Pelvic Floor Muscle Function Research Articles

Chemoradiation for cervical cancer treatment portends high risk of pelvic floor dysfunction.

GoalTo assess the impact of chemoradiation on pelvic floor (PF) muscle function after the treatment of cervical cancer (CC).MethodsWe performed a prospective cohort study of women between the ages of 20 and 70 years old who had a diagnosis of CC. Patients were treated with chemoradiation at the Barretos Cancer Hospital (BCH), between August 2016 and July 2017. We performed three evaluations at different time points after chemoradiation treatment to compare changes in muscle function. Pelvic floor muscle function was assessed through perineometry (PNM) and surface electromyography (EMG) at the following time points: Pretreatment Moment 1 (M1): evaluated before chemoradiation; Moment 2 (M2): at the first follow-up medical visit (usually 3 to 4 months after treatment); and Moment 3 (M3): at the second follow-up medical visit (usually after 6 to 9 months after treatment). Mean vaginal squeeze pressure levels were determined by PNM and muscle electromyographic activity by EMG and the results were evaluated by Generalized Linear Model comparisons.ResultsForty-nine patients were evaluated at M1; 35 at M2; and 32 at M3, so that 32 patients had all three muscle evaluations performed. There was a statistically significant increase in the frequency of women with urgency urinary incontinence at the M2 evaluation time (41.9%), compared to pretreatment M1 (18.6%), p<0.001. The means of the vaginal squeeze pressures reduced through M1 to M3 in the phasic (M1: 17.7 mmHg; M3: 11.27mmHg) and tonic contractions (M1: 10.56 mmHg; M3: 7.52mmHg), p = 0.01 and p = 0.03 respectively. There was no difference in pelvic floor function in the three evaluations M1-M3, measured by EMG. The pelvic floor strength assessed by PMN and their interactions with anthropometric, parity and hormonal status variables, showed that a high body mass index (BMI) significantly influenced decreases in pelvic floor muscle function before and after treatment.ConclusionThese results show that chemoradiation causes reduction of muscle function of the pelvic floor, especially in the late phase after the end of treatment. Both the high BMI and urgent urinary incontinence symptoms were related to decreased muscle strength.

Change in prevalence of major levator ani muscle defects from 6 weeks to 1 year postpartum, and maternal and obstetric risk factors: A longitudinal ultrasound study.

The present study aimed first to investigate the change in prevalence of major levator ani muscle (LAM) defects, also called avulsions, from 6weeks to 1year postpartum, and second to assess maternal and obstetric risk factors for having persistent major LAM defects/avulsions at 1year postpartum. This is a secondary analysis of data from a prospective cohort study including 300 nulliparous women at 17-19weeks of gestation. Major LAM defects were diagnosed at 6weeks and 1year postpartum using transperineal ultrasonography. We defined persistent major LAM defects as a defect diagnosed both at 6weeks and 1year postpartum. Maternal and obstetric data were obtained from the hospital's electronic birth records. Pelvic floor muscle function was measured vaginally by manometer at 21weeks of gestation. The main outcome measurement was change in prevalence of major LAM defects. Maternal and obstetric risk factors for having persistent major LAM defect were also assessed. Prevalence of major LAM defects was 19.4% at 6weeks and 10.4% at 1year postpartum. No new major LAM defects were diagnosed at 1year postpartum. Persisting major LAM defects were associated with longer second stage of labor (median 74.5minutes vs median 48.0minutes, P=.012) and higher neonatal birthweight (mean difference of 232.3g, 95% confidence interval [CI] 21.5-443.1). Vacuum delivery was independently associated with persistent major LAM defects, adjusted OR 3.0 (95% CI 1.0-9.0). There was a 50% reduction of sonographically diagnosed major LAM defects from 6weeks to 1year postpartum. This finding suggests that assessment of the major LAM 6weeks postpartum may be too early to diagnose defects/avulsions. Long second stage of labor, high neonatal birthweight and vacuum delivery were associated with persistent major LAM defects/avulsions.

