Pelvic Floor Muscle Dysfunction Research Articles

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<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<0.0001; ICa: 2.54±0.004 μm vs. 2.24±0.005 μm, p<0.0001; PCa: 2.85±0.001 μm vs. 2.17±0.001 μm, p<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.

Quantitative tools to assess pelvic floor muscle function - systematic review.

Urinary incontinence is pelvic floor muscles dysfunction, most often caused by a weakening of their strength. There are no guidelines on how to evaluate pelvic floor muscle function. Palpation is the most popular method of assessing pelvic floor muscle function, but it is subjective. The aim of the study was to review the objective methods used in the assessment of pelvic floor muscle function in women with urinary incontinence. A systematic literature review of the PubMed database was performed using the following keywords: ["Pelvic Floor" (mh)] AND [("Pelvic Floor Disorders" (mh)] OR ["Urinary Incontinence" (mh)]. The search was limited to English-language works published from 2011 to 2021. The inclusion criteria were interventional studies in which the pelvic floor muscle function of women with urinary incontinence was assessed using quantitative tools. Methods that cannot be used in the clinic were excluded from the analysis. Fifty-two articles were included in the analysis and five methods assessing the function of pelvic floor muscle were distinguished: manometry, electromyography (EMG), ultrasonography (USG), dynamometry, accelerometry. Manometry, EMG and USG are the most common objective methods of assessing pelvic floor muscle function. When taking measurements, it is important to choose the right position of the patient. The use of objective tools to assess the function of the pelvic floor muscle and obtaining quantitative and/or qualitative data allows us to precisely diagnose and monitor the treatment and rehabilitation progress.

Effectiveness of exercise interventions on urinary incontinence and pelvic organ prolapse in pregnant and postpartum women: umbrella review and clinical guideline development.

Dysfunction related to pelvic floor muscles (PFM) is common among pregnant and postpartum women and can cause symptoms such as urinary incontinence or pelvic organ prolapse (POP). As part of developing a nationwide clinical practice guideline for nursing in Finland, the aim of this umbrella review is to summarize the existing evidence about the effectiveness of exercise interventions on urinary incontinence and POP in pregnant and postpartum women. To promote knowledge translation, recommendations for health care professionals are presented. We conducted an umbrella review to summarize the existing evidence. The JBI methodology for umbrella reviews was used to guide the review. The level of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, and recommendations based on the evidence were formulated by a clinical guideline working group. Altogether, 9 systematic reviews, reporting findings from 89 original studies, were included. The methodological quality of the reviews was evaluated using JBI's checklist. The highest level of evidence was found for preventing the symptoms of postpartum urinary incontinence through exercise and pelvic floor muscle training (PFMT) during pregnancy. Moderate-level evidence showed that exercise and PFMT are likely to reduce the symptoms and severity of urinary incontinence, but the level of evidence was low on PFMT reducing the symptoms of POP. We recommend encouraging and guiding pregnant and postpartum women to exercise and train PFM. We also recommend identifying pregnant and postpartum women with symptoms of PFM dysfunction and directing them to a physiotherapist or other health care professional specializing in pelvic floor function.

The effect of myofascial therapy on postpartum rectus abdominis separation, low back and leg pain, pelvic floor dysfunction: A systematic review and meta-analysis.

