Pelvic Floor Muscle Training Research Articles

Kegel exercises with a guidebook for stress urinary incontinence treatment

BACKGROUND Stress urinary incontinence (SUI) is uncontrollable urine leakage when intra-abdominal pressure increases. Behavioral therapy with Kegel exercise is currently the best conservative management recommendation for treating SUI patients. This study aimed to investigate the success of supervised Kegel exercises using the Kegel exercises guidebook in women with SUI. METHODS This quasi-experimental study involved both groups being taught the same regiment of Kegel exercises, but the intervention group was given the Kegel exercises guidebook. After 12 weeks, the compliance, subjective, and objective success rates were evaluated through the patient’s notes, Urinary Distress Inventory-6, Incontinence Impact Questionnaire-7, perineometer, and pad test. RESULTS Patients with a higher level of education had lower compliance to Kegel exercises (p = 0.01; odds ratio [OR] 0.38; 0.18–0.79). No significant difference was observed in the subjective symptom improvement between the two groups. The intervention group had a significantly higher success rate based on objective success by analyzing the 1-hour pad test results. The intervention group was also more adherent (p<0.001; OR 4.78; 2.51–9.0). CONCLUSIONS Patients who received the Kegel exercises guidebook were more compliant and more objectively successful than those who did not receive the manuals.

Conservative interventions for female exercise-induced urinary incontinence: a systematic review.

To systematically review and synthesise what is known about the effectiveness of non-pharmaceutical conservative interventions for the management of urinary incontinence (UI) experienced by women during physical exercise. A systematic search was performed in the following databases in September 2023: the Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Excerpta Medica dataBASE (EMBASE), Scientific Electronic Library Online (SciELO), Latin American and Caribbean Health Sciences Literature (LILACS), and Physiotherapy Evidence Database (PEDro). Studies were deemed eligible if population consisted of females who reported symptoms of UI while participating in physical exercise, and the interventions involved any non-pharmaceutical conservative treatment to manage symptoms during exercise. The primary outcome was severity of UI signs and symptoms. The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO identifier: CRD42022379138). Of the 3429 abstracts screened, 19 studies were retained. Pelvic floor muscle training (PFMT) and intravaginal devices were the most commonly investigated modalities. Only two randomised controlled trials (RCTs), both among volleyball players, compared PFMT with no PFM exercise, showing a reduction in pad weight gain after the intervention in the experimental groups only. PFMT with and without biofeedback randomised among soldiers demonstrated a reduction in the frequency of urine leakage episodes in both groups, while supervised and unsupervised PFMT randomised among athletes from different sports showed pad weight gain reduction in the supervised group only. Seven single-arm studies suggested that PFMT alone or combined with other modalities may reduce UI severity in active women based on questionnaires, bladder diaries, and self-reported symptoms. A single-arm and a crossover study found pessary use beneficial in reducing urine leakage based on questionnaires and pad weight gain, respectively. When comparing pessary, tampon, and no intervention, two repeated-measures studies found tampons may reduce leakage more than pessaries in CrossFit exercisers and women performing aerobic exercises. A vaginal sponge also reduced pad weight gain during aerobic exercises. Other modalities (i.e., an intraurethral device, photobiomodulation, and combined therapies) were investigated using case series or single case studies. While all interventions showed some evidence of effectiveness, the results must be interpreted with caution due to methodological limitations and high risk of bias. In particular, despite a high reliance on pad tests as a primary outcome, we identified inconsistencies in how pad tests were administered and interpreted. Only the effectiveness of PFMT to reduce urine leakage during exercise has been evaluated through RCTs, with some evidence of effectiveness. We identified a clear need for higher quality studies, with better reporting on the interventions, and more judicious use and interpretation of outcome measures.

Clinical Observation of Acupuncture Combined with Biofeedback Electrical Stimulation in the Treatment of Female Stress Urinary Incontinence.