Efficacy of bio-assisted pelvic floor muscle training in women with pelvic floor dysfunction

ObjectivesTo evaluate the efficacy of 12-week pelvic floor muscle training (PFMT) using bio-assisted surface electromyography (EMG) feedback in women with complex pelvic floor dysfunction (PFD); to further differentiate the effect of exercise adherence from the biofeedback per se; and to assess and compare the severities of overactive bladder (OAB) symptoms, stress urinary incontinence (SUI), and stage of prolapse with the women’s perception of symptom cure or improvement following the program. Study designThis prospective observational study was conducted between December 2015 and November 2018 at a medical center in Taiwan. It included 83 women with PFD, manifesting solely as either OAB or SUI with (group 1) or without (group 2) concomitant stages I and II pelvic organ prolapse (POP). All women underwent a 12-week bio-assisted PFMT. The main outcome was the electromyographic activity of the pelvic floor muscles (PFMs). The severities of OAB symptoms, SUI, and stage of POP were assessed both subjectively and objectively before and after the intervention. ResultsA notable improvement of PFM function was identified after 12 weeks of training in all women with PFD. The number of effective PFM contractions achieved during bio-assisted PFMT was positively correlated with the improvement of PFM function in both groups of women in different body positions, except in the standing position in group 2. Exercise adherence, however, had no significant impact on the efficacy of the training. There was a significant improvement over time and high consistency between subjective and objective improvements of OAB symptoms and SUI severity after the completion of PFMT. Nonetheless, only the Ba point of the POP-Quantification system in women with POP showed a significant improvement after the intervention. ConclusionPFMT using surface EMG biofeedback significantly improves PFM function in women with complex PFD, and thus, has a significant therapeutic effect on OAB, SUI, and bladder prolapse.

Four-Dimensional Introital Ultrasound in Assessing Perioperative Pelvic Floor Muscle Functions of Women with Cystoceles.

Research on the use of ultrasound to explore the pelvic floor in women is rarely done with introital ultrasound. This study aimed to investigate the performance of four-dimensional (4D) introital ultrasound in the perioperative assessment of pelvic floor muscle (PFM) function in women with cystocele. The reliability and agreement of ultrasound measurements were determined by intraclass correlation coefficients (ICC) with 95 % confidence interval and Bland-Altman analysis in 20 women. The validity of ultrasound parameters was assessed by correlating squeezing ultrasound measurements with the modified Oxford scale (MOS) in 317women. 4D introital ultrasound data of 241 women with (n = 29) and without (n = 212) postoperative cystocele at the 12-month postoperative assessment were retrospectively analyzed. Levator avulsion was diagnosed using tomographic ultrasound imaging. Involuntary and voluntary PFM functions were explored by dynamic changes in the bladder neck and genital hiatus, respectively, upon coughing and squeezing on 4D introital ultrasound. The ICC for the reliability of all tested ultrasound parameters was good to very good. The changes and change ratios of most ultrasound measurements from resting to squeezing were fairly correlated with MOS. Women with postoperative cystocele demonstrated more rates of complete levator avulsion [41.3 % vs. 4.7 %, P < 0.001, odds ratio (OR) 14.26, 95 % confidence interval (CI) 4.88-42.42] and fewer rates of capable voluntary PFM contraction (65.5 % vs. 92.5 %, P < 0.001, OR 0.16, 95 % CI 0.06-0.43) than those without postoperative cystocele postoperatively. 4D introital ultrasound is feasible to assess perioperative PFM function in women with cystocele.