During pregnancy and postpartum, changes in biomechanics can cause dysfunctions in the myofascial system, such as rectus abdominis diastasis, various types of pain, and pelvic floor dysfunction. These common postpartum problems seriously threaten women's health. Myofascial therapy, as an effective means of improving biomechanics, has no unified understanding of its therapeutic effects on postpartum functional disorders. This study aims to systematically evaluate the rehabilitative effects of myofascial therapy on postpartum rectus abdominis diastasis, low back and leg pain, and pelvic floor dysfunction through a meta-analysis of published randomized controlled trials. A systematic literature search of databases in Chinese and English was performed through May 2023. The treatment methods were randomized controlled studies using myofascial therapy in the treatment of rectus abdominis separation, lumbo-leg pain, and pelvic floor dysfunction. The main outcome indicators were abdominal circumference, rectus abdominis separation distance, visual analogue pain score, pelvic floor muscle potential, ability to live daily activities, number of events, and treatment effectiveness. There were 22 studies, including 2235 patients. The result showed that compared with control group, myofascial therapy demonstrated to reduce abdominal circumference and rectus abdominis separation index, improve lumbar function significantly, and decrease urinary incontinence and pelvic organ prolapse. In the myofascial therapy group, pelvic floor muscle strength was significantly enhanced, anterior/posterior resting potential of pelvic floor muscle was significantly decreased, and pelvic floor muscle potential was enhanced. Compared with the control group, the number of patients with various types of pain and pain scores were significantly reduced after myofascial therapy. When myofascial therapy lasted <4 weeks, pain relief was greater. In the myofascial therapy group, the ability to perform daily activities was significantly improved. An analysis of the effectiveness of the treatment showed that after myofascial therapy, the patient's symptoms improved significantly. There also saw low heterogeneity among all outcomes. The results suggested that myofascial therapy could effectively reduce rectus abdominis separation, relieve pelvic floor muscle dysfunction, enhance lumbar function, relieve pain, and improve the ability of daily living activities. All the data demonstrated that myofascial therapy had a good therapeutic effect on postpartum dysfunction.

Empowering pelvic floor rehabilitation: Unveiling technological innovations in the pelvic floor muscle chair; insights and hurdles in the pakistani context

Owing to the expeditious advancement of research and technology, the Physical therapy and rehabilitation sciences have made a remarkable pace in recent years. This blooming enhancement has metamorphosed pelvic floor dysfunction treatment and has a great impression on the medical and allied health sciences field. In this article, technological advancements in pelvic floor muscles are explored. It also overviews Pakistan- specific challenges and considerations[1]. Intending to help and manage patients with pelvic floor dysfunction, biofeedback training uses sensors to put forward real-time feedback on pelvic floor muscle activity. It has illustrated Potential enhancement in pelvic floor muscle functioning and curtailing symptoms of pelvic floor muscle dysfunction[2]. The pelvic floor muscles are stimulated using low-intensity electrical currents, resulting in solid muscle contraction, and strengthening. It is promising in improving pelvic floor muscle dysfunction and urine incontinence[3]. Behavioral therapy aims to modify the routines and behavior open to pelvic floor dysfunction. It necessitates lifestyle modifications, bladder retraining, and pelvic floor muscle exercises. It has victoriously improved pelvic floor muscle weakness and urinary incontinence as well[4]. Manual treatment methods that include physical manipulation of the pelvic floor muscles and associated tissues include trigger point release and myofascial release. These methods reduce muscular stress, enhance blood flow, and increase muscle function[5]. While developed nations have successfully incorporated modern technology into rehabilitation practices, the Pakistani context presents unique insights and challenges. The lack of updated curriculum, limited training opportunities, and budgetary constraints hinder the adoption of the latest technological advancements in pelvic floor rehabilitation in Pakistan. To overcome these hurdles, the following steps are recommended; Curriculum Update: Rehabilitation degree programs should revise their curricula to align with global advancements in technology. The inclusion of courses focusing on pelvic floor rehabilitation and modern technological interventions would better equip future professionals. Continuous Professional Development: Continuous professional development programs should be designed to upskill already graduated professionals in the field of pelvic floor rehabilitation technology. These programs will ensure that healthcare practitioners stay updated with the latest innovations and can effectively incorporate them into their practice. Increased Budget Allocation: Allocating a higher budget to the rehabilitation sector, specifically for technological advancements, is crucial. Adequate financial resources would enable the acquisition of state-of-the-art equipment, infrastructure development, and research initiatives, thereby facilitating the integration of technological innovations in pelvic floor rehabilitation. Finally, technological innovations have transformed the landscape of pelvic floor rehabilitation, offering new possibilities for improved outcomes. In the Pakistani context, addressing the insights and hurdles specific to the country is vital for empowering pelvic floor rehabilitation and ensuring that individuals with pelvic floor disorders receive the benefits of modern technology.

Proregenerative extracellular matrix hydrogel mitigates pathological alterations of pelvic skeletal muscles after birth injury.

