Pelvic Floor Research Articles

EFFECTIVENESS OF HYPOPRESSIVE EXERCISES ON POSTNATAL MOTHERS WITH URINARY INCONTINENCE-A PILOT STUDY.

Background: Pelvic Floor Muscle Dysfunctions can lead to Urinary Incontinence, a condition which often affects women both during pregnancy and after childbirth. As a result of this, certain exercises are recommended during and after pregnancy to prevent and treat this incontinence. Hypopressive Exercise is one of these methods used to prevent Urinary Incontinence. Objective: The purpose of the study is to find the Effectiveness of Hypopressive Exercises on Postnatal Mothers with Urinary Incontinence. Methods: 30 Mothers (between the age group of 25 – 35 years) clinically pre diagnosed with urinary incontinence with PERFECT score were included in the study. with informed consent, the protocol was explained to the subjects. Mothers were given Hypopressive Exercises for 3 sessions per week for 4 weeks. This session lasted between 30 to 40 minutes. The outcome measure of the Exercises was measured using UI – QUID and PERFECT test. Results were tabulated using statistical analysis. Result: The analysis shows that the mothers who underwent Hypopressive exercises have significant reduction in urinary incontinence (p-value) P<0.0001. Conclusion: This study concluded that the mothers underwent Hypopressive exercises have significant reduction in Urinary Incontinence and increase in Pelvic Floor Muscle Strength Implications: The Hypopressive Exercises strengthens the Deep Core Muscles which increases body awareness by training the Pelvic Floor Muscles in women and reduces Urinary Incontinence. These Exercises not only pay attention to maintaining proper body posture and Pelvic Floor Muscles activation. But also had a positive impact on the Quality of Life and reduction of incidents of urine leakage among mothers.

Physical therapy approach and non-invasive modalities in treatment of vaginal laxity: a literature review.

Pelvic floor physical therapy (PFPT) and noninvasive modalities can be more safe and available treatments for vaginal laxity (VL) with less risk of postsurgical complications. The purpose of this review is to define the concepts of PFPT and noninvasive modalities, examine the evidence supporting those modalities as a treatment for VL, and evaluate their effectiveness. Between 2002 and 2023, clinical studies including women diagnosed with VL were examined in the Web of Science, Cochrane Library, Scopus, and PubMed databases. Exclusion criteria included studies with no outcomes or inadequate data, procedures, suggestions, editorials, book chapters, letters to editors, reviews, meta-analyses, animal research, and articles in languages other than English. Only seventeen studies have been identified. Four studies have demonstrated the impact of PFPT (low- and medium-energy radiofrequency (RF), ultrasound, low-energy laser treatment, par sacral stimulation, the knack method, and pelvic floor exercises), and thirteen studies have discussed the impact of noninvasive modalities (RF, combined multipolar RF with pulsed electromagnetic, combined RF and pulsed electromagnetic field, high-intensity focused ultrasound, CO2 laser, combining multipolar RF and hybrid fractional laser, microfocused ultrasound, and the VIVEVE surface-cooled RF) on vaginal laxity. This review indicates many knowledge areas that must be attempted in order to understand the influence of nonstrengthening physical therapy and noninvasive methods on vaginal laxity. In addition to the mechanisms behind their impacts. In addition, we strongly recommend that more clinical trials of high methodological and interventional quality are required to investigate the efficacy of various physical therapy approaches, including electrical stimulation, biofeedback exertion, acupressure, manual therapy, neuromodulation, core exercise therapy, hydrotherapy, well-designed ultrasound therapy protocols, and vaginal weight training.