The Influence of Early Exercise Postpartum on Pelvic Floor Muscle Function and Prevalence of Pelvic Floor Dysfunction 12 Months Postpartum

There is limited knowledge on how exercise impacts the pelvic floor muscles (PFM) and prevalence of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) postpartum. The purpose of this study was to investigate whether early onset of general exercise postpartum negatively affects the PFM and/or increases the risk of SUI and POP 12months postpartum. This study used a prospective cohort design. At 6weeks postpartum, 57 women classified as exercisers (exercising ≥3 times at ≥30min/wk) were compared with 120 nonexercisers (mean age=29 years, SD=4.3). Manometry was used to measure vaginal resting pressure, PFM strength, and PFM endurance, and symptoms of SUI and POP were assessed using questionnaires. Data were presented as standardized beta coefficients (B) and odds ratios (OR). No differences were found between exercisers (n=57) and non-exercisers (n=120) at 6weeks postpartum on vaginal resting pressure (B=-0.04 [95% CI=-3.4 to 2.1]), PFM strength (B=0.03 [95% CI=-4.7 to 7.4]), PFM endurance (B=-0.02 [95% CI=-59 to 46]), or symptoms of SUI (OR=0.51 [95% CI=0.25 to 1.1]) or POP (OR=0.62 [95% CI=0.26 to 1.5]) measured at 12months postpartum. Adjusting for covariates, women with body mass index between 25 and 29.9 and>30 were more likely to report SUI 12months postpartum (OR=2.2 [95% CI=1.0 to 4.7] and OR=3.3 [95% CI=1.2 to 9.4], respectively). Women with physically strenuous occupations were more likely to report POP 12months postpartum (OR=3.0 [95% CI = 1.2 to 7.3]). This study suggests that regular exercise 6weeks postpartum has no negative effect on PFM function or on SUI or POP. Being overweight, however, was associated with more SUI, and women with physically strenuous occupations reported more POP. Results from this study suggest that first-time mothers should be encouraged to start general exercise within the first 6weeks after giving birth. Women at risk for PFD should be advised accordingly and potentially modifiable risk factors should be addressed prior to delivery. First-time mothers are encouraged to talk with a physical therapist about starting regular general exercise in the early postpartum weeks. Health care providers should advise patients on possible preventive measures for women at risk for PFD.

Effects of individual pelvic floor muscle training vs individual training progressing to group training vs group training alone in women with stress urinary incontinence: A randomized clinical trial.

To assess the effects of individual pelvic floor muscle (PFM) training vs individual training (IT) progressing to group training (GT) vs group-only training in women with stress urinary incontinence (SUI). Randomized controlled and pragmatic clinical trials with 90 women with SUI. Participants were randomly allocated to one of three groups: IT, GT, or four individual sessions progressing to group training (IPGT). The intervention included 12 sessions, once a week, with direct supervision by a physical therapist. severity according to the King's Health Questionnaire. PFM function by palpation and manometer, bladder and exercise diaries, PFM training adherence, and self-efficacy. Reassessments were conducted at the end of the intervention, 3 and 6 months after the intervention. Intra- and intergroup analysis for all outcomes was performed using a multivariate analysis of variance. In the mixed-effects model used, the evaluation groups and times and their interactions were considered. A significance level of 5% was adopted. After the intervention, the severity measure improved in all three groups (P < .001), without difference between them (P = .56). The benefits of the intervention were maintained 3 and 6 months after the end of the supervised training (P < .001). The IPGT group had a significant improvement in PFM function when compared to the other groups posttreatment (P < .001). PFM training improved the severity of urinary incontinence in all groups after 12 sessions of training supervised by a physical therapist. IT progressing to GT improved the function of upper PFM when compared to the other groups.

Reliability of manometry for assessing pelvic floor muscle function in healthy men.

ObjectivesTo the best of our knowledge, no study has examined the reliability of assessment methods for male pelvic floor muscle (PFM) function. Therefore, this study aimed to clarify the reliability of manometry with an anal sensor (Peritron cat 9300A) to assess PFM function in healthy men.MethodsHealthy male subjects (n = 21) without urinary leakage underwent testing to assess PFM function, and intra‐ and interrater reliability tests among examiners were performed. The PFM function included maximal anorectal squeeze pressure, endurance, mean anorectal squeeze pressure, gradient, and area under the curve during PFM voluntary contraction.ResultsParticipants had a median age of 38 years (range 26‐51), and a mean BMI of 23.2 ± 2.0 kg/m2. Satisfactory intra‐ and interrater reliability scores were found for resting pressure, anorectal squeeze pressure, and endurance. The intra‐rater reliability of resting pressure, anorectal squeeze pressure, and endurance were 0.71, 0.89, and 0.75 for examiner 1 and 0.72, 0.89, and 0.87 for examiner 2. The interrater reliability for resting pressure, anorectal squeeze pressure, and endurance were 0.58, 0.93, and 0.61, respectively.ConclusionsThis is the first prospective study showing the favorable intra‐ and interrater reliability of manometry for PFM function in healthy men. Our findings demonstrated that manometry can provide both reliable and reproducible data regarding PFM function in continent men, suggesting Peritron cat 9300A can be used to evaluate the PFM function in men.