Pelvic floor disorders, including pelvic organ prolapse and urinary and fecal incontinence, affect millions of women globally and represent a major public health concern. Pelvic floor muscle (PFM) dysfunction has been identified as one of the leading risk factors for the development of these morbid conditions. Childbirth, specifically vaginal delivery, has been recognized as the most important potentially modifiable risk factor for PFM injury; however, the precise mechanisms of PFM dysfunction after parturition remain elusive. In this study, we demonstrated that PFMs exhibit atrophy and fibrosis in parous women with symptomatic pelvic organ prolapse. These pathological alterations were recapitulated in a preclinical rat model of simulated birth injury (SBI). The transcriptional signature of PFMs after injury demonstrated an impairment in muscle anabolism, persistent expression of genes that promote extracellular matrix (ECM) deposition, and a sustained inflammatory response. We also evaluated the administration of acellular injectable skeletal muscle ECM hydrogel for the prevention of these pathological alterations. Treatment of PFMs with the ECM hydrogel either at the time of birth injury or 4 weeks after injury mitigated PFM atrophy and fibrosis. By evaluating gene expression, we demonstrated that these changes are mainly driven by the hydrogel-induced enhancement of endogenous myogenesis, ECM remodeling, and modulation of the immune response. This work furthers our understanding of PFM birth injury and demonstrates proof of concept for future investigations of proregenerative biomaterial approaches for the treatment of injured pelvic soft tissues.

(039) Improve Your Online Findability: Search Engine Optimization for Providers of Patients with Vulvovaginal Pain

Abstract Introduction Women with vulvovaginal pain struggle to find detailed, reliable information, accurate diagnoses, and knowledgeable providers. It often takes many years and visits to multiple providers to reach diagnosis. One of the many factors impeding their journey is the small amount of information written for patients and difficulty locating what is available. Objectives The goal of this project was the compare the search terms used by patients looking for information before diagnosis to the search terms required to locate the desired information. Additionally, we sought to use those results to craft tips and best practices for sexual medicine providers and societies to improve their findability. Lastly, a case study was performed on our own website to demonstrate effects on findability. Methods To characterize the search terms required to locate detailed, reliable information on vulvodynia, an analysis was conducted on five websites with relatively comprehensive information written for patients. Three of the websites are owned by societies and two by individual practices. The top one hundred keywords were identified for each website using SEMrush analysis of organic traffic of the root domain. To characterize the search terms patients with vulvovaginal pain used to look for information before diagnosis, polls were conducted of members of three large online support groups and received over 400 votes. Inductive coding was used to identify emergent themes in the search terms and keywords. Results Poll results showed that the search terms used by patients were centered on their experiences. More than 90% of search terms directly described physical symptoms (such as vulvar/vaginal pain or burning) or a task they have difficulty with (such as inserting a tampon or intercourse). Less than 10% of search terms used by patients were names of sexual dysfunctions or vulvovaginal pain conditions. In contrast, preliminary analysis of the search terms required to locate information written for patients by providers or societies consisted of less than 25% physical symptoms (with more than half of these keywords coming from a single website) and about 30% names of sexual dysfunctions or vulvovaginal pain conditions. Based on this large discrepancy between patient search terms and informational websites’ keywords, we offer suggestions to improve searchability of providers and societies websites, such as using patients’ search terms in headers and webpage titles, blogging, and including links in content. Conclusions Women with vulvovaginal pain conditions, e.g. vulvodynia, vestibulodynia, clitorodynia, and pelvic floor muscle dysfunction, struggle to find information about these medical conditions online, in part due to discrepancy between the search terms they are using and the keywords of the desired websites. Simple changes to provider and society websites can begin to bridge this gap and help women find information and knowledgeable providers faster. Disclosure No.