To investigate the clinical efficacy of acupuncture combined with biofeedback electrical stimulation on female stress urinary incontinence. Ninety patients diagnosed in a hospital between January 2020 and January 2021 were randomly divided into three groups (A, B and C). Group A was treated with biofeedback electrical stimulation, 3 times a week for 30min for 15 times. Group B used acupuncture treatment, including Guanyuan, Qihai, Zhongji, Zusanli, Sanyinjiao and Yinlingquan, once a day, Monday-Friday, 30min each, for a total of 10 times. Group C was treated with acupuncture combined with biofeedback electrical stimulation. All three groups were combined with pelvic floor muscle training. Following treatment, the changes in class I and II muscle fibre strength, ICI-Q-SF score and urine leakage in the 1-hour pad test were compared. Prior to treatment, there was no significant difference in the general data of the three patient groups, as well as class I and II muscle fibre strength, ICI-Q-SF score and 1-hour urinary pad test (P > 0.05). Following treatment, class I and II muscle fibre strength in groups A and C improved compared with before, with statistical significance (P < 0.05); there was no significant difference in group B (P > 0.05). In the three groups, ICI-Q-SF scores and 1-hour urinary pad test results were lower compared with before (P < 0.05), with those in group C better than those in groups A and B (P < 0.05). The treatment efficiency of the three patient groups was 86.7%, 83.3% and 96.7%, respectively. Combined acupuncture and biofeedback electrical stimulation can improve pelvic floor muscle strength, urine leakage and quality of life, and can be superior to biofeedback and acupuncture treatment alone.

Developing a urinary incontinence primary care pathway: a mixed methods study.

While nearly 50% of adult women report at least one episode of urinary incontinence (UI), most never receive treatment. To better integrate primary and specialty UI care, we conducted (i) an environmental scan to assess the availability of key pathway resources in primary care, (ii) interviews with primary care providers to understand barriers to care, and (iii) a pilot UI care pathway intervention. Environmental scan: Clinic managers from all primary care clinics within a Midwestern healthcare system were invited to participate in an interview covering the availability of clinic resources. Provider interviews: Primary care providers were invited to participate in an interview covering current practices and perceived barriers to UI care. Pilot UI care pathway: Patients who screened positive for UI were provided resources for first-line behavioral management. Pilot patients completed questionnaires at baseline, 8 weeks, and 6 months. While many clinics had point-of-care urinalysis (17/21, 81%), most did not have a working bladder ultrasound (14/21, 67%) or on-site pelvic floor physical therapy (18/21, 86%). Providers (n = 5) described barriers to completing almost every step of diagnosis and treatment for UI. The most persistent barrier was lack of time. Patients (n = 15) reported several self-treatment strategies including avoiding bladder irritants (7/15, 47%) and performing Kegel exercises (4/15, 27%). Five patients (33%) requested follow-up care. At 6 months, patients reported small improvements in UI symptoms. Promising results from a novel UI care pathway pilot indicate that streamlining UI care may assist primary care providers in the first-line treatment of UI.

Pelvic Floor Rehabilitation for Urinary Incontinence after Radical Prostatectomy: Techniques and Recommendations

Introduction: Urinary incontinence is a common complication following radical prostatectomy, significantly impacting patients' quality of life. This systematic review aimed to evaluate the efficacy of various pelvic floor rehabilitation techniques in managing post-prostatectomy urinary incontinence. Methods: A comprehensive literature search was conducted using PubMed and Google Scholar, yielding 34 relevant studies for analysis. Results: The review found that pelvic floor rehabilitation, encompassing techniques such as pelvic floor exercises, biofeedback, electrical stimulation, and behavioral management, offers a non-invasive and cost-effective approach to improving continence outcomes. While the optimal timing and duration of rehabilitation remain debated, evidence supports initiating pelvic floor muscle training preoperatively and continuing postoperatively. Combining multiple rehabilitation techniques, particularly manual therapy with biofeedback or functional electrostimulation, appears to yield the best results in accelerating continence recovery. Preoperative rehabilitation showed mixed outcomes, with some studies reporting improved continence and others finding no additional benefit. Postoperative rehabilitation strategies varied, but generally focused on gradually increasing pelvic floor strength and control. The long-term efficacy of rehabilitation at 12 months post-surgery was comparable to no intervention in some studies. Conclusion: While pelvic floor rehabilitation demonstrates modest effectiveness in managing post-prostatectomy urinary incontinence, particularly in the short term, further research is needed to establish optimal protocols and long-term benefits. These findings underscore the importance of a comprehensive, patient-centered approach to post-prostatectomy care.