Predictors of pelvic muscle exercise on the self‐efficacy of women giving birth

AbstractThis article is a reported of a study of the relationship between lower urinary tract symptoms and pelvic muscle exercise attitudes as well as effects on the self‐efficacy in childbirth women. Pregnancy and childbirth are normal physiological processes, but their effects on the genitourinary system are great. The enlarged uterus resulting from foetal growth is a major cause of urinary incontinence because it affects the tissues supporting the female pelvis and causes relaxation of the pelvic floor muscle and lower urinary function. A descriptive research study was performed from August to November 2017. Overall, 141 women after childbirth were conducted who living in South Korea. The outcome measure was the lower urinary tract symptoms, attitudes toward pelvic muscle exercise and self‐efficacy for pelvic muscle exercise. In this study, even though the women after childbirth had moderate level of lower urinary tract symptoms, their self‐efficacy for pelvic muscle exercise was low. Also, the gestational diabetes history and exercise duration after birth were identified as variables affecting self‐efficacy for pelvic muscle exercise. The present study showed that nurses should provide knowledge and strategies about pelvic muscle exercise to enhance self‐efficacy for post‐partum women.

Re: Pelvic Floor Muscle Training in Radical Prostatectomy: A Randomized Controlled Trial of the Impacts on Pelvic Floor Muscle Function and Urinary Incontinence.

Re: Pelvic Floor Muscle Training in Radical Prostatectomy: A Randomized Controlled Trial of the Impacts on Pelvic Floor Muscle Function and Urinary Incontinence.

Transabdominal Ultrasound Imaging of Pelvic Floor Muscle Activity in Women With and Without Stress Urinary Incontinence: A Case-Control Study.

Transabdominal ultrasound (TAU) is an easy and noninvasive way to evaluate and retrain pelvic floor muscle (PFM) function. The purpose of this study was to compare PFM activity in women with and without urinary incontinence (UI) by measuring bladder base displacement (as a marker for PFM activity) using TAU during PFM contraction, Valsalva's maneuver, and abdominal curl. Sixty-three women, aged 20-55 years, volunteered to participate in this cross-sectional study: 21 were continent and 42 had UI (21 stress urinary incontinence [SUI] and 21 mixed urinary incontinence [MUI]). Mean bladder base displacement in millimeters was measured to evaluate differences between the three groups (continent, SUI, and MUI) and also between the continent and UI groups during the performance of each maneuver. No significant differences were seen between the three groups in bladder base elevation during PFM contraction (P > 0.05). Descent of the bladder base during Valsalva's maneuver and abdominal curl was significantly greater in women with SUI and MUI than in women in the continent group (P < 0.05). Comparison of the continent and UI groups showed no significant differences in elevation of the bladder base during PFM contraction, while descent of the bladder base was significantly greater in women with UI than in women in the continent group during Valsalva's maneuver and abdominal curl (P < 0.05). TAU indicated that bladder base descent was greater in women with SUI and MUI than those in the continent group during the performance of maneuvers that increased intra-abdominal pressure. This effect may be due to decreased PFM performance in women with urinary incontinence.

