Pelvic Floor Muscle Function Research Articles

Advancing women's pelvic floor muscle function diagnosis: the EFSMAP examination and its reliability evaluation

BackgroundThe accurate diagnosis of pelvic floor muscle impairments is essential. The plethora of terms and the lack of evidence to support widely used pelvic floor muscle function (PFMF) measurements hinder diagnostic labels. ObjectiveTo structure an examination of PFMF using visual observation and digital palpation and terms consistent with the ICF terminology, and to test its intra and interrater reliability/agreement. MethodsA panel of 9 physical therapists applied Delphi method to structure the PFMF exam under ICF terminology and to verify its measurements reproducibility. For reliability and agreement, a convenience sample of women aged 51.2 ± 14.7 years had the sensitivity to pressure, pain, muscle tone, involuntary movement reaction, control of voluntary movement (contraction/relaxation), coordination, strength, and endurance examined by two raters, in the same day for interrater (n = 40), and one week apart, for intrarater reliability (n = 25). Percent agreement, linear weighted kappa, intraclass correlation coefficient, and Bland-Altman's limits of agreement were calculated (alpha = 0.05). ResultsFour round Delphi discussion structured the PFMF exam, named EFSMAP (Exame das Funções Sensoriais e Motoras do Assoalho Pélvico/Examination of Pelvic Floor Sensory and Motor Functions), set a list of concepts and instructions targeted at reproducibility and established PFMF diagnostic labels. Reliability, except for pain and tone, were moderate to excellent (Kw= 0.67–1.0 and ICC=0.48–0.82). Agreement was substantial for most PFMF features (0.64–1.00), except pain. ConclusionsThe EFSMAP was successfully developed as a valid and reliable exam to be used in research and clinical practice; it provides labels for the diagnosis of pelvic floor muscle impairments. It might be easily adopted worldwide as it uses ICF terminology.

Do young women have an accurate perception about their pelvic floor muscle contraction? An agreement study about self-perception and physical evaluation of the pelvic muscles contraction by the PERFECT scheme

BackgroundMany women have difficulty in activating the pelvic floor muscles (PFM). This is a concerning factor for health professionals and public government institutions, as an unhealthy PFM could be associated with the presence of PFM dysfunctions. Therefore, the aim of the study was to analyze the agreement between the perception of young women about their PFM contraction and the results of a physical assessment, according to the strength, endurance, and contraction repetitions. MethodCross-sectional study with 43 university students between 18 and 35 years old. Examiner A filled out a semi-structured questionnaire to assess the self-perception about the ability to contract the PFM. The physical exam was performed by bidigital vaginal palpation, conducted by Examiner B, blinded to the answers of the previous stage, and according to the PERFECT scheme (P = power; E = endurance; R = repetitions of item “E; ” F = fast contractions). Data was assessed by the Cohenʼs linear weighted kappa (Kw). ResultsThe agreement between the self-perception and the physical evaluation of the PFM function presented a very poor agreement for all the items of the PERFECT scheme (P(Kw) = 0.12; E(Kw) = 0.07; R(Kw) = 0.09; F(Kw) = 0.04). ConclusionYoung women do not have sufficient knowledge about PFM contraction and function. It should concern health government and institutions, as a poor PFM awareness might increase the difficulty to identify signs and symptoms related to PFM dysfunctions and reduces demand for and adherence to PFM treatment programs.

Effects of different treatment frequencies of electromagnetic stimulation for urinary incontinence in women: study protocol for a randomized controlled trial

