Pelvic Floor Impact Questionnaire Scores Research Articles

Pelvic floor symptoms and symptom-related quality of life in the mothers of children with cerebral palsy: a pilot cross-sectional study.

Pelvic floor symptoms may occur in women with low back pain due to dysfunction of the spinal stabilization muscles. Low back pain is the most common musculoskeletal problem experienced by the mothers of children with cerebral palsy (CP). Therefore, our aim in this study was to examine pelvic floor symptoms and symptom-related quality of life in the mothers of children with CP. The study included 48 mothers of children with CP (n = 23) or without neurodevelopmental problems (n = 25). The mothers' pelvic floor symptoms and symptom-related quality of life were evaluated with the Pelvic Floor Distress Inventory-20 (PFDI-20) and the Pelvic Floor Impact Questionnaire-7 (PFIQ-7). PFDI-20 and PFIQ-7 scores did not differ between the two groups of mothers (p > .05). Additionally, moderately significant positive correlations were found between the age of the child with CP and duration of carrying and the PFDI-20 (r = 0.419, p = .047) and PFIQ-7 (r = 0.427, p = .042) scores. Pelvic floor symptoms and symptom-related quality of life in the mothers of children with CP were similar to those in the mothers of children without neurodevelopmental problems. As the age of the child with CP and duration of carrying increase, the urinary symptoms and urinary and colorectoanal symptoms-related quality of life in their mothers may worsen.

Effectiveness and safety of a novel, collapsible pessary for management of pelvic organ prolapse

Pessaries are an effective treatment for pelvic organ prolapse, yet currently available pessaries can cause discomfort with removal and insertion. An early feasibility trial of an investigational, collapsible pessary previously demonstrated mechanical feasibility during a brief 15-minute office trial. Longer-term, patient-centered safety and efficacy data is needed. To assess the effectiveness and safety of the investigational vaginal pessary for pelvic organ prolapse at three months. This was a prospective, seven-center, open-label equivalence study with participants serving as their own controls. Subjects were current users of a Gellhorn or ring pessary with ≥ Stage II prolapse. Baseline subjective and objective data were collected for one month using their current pessary, and then data were collected through a three-month treatment phase with use of the study pessary. The primary outcome was change in Pelvic Floor Distress Inventory-20 score. Secondary outcome measures included objective assessment of prolapse support, changes in the Pelvic Floor Impact Questionnaire-7, and pain with insertion and removal measured on a Visual Analog Scale. Subjects fitted with study pessary were analyzed as intention to treat and those who dropped out were assigned scores at the upper limit of the predefined equivalence limits. Secondary per protocol analyses included subjects who completed treatment. The study was powered to 80% with a minimal important change equivalence limit of 18.3 points on the Pelvic Floor Distress Inventory-20 scale. Square root transformations were used for non-parametric data and p-values adjusted for multiple comparisons. Seventy-eight subjects were enrolled, though 16 withdrew prior to study pessary placement. Sixty-two subjects (50 ring and 12 Gellhorn pessary users) were fitted with the study pessary, and 48 (62%) completed the three-month intervention. The change in Pelvic Floor Distress Inventory-20 scores at three months demonstrated equivalence compared to the subjects' baseline scores, (mean difference -3.96 (improvement), 90% confidence interval (CI) [-11.99, 4.08], p=0.002). Per protocol analysis of the Pelvic Floor Distress Inventory-20, equivalence was not demonstrated with scores favoring the study pessary (mean difference -10.45, 90% CI, [-20.35, 0.54] (p=0.095)). Secondary outcomes included: objective measures of support which were similar, mean difference Ba=0.54 cm, Bp=0.04 cm, favoring study pessary; improvement in mean Pelvic Floor Impact Questionnaire-7 scores for those who completed the trial (pre=32.23, post=16.86, p=0.019); and pain with insertion and removal, which was lower with the study pessary compared to subject's own pessary (mean difference Visual Analogue Scale insertion=9.91 mm (p=0.019), removal=11.23 mm (p=0.019)). No serious adverse events related to the pessary were reported. Equivalence was demonstrated in the study pessary primary outcome compared to current non-collapsible pessaries for change in severity and bother of pelvic floor symptoms. In participants who completed the trial, the Pelvic Floor Impact Questionnaire-7 improved with the study pessary and change in Pelvic Floor Distress Inventory-20 scores were non-equivalent, favoring the study pessary. Subjects reported significantly lower pain scores with both pessary insertion and removal with the novel collapsible pessary compared with their standard pessary.

Pelvic Floor Physical Therapy Attendance Among High-Risk Postpartum Patients.