CACNA1H downregulation induces skeletal muscle atrophy involving endoplasmic reticulum stress activation and autophagy flux blockade

Multiple vaginal delivery (MVD) is an important factor for pelvic floor muscle (PFM) function decline and pelvic floor dysfunction (PFD). PFD is common in middle-aged and elderly women, but its pathogenesis is not clear. In this study, we found that the expression of CACNA1H was lower in the PFM of old mice after MVD compared with old or adult mice. In in-vitro studies, we found that treatment with the T-type Ca2+ channel (T-channel) inhibitor NNC-55 or downregulation of the CACNA1H gene by siRNA intervention promoted myotube atrophy and apoptosis. Mechanistically, we revealed that NNC-55 increased the expression of GRP78 and DDIT3 in myotubes, indicating endoplasmic reticulum stress (ERS) activation, and that the IRE1 and PERK pathways might be involved in this effect. NNC-55 induced the formation of autophagosomes but inhibited autophagy flux. Moreover, rapamycin, an autophagy activator, did not rescue myotube atrophy or apoptosis induced by NNC-55, and the autophagy inhibitors 3-MA and HCQ accelerated this damage. Further studies showed that the ERS inhibitors 4-PBA and TUDAC relieved NNC-55-induced damage and autophagy flux blockade. Finally, we found multisite muscle atrophy and decreased muscle function in Cacna1h−/− (TH-null) mice, as well as increased autophagy inhibition and apoptotic signals in the PFM of old WT mice after MVD and TH-null mice. Taken together, our results suggest that MVD-associated PFD is partially attributed to CACNA1H downregulation-induced PFM atrophy and that ERS is a potential therapeutic target for this disease.

Effects of surface electrical stimulation during sitting on pelvic floor muscle function and sexual function in women with stress urinary incontinence

ObjectiveDysfunction of the pelvic floor muscles (PFM) is associated with sexual dysfunction in women with stress urinary incontinence (SUI). The EasyK7 device was developed to stimulate the PFM by surface electrical stimulation during sitting (SESdS). We investigated the effects of SESdS on PFM function and sexual function in women with SUI.MethodsWomen with SUI were randomized into the SESdS and control groups. PFM function and sexual function were assessed using a perineometer and the pelvic organ prolapse–urinary incontinence sexual function questionnaire (PISQ), respectively. After 8 weeks, the groups were compared using either analysis of covariance with the baseline values as covariates or the paired Student's t-test.ResultsThe final analysis included 16 subjects from each group. There were significant differences between the SESdS and control groups after the intervention, as well as within the SESdS group between the pre- and post-intervention measurements. The P-values for the differences in PFM measurements between the groups, and between the pre- and post- intervention measurements within the SESdS group, were 0.001 and 0.004 for power, 0.015 and 0.011 for strength, and 0.012 and 0.034 for endurance, respectively. In addition, in the PISQ, there were significant differences between the groups and between the pre- and post-intervention measurements within the SESdS group in the partner-related domain (between groups: P=0.003; within SESdS group: P=0.024) and total score (between groups: P<0.001; within SESdS group: P=0.001).ConclusionSESdS can improve PFM function and sexual function in women with SUI.Trial RegistrationClinical Research Information Service Identifier: KCT0003357

Linking Pelvic Floor Muscle Function Terminology to the International Classification of Functioning, Disability and Health.

A previous systematic review on pelvic floor muscle function (PFMF) identified a miscellaneity of terms. The lack of consensual terminology might have come from the complexity of neuromusculoskeletal function itself. This study sought to link the previously identified PFMF terms to the International Classification of Functioning, Disability and Health (ICF) terminology. In this secondary analysis study, 10 linkage rules were applied to link 196 previously identified PFMF terms to the ICF. Two researchers performed the linking process independently. Disagreements were solved by open dialogue with a third researcher. Percentage agreement was computed for main outcome. A total of 184 (93.9%) PFMF terms were subsumed into the following 6 ICF terms: tone, involuntary movement reaction, control, coordination, strength, and endurance. The most frequently investigated PFMF was strength (25.5%), followed by involuntary movement reaction (22.9%), endurance (17.2%), control (14.1%), coordination (9.9%), and tone (4.2%). Only 6.2% PFMF could not be linked to ICF terminology. A wide variation of instruments/methods was used to measure PFMF. Vaginal palpation was the only method employed to measure all 6 PFMF. Percentage agreement between raters was 100%. Linking PFMF terminology to the ICF was feasible and valid. It allowed the identification of the most investigated PFMF and their measuring methods. ICF terminology to describe PFMF should be used since it may improve communication, data gathering, and the advance in scientific knowledge. Standardized terminology anchored in a theoretical framework is crucial to data gathering, communication, and dissemination of evidence-based practice. PFMF terminology based on ICF can be used to improve data pooling and communication.