The relative activation of pelvic floor muscles during selected yoga poses

BackgroundIndividuals with pelvic floor muscle (PFM) dysfunction can benefit from core stabilization exercises. Yoga is a popular activity that can generate moderate to high trunk activity and has been shown to benefit this patient population. No data exist regarding PFM activity during yoga. Determining PFM activity will provide important information for developing an evidence-based exercise program. ObjectivesTo determine the relative activation of the PFM during select yoga poses. Study designCross-sectional design. MethodsPerianal surface EMG sensors were used to capture levator ani (LA) activation. Peak activity of a maximum voluntary isometric contraction (MVIC) represented 100% activity. For testing, subjects held the following poses for 30 s: locust; modified side plank; side angle; and hands-clasped front plank. The average EMG activity, expressed as a 100% percent of the MVIC (%MVIC), from 5 to 25 s of each pose was analyzed. ResultsSubjects generated the most activity (63.5 %MVIC) during the locust. Side angle (35.3 %MVIC) required greater activity than the side (29.1 %MVIC) and front planks (26.3 %MVIC). Locust activity was significantly greater (P < 0.001) than all poses; side angle activity was significantly greater (P < 0.01) than the front and side planks. ConclusionLA activation during locust was very high and sufficient for strength gains. LA activation during side angle, front plank, and side plank would be best for improving endurance and/or neuromuscular control of the PFM. Findings from this study showed differing levels of PFM activation across yoga poses that may benefit patients with pathology associated with PFM dysfunction.

Pathogenesis of dyspareunia associated with pelvic floor dysfunction: A review

Dyspareunia is a condition associated with a wide range of disorders. Pelvic floor dysfunction, manifesting as a myofascial syndrome or pelvic floor muscle hypertonia, may predict dyspareunia in women in different age groups. The review addresses the current view on the dyspareunia pathogenesis associated with pelvic floor muscle dysfunction.

Overactive Bladder Patients With and Without Urgency Incontinence: A Spectrum of One Condition or Different Phenotypes?

ABSTRACT The International Continence Society classifies overactive bladder (OAB) as a storage symptom syndrome characterized by “urgency, with or without urgency urinary incontinence, usually with increased daytime frequency and nocturia.” Although heterogenous in nature, some OAB patients exhibit only frequency and urgency (“OAB-dry”), whereas others exhibit frequency and urgency with urgency incontinence (“OAB-wet”). This study aimed to further explore the unique features of each of these diagnoses via comparison of data for women seeking lower urinary tract symptom (LUTS) care, including data such as physical examination findings, self-reported symptoms, and demographic data. Better understanding of OAB-wet and OAB-dry definitive features may lead to more effective treatment. Through the LURN (Lower Urinary Tract Dysfunction Research Network)—sponsored via the research network NIDDK (National Institute of Diabetes and Digestive and Kidney Diseases)—physical examination, demographic data, and questionnaire data were obtained for women seeking LUTS-based care at 6 centers in the United States. Enrollment entailed categorization of patients into urinary incontinence subtypes, as determined by LURN clinical staff from patient LUTS Tool responses. Subgroups included both OAB-dry and OAB-wet categories, as well as a control LUTS group lacking symptoms. The multicenter data set found 545 LUTS-presenting women, with 84 patients being defined as OAB-wet, 56 patients defined as OAB-dry, and 67 patients defined as the control population. The study population was predominantly White (83%), with mean age of the cohort as 58.8 ± 14.1 years. Demographics did not vary between the categories. The groups experienced very similar symptoms, except OAB-wet patients had urgency incontinence, and OAB-dry reported significantly more bladder pain, incomplete emptying, and straining to urinate. Both OAB groups exhibited identical levels of frequency, nocturnal, urgency, and level of bother. Both OAB groups experienced more bother than controls. However, bother for OAB-wet was directly related to severity of incontinence, and bother for OAB-dry was directly related to pelvic floor tenderness on examination. These results may indicate that the individual conditions hail from divergent etiologies, which contradicts traditional disease concepts. Since OAB-dry patients commonly report sensations of incomplete emptying, bladder pain, and straining to urinate, the authors hypothesized that these symptoms may represent a pelvic floor muscle dysfunction rather than a true bladder pathology. This hypothesis is based on the significant overlap between bladder symptoms of OAB-dry and bladder symptoms in high-tone pelvic floor dysfunction (HTPFD) patients (or those with myofascial pelvic pain). Possible causes were this to be the case might be changes in muscle function leading to alterations in the resting angle of the urethrovesical junction and irritation of the bladder neck or urethra. In addition, neuromuscular dysfunction may lead to symptoms of HTPFD and OAB. Strengths of this study include its large study parameters involving multiple centers across the nation, including all patients seeking care for LUTS. Because most women in the study were White, generalizability of the study to a more diverse patient population is limited. In addition, patient self-reporting of incontinence type lacked simultaneous objective testing. Moreover, significant pelvic pain excluded patients from this cohort, which may have excluded patients with more severe forms of OAB-dry from the study population. Although traditionally grouped and treated together under a larger OAB diagnosis, OAB-wet and OAB-dry have unique symptomatic features, suggesting divergent etiologies. Unique symptoms such as pain, a feeling of incomplete emptying, and straining with urination all suggest pelvic floor myofascial dysfunction for OAB-dry patients. Further examination of a distinct pathophysiology for these 2 groups is warranted.