BackgroundUrinary incontinence is highly prevalent in women while pelvic floor muscle training is recommended as the first-line therapy. However, the exact treatment regimen is poorly understood. Also, patients with pelvic floor muscle damage may have decreased muscle proprioception and cannot contract their muscles properly. Other conservative treatments including electromagnetic stimulation are suggested by several guidelines. Thus, the present study aims to compare the effectiveness of electromagnetic stimulation combined with pelvic floor muscle training as a conjunct treatment for urinary incontinence and different treatment frequencies will be investigated.Methods/designThis is a randomized, controlled clinical trial. We will include 165 patients with urinary incontinence from the outpatient center. Participants who meet the inclusion criteria will be randomly allocated to three groups: the pelvic floor muscle training group (active control group), the low-frequency electromagnetic stimulation group (group 1), and the high-frequency electromagnetic stimulation group (group 2). Both group 1 and group 2 will receive ten sessions of electromagnetic stimulation. Group 1 will be treated twice per week for 5 weeks while group 2 will receive 10 days of continuous treatment. The primary outcome is the change in International Consultation on Incontinence Questionnaire–Short Form cores after the ten sessions of the treatment, while the secondary outcomes include a 3-day bladder diary, pelvic floor muscle function, pelvic organ prolapse quantification, and quality of life assessed by SF-12. All the measurements will be assessed at baseline, after the intervention, and after 3 months of follow-up.DiscussionThe present trial is designed to investigate the effects of a conjunct physiotherapy program for urinary incontinence in women. We hypothesize that this strategy is more effective than pelvic floor muscle training alone, and high-frequency electromagnetic stimulation will be superior to the low-frequency magnetic stimulation group.

Ultrasound Elastography in Benign Gynecology: A Scoping Review.

To perform a scoping review of the literature in which ultrasound elastography (UE) has been used in benign gynecology and identify avenues for its use in future research and clinical implementations. A structured search of EMBASE, Medline and Cochrane databases was conducted (last search date April 15th, 2022). Eligible studies included adult participants with female pelvic anatomy. English language papers focusing on the utility of ultrasound elastography applied to benign gynecology were included. Narrative reviews, conference abstracts, and letters to the editor were excluded. Two independent reviewers screened titles and abstracts for inclusion, a third reviewer was consulted in cases of disagreement. Study quality was assessed by a checklist for study implementation and elastography technique. Extracted data included elastography technology, gynecologic application, opportunities for clinical implementation, and strengths and limitations. The search returned 2026 studies. A total of 40 studies, published between 2013 and 2022, were retained for data extraction. Studies most frequently used shear wave elastography as the method of UE (n = 23), followed by strain elastography (n = 13) and acoustic radiation force impulse (n = 4). Most common clinical applications for UE were the diagnosis of adenomyosis and uterine fibroids (27.5%), assessment of pelvic floor muscle function (22.5%), and describing the elastic properties of polycystic ovaries (17.5%) and the uterine cervix (15.0%). Limitations of the technology were identified as the lack of published reference values for gynecologic organs and difficulties in assessing tissues deep to the transducer. Future research is needed to validate the use of ultrasound elastography in gynecology under both normal and pathologic conditions.

Physiotherapy for continence and muscle function in prostatectomy: a randomised controlled trial.

To assess the effectiveness of pre- and postoperative supervised pelvic floor muscle training (PFMT) on the recovery of continence and pelvic floor muscle (PFM) function after robot-assisted laparoscopic radical prostatectomy (RARP). We carried out a single-blind randomised controlled trial involving 54 male patients scheduled to undergo RARP. The intervention group started supervised PFMT 2 months before RARP and continued for 12 months after surgery with a physiotherapist. The control group was given verbal instructions, a brochure about PFMT, and lifestyle advice. The primary outcome was 24-h pad weight (g) at 3 months after RARP. The secondary outcomes were continence status (assessed by pad use), PFM function, and the Expanded Prostate Cancer Index Composite (EPIC) score. Patients who participated in supervised PFMT showed significantly improved postoperative urinary incontinence (UI) compared with the control group (5.0 [0.0-908.0] g vs 21.0 [0.0-750.0] g; effect size: 0.34, P = 0.022) at 3 months after RARP based on 24-h pad weight. A significant improvement was seen in the intervention compared with the control group (65.2% continence [no pad use] vs 31.6% continence, respectively) at 12 months after surgery (effect size: 0.34, P = 0.030). Peak pressure during a maximum voluntary contraction was higher in the intervention group immediately after catheter removal and at 6 months, and a longer duration of sustained contraction was found in the intervention group compared with the control group. We were unable to demonstrate a difference between groups in EPIC scores. Supervised PFMT can improve postoperative UI and PFM function after RARP. Further studies are needed to confirm whether intra-anal pressure reflects PFM function and affects continence status in UI in men who have undergone RARP.

Can pelvic floor muscle function before surgery determine the outcome of surgical treatment of stress urinary incontinence in women?