Urinary Incontinence in Female Athletes: A Systematic Review on Prevalence and Physical Therapy Approaches.

Urinary incontinence (UI) is an involuntary leakage of urine and is classified as stress, mixed, or urge. It is more common in females due to anatomical and physiological body differences. Moreover, the literature remarks an evident presence of UI with high-intensity physical activities. Therefore, the present integrative systematic review focused on the studies aimed at investigating the prevalence of UI in nulliparous sportswomen, studies illustrating sport-specific prevalence of UI, and studies demonstrating the impact of physical therapy intervention on UI. A literature search was carried out systematically on electronic databases consisting of Cochrane and Google Scholar databases from 2018 to December 2023. The keywords utilized to perform the literature search and include relevant articles consisted of "urinary incontinence," AND "nulliparous," AND "sportswomen," OR "female athletes," AND "physical therapy". A total of nine studies were included in the present systematic review. The quality assessment of the studies was performed by using a measurement tool to assess systematic reviews (AMSTAR 2) scale, and the Mixed Methods Appraisal Tool was used for cross-sectional and randomized controlled trial studies. The data extracted included first author and year of publication, study design, sample or number of individuals involved in the study, age range of the participants, type of UI, type of sports involved, purpose of the study, methodological part, outcome measures derived, conclusion, and quality assessment of the studies. The review concludedthat nulliparous athletes, especially those participating in high-impactactivities, have a significant prevalence of UI. In addition,the physical therapy intervention consisting of pelvic floor muscle training (PFMT)along with education about pertinent pelvic anatomy was mostly performed on female athletes for the prevention and management of UI.

Asuhan Keperawatan pada Lansia Wanita dengan Penerapan Pelvic Floor Muscle Exercise terhadap Frekuensi Berkemih

In old age, physiologically the body's cells can decline, resulting in decreased body function and endurance. One example is the urinary system which will affect changes or instability in the function of the urinary tract, so that the elderly will experience abnormal urination patterns. The management that can be carried out as an effort to restore the function of the urinary tract, especially the frequency of urination, is pelvic floor muscle exercise. Can analyze gerontic nursing care in the elderly to control decreased urinary tract function. This case study uses a descriptive method with a nursing process approach which was carried out on 3 patients using a one group pretest posttest research design. There was a change in the frequency of urination in the three respondents who had implemented pelvic floor muscle exercises. It is hoped that this nursing care report can become a reference in gerontic nursing care for the elderly with decreased urinary tract function.

Mechanisms for pelvic floor muscle training: Morphological changes and associations between changes in pelvic floor muscle variables and symptoms of female stress urinary incontinence and pelvic organ prolapse-A narrative review.

Today there is Level 1, recommendation A for pelvic floor muscle training (PFMT) to be effective in treatment of stress urinary incontinence (SUI) and pelvic organ prolapse (POP). However, the mechanisms of action are discussed. The aim of the present overview was to give an update of studies evaluating the effect of PFMT on pelvic floor morphology and associations between changes in PFM strength and symptoms of female SUI and POP. MATERIALS ANDMETHODS: This was a narrative review retrieving studies from systematic reviews of PFMT for SUI and POP. In addition, an open search on PubMed with the search terms PFMT and morphology was conducted. Both randomized controlled trials (RCTs) and pre-posttest design studies were included. PEDro rating scale (0-10) was used to assess risk of bias. Ten studies were found reporting on morphological changes after PFMT. The four RCTs had PEDro score between 5 and 8/10. The studies found significant higher bladder neck position and narrower levator hiatus dimensions, thicker external urethral sphincter, increased cross-sectional area of PFM, improvement in PFM tears and blood flow. Twenty studies analyzed associations between changes in different PFMT variables and SUI and POP. Eleven studies found a positive weak to moderate association and six studies reported no association. Studies comparing responders and nonresponders to PFMT found statistically significant better PFM variables in responders. PFMT can change pelvic floor muscle and external urethral sphincter anatomy. This contributes to the understanding on how PFMT can be effective in prevention and treatment of SUI and POP.