Gynecological prerequisites for the development of chronic pelvic pain syndrome – diagnosis and treatment (Literature review)

Chronic pelvic pain syndrome is a complex process and mostly includes several organ systems. The gynecologic aspects of chronic pelvic pain syndrome can be divided into four distinct components: intra-abdominal pain, vaginal pain, pelvic floor pain, and sexual pain. The сommon gynecological causes of chronic pelvic pain are endometriosis, adenomyosis, vulvovaginal pain syndrome, pelvic floor muscle dysfunction, and sexual pain in women.This article describes the gynecological examination of patients with chronic pelvic pain and discusses the most common gynecological diseases and methods of their treatment. A review of the literature was conducted, which included the recommendations of the International Society for Urinary Incontinence, the European Association of Urology, and the International Association for the Study of Pain.Gynecological examination of patients with chronic pelvic pain begins with a history taking and physical examination. Laboratory tests, imaging examinations, and diagnostic procedures can be used additional methods to make a more accurate diagnosis. Treatment methods include physical therapy, medication, trigger point injections, and surgery.Because the diagnosis and treatment of chronic pelvic pain can be complex, it is important that physicians know the various aspects of this syndrome to be able to provide appropriate care for patients. Detailed history taking and physical examination for identifying the cause of the pain can help to determine the next step in evaluation and treatment. However, gynecological pathology is one of many, but not the only, that can be associated with chronic pelvic pain. This, it is necessary to perform a multimodal and multidisciplinary approach in the management of patients with chronic pelvic pain.

Pelvic floor dysfunction and its impact on quality of life among female health care employees.

In today's fast-paced world, both men and women have to be equally competent to handle their responsibilities in order to look after their family members and children. In this pace of competency women tend to forget to take care of their own health and face many health issues, including pelvic floor dysfunction. This study aimed to analyse the prevalence rate of pelvic floor dysfunction among the working women in regards to their age and body mass index as well as their quality of life. One hundred sixty one post-partum working female participants from the medical fraternity were involved in this study after their consent was obtained. Pelvic floor muscle strength was assessed and their quality of life measured using King's health questionnaire. There was a strong correlation between the pelvic floor muscle dysfunction and its impact on the quality of life among the females with increasing age. Significant statistical significant difference of P(<0.0001) was noted. Pelvic floor dysfunction among females has a direct impact on their quality of life.

Pelvic Pain and Pelvic Floor Muscle Dysfunction in Women Seeking Treatment for Prolapse.

Pelvic floor muscle dysfunction (PFMD) can cause pelvic pain, but its associations with pelvic organ prolapse (POP) and POP treatment outcomes are poorly understood. The objectives of this study were to determine (1) if pelvic pain is associated with PFMD in women seeking POP treatment and (2) if baseline PFMD in women seeking management of POP is associated with improvement in pelvic pain at 12 months. This was an ambispective cohort study of women enrolled at one site of the Pelvic Floor Disorders Registry. Pelvic floor muscle dysfunction was identified if tenderness was reported on a standardized pelvic floor muscle examination at baseline. Outcomes included a pelvic pain questionnaire (score 0-70, assessed pain in the past 24 hours in 7 pelvic locations) and the Global Health-10 overall average pain rating (0-10). One hundred forty-four women planning surgery (118) or pessary (26) were included. Twenty (13.9%) had baseline PFMD. Women with PFMD versus no PFMD had greater baseline Pelvic Pain scores (median [IQR], 9.7 [4-23] vs 2.5 [0-7], P < 0.001) and overall average pain (4 [3-6] vs 1 [0-3], P < 0.001). In 107 women with 12-month treatment outcomes, those with PFMD at baseline had greater improvement in pelvic pain compared with those without PFMD (change score -6.5 [-15.2 to 0] vs 0 [-3 to 0] respectively, P = 0.03). Overall pain improved after treatment in the no PFMD group but not in the PFMD group. Patients with baseline PFMD vs none undergoing treatment for prolapse had higher baseline pelvic pain and greater improvement in pelvic pain at 12 months.