The Effect of Incontinence Severity on Symptom Distress, Quality of Life, and Pelvic Floor Muscle Function in Turkish Women with Urinary Incontinence

Objective: The aim of the present study was to compare the differences in symptom distress, quality of life, and pelvic floor muscle function among Turkish women with mild, moderate, or severe urinary incontinence.Study design: One hundred and twenty women with a diagnosis of urinary incontinence (54.2% stress urinary incontinence and 45.8% mixed-urinary incontinence) participated in the present study. The severity of the urinary incontinence was stratified by the Incontinence Severity Index. The Turkish versions of the Urinary Distress Inventory-6 and the Incontinence Impact Questionnaire-7 were used to assess symptom distress and quality of life, respectively. Pelvic floor muscle strength and endurance were measured using a non-invasive vaginal perineometer.Results: Symptom distress and quality of life significantly differed among the mild, moderate, and severe urinary incontinence groups (p&lt;0.001). Patients with severe stress urinary incontinence displayed a higher decrease in quality of life than those with mild stress urinary incontinence (p&lt;0.001). Furthermore, severe mixed urinary incontinence had a greater impact on symptom distress and quality of life compared to mild and moderate mixed urinary incontinence (p&lt;0.05). The Incontinence Severity Index score was significantly associated with the Urinary Distress Inventory-6 and Incontinence Impact Questionnaire-7 scores (p&lt;0.001).Conclusion: Urinary incontinence affected the symptom distress and quality of life of patients in proportion to the severity of the symptoms. Therefore, the relationship between the severity of urinary incontinence and patients’ quality of life should be evaluated in clinical settings. To prevent the greater influence of incontinence on the quality of life of women with urinary incontinence, early detection of urinary incontinence and early management strategies are essential.

Pelvic floor muscle training: mechanisms of action for the improvement of genitourinary syndrome of menopause

Objective: This study aims to investigate the mechanism of action of pelvic floor muscle training (PFMT) for the improvement of the signs and symptoms of genitourinary syndrome of menopause (GSM) in postmenopausal women with GSM and urinary incontinence (UI).Methods: Twenty-nine women were included in the secondary analysis of a single-arm feasibility study. Using color Doppler ultrasound, the peak systolic velocity, time-averaged maximum velocity, and pulsatility index of the internal pudendal and dorsal clitoral arteries were measured at rest and after a pelvic floor muscle (PFM) contraction task. PFM function was assessed by dynamometry, and vulvovaginal tissue elasticity was measured using the Vaginal Atrophy Index.Results: PFMT significantly improved blood flow parameters in both arteries (p < 0.05) and significantly increased the speed of PFM relaxation after a contraction (p = 0.003). After the intervention, a marginally significant decrease in PFM tone was observed, as well as an increase in PFM strength (p = 0.060 and p = 0.051, respectively). Finally, improvements in skin elasticity and introitus width were observed as measured by the Vaginal Atrophy Index (p < 0.007).Conclusion: Our findings suggest that PFMT improves blood flow in vulvovaginal tissues, PFM relaxation capacity, and vulvovaginal tissue elasticity in postmenopausal women with GSM and UI.