Limited data describe attendance to pelvic floor physical therapy (PFPT) in a postpartum patient population. The objective was describe attendance to PFPT in a cohort of postpartum women at high-risk of pelvic floor concerns. We secondarily compared attendance between patients with and without evaluation in a postpartum pelvic floor healing clinic (PPFHC). This was a retrospective cohort study of 2 convenience samples from an academic hospital. The PPFHC cohort comprised all postpartum vaginal delivery patients evaluated in the PPFHC from July 2021 to July 2022. The historical pre-PPFHC cohort comprised patients with third/fourth-degree obstetrical lacerations from December 2019 to January 2021. We abstracted attendance to PFPT, number of visits, Pelvic Floor Distress Inventory-20 (PFDI-20) scores, Pelvic Floor Impact Questionnaire (PFIQ) scores, and discharge status. Our cohort contained 464 patients, 195 (42.0%) from pre-PPFHC and 269 (58.0%) from PPFHC. Among all patients 302 (65.1%) were referred to PFPT and 170 (56.3%) attended at least 1 visit, 82 (48.2%) were discharged from PFPT with goals met, and the median number of visits was 6 (3-10). The majority of patients (97.0%, n = 261) seen in the PPFHC were referred to PFPT, compared with 22.0% (n = 41) of pre-PPFHC patients (P < 0.01). More patients in the pre-PPFHC cohort attended PFPT than in those the PPFHC cohort (75.6% vs 53.5%, P ≤ 0.01). Most patients exhibited improved PFDI and PFIQ scores after PFPT (n = 88, 80.0%, and n = 89, 81.7% respectively). Patients attending postpartum PFPT demonstrated high therapy completion rates. A dedicated PPFHC had more referrals, however, lower PFPT attendance rates, when compared with a historical cohort.

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

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

Application of health education based on the integrated theory of health behavior change in the pelvic floor rehabilitation of patients with cervical cancer after radical surgery

To analyze the effect of applying health education based on the integrated theory of health behavior change in the pelvic floor rehabilitation of patients with cervical cancer after radical surgery. We recruited 130 patients with cervical cancer who underwent gynecological surgery in our hospital between the 01 February 2021 and the 01 March 2022. According to the random number table method, the patients were divided into a control group and an observation group (65 cases per group). The control group received routine health education, while the observation group received health education based on the integrated theory of health behavior change. We compared the two groups with regards to pelvic floor function, quality-of-life, and psychological status before and after intervention by analyzing PFDI-20 (Pelvic Floor Distress Inventory Questionnaire-20), PFIQ-7 (Pelvic Floor Impact Questionnaire-7), HAMA (Hamilton Anxiety Scale) and HAMD (Hamilton Depression Scale) questionnaires, treatment compliance and nursing satisfaction. After intervention, the PFDI-20 scores and total scores of patients in the observation group were lower than those in the control group (p &lt; 0.05). The PFIQ-7 scores and total scores of patients in the observation group were lower than those in the control group (p &lt; 0.05). The HAMA and HAMD scores in the observation group were significantly lower than those in the control group (p &lt; 0.05). The treatment compliance and nursing satisfaction rate of patients in the observation group were higher than those in the control group (p &lt; 0.05). Health education based on the integrated theory of health behavior change can improve pelvic floor muscle strength, the quality-of-life, and the treatment compliance of patients after radical surgery for cervical cancer. In addition, this strategy can alleviate anxiety and depression, and improve nursing satisfaction and is worthy of wider clinical application.

CO2 laser therapy for management of stress urinary incontinence in women: a systematic review and meta-analysis.