Strength and Bioelectrical Activity of the Pelvic Floor Muscles and Sexual Function in Women with and without Stress Urinary Incontinence: An Observational Cross-Sectional Study.

Stress urinary incontinence (SUI) results from an increase in intravesical pressure, which exceeds the pressure at which the urethra remains closed. Symptoms cause social and sexual intercourse discomfort directly or indirectly, which affect health-related quality of life and are associated with pelvic floor muscle (PFM) dysfunction. We aimed to verify the variation in strength and PFM bioelectrical activity and sexual function in women with SUI. Additionally, we analyzed the impact of this dysfunction on quality of life. This was an observational cross-sectional study. Women aged 25-55 years with frequent sexual intercourse were included. Women with SUI were included in a study group (G2, n = 17), and those without any type of incontinence were included in a control group (G1, n = 16). Primary outcomes were level of strength and PFM bioelectrical activity and sexual function as determinants of worse SUI in the control group. Secondary outcomes were associated between the primary outcomes and severity of urinary loss, impact on daily life, and quality of life in women with SUI. In the domains evaluated in the Female Sexual Function Index (FSFI), only sexual desire was lower in women with SUI (G2) than in the controls (p = 0.033). During analysis of G1 variables, a positive and moderate correlation was observed between power/myoeletric activation and maximum voluntary contraction (MVC) (p &lt; 0.01), peak (p &lt; 0.01), and mean amplitudes (p = 0.017). There was a high positive correlation between sexual arousal and other variables, including vaginal lubrication, sexual orgasm, and total FSFI value (p &lt; 0.001 for all analyses). During evaluation of G2 variables, the MVC was positively correlated with the peak and mean amplitudes (p &lt; 0.0001). Additionally, there was a high and positive correlation between the mean amplitudes (%MVC) and personal relationships (KHQ) (p = 0.001); the same was observed between the total (ICIQ) and activities of daily living (ICIQ) (p &lt; 0.0001). Therefore, women with SUI presented with lower sexual desire and bioelectric activity but were not related to PFM strength. Additionally, the domains of sexual function and certain variables of quality of life are aggravated by SUI.

Pelvic Pain in Transgender People Using Testosterone Therapy.

Purpose: This descriptive study aimed to assess the characteristics of pelvic pain and explore predictive factors for pelvic pain in transgender (trans) individuals using testosterone therapy. Methods: An online cross-sectional survey was open between August 28, 2020, and December 31, 2020, to trans people presumed female at birth, using testosterone for gender affirmation, living in Australia, and >16 years of age. The survey explored characteristics of pelvic pain following initiation of testosterone therapy, type and length of testosterone therapy, menstruation history, and relevant sexual, gynecological, and mental health experiences. Logistic regression was applied to estimate the effect size of possible factors contributing to pain after starting testosterone. Results: Among 486 participants (median age = 27 years), 351 (72.2%)* reported experiencing pelvic pain following initiation of testosterone therapy, described most commonly as in the suprapubic region and as "cramping." Median duration of testosterone therapy was 32 months. Persistent menstruation, current or previous history of post-traumatic stress disorder, and experiences of pain with orgasm were associated with higher odds of pelvic pain after testosterone therapy. No association was observed with genital dryness, intrauterine device use, previous pregnancy, penetrative sexual activities, touching external genitalia, or known diagnoses of endometriosis, vulvodynia, vaginismus, depression, anxiety, or obesity. Conclusions: Pelvic pain is frequently reported in trans people following initiation of testosterone therapy. Given the association with persistent menstruation and orgasm, as well as the known androgen sensitivity of the pelvic floor musculature, further research into pelvic floor muscle dysfunction as a contributor is warranted.

Prevalence of diastasis m. rectus abdominis and pelvic floor muscle dysfunction in postpartum women.