The study aimed to determine whether pelvic floor muscle (PFM) function before surgery may correlate with the success of surgical interventions for treating stress urinary incontinence (SUI). Our hypothesis was that addressing identified variables in preoperative rehabilitation could potentially improve surgical outcomes. This prospective observational study was conducted at a single center and enrolled women qualified to mid-urethral tape insertion for SUI between 2020 and 2022. Digital palpation and manometry (Peritron™ 9300 V) were used to evaluate PFM function. The following parameters were acquired: vaginal resting pressure, vaginal pressure during maximal voluntary contraction (MVC), the area under the curve during a 10-second MVC, moreover the ability to perform correct PFM contraction, reflexive PFM contraction during cough and relaxation were assessed. All measurements were performed before the surgical treatment and during follow-up assessments at 1, 3, and 6 months postoperatively. The primary endpoint of the study was defined as objective cure, characterized by a negative cough stress test (CST), along with a subjective assessment based on the Urogenital Distress Inventory-6 (UDI-6) and Incontinence Impact Questionnaire-7 (IIQ-7). The study involved 57 eligible female participants, all of whom completed the 6-month follow-up. Objective cure was observed in 75.44% of cases, while subjective cure was reported in 33%. There was no association between PFM parameters and surgical outcomes. The success of surgical treatment of SUI 6 months postsurgery is not related to preoperative pelvic floor muscle function.

The Reliability of the Rehabilitative Ultrasound Imaging Method for Assessing Pelvic Floor Muscles Function in Pregnant Women

Background: To our knowledge, there is scant research on the use of rehabilitative ultrasound imaging (RUSI) method for evaluating bladder base displacement in pregnant women. The RUSI is a non-invasive and simple method that assesses the function of pelvic floor muscles (PFM) based on the movement of the bladder base. Objectives: This study aims to assess the reliability of the RUSI for the assessment of PFM function in pregnant women during voluntary muscle contractions. Materials & Methods: In this cross-sectional study, 18 pregnant women with different gestational ages participated. The amount of bladder base displacement during PFM contraction was assessed in all women and considered an indicator of PFM function. The test re-test reliability was evaluated using the intraclass correlation coefficient (ICC) and Bland-Altman plot. The percentages of standard error of measurement (SEM%) and minimal detectable change (MDC%) were also calculated. Results: The mean amount of bladder base displacement during PFM contraction at time points 1 and 2 was 4.89±1.43 and 4.81±1.41, respectively. The ICC was 0.989 (95% CI, 0.969%, 0.996%), which indicates excellent reliability. The Bland-Altman plot showed that all the points were within the 95% limits of agreement with no considerable trend or bias. The SEM% and MDC% were 3.09% and 8.41%, respectively. Conclusion: The intra-rater reliability of the RUSI to assess PFM function in pregnant women is high, and can be useful for further studies on the PFMs in pregnant women.

Does research support the current conservative care recommendations for pregnancy-related diastasis rectus abdominis? A scoping review

Pregnancy-related diastasis rectus abdominis (DRA) is a widespread condition. The current evidence for its conservative management is contradictory, as are the criteria for making a diagnosis, which has stimulated debate among practitioners. The aim of this scoping review was to synthesize the existing peer-reviewed literature to determine whether there is evidence to support or refute recently published recommendations for the conservative care of perinatal DRA. These guidelines suggest that it should be approached from the perspective of considering the linea alba (LA) as an integrative component of the thoracopelvic abdominal system, which assumes functional relationships between the structures of the thorax and pelvis. Specifically, the present authors explored whether relationships exist between: (1) the LA and breathing mechanics; (2) pelvic floor muscle (PFM) function; (3) lumbopelvic pain (LPP) control; and (4) aspects of the structure and function of the abdominal wall. Of the 31 studies included, none were found relating to the LA and breathing mechanics, 11 investigated PFM function, 10 explored LPP, and 18 examined the LA with respect to the structure and/or function of the abdominal wall. The research reviewed does not appear to substantiate several of the recommendations for the conservative care of DRA, but does align with cited gaps in knowledge about this condition. The studies included neither support nor necessarily refute the relationships between breathing, PFM function and LPP. This scoping review also highlights the limitations of the current characterization of DRA and related assessment strategies, particularly the reliance on heterogeneous measurements of inter-recti distance as the primary and sometimes only measurement to inform clinical reasoning with respect to the condition.

Investigating the role of the pelvic floor muscles in sexual function and sexual response: a systematic review and meta-analysis.