Development and validation of a risk prediction model for postpartum urinary incontinence in primiparas with singleton pregnancies: a multicenter clinical investigation

BackgroundPostpartum urinary incontinence (UI) is a serious condition that significantly affects the quality of life. Several studies have demonstrated that it is associated with pelvic floor dysfunction. This study aimed to develop and validate a UI risk prediction model to identify primiparas with singleton pregnancies at high risk.MethodsA multistage stratified random sampling process was used. UI was measured using the International Standard Consultation on Incontinence Questionnaire Form (a modified Bristol questionnaire, ICIQ-FLUTS). Records of 1,340 primiparas with singleton pregnancies were reviewed, and data were collected from January 2014 to December 2014 in multiple centers. A univariate logistic regression analysis was performed, followed by a multivariable logistic regression analysis of the data. Using bootstrap resampling, we constructed a nomogram to assess postpartum UI risk.ResultsA total of 1,340 patients were enrolled, including 345 with postpartum UI and 995 with non-postpartum UI. The occurrence of postpartum UI was significantly related to the mode of delivery, family history of UI, coffee or tea consumption, antenatal UI, and frequent cough. The nomogram exhibited good discriminatory ability with a C-index of 0.718 (95% confidence interval: 0.684–0.752) and a bootstrap-corrected C-index of 0.716. Additionally, the calibration curve demonstrated that the predicted outcomes aligned well with the actual observations. Ultimately, the decision curve analysis indicated that the nomogram exhibited favorable clinical applicability.ConclusionThe decision curve analysis suggests that the nomogram could provide clinical value. The clinician will then feel more confident about making clinical recommendations regarding postpartum UI screening for primiparous women with singleton pregnancies.

Combined effects of high-intensity focused electromagnetic therapy and pelvic floor exercises on pelvic floor muscles and sexual function in postmenopausal women. A randomized controlled trial.

This study aimed to explore the impact of high-intensity focused electromagnetic therapy (HIFEMT) on the pelvic floor muscles (PFM), sexual function, and quality of life (QoL) among postmenopausal women. Fifty postmenopausal women with PFM weakness and sexual dysfunction were randomly allocated into two equal groups. The HIFEMT group participated in the PFM training program in addition to HIFEMT, whereas the control group performed PFM training only. For 12 weeks, HIFEMT was scheduled two times a week, while PFM training was performed daily. At baseline and after 12 weeks, PFM strength and endurance were assessed using a perineometer and sexual function was examined using the female sexual function index (FSFI) and menopause-specific quality of life questionnaire (MENQOL). The HIFEMT and control groups showed significant increases in PFM strength and endurance and FSFI scores, and significant declines in MENQOL compared with baseline measures (P<0.05). Compared to the control group, the HIFEMT group showed substantial improvements in all measured variables after 12 weeks (P<0.05). Addition of HIFEMT to PFM training improved the PFM strength, endurance, sexual function, and QoL in postmenopausal women with PFM weakness and sexual dysfunction.

Low-dose add-on methadone for cancer pain management: a retrospective analysis of 102 Japanese patients.

Methadone was introduced in 2013 for the treatment of intractable cancer pain in Japan and is indicated for patients receiving opioid doses ≧60mg/day as an oral morphine equivalent. Low-dose (≦10mg/day) add-on methadone to prior opioids has been reported from European countries to successfully relieve various types of intractable cancer pain; however, there are few reports of such use in Japan. The aim of this study was to analyze more than a hundred cases with low-dose add-on methadone to treat intractable pain in Japanese cancer patients. All cases in which 5 or 10mg/day of methadone was added to prior opioids by the Palliative Care Team or Division of Palliative Medicine in our hospital during the period between April 2016 and September 2023 were extracted and analyzed retrospectively on electrical medical charts. A total of 102 cases were extracted with a male-to-female ratio of60:42, and the age (mean±SD) was 62.8±14.7years old. Methadone was introduced in an inpatient setting to 86 patients. The major pathologies that caused intractable pain were spinal metastases in 48, pelvis or pelvic floor lesions in 29 and pleural and/or chest wall lesions in 16. The most common mechanism of pain was the mixture of somatic and neuropathic components. The major opioids administered prior to methadone included tapentadol in 46 patients, hydromorphone in 36 and oxycodone in 19. The dose of the prior opioids [median, (interquartile range: IQR)] was 97, (62.8-167.3) (range: 15-1313) mg/day of oral morphine equivalent. Radiotherapy, chemotherapy and nerve blocks were performed as concomitant therapies in 48, 22 and 11 patients, respectively (with some overlap). The number of rescue doses [median (IQR)] was significantly decreased from three (two to five) on the day before methadone to one (zero to four) after seven days from methadone initiation. The side effects leading to discontinuation of methadone were drowsiness in three cases, nausea in three cases and dizziness in one case (with some overlap). Compared with complete switching from other opioids, low-dose add-on methadone can reduce the possibility of major dose discrepancies and can be quickly adjusted by combined opioid reduction/increase. Low-dose add-on methadone can be an effective and safe method for intractable cancer pain.