Carbon dioxide (CO2) laser therapy is an emerging treatment for women with stress urinary incontinence (SUI). To examine the efficacy of CO2 laser therapy for management of SUI-related symptoms in women. A systematic review and meta-analysis of randomized controlled trials and cohort studies. Four databases were screened until January 2023. All efficacy continuous endpoints were assessed via subtraction of the posttreatment from pretreatment values. The data were summarized as mean difference (MD) with 95% confidence interval (CI) using the random-effects model. A total of 15 studies with 700 patients were analyzed. CO2 laser therapy significantly decreased the 1-h pad weights at 3 months [n = 5 studies, MD = -3.656 g, 95% CI (-5.198, -2.113), p < 0.001], 6 months [n = 6 studies, MD = -6.583 g, 95% CI (-11.158, -2.008), p = 0.005], and 12 months [n = 6 studies, MD = -3.726 g, 95% CI (-6.347, -1.106), p = 0.005]. Moreover, CO2 laser therapy significantly decreased the International Consultation of Incontinence Questionnaire-Urinary Incontinence Short Form Scores at 3 months [n = 10 studies, MD = -4.805, 95% CI (-5.985, -3.626), p < 0.001] and 12-months [n = 6 studies, MD = -3.726, 95% CI (-6.347, -1.106), p = 0.005]. Additionally, CO2 laser therapy significantly decreased the Pelvic Floor Impact Questionnaire scores at 6 months [n = 2 studies, MD = -11.268, 95% CI (-18.671, -3.865), p = 0.002] and 12 months [n = 2 studies, MD = -10.624, 95% CI (-18.145, -3.103), p = 0.006]. Besides, CO2 laser therapy significantly decreased the Urogenital Distress Inventory-6 scores at 3 months [n = 2 studies, MD = -21.997, 95% CI (-32.294, -11.699), p < 0.001], but not at 6 months [n = 3 studies, MD = -3.034, 95% CI (-7.357, 1.259), p = 0.169]. Lastly, CO2 laser therapy significantly increased the Vaginal Health Index Score at 6 months [n = 2 studies, MD = 2.826, 95% CI (0.013, 5.638), p = 0.047] and 12 months [MD = 1.553, 95% CI (0.173, 2.934), p = 0.027]. CO2 laser therapy improved the SUI-related symptoms in women. To obtain solid conclusions, future studies should be well-designed with standardized settings, consistent therapeutic protocols, and long-term follow-up periods.

Mid-term efficacy of surgical treatments for post-hysterectomy vaginal vault prolapse: a retrospective study

The surgical treatment of post-hysterectomy vaginal vault prolapse (PHVP) has been reported in several clinical studies, but mostly are short-term studies. This study aims to explore the mid-term efficacy of surgical treatments for PHVP. A total of 138 PHVP patients underwent surgery from January 2005 to January 2020 at the Fourth Medical Center of PLA General Hospital, Beijing. The clinical data of 119 patients who completed follow-up were retrospectively analyzed. Both groups of patients are diagnosed Pelvic Organ Prolapse Quantification system (POP-Q) III-IV stage of prolapse, with obvious prolapse-related symptoms and requiring surgical treatment. Among them, pelvic floor reconstruction surgery (RPS) was performed in patients who wanted to retain vaginal function and colpocleisis were used for frail patients who cannot tolerate RPS. We used the POP-Q scores for the objective efficacy evaluation, and use the Pelvic Floor Distress Inventory-Short Form 20 (PFDI-20) and Pelvic Floor Impact Questionnaire-7 (PFIQ-7) to evaluate the subjective symptom during follow up. Among them, 61 patients underwent pelvic floor RPS (Group R), and 58 received colpocleisis (Group C). The surgeries in both groups were successfully completed, the median follow-up time after surgery was 4.3 years (0.25-13 years) and 5.3 years (0.33-15 years), respectively; the overall surgical success rate was 86.9% (53/61) and 100% (58/58), respectively; the subjective satisfaction rate was 90.2% (55/61) and 91.4% (53/58), respectively; and the PFDI-20 and PFIQ-7 scores in both groups were significantly improved compared with the preoperative levels (P<0.05). In Group R, 6 cases (9.8%, 6/61) were dissatisfied after surgery; in Group C, 5 cases (8.6%, 5/58) were dissatisfied after surgery. Reconstructive surgery and colpocleisis have a good mid-term effect on PHVP, with good outcome and few complications. The surgeon is expected to ascertain an appropriate surgical procedure based on the characteristics of the patient, the degree and the location of prolapse, in order to achieve the best surgical efficacy and minimize the damage.

Psychometric Properties of the Turkish Version of Prolapse and Incontinence Knowledge Questionnaire

