significant bladder descent based on distance to GH. Women with bladder descent were older (64.0 ± 11.8 vs 51.2 ± 15.6, p < 0.001), had increased parity (3 [1-7] vs 2 [0-5], p = 0.009), and had a bladder that descended lower than the H-line at rest (1.9 ± 0.5 vs 2.2 ± 0.4, p = 0.003) and evacuation (-2.4 ± 1.6 vs -0.7 ± 1.1, p < 0.001). Multivariate regression analysis confirmed that age, length of the H-line at evacuation, the perpendicular distances between the H-line and the lowest bladder point at rest, and the PCL to the lowest bladder point at evacuation significantly correlated with bladder descent.Receiver operating characteristic analysis was used to identify a measurement threshold to diagnose clinically significant cystocele for both measurements, bladder base to the H-line: -1.2 (80.0, 72.5) area under the curve (AUC) 0.82, and bladder base PCL: -3.3 (77.8, 79.5) AUC 0.86. Our data support the application of using the minimal levator hiatus plane and specifically the H-line as a reliable landmark to diagnose bladder descent using MR defecography imaging.

Pelvic floor function after third and fourth degree perineal lacerations: a case-control study on quality of life

BackgroundThe primary aim of this study was to compare the quality of life between women with obstetric anal sphincter injury (OASI) and women with intact perineum or minor vaginal tears following their first vaginal birth through a validated urogynaecological questionnaire. As a secondary aim, we wanted to identify the specific symptoms for pelvic floor dysfunction after a vaginal birth.MethodsOne hundred thirty-three cases (III- and IV-degree vaginal tears) and 133 controls (intact perineum or I- and II-degree vaginal tear) were asked to fill the PFDI-20 condition-specific and quality of life survey at three and 12 months after vaginal delivery. The survey evaluates pelvic floor dysfunction symptoms through three subsections: the Pelvic Organ Prolapse Distress Inventory (POPDI), the Colorectal-Anal Distress Inventory (CRADI), and Urinary Distress Inventory, (UDI). The scoring system ranges from 0 (no distress) to 100 (maximum distress) for each subsection, subsequently summed up to obtain the summary score (0 to 300). The patients recruited were asked to complete the survey at 3- and 12-months follow-up visit. Accordingly, data collection started. Categorical variables were subjected to Chi-square test or Fisher’s Exact test. Quantitative variables were compared through Student’s t-test or Mann-Whitney test.ResultsAll surveys have shown statistically significant differences when comparing the cases to the control group. Consequently, PFDI-20 has shown a strong correlation between III- and IV-grade lacerations and pelvic floor dysfunction persistence at 12 months after delivery. Intestinal symptoms were the most reported disturbances among women with previous OASI.ConclusionsMajor vaginal tears have demonstrated to have a strong impact on women’s quality of life up to a follow-up of 12 months. The use of PFDI-20 questionnaire is a useful and valid tool in the diagnosis and follow-up of genital prolapse, fecal and urinary incontinence in primiparous women with a history of OASI. Thus, its application in clinical practice can help offering the most adequate rehabilitative treatment.

What is known about changes in pelvic floor muscle strength and tone in women during the childbirth pathway? A scoping review.

This scoping review aims to comprehensively explore the existing research on the changes in pelvic floor function that occur throughout the childbirth pathway (antenatal, intrapartum, and postnatal period). Furthermore, it seeks to identify new opportunities and directions for future research in this field. In particular, this review focuses on investigating pelvic floor muscle strength and tone in women during the childbirth pathway. The following databases were investigated from their inception: PubMed, OVID, Medline, ScienceDirect, The Cochrane Central Library, Scopus, Web of Science, PEDro, Scholar Google, Embase, and CINHAIL. Literature research was carried out from March to October 2022. Records identified through database searching were imported to Covidence. According to Arksey and O'Malley's five-stage scoping review framework, researchers screen titles and abstracts for eligibility and exclude records that do not meet the inclusion criteria. A total of 40 studies were included in the data extraction phase. These articles underwent a review, with a specific emphasis on examining the tone, strength, and distensibility of the pelvic floor throughout the childbirth pathway. Among the selected studies, 22 investigated pelvic floor strength, 7 the distensibility, and 3 articles the tone. This review identified both areas of agreement and disagreement across all three themes examined, with a particular emphasis on labor and the postpartum period. Notably, the review unveiled a significant scarcity of data concerning the tone of pelvic floor muscles throughout the childbirth pathway. Further studies to investigate the relationship between midwifery care and pelvic floor outcomes are required to improve clinical practice.