Pelvic floor muscle training vs radiofrequency for women with vaginal laxity: randomized clinical trial.

Vaginal laxity (VL) is a complaint of excessive vaginal looseness with a prevalence ranging from 24% to 38% across studies. The study sought to compare the effect of radiofrequency (RF) and pelvic floor muscle training (PFMT) on the treatment of women with VL. From February 2020 to December 2021, a prospective, parallel, noninferiority, randomized clinical trial was carried out in women ≥18years of age and complaining of VL in a tertiary hospital. Two groups (RF and PFMT) were evaluated at the beginning of the study and 30days and 6 months postintervention. A total of 42 participants per arm was sufficient to demonstrate a difference in sexual function on the Female Sexual Function Index at 90% power, 1-sided type 1 error of 0.025 with a noninferiority margin of 4 on the FSFI total score. Analysis was intention-to-treat and per-protocol based. The primary endpoint was the change of FSFI score after treatment, and the secondary outcomes were improvement in symptoms of VL and changes in questionnaire scores of sexual distress, vaginal symptoms, and urinary incontinence, in the quantification of pelvic organ prolapse, and pelvic floor muscle (PFM) contraction. Of 167 participants recruited, 87 were included (RF: n = 42; PFMT: n = 45). All questionnaires improved (P < .05) their total scores and subscales in both groups and during the follow-ups. After 30days of treatment, RF was noninferior to PFMT to improving FSFI total score (mean difference -0.08 [95% confidence interval, -2.58 to 2.42]) in the per-protocol analysis (mean difference -0.46 [95% confidence interval, -2.92 to 1.99]) and in the intention-to-treat analysis; however, this result was not maintained after 6 months of treatment. PFM contraction improved significantly in both groups (RF: P = .006, 30days; P = .049, 6 months; PFMT: P < .001, 30days and 6 months), with better results in the PFMT group. Sexual, vaginal, and urinary symptoms were improved after 30days and 6 months of treatment with RF and PFMT; however, better results were observed in the PFMT group after 6 months. The present randomized clinical trial used several validated questionnaires evaluating quality of life, sexual function and urinary symptoms, in addition to assessing PFM contraction and classifying the quantification of pelvic organ prolapse aiming at anatomical changes in two follow-up periods. The limitations were the lack of a sham-controlled group (third arm) and the difficulty of blinding researchers to assess treatments due to the COVID-19 pandemic. After 30days and 6 months of treatment, sexual, vaginal, and urinary symptoms improved with RF and PFMT; however, better results were observed in the PFMT group after 6 months. RF was noninferior to PFMT in improving FSFI total score after 30days; however, this result was not maintained after 6 months of treatment.

KNOWLEDGE AND BELIEFS TOWARDS PELVIC FLOOR MUSCLE TRAINING DURING PREGNANCY AND POSTPARTUM PERIOD; A CROSS-SECTIONAL OBSERVATIONAL STUDY IN THE URBAN POPULATION OF PAKISTAN

Background of the Study: This study aimed to assess knowledge and beliefs about pelvic floor muscle training to prevent urinary incontinence (UI) during pregnancy and postpartum in Karachi. Also, to determine the prevalence of urinary incontinence. Methodology: This cross-sectional study was conducted at the Department of Gynecology and Obstetrics, Dow University Hospital, Karachi. Non-probability sampling technique was done on N=380. QUID scale questionnaire and items to assess knowledge and beliefs were executed. Participants were invited either during their consultancy visit or post-delivery. The logistic regression analysis using SPSS Version 26.0 was performed to predict the knowledge level of PFMT, classification of gravida and parity, delivery type and other variables. Results: The study founded lack of awareness regarding pelvic floor muscle training and an inadequate level of knowledge during the antenatal period (n=168). It was found that 23.0% responded the question as they are currently “Doing Pelvic Floor Muscle Exercise” in the antenatal period. Logistic analysis showed that women with cesarean-section delivery have more probabilities of adequate knowledge (OR=1.65, 95% CI=1.03-2.64, p-value= 0.035). Women strongly believe that urine leakage is normal during pregnancy. Conclusion: The study concluded that stress incontinence and urge incontinence are most common among others. Lack of awareness regarding pelvic floor muscle training was found among both groups. In contrast, a high level of knowledge regarding pelvic floor muscles’ anatomy and function and urinary incontinence was found in the postpartum group.