OBJECTIVE: This study aimed to translate and culturally adapt the prolapse and incontinence knowledge questionnaire into Turkish, and to investigate the psychometric properties of the Turkish version prolapse and incontinence knowledge questionnaire.STUDY DESIGN: Psychometric properties of the Turkish version prolapse and incontinence knowledge questionnaire, which was developed according to standard scientific translation procedures, were analyzed on 206 volunteer women (31.79±8.79-year-old), after being tested for its comprehensibility and content validity. The participants were questioned about their physical and socio-demographic characteristics, obstetrical-gynecological histories and menstrual states, current medical complaints, and reasons for applying to the clinics. In addition to Turkish version prolapse and incontinence knowledge questionnaire, they completed the Turkish incontinence quiz, global pelvic floor bother questionnaire, pelvic floor distress inventory-20 and pelvic floor impact questionnaire. Retests were performed on 27 participants, after one week. Internal consistency, test-retest reliability, and construct validity of the Turkish version prolapse and incontinence knowledge questionnaire were investigated. RESULTS: Internal consistencies of the Turkish version prolapse and incontinence knowledge questionnaire subscales (Turkish version prolapse and incontinence knowledge questionnaire-UI and Turkish version prolapse and incontinence knowledge questionnaire-pelvic organ prolapse) were high (Cronbach α=0.754 for both); item-total correlations were 0.127-0.576 and 0.217-0.509, respectively. Also, test-retest reliabilities of the subscales and the overall scale were high (Intraclass correlation coefficient =0.949, 0.911 and 0.878, respectively). Turkish version prolapse and Incontinence knowledge questionnaire scores were highly correlated with incontinence quiz scores and weakly correlated with pelvic floor distress inventory-20 and pelvic floor impact questionnaire-7 scores (p&lt;0.05).CONCLUSION: It was concluded that Turkish version prolapse and incontinence knowledge questionnaire is a reliable and valid tool to measure Turkish women’s knowledge and awareness about urinary incontinence and pelvic organ prolapse.

The impact of personality traits on pessary treatment outcomes in patients with pelvic organ prolapse.

Personality traits can play an important role in outcomes of different chronic disorders. We hypothesize that the pessary treatment outcomes in symptomatic pelvic organ prolapse (POP) can also be influenced by personality traits. This prospective observational study included consecutive women with symptomatic POP seeking pessary treatment between December 2018 and January 2020. The personality profile was measured using the Eysenck Personality Questionnaire (EPQ-R) at baseline, and patient health-related quality of life (HRQoL) was measured using the Pelvic Floor Impact Questionnaire-7 (PFIQ-7) and the Pelvic Floor Distress Inventory (PFDI-20) at baseline and at 3months. The correlation between HRQoL and personality traits was investigated by means of linear regression. In total, 213 patients were included, of which 163 patients (76.5%) achieved success by the 3-month follow-up. No significant differences were found in the EPQ scores between the successful and unsuccessful groups. The scores on both the PFIQ-7 and PFDI-20 correlated significantly with neuroticism and correlated inversely with extraversion at both baseline and the 3-month follow-up. The degree of improvement in PFIQ-7 and PFDI-20 scores was not associated with personality traits. Our data indicate that neurotic and introverted women were more bothered by POP-related symptoms, although the improvement in symptoms was not significantly associated with personality traits after 3months of pessary treatment.

Safety and efficacy of a self-developed Chinese pelvic repair system and Avaulta repair system for the treatment of pelvic organ prolapse in women: A multicenter, prospective, randomized, parallel-group study.

The pelvic organ prolapse (POP) repair systems used in China are imported and expensive. Our aim was to compare the efficacy and safety of a self-developed pelvic floor repair system versus the Avaulta system.This was a multicenter, randomized, parallel-group, noninferiority trial of 132 patients with POP stage ≥II from the Tongji Hospital Affiliated to Tongji University and the General Hospital of Ningxia Medical University enrolled from 02/2014 to 03/2015. The patients were randomized 1:1 to POP repair using the self-developed system or the Avaulta system. Perioperative conditions, POP quantification, pelvic floor impact questionnaire-7, and prolapse quality of life questionnaires, gynecological ultrasound, and postoperative complications were compared. Patients were followed at 1.5, 3, and 6 months.According to the POP quantification scores obtained at 6 months after surgery, the cure rates of the self-developed and Avaulta groups were 98.3% and 100.0%, respectively (P > .999). At 6 months follow-up, the pelvic floor impact questionnaire-7 scores of the self-developed and Avaulta groups were both improved (P < .001 vs baseline), with no between-group difference observed (P = .488). There were no differences between the 2 groups for subjective symptoms of POP (all P > .05). There were no significant differences between the 2 groups regarding complications (all P > .05).The self-developed pelvic reconstruction system is safe and effective for the treatment of POP and improves the patients' quality of life, without difference compared to the Avaulta system.

Compression shorts reduce prenatal pelvic and low back pain: a prospective quasi-experimental controlled study.