Prevalence of Pelvic Floor Disorders in Parous Women from the Tibet Autonomous Region: A Cross-Sectional Study.

Pelvic floor disorder (PFD) seriously affects the everyday life of women. This cross-sectional study aimed to evaluate the prevalence and risk factors for postpartum PFD in women living in the Tibet Autonomous Region (TAR). Parous women who attended the outpatient gynaecology clinic at our hospital between June 2022 and August 2022 were screened in this study. The demographic and clinical data of these women were collected. Their pelvic floor functions were evaluated via a pelvic organ prolapse (POP) quantification examination, the Pelvic Floor Distress Inventory Questionnaire-20 (PFDI-20) and the Overactive Bladder Symptom Score (OABSS). A total of 201 women were included in this study, of whom 81.09% (163/201) were Tibetan. Twenty-seven women (13.43%) were diagnosed with POP stage ≥2 and 27 women (13.43%) with an OABSS score ≥3. The median PFDI-20 total score was 4.17 (range 0-43.75). Han women (n = 38) in the TAR had much lower PFDI-20 total scores, compared with Tibetan women (n = 163) (p < 0.05). The results of the multiple linear regression models showed that the PFDI-20 scores obtained from women living in the TAR were closely related to parity, history of heavy weight lifting, age, history of instrumental deliveries, ethnicity and number of caesarean sections. Pelvic floor disorder is common among parous women living in the TAR. Ethnicity, parity, history of heavy weight lifting, age, history of instrumental deliveries and number of caesarean sections are the factors closely related to the PFDI-20 scores.

Efeitos do modelo de enfermagem de Newman na qualidade de vida e recuperação muscular do assoalho pélvico em pacientes com disfunção do assoalho pélvico pós-parto

Abstract Objective We aimed to evaluate the effects of the Newman nursing model on the quality of life and pelvic floor muscle recovery in patients with postpartum pelvic floor dysfunction. Methods Eighty-eight patients with postpartum pelvic floor dysfunction treated from January to April 2023 were divided into observation and control groups (n=44) using a random number table. The control group was given routine nursing, based on which the observation group was given Newman nursing. The quality of life was assessed by the Short Form-36 Health Status Questionnaire. The pelvic floor function was evaluated using the Pelvic Floor Impact Questionnaire-7 (PEIQ7) and Pelvic Organ Prolapse Quantification (POPQ). Results After intervention, the scores of role physical, language communication, physical functioning, social functioning and motor functioning of the observation group were higher than those of the control group (P&lt;0.05). The Self-rating Anxiety Scale and Self-rating Depression Scale scores of the observation group were lower than those of the control group. The awareness rate of disease knowledge of the observation group was higher than that of the control group (P&lt;0.05). The observation group had higher class I and class II muscle fiber potentials, whereas lower class I and class II muscle fiber fatigue degrees than those of the control group (P&lt;0.05). The PEIQ7 and POPQ scores of the observation group were lower than those of the control group (P&lt;0.05). Conclusion Newman nursing helps improve the pelvic floor function, quality of life and awareness of the disease knowledge, and relieve anxiety, depression and other adverse emotions.

Acute and chronic effect of resistance training on pelvic floor muscle morphology and function in older women: a clinical trial

We aimed to evaluate the effects of resistance training with and without pelvic floor muscle (PFM) contraction on pelvic floor morphology and muscle function in older women. Seventeen older women without pelvic floor disorders participated in this clinical feasibility trial. The women were divided into three groups: resistance training without PFM contraction (RT); resistance training with simultaneous PFM contraction (RT+PFMC); and control. Maximum voluntary contraction (MVC) and the endurance of PFM contraction were measured by perineometer, and bladder neck angle and Hiatal area by translabial ultrasound. As an acute effect, MVC increased in the RT group (effect size r = −0.51). After 12 weeks, worsening was observed in the duration of contraction in RT (effect size r = −0.55) and RT+PFMC (effect size r = −0.52). Bladder neck angle improved in the RT+PFMC group (effect size r = −0.51). Resistance training acutely improves MVC and chronically worsens the duration of contraction. Resistance training with simultaneous PFM contraction improves the bladder neck angle after 12 weeks.