Association between lipid accumulation products and stress urinary incontinence: a cross-sectional study from NHANES 2005 to 2018

BackgroundStress urinary incontinence (SUI), a common disorder of the pelvic floor, often results in anxiety, poor quality of life, and psychological issues among its sufferers. The relationship between lipid accumulation products (LAP) and stress-related urine incontinence remains unclear. This research aimed to investigate any possible correlation between the risk of SUI and the level of lipid accumulation products.MethodsFor this cross-sectional research, people with SUI who were 20 years of age or older were recruited using information from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018. A weighted multivariate logistic regression model was used to evaluate the findings. As a potential biomarker, lipid accumulation product levels were sorted among individuals in ascending order and subjected to a trend test (P for trend). Additionally, a nonlinear analysis was conducted using smooth curve-fitting methods. Lipid accumulation products' effectiveness in predicting SUI was evaluated using receiver operating characteristic (ROC) curves. Finally, a subgroup analysis was performed to confirm that the connection between SUI and lipid accumulation products was consistent across all demographic groups.ResultsA thorough survey performed on 14,945 participants indicated that 23.61% of the respondents had SUI. A noteworthy association was observed between higher lipid accumulation product values and a greater probability of SUI in multivariate logistic regression analysis. Specifically, the stratification of lipid accumulation products into quartiles demonstrated a substantial positive correlation between the upper and lower quartiles, as evidenced by an elevated odds ratio for SUI (OR = 1.92; 95%CI 1.51–2.44; P < 0.0001). The subgroup analysis supported link consistency across all cohorts under investigation. Finally, the ROC curve indicated that lipid accumulation products (AUC = 0.67, 95%CI 0.654–0.690) had a superior predictive effect on the likelihood of SUI.ConclusionsIncreased lipid accumulation product values are associated with a higher chance of SUI in adult participants. This suggests that lipid accumulation products could be a valuable marker for detecting SUI, offering new perspectives for its evaluation and treatment.

Electromyographic parameters for treatment of pelvic floor disorders in pregnant and postpartum women: A review protocol.

Electromyography is a widely used instrument in clinical practice to evaluate and treat pelvic floor disorders in pregnant and postpartum women. The objective of this study is to analyze the scientific evidence on the electromyography parameters used for treatment of pelvic floor disorders in pregnant women in any gestational week and postpartum women up to 12 months after delivery. A systematic review of randomized controlled experimental studies (clinical trials) and quasi-experimental studies in English, Portuguese or Spanish, which used electromyography as an intervention for treatment of pelvic floor disorders in pregnant or postpartum women up to 12 months after delivery will be performed in online databases (Scopus, Medline, Pedro, Scielo and Pubmed),. Risk of bias assessment will be performed using Cochrane group tools. The Rob 2.0 tool will be used for experimental studies and the Robins-I tool for non-experimental studies. The protocol was registered in PROSPERO (no.433510). The quality of the evidence will be analyzed using the GRADE System Methodological Guide and the systematic review structure will be performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Knowledge of pelvic floor muscles in community-dwelling women aged over 60: its relationship with urinary incontinence.