BackgroundCommon prenatal ailments negatively impact performance of activities of daily living and it has been proposed that the use of dynamic elastomeric fabric orthoses, more commonly referred to as compression garments, during pregnancy might aid in the reduction of pain from these ailments, allowing for improved functional capacity. However, the effectiveness of such garments in this context has not been established. This study aims to determine whether compression shorts are effective and thermally safe in the prevention and management of prenatal pelvic and low back pain (LBP).MethodA prospective quasi-experimental controlled study using parallel groups without random allocation was conducted, involving 55 childbearing women (gestational weeks 16–31) recruited from hospital and community-based maternity care providers. The compression shorts group (SG) wore SRC Pregnancy Shorts in addition to receiving usual care. The comparison group (CG) received usual care alone. Primary outcome measures—Numeric Pain Rating Scale (NPRS) and Roland Morris Disability Questionnaire (RMDQ) and secondary measures Pelvic Floor Impact Questionnaire - 7 (PFIQ-7) and SF-36 Short Form Health Survey—were assessed fortnightly over 6-weeks for both groups. The compression SG self-assessed daily their body temperatures to monitor thermal impact. Data analysis involved descriptive analyses of the primary and secondary outcome measures scores by group and time-point, and multivariable linear regressions to assess between-group differences in change scores at 6-weeks from baseline while controlling for baseline factors.ResultsAfter controlling for baseline scores, gestational weeks and parity, statistically significant differences in NPRS and RMDQ change scores between groups were in favour of the compression SG. At 6-weeks, mean (SD) NPRS change scores in the compression SG and CG were significantly different, at −0.38 (2.21) and 2.82 (2.68), respectively, p = 0.003. Mean (SD) RMDQ change scores in the compression SG and CG were also significantly different, at 0.46 (3.05) and 3.64 (3.32), respectively, p = 0.009. A total of 883 (99.7%) of the reported daily self-assessed body temperatures ranged between 35.4 and 38.0 °C when wearing the compression shorts. At 6-weeks, mean (SD) PFIQ-7 and SF-36 change scores in the compression SG and CG were not significantly different.ConclusionCompression shorts are effective and thermally safe for prenatal management of pelvic and LBP.RegistrationTrial registration was not required (Australian Government Department of Health Therapeutic Goods Administration (TGA), 2018).

Short-term Outcomes of Non-robotic Single-incision Laparoscopic Sacrocolpopexy: A Surgical Technique

Our main purpose was to describe the surgical technique and short-term outcomes of single-incision laparoscopic sacrocolpopexy (S-LSC) for the treatment of pelvic organ prolapse (POP). This study consisted of a retrospective analysis of 49 consecutive cases. This study was set at the Third Affiliated Hospital of Guangzhou Medical University from October 2016 to November 2017. The population for this study consisted of women with stage II to IV POP who met eligibility criteria for laparoscopic surgery. S-LSC included the use of V-loc barbed suture and retroperitoneal tunneling, in addition to standard single-incision laparoscopic surgery techniques. All 49 cases were successfully completed. All cases included concomitant procedures; 42 (85.7%) had removal of the uterus and adnexa. The main measured outcomes include patient characteristics, perioperative outcomes, and change in pelvic floor support (Pelvic Organ Prolapse Quantification System), and quality of life (Pelvic Floor Impact Questionnaire). All patients were parous, and 42.9% had a history of previous abdominal surgery. The mean operative duration from skin to skin was 201.20 ± 46.53 minutes. The mean estimated blood loss was 27.0 ± 16.6 mL. The mean pre- and post-operative Pelvic Organ Prolapse Quantification System scores were 2.2 ± 1.1 cm versus -2.6 ± 0.5 cm for the Aa point and 3.2 ± 2.8 cm versus -4.6 ± 0.8 cm for the C point (p <.05 for both). The mean pre- and post-operative Pelvic Floor Impact Questionnaire scores were 106.4 ± 18.9 versus 8.9 ± 4.26 (p <.05), suggesting that S-LSC significantly improved physical prolapse and quality of life. Four patients suffered from postoperative complications (3 mesh exposure and 1 lumbosacral pain). Six patients complained of new onset of stress urinary incontinence. Single-incision laparoscopic sacrocolpopexy is a feasible method to manage POP. However, the long-term effects and complications need to be further investigated.

Transvaginal Natural Orifice Transluminal Endoscopic Surgery for Sacrocolpopexy: A Pilot Study of 26 Cases