The aim of this study was to determine the prevalence of Diastasis of the rectus abdominis muscles (DRAM) and pelvic floor muscle dysfunction (PFMD) in postpartum women.Design: The observational prospective study. 150 of 180 women (83.3 %) from 6 weeks to 6 months postpartum, with a mean age of 33.1 years. For diastasis examination, inter recti distance (IRD) was measured by a linear 2D ultrasound probe, 4.5 cm above the navel, in its area and 4.5 cm below the navel when lying on the back at rest and under a load test. The degree of DRAM was classified intofour grades. Urinary leakage symptoms were assessed by the International Incontinence Consultation Questionnaire (ICIQ - UI SF). The first degree of diastasis during the load test was 38.1 % above the navel, 36.4 % in the navel area, and 23.7 % below the navel. The second degree of diastasis with load was 28.8 % above the navel, 21.2 % in the navel area, and 10.2 % below the navel. PFMD showed 31.3 % of women with mild symptoms of SUI, 32.2 % of women with grade 1 cystocele. The average IRD distance at rest and during the load test confirmed the first grade of DRAM out of four degrees of severity. Moderate and medium DRAM occurred according to location in an average of one-third of the cases. The highest percentage of DRAM was above the navel, and the lowest percentage below the navel. PFMD was detected in an average of one-third of cases. It is important to monitor these parameters with a view to improving the quality of life index in the future (Tab. 5, Ref. 22).

Interdisciplinary consensus on the use of high-intensity magnetic stimulation in the treatment of pelvic floor muscle dysfunction manifested by anal incontinence

This paper presents interdisciplinary consensus on the use of protocols of high-intensity magnetic stimulation for the treatment of pelvic floor muscles dysfunction with anal incontinence in Russia.AIM: to highlight the discussion and the decision-making on the basis of an interdisciplinary consensus on the use of a new algorithm of peripheral and transcranial magnetic stimulation in the treatment of pelvic floor muscles dysfunction with the clinic of anal incontinence.RESULTS: the adoption of this consensus can serve as a basis for further research of this problem and optimize the results of treatment of patients with pelvic floor muscle dysfunction with anal incontinence. The data may be interesting for a wide range of medical specialists: general practitioners, gastroenterologists, coloproctologists, surgeons, neurosurgeons, gynecologists, urologists — anyone who encounter with manifestations of this disorder in a routine practice and chooses diagnostic and treatment options.CONCLUSION: protocols for the treatment of anal incontinence using high-intensity magnetic stimulation aimed at improving the quality of treatment of patients with anal incontinence are based on the Russian experience of using the methods discussed and the analysis of the results obtained are validated.

Muscle stem cells and fibro-adipogenic progenitors in female pelvic floor muscle regeneration following birth injury

Pelvic floor muscle (PFM) injury during childbirth is a key risk factor for pelvic floor disorders that affect millions of women worldwide. Muscle stem cells (MuSCs), supported by the fibro-adipogenic progenitors (FAPs) and immune cells, are indispensable for the regeneration of injured appendicular skeletal muscles. However, almost nothing is known about their role in PFM regeneration following birth injury. To elucidate the role of MuSCs, FAPs, and immune infiltrate in this context, we used radiation to perturb cell function and followed PFM recovery in a validated simulated birth injury (SBI) rat model. Non-irradiated and irradiated rats were euthanized at 3,7,10, and 28 days post-SBI (dpi). Twenty-eight dpi, PFM fiber cross-sectional area (CSA) was significantly lower and the extracellular space occupied by immune infiltrate was larger in irradiated relative to nonirradiated injured animals. Following SBI in non-irradiated animals, MuSCs and FAPs expanded significantly at 7 and 3 dpi, respectively; this expansion did not occur in irradiated animals at the same time points. At 7 and 10 dpi, we observed persistent immune response in PFMs subjected to irradiation compared to non-irradiated injured PFMs. CSA of newly regenerated fibers was also significantly smaller following SBI in irradiated compared to non-irradiated injured PFMs. Our results demonstrate that the loss of function and decreased expansion of MuSCs and FAPs after birth injury lead to impaired PFM recovery. These findings form the basis for further studies focused on the identification of novel therapeutic targets to counteract postpartum PFM dysfunction and the associated pelvic floor disorders.