Pelvic floor muscle training for urinary incontinence after radical prostatectomy. Literature review

Pelvic floor muscles training is the main method of treatment for urinary incontinence in prostate cancer patients after radical prostatectomy. For increasing the effectiveness of the method, the authors suggest starting the exercises before surgery and continuing them in the postoperative period. Other researchers modify the classic exercise program by adding exercises aimed at activating fast-twitch and slow-twitch muscle fibers, or combining with vibration therapy, electromyographic biofeedback. Pelvic floor muscles training in various combinations and modifications, as the literature review shows increases the effectiveness of recovery of urinary control function after radical prostatectomy in patients with prostate cancer.

Does Pelvic Floor Muscle Exercise Change the Hemodynamic Responses of the Inferior Vena Cava in Pregnant Women? A Prospective-Controlled Study.

This study was aimed at exploring the immediate impacts of pelvic floor muscle exercises (PFMEs) on various maternal physiological parameters in pregnant women. The study included a total of 52 women, 26 pregnant (Pregnant group: 28.04±6.01 years; 26.83±3.81 kg/m2) and 26 nonpregnant (Control group: 29.42±5.73 years; 25.41±3.03 kg/m2) individuals. All women received PFME as follows: PFME was performed for 5 min (6-s holding contraction, 10 s of relaxation, 3 rapid PFM contractions). Evaluations were conducted before, immediately after, and 5 min post-exercise, with measurements including inferior vena cava (IVC) diameters and pulsatility index, blood pressure, oxygen saturation, and heart rates. Two-way analysis of variance was performed for group and time comparisons in repeated measurements. In both groups, the IVC collapsibility index values were lower 5 min after exercise, although this decrease, although clinically significant, did not reach statistical significance (p= 0.057). Post-exercise systolic blood pressure significantly decreased in both groups, whereas diastolic blood pressure decreased significantly in the pregnant group (p= 0.001, p= 0.023). The study found no statistically significant changes in the collapsibility index of the IVC after PFME but observed a clinically suggestive decrease. The clinical decrease in the collapsibility index can be interpreted as PFME in the supine position increasing venous return. Additionally, PFME was found not to alter maternal and fetal heart rates but contributed to the decrease in maternal systolic and diastolic blood pressure. Our study supports the view that the acute effects of PFME neither induce fetal stress nor pose maternal risks.

Acute Effect of Transcranial Direct Current Stimulation in Pelvic Floor Muscle Function in Young Healthy Women: Initial Findings of a Randomized Controlled Trial.

Transcranial direct current stimulation (tDCS) can enhance muscle function in healthy individuals. However, it is unknown if tDCS associated with pelvic floor muscle training (PFMT) can improve pelvic floor muscle function (PFMF) in healthy women. The aim of this study was to investigate the acute effect of a single session of tDCS in PFMF compared with sham-tDCS in healthy women. A double-blind, cross-over, randomized clinical trial was conducted with healthy, nulliparous and sexually active women. PFMF was assessed by bidigital palpation (PERFECT scale) and intravaginal pressure by a manometer (Peritron™). Participants randomly underwent two tDCS sessions (active and sham) 7 days apart. The electrode was positioned equal for both protocols, the anode electrode in the supplementary motor area (M1) and the cathode electrode in the right supraorbital frontal cortex (Fp2). The current was applied for 20min at 2mA in active stimulation and for 30s in sham-tDCS. The tDCS applications were associated with verbal instructions to PFMT in a seated position. After each tDCS session PFMF was reevaluated. Twenty young healthy women (aged 23.4 ± 1.7years; body mass index 21.7 ± 2.2kg/m2) were included. No difference was observed in power, endurance, and intravaginal pressure of PFMF (p > 0.05). The number of sustained contractions improved from 3.0 (2.0-3.5) to 4.0 (3.0-5.0) after active-tDCS (p = 0.0004) and was superior to sham-tDCS (p = 0.01). The number of sustained contractions of PFM improved immediately after a single active-tDCS session, with a difference compared with the post-intervention result of sham-tDCS in healthy young women.