Construction and application of cluster nursing measures for urinary retention after gynecological tumor radical operation

Objective To develop cluster nursing measures for urinary retention after gynecological tumor radical operation, and explore the prevention methods of urinary retention after gynecological tumor radical operation. Methods We established a gynecological rehabilitation nursing team, retrieved domestic and foreign literature, conducted a Meta-analysis on the key measures to effectively treat urinary retention, and designed and developed a set of cluster nursing measures for urinary retention after radical gynecological tumor surgery. A controlled trail was conducted in this study. Totally 54 patients treated in the gynecological ward of the First Affiliated Hospital of Shenzhen University from January 2016 to June 2017 were selected as the control group, while another 52 patients treated from July 2017 to August 2018 were selected as the experimental group. Patients in the control group received routine gynecological nursing, while patients in the experimental group received cluster nursing based on routine nursing. Data were collected using an observation record form, which included observations of patients' practice and limb mobility effects. The execution time and frequency of urinary interruption training, pelvic floor muscle function training, ankle pump exercise and thoraco-abdominal gymnastics, and the reasons for not using them, drinking test at extubation and intermittent clean self catheterization (CISC) . Data were processed and analyzed using SPSS 21.0. Results One out of the 52 patients in the experimental group had urinary retention, accounting for an incidence rate of 1.92%, delayed extubation occurred in 2 cases, with a total complication rate of 5.77% (3/52) ; while 5 out of the 54 patients in the control group had urinary retention, accounting for an incidence rate of 9.26%, delayed extubation occurred in 6 cases, with a total complication rate of 20.37% (11/54) . There was a statistically significant difference in the incidence of complications between the two groups (P<0.05) . Conclusions The cluster nursing measures are a combination of multiple effective measures, and the clinical application results have shown that they can effective prevent the occurrence of urinary retention after gynecological tumor radical surgery. Key words: Gynecological oncology; Urinary retention; Cluster nursing; Meta-analysis

Are there differences in short-term pelvic floor muscle function after cesarean section or vaginal delivery in primiparous women? A systematic review with meta-analysis.

The literature presents controversial results regarding the role of delivery mode in pelvic floor muscle (PFM) function after birth. Some studies showed a greater impairment of PFM function after vaginal delivery compared with cesarean section, while others have not identified a significant difference between these two modes of delivery. This study aimed to investigate whether there was a difference in short-term PFM function after childbirth in primiparous women who underwent cesarean section compared with those who underwent vaginal delivery. Up to December 2018, the PubMed-MEDLINE, CINAHL, Embase, Bireme, Scopus, Web of Science, and Science Direct databases were searched. Two independent reviewers performed the selection process based on titles, abstracts, and full-text reading. Observational studies comparing PFM function after cesarean section versus vaginal delivery in primiparous women were included. PRISMA guidelines and Cochrane recommendations were followed. Methodological quality of the primary studies was assessed through the checklist proposed by the Joanna Briggs Institute for cross-sectional studies. Random effects meta-analysis was performed to synthesize evidence regarding PFM strength in primiparous woman after vaginal delivery compared with cesarean section. The GRADE approach was applied to classify the quality of the evidence. Eleven studies met the inclusion criteria and were included in this review. A total of 1726 primiparous women were analyzed after childbirth. Five studies were included in the meta-analysis. No difference in PFM strength after childbirth was identified when cesarean section was compared with vaginal delivery [standardized mean difference (SMD): -0.15, 95% confidence interval (CI): -0.85 to 0.56]. Differences in PFM strength were identified when patients who underwent cesarean section were compared with those with an episiotomy or instrumented vaginal delivery (SMD: -12.51, CI 95%: -24.57 to -0.44), favoring the cesarean section group. In both cases, the quality of evidence was classified as very low because of the observational design of the included studies and population heterogeneity. There was no difference in short-term PFM strength after childbirth between primiparous women who underwent cesarean section or vaginal delivery, as assessed through vaginal manometry. However, we identified reduced PFM strength in women who underwent an episiotomy or instrumented vaginal delivery compared with those who underwent cesarean section. Nevertheless, this conclusion should be cautiously considered as the observational design of the primary studies and possible heterogeneity among the primiparous women included in the studies contributed to reducing the quality of the evidence synthesized. Future primary studies with longitudinal designs and long-term follow-up periods are needed to strengthen the quality of evidence and provide more conclusive evidence to guide clinical practice.