The pelvic floor muscles (PFMs) have been suggested to play a key role in sexual function and response in women. However, syntheses of the evidence thus far have been limited to interventional studies in women with pelvic pain or pelvic floor disorders, and these studies have failed to fully capture the involvement of the PFMs in a broader population. We sought to appraise the evidence regarding the role of the PFMs in sexual function/response in women without pelvic pain or pelvic floor disorders. More specifically, we examined the following: (1) effects of treatment modalities targeting the PFMs on sexual function/response, (2) associations between PFM function and sexual function/response, and (3) differences in PFM function between women with and those without sexual dysfunction. We searched for all available studies in eight electronic databases. We included interventional studies evaluating the effects of PFM modalities on sexual outcomes, as well as observational studies investigating the association between PFM function and sexual outcomes or the differences in PFM function in women with and those without sexual dysfunction. The quality of each study was assessed using the Mixed Methods Appraisal Tool. Estimates were pooled using random-effects meta-analyses whenever possible, or a narrative synthesis of the results was provided. The main outcomes were sexual function (based on a questionnaire)/sexual response (based on physiological test), and PFM function (assessment of the PFM parameters such as strength and tone based on various methods). A total of 33 studies were selected, including 14 interventional and 19 observational studies, most of which (31/33) were deemed of moderate or high quality. Ten out of 14 interventional studies in women with and without sexual dysfunctions showed that PFM modalities had a significant effect on sexual function. Regarding the observational studies, a meta-analysis revealed a significant moderate association between PFM strength and sexual function (r = 0.41; 95% CI, 0.08-066). Of the 7 observational studies performed to assess sexual response, all showed that the PFMs were involved in arousal or orgasm. Conflicting results were found in the 3 studies that evaluated differences in PFM function in women with and those without sexual dysfunction. Our results highlight the contribution of the PFMs in sexual function/response. One strength of this review is the inclusion of a broad range of study designs and outcomes, allowing a thorough synthesis of evidence. However, interpretations of these data should consider risk of bias in the studies, small sample sizes, and the absence of control/comparison groups. The findings of this review support the involvement of the PFMs in sexual function/response in women without pelvic pain or pelvic dysfunction. Well-designed studies should be performed to further investigate PFM modalities as part of the management of sexual dysfunction.

Pelvic floor status in opera singers. a pilot study using transperineal ultrasound

BackgroundControl of pelvic floor muscles (PFM) is emphasized as important to obtain functional breath support in opera singing, but there is not much research that proves PFM function as part of breath support in classical singing. Transperineal ultrasound is a reliable method for quantification of PFM contraction in urogynecology. Our aim was to establish if transperineal ultrasound can be used for observation of movement of the PFM during singing and to quantify pelvic floor contraction.MethodsCross sectional study of 10 professional opera singers examined with transperineal ultrasound in the supine position at rest and contraction, and standing at rest and during singing. Levator hiatal area was measured in a 3D rendered volume. Levator hiatal anteroposterior (AP) diameter and bladder neck distance from symphysis were measured in 2D images.ResultsThe AP diameter was shortened from supine rest to contraction (15 mm), standing (6 mm) and singing (9 mm), all p < 0.01. The bladder neck had a non-significant descent of 3 mm during singing. The mean proportional change in AP diameter from rest to contraction was 24.2% (moderate to strong contraction) and from rest to singing was 15% (weak to moderate contraction).ConclusionsTransperineal ultrasound can be used to examine the PFM during singing. The classically trained singers had good voluntary PFM contraction and moderate contraction during singing. AP diameter was significantly shortened from supine to upright position, with further shortening during singing, confirming that female opera singers contracted their pelvic floor during singing.

The effect of using mobile phone applications for intelligent pelvic floor rehabilitation on elderly female patients with stress urinary incontinence.