Sexually Induced Orgasm to Improve Postpartum Pelvic Floor Muscle Strength and Sexual Function in Primiparous Women After Vaginal Delivery: A Prospective Randomized Two-Arm Study

BackgroundPostpartum pelvic floor dysfunction is known to affect the quality of life of women and the methods to treat it are more complex with majority requiring training under supervision. AimTo compare the efficacy of sexually induced orgasm along with Kegels exercises versus Kegels exercises alone as a treatment method to enhance postpartum pelvic floor muscle strength and sexual function in primiparous women undergoing uncomplicated vaginal deliveries. MethodsThe prospective randomized two-arm study was conducted on sexually active primiparous women who had undergone uncomplicated vaginal deliveries. Those with risk factors for female sexual dysfunction and pelvic floor muscle dysfunction were excluded. Participants in Group 1 were advised daily Kegel's exercises, whereas, those in Group 2 were advised to initiate self-initiated/partnered sexual activity-induced orgasms along with daily Kegel's exercises. Their pelvic floor muscle strength on voluntary contraction, ability to relax pelvic floor voluntarily, and sexual function (using FSFI-6) were assessed monthly for 6 months and the analysis was done using G* Power software (© 2021 Heinrich-Heine-Universität Düsseldorf, Germany). Main Outcome MeasurePostpartum pelvic floor strength and sexual function in 2 groups of women under study. ResultsThe study period was from January 2020 to December 2020. The Group 1 had 26 participants (mean age 29.69 ± 2.2 years) and Group 2 had 29 participants (mean age 30.07 ± 2.57 years). The sexual function as well as ability to relax pelvic floor were significantly better in Group 2 compared to Group 1 at each monthly intervals whereas strength of pelvic floor muscles during voluntary contraction was significantly higher in Group 2 compared to Group 1 at the end of 6 months and it was statistically significant at a P value of .05. Clinical ImplicationsNovel method of using naturally occurring sexually induced orgasms for postpartum pelvic floor rehabilitation can revolutionize postpartum pelvic floor training in women, as it can be practiced at home with ease, along with easily performable Kegel's exercises. Strengths and LimitationsUse of prospective randomization and minimization of confounding factors is the strength of the study. The small sample size is the limitation of the study. ConclusionsPostpartum pelvic floor muscle strength and sexual function in primiparous women who have undergone uncomplicated vaginal deliveries can be significantly improved with the addition of sexually induced orgasm as a therapeutic tool along with physical exercises such as Kegels exercises in these women.Bhat GS, Shastry A. Sexually Induced Orgasm to Improve Postpartum Pelvic Floor Muscle Strength and Sexual Function in Primiparous Women After Vaginal Delivery: A Prospective Randomized Two-Arm Study. J Sex Med 2022;19:1634–1643.

Effects of Labor Analgesia on Pelvic Floor Function at 6 to 8 Weeks after Delivery: A Prospective Cohort Study.

The aim of the study is to determine whether the use of labor analgesia had a higher risk of pelvic floor functional problems after delivery. All primiparas who delivered at our hospital between June 2019 and May 2020 were enrolled in the study. They were divided into two groups according to their choices: delivery with labor analgesia (analgesia group, n = 76), and delivery without labor analgesia (nonanalgesia group, n = 78). The primary outcome of the study was to test the pelvic floor function by electromyography (EMG) at postpartum 6 to 8 weeks. Participants also completed questionnaires including Pelvic Floor Distress Inventory (PFDI-20), International Consultation on Incontinent Questionnaire-Short Form (ICIQ-SF), and Overactive Bladder Symptom Score (OABSS) at postpartum 6 to 8 weeks. Primiparas in the analgesia group experienced longer first and second stages of labor (p< 0.05), and had significantly higher PFDI-20 scores at postpartum 6 to 8 weeks (p< 0.05). But the differences in ICIQ-SF, OABSS scores, and Pelvic Organ Prolapse Quantification (POP-Q) system between the two groups were not significant (p > 0.05). No statistically significant difference was found in class II and class I muscles, scores of pretest resting baseline, and posttest resting baseline between primiparas with or without labor analgesia (p > 0.05). Our results strongly confirmed that labor analgesia did not increase the risk of pelvic floor dysfunction up to 6 to 8 weeks after delivery, although symptom burden might be increased after labor analgesia. · Labor analgesia did not increase risk of pelvic floor muscle dysfunction after delivery.. · There are longer first and second stages of labor in primiparas with labor analgesia.. · Primiparas with labor analgesia had more obvious subjective symptoms of PFD..