To investigate the awareness of the pelvic floor muscles (PFMs) and PFM exercises (PFME) knowledge, training and experience in community-dwelling women aged 60 and over and its relationship with urinary incontinence (UI). This is a questionnaire based study which was carried out in 9 Physical Medicine and Rehabilitation Centers, including a total of 500 women aged 60 and over and living in the community. The questionnaire included questions about awareness of PFMs, UI complaints and PFME knowledge, training and experience. Knowledge and awareness of PFMs and PFME knowledge, training and experience were compared in subgroups with or without urinary incontinence. The mean age of the women included in the study was 67.8 ± 6.1 (60-88). Knowledge and awareness of PFMs and PFME knowledge, training and experience were low in the study population. Knowledge and awareness of PFMs were significantly low in the subgroup with urinary incontinence (p < 0.05). Kegel exercise training and experience were significantly low in the subgroup without urinary incontinence (p = 0.01, p < 0.01). Knowledge and awareness of PFMs and PFME knowledge, training and experience are low in community-dwelling women aged 60 and over and training programs should be organized to teach the function of the PFMs and to perform PFME correctly in this population.

Influence of High-Impact Physical Activity on Pelvic Floor and Lumbar Muscle Mechanical Properties in Asymptomatic Nulliparous Women.

High-impact physical activity is a known risk factor for the development of pelvic floor disorders (PFDs) in women, affecting the pelvic floor muscles (PFMs). However, there is insufficient information to determine whether alterations in PFMs, or even in the lumbar muscles, can be detected before the onset of symptoms. The aim of the study was to identify whether high-impact physical activity influences the muscle mechanical properties (MMPs) of the lumbopelvic region in continent nulliparous women. An observational cross-sectional study with a nonprobabilistic sampling of consecutive cases was designed. Fifty women who had practiced high-impact physical activity at least three times per week for more than 2 years were included in the high-impact group, and 50 women who did not practice high-impact activity were included in the control group. Data collection for both groups included sociodemographic data and MMPs (frequency, characterizing muscle tone; stiffness; logarithmic decrement, characterizing the inverse of the elasticity; relaxation time of stress; creep, characterizing fluidity) of PFMs and lumbar muscles, externally assessed using a hand-held tonometer device. Between-group comparison of the MMPs were calculated, together with intragroup correlations between the outcomes. The MMPs of PFMs showed statistically significant lower tone (0.76Hz, 95% CI 0.04, 1.48) and stiffness (23.76 N/m, 95% CI 1.10, 46.42) and were more viscoelastic (relaxation: -1.04ms, 95% CI -1.98, -0.11; creep: -0.04 De, 95% CI -0.07, -0.02) in women who practiced high-impact physical activity. No lumbar MMPs showed statistically significant between-group differences. High-impact physical activity alters the MMPs of PFMs in nulliparous women, although not lumbar spinal MMPs, even before the appearance of signs.

Long-term effects of pelvic floor training in male chronic pelvic pain, correlation between subjective and objective outcomes: a study protocol for a randomised controlled trial

IntroductionChronic primary pelvic pain syndrome (CPPPS) is a condition characterised by pain in the pelvic area together with lower urinary tract symptoms. Pathophysiology remains largely unclear. Common treatment modalities show...

Effects of using a mobile application on pelvic floor training in women with stress urinary incontinence: A randomized controlled clinical study.