The Prevalence of Urinary Incontinence, Knowledge and Practice of Pelvic Floor Muscle Training Among Female Recruits in Basic Training

OBJECTIVETo describe the prevalence, and severity of urinary incontinence (UI) among female recruits during basic training and their knowledge and practice of pelvic floor muscle training (PFMT). Furthermore, to determine if there is a relationship between the severity of UI and PFMT knowledge and practice. METHODSThis correlational study’s utilized a demographic and health questionnaire, a UI questionnaire [International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF)], and a PFMT questionnaire- Short version of the Patient-reported Outcome Measures (PFMT-P)]. RESULTSThe study included 349 female recruits with a mean age of 18.17 (± 0.390). The prevalence of UI was 26.7%, with a low mean of 2.03 (± 3.893) on the ICIQ-SF. PFMT knowledge level of was moderate, 1.46 (± 0.790), and the mean practice of PFMT was low, 2.51(± 1.180). No significant correlation was found between the ICIQ-SF score and the level of knowledge, rs=-0.09, p=0. 092. There was a weak but significant correlation between the ICIQ-SF score and PFMT practice, rs=0.170, p.= 0.003. CONCLUSIONSA little more than a quarter of the female recruits reported UI with a low severity. A relationship was found between UI and PFMT practice.

The Effect of Yoga and Pelvic Floor Muscle Exercise on Sexual Function and Sexual Self-esteem of Reproductive-age Women: A Randomized Clinical Trial.

Sexual function is a part of sexual health which is an important aspect of the quality of life. Physical activity is one of the healthiest activities that can effectively reduce the risk of sexual disorders. Therefore, this study was conducted with the aim of evaluating the effect of yoga and pelvic floor muscle exercises on the sexual function and sexual self-esteem of reproductive-age women. This randomized clinical trial study was conducted from September to December 2023 on 46 women of reproductive age working in the Shahrekord University of Medical Sciences and its affiliated health centers. Multi-stage cluster sampling was used to select the subjects; later, they were randomly divided into two intervention groups A (N=21) and B (N=25). Participants in intervention groups A and B performed pelvic floor muscle exercises at home using an educational pamphlet 3 times a week for 6 weeks, with 3 times a day repetition. In addition, women in the intervention group A participated in a yoga training program for 2 sessions per week for 6 weeks. Data collection tools included a demographic information form, the Female Sexual Function Index, and Sexual Self-Esteem Inventory for women. Questionnaires were completed by both groups before, immediately, and one month after the intervention. The data were analyzed using the chi-square test, fisher's exact test, independent two-sample t-test, repeated measures test, and analysis of covariance in SPSS software version 16. A significance level of less than 0.05 was considered. The results showed no statistically significant difference between the two groups in sexual function (P=0.21) and sexual self-esteem (P=0.22) scores before the intervention. Also, the results showed no statistically significant difference between the two groups in terms of sexual function (P=0.35) and sexual self-esteem (P=0.59) scores one month after the intervention. However, the mean score of the sexual function index immediately after intervention showed a statistically significant difference between the intervention groups A (31.43±3.76) and B (29.41±2.38) (P<0.001). The mean score of the sexual self-esteem immediately after the intervention showed a statistically significant difference between the intervention groups A (181.19±19.90) and B (171.32±15.02) (P<0.001). Adding yoga exercises to pelvic floor muscle exercises can improve the sexual function and sexual self-esteem of women at their reproductive age. Trial Registration Number: IRCT20100524004015N1.