Pelvic floor dysfunction in postpartum women: A cross-sectional study.

Pelvic floor dysfunction (PFD) is a disease of weakened pelvic floor support tissues, leading to changes in the pelvic organ position and function of pelvic organs, with long-term effects on women. This study aimed to assess pelvic floor function using electrophysiology and clinical symptoms, exploring the risk factors for PFD one month postpartum. This cross-sectional study included 845 women from postpartum outpatient clinic of Nantong Affiliated Hospital from August 2019 to October 2021. Pelvic floor muscle strength was evaluated via pelvic floor surface electromyography. Clinical symptoms (urinary incontinence (UI) and pelvic organ prolapse) were diagnosed by gynecologists. Sociodemographic, pregnancy, and obstetrical data were obtained from self-reported questionnaires and electronic records. The study identified maternal age, parity, immigrant status, and economic income as factors were related to PFD. Gestational constipation increased the risk of abnormal resting muscle strength (OR:1.553, 95%CI: 1.022-2.359). Cesarean delivery was associated with higher rates of abnormal resting muscle strength than vaginal delivery (post-resting stage: OR, 2.712; 95% CI, 1.189-6.185), but a decreased incidence of UI (OR: 0.302; 95% CI, 0.117-0.782). Increased gestational weight gain was correlated with a greater risk of developing UI (OR:1.030, 95%CI: 1.002-1.058). Women with vaginal inflammation faced a higher risk of abnormal fast-twitch muscle (OR: 2.311, 95%CI: 1.125-4.748). In addition to uncontrollable factors like mode of delivery, age, and parity, interventions targeting weight gain and constipation during pregnancy and vaginal flora could mitigate the risks of PFD. Educational programs for pregnant women should emphasize a proper diet and lifestyle. For women with vaginal inflammation, clinical treatment should be carried out as soon as possible to avoid further aggravating the damage to the pelvic floor muscles.

The Application of Three-level Standardized Process Management in the Rehabilitation of Pelvic Floor Function in Primiparous Women

The Application of Three-level Standardized Process Management in the Rehabilitation of Pelvic Floor Function in Primiparous Women

Effects of Electrical Stimulation, Pelvic Floor Muscle Exercise, and Biofeedback Program on Improving Pelvic Floor Function and Quality of Life in Postoperative Patients with Early-Stage Cervical Cancer.

Effects of Electrical Stimulation, Pelvic Floor Muscle Exercise, and Biofeedback Program on Improving Pelvic Floor Function and Quality of Life in Postoperative Patients with Early-Stage Cervical Cancer.

Effect of vaginal CO2 laser terapy in mixed urinary incontinence

Objective. This prospective study provides preliminary findings on the clinical effectiveness of minimally invasive CO2 vaginal laser for patients suffering from mixed urinary incontinence. Materials and Methods. Thirty females suffering from mild to moderate degrees of mixed urinary incontinence underwent CO2 laser treatment with a specialized applicator and wavelength of 10,600 nm in an outpatient setting without anaesthetics or postoperative drugs. All patients received a total of two sessions, each separated by a 4-week period. The ICIQ-UI SF questionnaire (Arabic form) as well as a cough stress test were used to assess the clinical outcome 3 months following treatment in all patients. Patients were given the ICIQ-UI SF to complete before starting treatment and once again three months after completing two sessions of therapy. Results. A statistically significant decline in the ICIQ UI -SF was observed from baseline (from 8 ± 0.58) to the 3-month follow-up (5.1 ± 0.79). Moreover, eight patients (26.7%) had a negative cough stress test 3 months after the second laser session. During the study duration, there were no severe side effects. Conclusions. Collagen remodeling and production induced by vaginal CO2 laser may assist in the recovery and repair of pelvic floor function. In patients with MUI, this treatment method demonstrated effective as well as safe clinical outcomes as evaluated by the ICIQ-UI SF questionnaire, despite the limited sample size and short follow-up.