Urinary incontinence (UI) is defined as any involuntary loss of urine that causes negative impacts on women's lives. Pelvic floor muscle training (PFMT) is considered to be "level A" of scientific evidence in the treatment of UI. Despite its efficacy, it is known that the effect of PFMT may depend on continuous adherence. Therefore, healthcare professionals are looking for alternatives to improve adherence in their patients. Healthcare has been innovating through mobile device apps. Thus, the objective of this study was to verify the effects of PFMT with the use of a mobile device app in incontinent women. This was a controlled, randomized clinical trial that occurred remotely. A total of 104 women with stress UI and/or mixed incontinence, over 18 years old, literate, with preserved cognitive capacity, with internet access and a mobile device with the Android system, participated in this study. They were randomly divided into two groups: The App group and the Booklet group, which underwent a PFMT protocol guided by a mobile app and a booklet, respectively. Both groups received daily reminders to perform the exercises. Before and after 12 weeks of intervention, it was evaluated using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and the King's Health Questionnaire (KHQ). Both groups showed improvements in the final ICIQ-SF score. However, superior results were shown for the Booklet group (App: pre: 11.5 [±3.8], post: 9.8 [±4.5]; Booklet: pre: 12.6 [±4.5], post: 7.4 [±4.3]; p = 0.03). It was concluded that PFMT, with the use of a mobile app, is capable of reducing UI and the impact of UI, but it is not superior to training with the use of booklet instructions.

A Systematic Review of Comparative Effectiveness of Interventions for Low Anterior Resection Syndrome: Impacts on Bowel Function and Quality of Life.

Low anterior resection syndrome (LARS) is a common complication following sphincter-preserving surgical resection for rectal cancer, characterized by symptoms such as fecal incontinence, urgency, and altered bowel habits, which significantly affect patients' quality of life. This cluster of symptoms not only limits their day-to-day physical activity but also has a debilitating effect on their emotional and mental well-being, undermining their integration and overall psychological health. This systematic review aimed to evaluate the effectiveness of invasive and non-invasive interventions for LARS, including pelvic floor rehabilitation, transanal irrigation, and various surgical options such as sacral neuromodulation and stoma formation, either as part of primary surgery or as a definitive treatment option for refractory cases. We systematically searched relevant databases for studies published in the last decade, focusing on adult patients diagnosed with LARS post-low anterior resection (LAR), with outcomes assessed through bowel function and quality of life metrics. The review identified six studies that met our eligibility criteria; a pooled cohort of 794 patients was identified, with sample sizes ranging from 37 to 430 participants. Our analysis revealed that pelvic floor rehabilitation significantly improves bowel function and quality of life in patients with LARS; yet, the optimal management approach remains unclear due to variability in patient responses. These findings highlight the inherent complexity and heterogeneity of LARS management, underscoring the necessity for multifaceted and individualized treatment strategies. Although pelvic floor rehabilitation shows promise, especially among motivated patients, its long-term sustainability remains uncertain. Surgical options are typically reserved for severe cases and carry significant risks and psychological impacts. For patients identified as being at high risk for LARS, treatment options must be considered and discussed at an earlier phase of their care. Our review concludes with the need for a tailored, patient-centered approach to managing LARS, highlighting the importance of ongoing research to fill existing evidence gaps. There is a need for translational research across various treatment modalities, comparing their effects, cost-effectiveness, implementation strategies, and the consequent effects on patients' quality of life and mental health.

Inter-rater and Intra-rater Reliability of Het’s MMT in Pelvic Floor Assessment

Abstract Objective: Pelvic floor dysfunctions (pfds) such as urinary incontinence, pelvic organ prolapse, and vaginismus are very common and are affecting the quality of life of the female suffering through it. The pelvic floor muscles can be in spasm, thus resulting in the inability to relax or the pelvic floor muscles can be extremely weak or loose, resulting in the inability to contract strongly and completely. The spasmodic pelvic floor can result in vaginismus, dyspareunia, chronic pelvic pain, constipation, etc., Moreover, a weak pelvic floor can lead to issues such as urinary incontinence, pelvic organ prolapse, and sexual dysfunction. There is a scarcity of a valid and reliable scale that assesses both the components of pfd. Subjects and Methods: The present study was conducted on 1349 participants which were divided into three groups on the basis of their symptoms. Group A – No symptoms (n = 439), Group B – Hypotonus pfd (n = 658), and Group C – Hypertonus pfd (n = 252). Examination: Vaginal examination to assess the pelvic floor muscles relaxation and contraction was done by Het’s Manual Muscle Testing (MMT). Inter rater reliability was assessed by comparing the data of two independent examiners on the same day. The intra rater reliability was assessed by comparing the data of test and retest at an interval of 1 week. Results: The intra rater reliability at 95% confidence interval (CI) was 0.92 – Normal pelvic floor function, 0.96 – Hypotonus pfd, and 0.97 – Hypertonus pfd. Moreover, inter rater reliability at 95% CI was 0.93 – normal pelvic floor function, 0.95 for hypotonus pfd, and 0.98 – hypertonus pfd. Conclusions: This study concludes Het’s MMT is a highly reliable manual muscle testing tool to assess the pelvic floor muscles.