Stress urinary incontinence is prevalent among women and the incidence increases with age. To explore the effect of intelligent pelvic floor muscle rehabilitation on elderly female patients with incontinence. A total of 209 patients with urinary incontinence who were treated with pelvic floor muscle rehabilitation at Peking University International Hospital from September 2020 to January 2022 were selected by convenient sampling. All subjects were divided into the 50-60 year old patient group (n= 51) and over 60 years old patient group according to age (n= 158). The subjects of different age group were divided into an experimental group and a control group. The patients in the control group received routine nursing and health education, and the patients in the observation group received a combination of mobile application use and smart dumbbells. Based on this, we constructed an intervention model for intelligent, continuous pelvic floor rehabilitation. After 7 and 12 weeks, pelvic floor muscle function knowledge and exercise compliance in the two groups were evaluated. The improvement of urinary incontinence symptoms, pelvic floor muscle strength grades and quality-of-life scales were evaluated. The results showed that pelvic floor knowledge and exercise compliance in the experimental group were better than in the control group at 7 and 12 weeks after intervention (P< 0.05). There was no significant difference in pelvic floor muscle strength and quality of life between the two groups at 7 weeks after intervention (P> 0.05). However, there was a significant difference in pelvic floor muscle strength and quality of life between the two groups at 12 weeks after intervention (P< 0.05). There was no significant difference between different age groups. The intelligent pelvic floor rehabilitation model that combines a mobile application with smart dumbbells can maintain and strengthen the clinical treatment effect for elderly patients with urinary incontinence.

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

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

Australian healthcare professionals' beliefs and practice behaviours in management of chronic pelvic pain: a cross-sectional survey.

Background Chronic pelvic pain (CPP) is a common and debilitating condition, and sufferers present to healthcare professionals with variable complex symptoms and co-morbidities. This study aimed to investigate the current beliefs and practice behaviours of healthcare professionals towards the management of CPP in Australian females. Methods We distributed an online survey to Australian healthcare professionals. Participants were questioned regarding their beliefs, the importance of various contributing factors and assessment variables, and their management preferences for two CPP vignettes. Demographic information and responses were analysed with descriptive statistics. Results Complete data were obtained and analysed from 446 respondents including gynaecologists (n =75), general practitioners (GPs) (n =184) and physiotherapists (n =187). Most of the respondents were female (88.1%), with male (11.7%) and other (0.2%) making up a smaller representation. Physiotherapists rated themselves higher in understanding mechanisms of CPP (64.7% very good to excellent) compared to gynaecologists (41.3%) and GPs (22.8%). Physiotherapists also reported higher levels of confidence in managing patients with CPP (57.8% quite or extremely confident) compared to 41.3% of gynaecologists and 22.3% of GPs who reported being quite or extremely confident. All three professions rated patient's beliefs (89.8%), nervous system sensitisation (85.7%), stress/anxiety/depression (91.9%), fear avoidance (83.3%), history of sexual/emotional/physical abuse (94.1%) and pelvic floor muscle function (85.0%) as very/extremely important factors in the development of chronic pelvic pain. Most gynaecologists (71.0%) and GPs (70.2%) always referred for pelvic ultrasound during assessment. Physiotherapists assessed goal setting (88.8%) and screened for patients' beliefs (80.9%) more often than gynaecologists (30.4% and 39.1% respectively) and GPs (46.5% and 29.0% respectively). Conclusions All three groups of healthcare professionals demonstrated a good understanding of pain mechanisms and incorporated a biopsychosocial and multidisciplinary approach to management of females with chronic pelvic pain. However, both gynaecologists and GPs were less confident in their understanding of and management of CPP, and less likely to consider patient beliefs and goals. The findings of this online survey may assist in the provision of more targeted education to further improve management of this condition.

Comparative Analysis of Pelvic Floor Muscle Damage Postpartum: Vaginal Delivery vs. Cesarean Section