Effectiveness of Pelvic Floor Strengthening Exercises in Females with Stress Urinary Incontinence – A Systematic Review

Abstract Background: Urinary incontinence (UI) is an unpleasant and socially constrained disorder that affects one in three women. Stress UI (SUI) is the most prevalent type of UI and is identified in 50% of affected women. The main objective of this systematic review was to evaluate the updated literature exploring the effectiveness of pelvic floor strengthening exercises and their dosimetry in women with SUI. Methods: Randomized controlled trials published between January 2013 and February 2023 and in English were included in this review. Case reports, systematic reviews, meta-analyses, and studies published in languages other than English were excluded from the study. Databases such as PubMed, Cochrane Library, and Physiotherapy Evidence Database (PEDro) were used to locate the literature. The quality of the data included was evaluated using PEDro scoring, and the risk of bias in the included studies was evaluated using RoB 2, a modified Cochrane risk-of-bias tool. Results: After screening, 12 studies were selected and included for qualitative analysis for the review. The findings of this review showed that pelvic floor muscle training (PFMT) exercises are an effective intervention for treating symptoms of SUI and improving quality of life whether used in combination or isolation. It is also suggested that a minimum of 12 supervised sessions of PFMT with a frequency of three times a week is suggestive to be an effective intervention and can be seen as a first line of treatment of SUI. It can be concluded that the PFMT is an effective intervention to treat the symptoms of SUI in females. Registration and Protocol: The systematic review applied for registration in PROSPERO but declined the registration because of an excessive inflow of trials that needed to be registered in PROSPERO as it was not accepting trials other than COVID-19 trials.

Effect of Kegel Exercise and Prone Position on After Pain Among Postpartum Mothers

ABSTRACT Background: Afterpain is a common discomfort felt by most of the postpartum mothers which is occurred due to delayed involution. Kegel exercise and prone position enhance the involution. Aim: The aim of the study was to determine the effectiveness of Kegel exercise and prone position on afterpain among postpartum mothers. Material and Methods: A Quasi-experimental pretest post-test with control group research design was used. Using nonprobability purposive sampling technique recruited 60 postpartum mothers who met the criteria. The level of afterpain was assessed by using visual analog scale. Experimental group was educated to do Kegel exercise for 3 days and lie in prone position for 3–5 minutes, 3 times for 3 days. Control group follows routine postnatal care posttest was conducted. Results: The study results concluded that the afterpain mean difference was 0.53, 1.70, 1.80, and 4.03. The calculated paired t-test value of t = 5.757 between pretest and post-test 1, t = 12.420 between post-test 1 and post-test 2, t = 12.953 between post-test 2 and post-test 3, and t = 21.378 between pretest and post-test 3 was found to be statistically significant at P &lt; 0.001 level. Conclusion: Therefore, Kegel exercise and prone position was effective in reducing afterpain during postpartum period.

Comparison of Surgical Outcomes of Laparoscopic Ventral Mesh Rectopexy and Stapled Transanal Rectal Resection for Managing Obstructed Defecation Syndrome

Abstract Background: Obstructed defecation syndrome has several underlying causes and is a prevalent but poorly understood condition. It is characterized by the inability to pass stool even when one experiences the urge to defecate. Initial therapy for ODS usually involves diet modifications, pelvic floor exercises, and biofeedback, which can considerably reduce symptoms. Surgical intervention may be recommended for individuals who present with certain anatomical anomalies and who do not respond to conservative therapies. Objectives: To assess and compare the surgical outcomes of laparoscopic ventral mesh rectopexy (LVMR) and stapled transanal rectal resection (STARR) for ODS management. Design: The study conducted a retrospective review of prospectively gathered data on the outcomes of 162 patients treated for ODS at our facility between January 2015 and January 2022 using either LVMR or STARR. Settings: The study was conducted at our facility between January 2015 and January 2022, evaluating 162 patients with ODS who underwent either LVMR (118 patients) or STARR (44 patients). Patient and Methods: The Modified Longo’s Scores (MLS) were used as the primary evaluation tool, determined preoperatively and postoperatively at 1 month, 6 months, and 12 months. Sample Size: A total of 162 patients were included in the study, with 118 patients who underwent LVMR and 44 patients who underwent STARR for the treatment of ODS at our facility between January 2015 and January 2022. Results: Preoperative MLS for LVMR patients averaged 23.41, which was similar to that of STARR patients (23.52), showing no statistically significant difference. After 1 month, the mean MLS showed a significant decrease of 93.3% among LVMR patients and that of 18.0% among STARR patients from the preoperative mean MLS, indicating a significantly greater change among LVMR patients than among STARR patients. Similarly, after 6 months, the preoperative mean MLS for LVMR patients and STARR patients revealed a substantial decline of 95.4% and 6.5%, respectively, with LVMR patients experiencing a considerably greater change than STARR patients. After 12 months, the mean MLS showed a significant decrease of 96.6% and 3.6% among LVMR and STARR patients from the preoperative mean MLS, respectively, with change being significantly more among LVMR patients than STARR patients. Conclusion: LVMR can be the preferred method because it outperforms STARR in terms of alleviating ODS symptoms. Limitations: This research involved a retrospective study using a small sample size and a short follow-up period. Conflicts of Interest: None.