Study ObjectiveTo describe the surgical technique and short-term outcomes for 26 cases of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) sacrocolpopexy for the treatment of pelvic organ prolapse (POP). DesignRetrospective case series study (Canadian Task Force classification II-2). SettingAcademic tertiary care university hospital in Guangdong, China. PatientsWomen diagnosed with stages II to IV POP between May 2017 and May 2018. InterventionsvNOTES sacrocolpopexy. Measurements and Main ResultsA total of 26 patients were identified. vNOTES sacrocolpopexy was standardized after case 4, and 23 cases were completed successfully. Operative duration was a median of 184 minutes (interquartile range, 158.5–202.5), and mean estimated blood loss was 30.87 ± 20.8 mL. Mean pre- and postoperative POP Quantification System scores for the Aa point were, respectively, 1.4 ± 1.7 cm (range, –2 to 3) versus –1.85 ± .6 cm (p <.0001) and for the C point were 2.2 ± 1.9 cm (range, –1 to 5) versus –6.1± .7 cm (p <.0001). Mean pre- and postoperative Pelvic Floor Impact Questionnaire scores were 163.1 ± 46.2 versus 18.4 ± 29.3 (p <.0001). These suggest significant improvements in both physical prolapse and quality of life at 1 month after surgery. There were no complications of mesh exposure, pain, hematoma, infection, or new urinary incontinence. ConclusionvNOTES is a feasible approach for sacrocolpopexy, with promising short-term efficacy and safety data. Larger studies across multiple sites and surgeons should evaluate the long-term efficacy and safety profile of vNOTES sacrocolpopexy.

Delay in Seeking Care for Pelvic Floor Disorders Among Caregivers.

In 2015, 44 million adults were informal, unpaid caregivers to an adult or child. Caregiving (CG) is associated with poor self-care, higher depression rates, and decreased quality of life. Our primary objective was to determine if CG is associated with a delay in seeking care for pelvic floor disorders (PFDs). We performed a cross-sectional survey of new urogynecology patients from September 2015 to January 2016. Subjects completed the Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire, Patient Reported Outcomes Measurement Information System-Depression surveys, and a survey of care-seeking practices. Caregiving was defined as considering one's self a primary caregiver and assisting with 2 or more activities and instrumental activities of daily living. Multiple logistic regression identified variables associated with delayed care-seeking for 1 or more year. Two hundred fifty-six patients completed the survey, 82 caregivers (32%) and 174 noncaregivers (NCGs). Sixty-seven percent of caregivers cared for a child and 33% for an adult. There was no difference between caregivers and NCGs in PFD symptom duration, Pelvic Floor Distress Inventory, or Patient Reported Outcomes Measurement Information System depression scores. Caregiving had higher mean Pelvic Floor Impact Questionnaire scores (69.6 vs 51.0, P = 0.02). There was no difference in proportion of patients who delayed care for 1 year or more (42% vs 54%, P = 0.08). A higher proportion of caregivers for an adult waited for 1 year or more (75% vs 42% NCG, P = 0.001). On multiple logistic regression, CG for adults only was associated with delaying care for 1 year or more (adjusted odds ratio, 3.73; confidence interval, 1.33-10.44; P = 0.01). One third of patients presenting to a urogynecology practice are caregivers. Caregiving for an adult was associated with a delay in seeking care for PFDs.

Reliability and validity of the Tigrigna version of the Pelvic Floor Distress Inventory-Short Form 20 (PFDI-20) and Pelvic Floor Impact Questionnaire-7 (PFIQ-7).

This study adapted the Pelvic Floor Distress Inventory-Short Form 20 (PFDI-20) and the Pelvic Floor Impact Questionnaire-7 (PFIQ-7) into the Tigrigna language of northern Ethiopia and validated the their reliability and validity through patient interviews. Expert translation, cognitive interviewing, and patient interviews using translated questionnaires were conducted. A subset of women was reinterviewed 1 week later. Intraclass correlation coefficients (ICC), Bland-Altman analysis, and Cronbach's alpha values were assessed. Total and subscale scores were compared between women with and without pelvic floor disorders (PFDs) using the Mann-Whitney U test. Spearman's correlation coefficients were used to compare severity of pelvic organ prolapse (POP) stage according to the POP Quantification (POP-Q) system and PFDI-20 and PFIQ-7 and subscale scores. Ten women participated in cognitive interviewing and 118 age 49±10years, mean ±standard deviation (SD) with and without PFDs were interviewed using the translated questionnaires, both of which presented adequate face validity and test-retest reliability [intraclass correlation coefficient (ICC) 0.765-0.969, p< 0.001]. Construct validity was significant between clinical symptoms and full forms (p <0.001) and their subscales (p <0.001), except for the Pelvic Organ Prolapse Impact Questionnaire (POPIQ). Differences between first and second scores on total PFDI-20 and PFIQ-7 and subscales largely fell within 0 ± 1.96 SD. Cronbach's alpha values were 0.891-0.930 for PFDI-20 and 0.909-0.956 for PFIQ-7 (p< 0.001). Analysis of known groups showed differences PFDI-20 and PFIQ-7 scores between women with and without PFDs (p <0.001 for full forms and subscales, except for anal incontinence (AI) and the Urinary Impact Questionnaire (UIQ)/POPIQ. The translated Tigrigna versions of the PFDI-20 and PFIQ-7 questionnaires are reliable, valid, and feasible tools to evaluate symptoms and quality of life (QoL) of Tigrigna-speaking Ethiopian women with PFDs.