Background. Evaluation of pelvic floor muscle (PFM) strength damage across different delivery modes, providing insights into potential preventive measures for pelvic floor dysfunctions (PFDs) in the early postpartum period. Aim. Compare the differences in PFM strength and endurance between full‐term cesarean section (CS) and vaginal delivery (VD) in the early postpartum period of primiparous women. Methods. The assessment included stress urinary incontinence (SUI), pelvic organ prolapse (POP), and pelvic floor electromyography (PFE). Muscle fiber strength was categorized into four modes at a threshold level of 3: I &lt; 3 II &lt; 3, I &lt; 3 II &gt; 3; I &gt; 3 II &lt; 3, I &gt; 3 II &gt; 3. Multinomial logistic regression was employed for CS and VD, and a sensitivity analysis was conducted using level 2 as the threshold. Outcomes. When muscle fiber strength was categorized into four modes at a threshold level of 3, Type I, and Type II fiber muscle endurance (FME) are differences between the CS and VD groups. Results. The CS and VD groups differed significantly in SUI and anterior and posterior vaginal wall conditions. MDVP was below the normal range in both groups, and MDVP, PFM strength, and PFM endurance did not differ significantly (P &gt; 0.05). Logistic regression results indicated that higher MDVP, Type I, and Type II FME were protective factors when I &lt; 3 in the VD group. However, I &lt; 3‐II &gt; 3, higher MDVP, and Type I FME were protective factors (OR: 0.339, 95% CI: 0.223, 0.516) in the CS group. Clinical Implications. The study introduces a nuanced understanding of the impact of different delivery modes on PFM, contributing valuable insights for clinical prevention and treatment strategies in the early postpartum period. Strengths and Limitations. Muscle fiber strength was categorized into four modes and further sensitivity analysis was conducted. This study only conducted a correlation analysis of outcome variables without considering intervenable variables. Conclusions. The VD group had a higher incidence of pelvic floor dysfunction in the early postpartum period than the CS group. Both groups experienced a decline in PFM function without significant differences. CS was primarily associated with Type I muscle fiber damage, while VD was related to both Type I and II muscle fiber damage. Improving PFM endurance is beneficial for muscle strength recovery.

Transabdominal ultrasonography-guided biofeedback training for pelvic floor muscles integrated with stabilization exercise improved pregnancy-related pelvic girdle pain and disability: a randomized controlled trial

ObjectivesInvestigate effects of integrated training for pelvic floor muscles (PFM) with and without transabdominal ultrasonography (TAUS) imaging-guided biofeedback in postpartum women with pregnancy-related pelvic girdle pain (PPGP). DesignThree-arm, single-blinded randomized controlled trial SettingUniversity laboratory ParticipantsFifty-three postpartum women with PPGP randomized into stabilization exercise with TAUS-guided biofeedback (BIO+EXE), exercise (EXE), and control (CON) groups. InterventionsThe BIO+EXE and EXE groups underwent an 8-week exercise program, with the BIO+EXE group receiving additional TAUS-guided biofeedback for PFM training during the first 4 weeks. The CON group only received a pelvic educational session. Main outcome measuresPrimary outcomes included self-reported pain (numeric rating scale) and disability (pelvic girdle questionnaire). Secondary outcomes included functional tests (active straight leg raising [ASLR] fatigue, timed up-and-go, and 6-meter walking tests) and muscle contractibility indicated by muscle thickness changes for abdominal muscles and bladder base displacement for PFM (ultrasonographic measures). ResultsThe BIO+EXE group had lower pain [1.8 (1.5) vs. 4.4 (1.5), mean difference −2.6, 95% confidence interval (CI) −3.9 to −1.2] and disability [14% (10) vs. 28% (21), mean difference −14, 95% CI −25 to −2] and faster walking speed [3.1 seconds (1) vs. 3.3 seconds (1), mean difference −0.2, 95% CI −1.0 to −0.2] than the CON group. The EXE group only had lower pain intensity compared to the CON group [2.7 (2.0) vs. 4.4 (1.5), mean difference −1.7, 95% CI −3.1 to −0.4]. No significant differences were observed among groups in timed up-and-go, ASLR fatigue, or muscle contractibility. ConclusionsIntegrated training for PFM and stabilization with TAUS-guided biofeedback seems to be beneficial for reducing pain and disability in postpartum women with PPGP. Contribution of the paper•8-week integrated training for PFM and stabilization with TAUS imaging-guided biofeedback reduced pain and disability, although there was no change in abdominal muscle thickness and PFM function•Correct PFM contraction through visual biofeedback was effective and may be beneficial in the treatment of postpartum women with PPGP

Pelvic floor muscle training in women with urinary incontinence and pelvic organ prolapse: A protocol study.