Incidence of Urinary Incontinence During the Postpartum Period in Rajavithi Hospital: A Prospective Cohort Study.

The objective was to study the incidence of urinary incontinence (UI), associated risk factors and quality of life (QOL) in postpartum women. A prospective study was conducted with 406 postpartum women at Rajavithi Hospital and followed up over the phone between June 2020 and September 2021. Inclusion criteria were singleton pregnant women aged 18-45years, and gestational age ≥ 37weeks. Baseline characteristics (age, body mass index, birthweight, gestational age, parity, delivery type, smoking, and alcohol and caffeine intake) were recorded. UI was defined as a score ≥ 16.7% using the Urogenital Distress Inventory. Incontinence-related QOL was evaluated using the Incontinence Impact Questionnaire: a score of ≥ 70 indicated poor QOL. Outcomes were assessed during the postpartum period at 2days, 6weeks, 3 months, and 6months. Multivariate logistic regression was used to analyze risk factors for UI. The incidence of self-reported UI at 2days, 6weeks, 3 months, and 6months postpartum were 39%, 3%, 1%, and 0% respectively. Caffeine consumption during pregnancy was only a risk factor for UI (adjusted RR 1.61, 95%CI 1.27-2.05, p < 0.001) after adjusting for age, BMI, birthweight, parity, delivery type, alcohol, smoking, and pelvic floor exercise. Three women with UI had poor QOL, whereas all women without UI reported a good QOL. In our study sample, urinary incontinence was found in one-third of women during the early postpartum period, but for most women symptoms improved with the first 6weeks and all resolved at 6months. In this study, caffeine consumption during pregnancy was the only risk factor for UI.

The Effect of Kegel Exercises and Pelvic Floor Physiotherapy on the Improvements of Stress Urinary Incontinence and Urge Incontinence in Women with Normal Vaginal Delivery

Objectives: Pregnancy and normal vaginal delivery, are the main risk factors for urinary incontinence in women. A variety of treatments such as bladder training and pelvic floor exercises are effective for urinary incontinence. This interventional study has been conducted to compare the influence of Kegel exercises and pelvic floor physiotherapy on the improvements of urge and stress incontinence in women with first or second singleton pregnancies who have experienced normal vaginal delivery. Methods: One hundred fifty women with urinary incontinence in the postpartum period, who were divided randomly into 3 groups of 50 patients, participated in this prospective interventional study. The women were primigravida or it was their second labor. None of them complained of urinary incontinence before pregnancy. All of them had a normal vaginal delivery. The first group included females who were asked to perform Kegel exercises. The second group had 8 weekly physiotherapy appointments. The control group, included mothers who received routine care. We compared the prevalence of urge and stress incontinence between groups. Results: We found that the relative risk of urge and stress incontinence among mothers in the control group was more than in the intervention groups, but this difference was only statistically significant in the subject of stress incontinence between the Kegel and control groups. The reduction of urge incontinence prevalence among mothers in the Kegel and physiotherapy groups, was more than control group, although this reduction was not significant. Conclusion: There is a significant decrease in the prevalence of stress urinary incontinence at the end of the 8th and 12th weeks postpartum compared to the control group. Although the prevalence of urge incontinence among women in intervention groups was lower than in the control group, it was not significant. It seems the effect of Kegel exercises and pelvic floor physiotherapy, in reducing stress incontinence at the end of the 8th week, is almost equal.