Depressive symptoms screening in postmenopausal women with symptomatic pelvic organ prolapse

This study aimed to investigate the prevalence of depressive symptoms in postmenopausal women with symptomatic pelvic organ prolapse (POP) and to identify the factors associated with depressive symptoms in this population. We conducted a cross-sectional study involving postmenopausal women with symptomatic POP who visited the Center of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, between July 2016 and March 2017. We collected data pertaining to participants' sociodemographic characteristics and medical histories. The participants enrolled in the study were evaluated by POP quantification (POP-Q), the Pelvic Floor Distress Inventory-20 (PFDI-20), and the Pelvic Floor Impact Questionnaire-7 (PFIQ-7), and the severity of their depressive symptoms was assessed by the Patient Health Questionnaire-9 (participants with scores ≥10 were considered "positive" for depressive symptoms, whereas participants with scores <10 were considered "negative" for depressive symptoms). We performed independent-sample t tests, Mann-Whitney U test, chi-square tests, Fisher's exact test, and logistic regression to analyze our data. In all, 177 participants completed the entire study and were thus included in the analysis. Overall, 32.8% of participants were found to have depressive symptoms. We noted no differences in sociodemographic characteristics or POP-Q stage between participants with and without depressive symptoms (P > 0.05). However, depressive symptoms were associated with higher PFIQ-7 and PFDI-20 subscale scores (P < 0.001). PFIQ-7 subscale Urinary Impact Questionnaire (UIQ)-7 (odds ratio [OR] 1.038, 95% confidence interval [CI] 1.010-1.066, P = 0.008), PFDI-20 subscale UDI-6 (OR 1.025, 95% CI 1.007-1.044, P = 0.008), and Colorectal-Anal Distress Inventory-8 (OR 1.025, 95% CI 1.005-1.046, P = 0.016), which represented the impact on quality of life from lower urinary tract symptoms, the distress caused by lower urinary tract symptom and bowel dysfunction, respectively, were the risk factors that were independently associated with depressive symptoms after multiple logistic regression analysis. Depressive symptoms were present in approximately one-third of postmenopausal women with symptomatic POP. Depressive symptoms are not associated with POP stage, but are associated with the lower urinary tract symptom and bowel dysfunction scores attributable to prolapse. Clinicians should be mindful of whether patients with symptomatic POP have depressive symptoms and should address POP and any concomitant depressive symptoms as early as possible.

Effect of generalized anxiety disorders on the success of pessary treatment for pelvic organ prolapse.

Our aim was to evaluate the impact of generalized anxiety disorders (GAD) on the effectiveness of pessary treatment for pelvic organ prolapse (POP) in postmenopausal women. One-hundred and ten women with symptomatic POP who underwent pessary treatment were enrolled in this prospective study. Subjective evaluations of pelvic floor symptoms were assessed using the Pelvic Floor Distress Inventory (PFDI-20) and the Pelvic Floor Impact Questionnaire-7 (PFIQ-7), both at baseline and at the 3-month follow-up visit after pessary use. GAD was measured by the Generalized Anxiety Disorder-7 (GAD-7). Independent samples t tests, Mann-Whitney U test, chi-square test, Fisher's exact test, and Wilcoxon signed rank test were used to analyze data. Twenty-one patients (20.6%) had GAD at baseline. After 3months of pessary use, PFIQ-7, PFDI-20, and GAD scores were significantly improved in all participants (P < 0.001). In the GAD-negative group, total PFIQ-7 and PFDI-20 scores, including all subscales scores, were significantly decreased from baseline to posttreatment (P < 0.05). However, in the GAD-positive group, both PFIQ-7 and PFDI-20 scores, including subscales, were also significantly decreased from baseline to posttreatment (P < 0.05), except for subscale Colorectal-Anal Impact Questionnaire (CRAIQ-7) of PFIQ-7 (P = 0.225), which represented the impact on quality of life (QoL) from bowel dysfunction. Both groups of women with or without GAD showed significant improvement in QoL scores after 3months of pessary treatment. GAD had no influence on the success of pessary treatment for POP.

Effect of Mula Bandha Yoga in Mild Grade Pelvic Organ Prolapse: A Randomized Controlled Trial.