Which pelvic floor muscle functions are associated with improved subjective and objective symptoms after 8 weeks of surface electrical stimulation in women with stress urinary incontinence?

ObjectiveStress urinary incontinence (SUI) is defined as involuntary urine loss during effort, sneezing, or coughing. We investigated which pelvic floor muscle (PFM) functions (muscle strength, power, and endurance) are associated with improvement in subjective and objective symptoms after 8 weeks of surface electrical stimulation (SES) training. This study was performed to determine the effects of SES in the seated position on PFM functions and subjective and objective symptoms, and to identify predictors of improved subjective and objective symptoms after 8 weeks of SES training via secondary analysis of females with SUI. Study designThe study was performed between August 2018 and December 2018. Patients with SUI were randomized into an SES group (n = 17) and a control group (n = 17). Both groups were assessed pre-intervention and after 8 weeks of intervention. The outcome measures were PFM functions (strength, power, and endurance) as measured via perineometry, the score on the urogenital distress inventory-6 (UDI-6), and the ultra-short perineal pad test result. ResultsSignificant differences in all PFM functions, the UDI-6 score, and the pad weight were evident both between the groups (SES vs. control group) and within the groups (pre-SES vs. post-SES). On regression of factors predicting relative changes in subjective and objective symptoms, the relative change in PFM power accounted for 15 and 13 % of the variance in the UDI-6 score (P < 0.05) and pad weight (P < 0.05), respectively. ConclusionsSES in a seated position improved both subjective and objective symptoms in females with SUI. PFM power, the UDI-6 score, and the pad weight test result should be considered when developing intervention guidelines to improve the subjective and objective symptoms of females with SUI.

Exploring pelvic floor muscle activity in men with lower urinary tract symptoms.

AimWe aimed to explore the utility of the Multiple Array Probe Leiden (MAPLe) device to assess pelvic floor muscle activity in men with lower urinary tract symptoms (LUTS).MethodsThis was an observational cohort study performed at the urology outpatient department of a large teaching hospital in the Netherlands between April and October 2018. We recruited male patients referred for the assessment of LUTS, without a history of prostate surgery, if they had an International Prostate Symptom Score greater than or equal to 8. The MAPLe device was then used to assess the puborectalis, pubococcygeus, iliococcygeus, urogenital diaphragm, and the internal and external anal sphincters during three tasks: a rest period (1 minute), five maximum voluntary contractions (held for 3 seconds each), and three maximal endurance contractions (held for 15 seconds each).ResultsIn total, 57 patients were included, 5 of which had diabetes mellitus. Muscle activity at rest was significantly lower than during either contraction task and did not differ between the muscle groups. By contrast, the external anal sphincter had significantly less activity than any other muscle group during the endurance task, and the internal anal sphincter and puborectalis had significantly less activity during the maximum voluntary contraction task. No association was found between pelvic floor muscle activity and LUTS severity during any task.ConclusionPelvic floor muscle activity and LUTS severity appear to be unrelated, but this does not completely exclude the possibility of muscle involvement in the development or experience of symptoms. Further research is needed.

Relationship between pelvic floor muscle and sexual function in physically active older women

Abstract Introduction: Physical activity is beneficial to psychological and physical health, which ultimately affects sexual health and quality of life. In turn, strong pelvic floor muscles (PFM) can positively affect the sex life of women. Objective: Assess the relationship between pelvic floor muscle and sexual function in physically active older women. Method: 35 sexually and physically active older women with an average age of 69.5 years participated in this study. Physical activity level was assessed with an accelerometer. A diagnostic flow chart and the female sexual function index (FSFI) were applied to assess female sexual function and the PERFECT scheme to assess PFM. Data were collected by two previously trained and blinded researchers and submitted to descriptive statistics and Spearman’s correlation. Results: There was a significant correlation between the number of fast-twitch muscle fiber contractions and sexual function (rho = -0.41032; p = 0.0144) and the orgasm dimension (rho = -0.34679; p = 0.0413) in older participants. Conclusion: Pelvic floor muscles are related to female sexual function and it is important for older women to remain physically active.