To evaluate the effectiveness of pelvic floor muscle training (PFMT) on pelvic floor muscle (PFM) function and quality of life (QoL) in women with stress urinary incontinence (SUI) and pelvic organ prolapse (POP). This study will be a randomized, controlled, parallel, and blinded clinical trial. The final sample will consist of 32 women diagnosed with SUI and cystocele (stage I and II). All volunteers will be assessed and reassessed using the same protocol: assessment form, gynecological examination, functional evaluation of PFM, and questionnaires to assess quality of life, urinary function, and sexual function. All volunteers will be evaluated for satisfaction levels post-treatment. The intervention will be PFMT, totaling 16 sessions to be conducted twice a week. Reevaluation will take place at the end of treatment and 1 month after completion of PFMT. Descriptive analysis and repeated measures ANOVA will be used for result analysis. A significance level of p<0.05 will be considered for all statistical tests. This study has been submitted to the Ethics in Research Committee of the Federal University of Rio Grande do Norte and approved under protocol number 5.826.563. It has been registered with the Brazilian Clinical Trials Registry ReBec (RBR-49p6g3t). It is expected that these studies will provide a deeper understanding of the efficacy of PFMT in women with SUI and cystocele. Additionally, it aims to provide more insights into the efficacy of PFMT prior to surgery.

Physiotherapeutic evaluation of pelvic floor muscle function in patients after radical prostatectomy using ultrasound imaging: retrospective study

Physiotherapeutic evaluation of pelvic floor muscle function in patients after radical prostatectomy using ultrasound imaging: retrospective study

Effects of Kegel exercise combined with rational emotive behavior therapy on pelvic floor muscle function and sexual life quality in patients with total hysterectomy: A retrospective study

To explore the clinical effects of Kegel exercise combined with rational emotive behavior therapy (REBT) on the pelvic floor muscle function, medical coping style, and sexual life quality after total hysterectomy. This was a retrospective cohort study. A total of 91 patients were collected in this study: 39 patients in Kegel group (received Kegel exercise alone) and 52 patients in combination group (received Kegel exercise combined with REBT). Propensity score matching (PSM) with 1:1 ratio was conducted to avoid the selection bias. The female sexual function index (FSFI) was used to evaluate and compare sexual life quality. After PSM, 35 patients were in each group (combination vs Kegel). The normal rate of pelvic floor muscle in combination group was significantly higher than that in Kegel group (88.57% vs 54.29%, P = .041). After surgery, the score of confrontation was higher, while the scores of avoidance and acceptance-resignation were lower in combination group compared with those in Kegel group. The postoperative total FSFI score and the scores of all dimensions were higher in combination group than those in Kegel group. In patients with total hysterectomy, Kegel exercise combined with REBT can significantly improve pelvic floor muscle function, medical coping style and sexual life quality. Therefore, it is worthy of clinical application.

Is there a synergistic relationship between diaphragm and pelvic floor muscles in pregnant women?

ObjectiveThe aim of this study is to examine whether there is a synergistic relationship between the diaphragm and pelvic floor muscles (PFM) in pregnant women. Material and MethodsOur study was carried out as a cross-sectional study in primigravid pregnants in the second and third trimesters. Superficial electromyography (EMG), 2D/3D ultrasonography (USG), pulmonary function test (PFT), PERFECT, maximum expiratory pressure (MEP) and inspiratory pressure (MIP) measurements were used to evaluate pelvic floor and diaphragm muscle functions during pregnancy. Mann-Whitney U test was used to show the change in the second and third trimesters, and Spearman correlation was used to determine the relationship. ResultsNo correlation was found between the EMG data of the PFM and diaphragm, or between the USG data of the PFM and diaphragm in all participants, in the second and third trimesters. In the third trimester of the study, diaphragmatic thickness and levator hiatal area (LHA) decreased and both diaphragm and PFM % MVC EMG parameters increased. In the third trimester, FVC, MIP, MEP decreased, and nonsignificant increase in FEV1, FEV1/FVC and peak ekspiratuar flow(PEF) were detected. A significant correlation was found between pelvic floor levator hiatal area USG and FEV1/FVC in both trimesters (r: 0,577p: 0,004). ConclusionThere may be a synergistic relationship between the diaphragm and PFM in pregnant women, the relationship may weaken as pregnancy progresses, and there may be no coactivation relationship between the two muscles. In order to prevent the occurrence of pelvic floor dysfunction during pregnancy and to increase the effect of rehabilitation programs, the relationship between the diaphragm and the PFM should be determined and more studies should be conducted.

Effects of Acupuncture and Massage Combined with Biofeedback Electrical Stimulation on Pelvic Floor Muscle Function and Quality of Life After Delivery

Effects of Acupuncture and Massage Combined with Biofeedback Electrical Stimulation on Pelvic Floor Muscle Function and Quality of Life After Delivery