Background:Pelvic organ prolapse is the growing health issue related to women of the reproductive and postmenopausal age group in India and across the globe. Treatment option for pelvic organ prolapse includes both surgical and non-surgical intervention. The development of pelvic organ prolapse is an indication for major surgery among 20% of all women. Nevertheless, the recurrence of pelvic organ prolapse is detected among 58% of the patient after surgery. This highlights the need for preventive measures for reducing the impact of pelvic organ prolapse.Aims and Objective:To study the effect of 3 months yoga therapy in female patients suffering from mild pelvic organ prolapse.Material and Methods:50 Participants were allocated into two groups (25 in each group) by generating Random allocation sequence. Women aged 20-60 with symptomatic mild pelvic organ prolapse in the yoga group were offered Mulabandha yoga therapy along with other conventional treatment modalities, while the control group was only on conventional treatment. All participants gave written informed consent. An assessment was done by improvement in chief complaints and Pelvic Floor Distress Inventory-20 (PFDI-20) & Pelvic floor impact Questionnaire-7 (PFIQ-7) at baseline and at the end of 4, 8 & 12 weeks. Results At the end of 12 weeks, Post-study comparison between the two groups showed a significant improvement in chief complaints like perennial pain, P/V discharge, Perineal muscle laxity and Feeling of something coming out P/V (P < 0.001). Participants in the yoga group improved by (on average) 5.7 (95% confidence interval 3.1 to 14.7) points more on the PFDI-20 than did participants in the control group (P = 0.1) and a mean score of PFIQ-7 was also improved significantly.Conclusions:Although Mulabandha (Root Lock) yoga therapy led to a significantly greater improvement in PFDI-20 & PFIQ-7 scores the difference between the groups was below the presumed level of clinical relevance (15 points). More studies are needed to identify factors related to the success of Mulabandha (Root Lock) yoga therapy and to investigate long-term effects.

Prevalence of cognitive impairment in older women with pelvic floor disorders.

This study aimed to determine the prevalence of mild cognitive impairment (MCI) and early dementia among women >55 years seeking care for pelvic floor disorders (PFDs) and to describe the impact of cognitive impairment on condition-specific quality of life (QoL). We hypothesized that the prevalence of MCI would be at least 15% among this population. This was a cross-sectional study of English-speaking women >55 years presenting for evaluation of PFDs. We assessed baseline demographics and administered the Short Test of Mental Status (STMS) to screen for cognitive impairment. We predicted a sample of 196 would be needed for a precision of ±5% of the estimated sample prevalence in participants with PFDs. Chi-square tests were used to compare categorical variables and Student's t tests and analysis of variance (ANOVA) for continuous variables. Multivariate regression analysis was used to assess for any independent association with cognitive impairment and condition-specific QoL. Between July 2013 and July 2014, 211 participants were enrolled. The prevalence of MCI and early dementia were 15% [95% confidence interval (CI) 10.9-20.6; n = 32)] and 17% (95% CI 11.9-22.1; n = 36], respectively. Patients with MCI and early dementia had higher Patient Heath Questionnaire scores indicating greater depressive symptoms (p = 0.006) and higher overall Pelvic Floor Impact Questionnaire scores indicating worse condition-specific QoL (p = 0.008). MCI and early dementia were prevalent in our population seeking care for PFDs. Women with cognitive impairment experienced worse condition-specific QoL.

Hypoxia Induces Apoptosis through HIF-1α Signaling Pathway in Human Uterosacral Ligaments of Pelvic Organ Prolapse.

The purpose of this study is to evaluate the expression of hypoxia-inducible factor-1α (HIF-1α) in women uterosacral ligament tissues with pelvic organ prolapse and women with normal uterine support structures and illuminate its relationship with apoptosis. Samples were collected from 38 women with pelvic organ prolapse and 31 age matched controls. The expression levels of HIF-1α and BNIP3 in the uterosacral ligaments were measured using immunohistochemistry, qRT-PCR, and Western blot. To assess apoptosis we performed TUNEL assay and Western blot analyses. Lastly, the short form of the Pelvic Floor Impact Questionnaire-7 (PFIQ-7) was used to evaluate prognosis of surgical patients and twenty patients finished the follow-up. The expressions of HIF-1α and BNIP3 in the uterosacral ligaments were significantly higher in patients with pelvic organ prolapse than in control group. Pearson's correlation test revealed significant positive correlations between HIF-1α and apoptosis index. Similarly, Western blot analysis showed the expression of proapoptosis proteins (Bax and Bad), Cytochrome-c, cleaved caspase-3, and caspase-9 in patients with pelvic organ prolapse was upregulated. The PFIQ-7 scores were higher in HIF-1α positive group than in the negative group. Hypoxia may contribute to the pathological process of pelvic organ prolapse by increasing apoptosis via activating HIF-1α signaling pathway.