Stable pelvic floor muscle training improves urinary incontinence in women with gestational diabetes mellitus

Background Gestational diabetes mellitus (GDM) is a common metabolic disease that contributes to urinary incontinence (UI) in pregnant women. The aim of this study was to investigate the therapeutic potential of stable pelvic floor muscle (PFM) training with transverse abdominal muscle for pregnancy-specific UI in patients with GDM. Methods This was a randomised controlled trial. A total of 73 pregnant women with GDM and pregnancy-specific UI were screened, 35 of whom received stable PFM training with transverse abdominal muscle in the second trimester. After six weeks of training, UI status was assessed by the quantity of fluid loss and the International Consultation on Incontinence Questionnaire short form (ICI-Q-SF), and the quality of life was evaluated by the Incontinence Quality of Life Questionnaire score. Additionally, the thickness of the transverse abdominal muscle was measured by ultrasonography. Results At 6 weeks later, the quantity of fluid loss and ICI-Q-SF score were significantly lower, and the overall healing rate was significantly higher in the training group than those in the control group. The training also significantly improved the quality of life, especially in terms of behavioural limitation and psychosocial impact. Additionally, the thickness of transverse abdominal muscle under the status of maximal contractions of transverse abdominal muscle and PFM was significantly higher in the training group than in the control group after 6 weeks. Conclusions Stable PMF training with transverse abdominal muscle alleviated UI and improved the quality of life in patients with GDM. The thickening of transverse abdominal muscle induced by the training contributes to the remission of UI through the cooperation of PMF.

Patient Perception of Prolapse Condition Questionnaire: A Validated Patient-Reported Outcome Measure.

Identifying patient-reported outcome measures allows management of urogenital prolapse to be tailored to reflect symptom bother and expectations of treatment. We devised a new single-item questionnaire, the Patient Perception of Prolapse Condition (PPPC), based on the Patient Perception of Bladder Condition (PPBC). The aim was to evaluate the criterion validity, test/re-test reliability and responsiveness of the PPPC. Women attending a tertiary urogynaecology clinic were recruited. At visit 1, patients completed the Prolapse Quality of Life (P-QOL) and PPPC questionnaires, and underwent a Pelvic Organ Prolapse Quantification (POP-Q) examination. This allowed assessment of criterion validity using Spearman's rank correlation (rho) of the PPPC against validated subjective and objective outcomes. At visit 2, within the next 6weeks, PPPC was repeated to assess test/re-test reliability using Cronbach's alpha (α). In those undergoing pelvic floor surgery, responsiveness of the PPPC was assessed at visit 3 by correlating PPPC and P-QOL scores 6weeks post-operatively. A total of 178 patients attended visit 1, 60 attended visit 2 and 58 attended visit 3. At visit 1, there were moderate correlations between the PPPC and both objective (POP-Q: rho = 0.385, p < 0.01, CI 0.192-0.549) and subjective (P-QOL: rho = 0.635, p < 0.01, CI 0.493-0.744) measures confirming criterion validity. Test/re-test reliability was high (α = 0.89). Correlation with post-operative PPPC and P-QOL confirmed moderate responsiveness (rho = 0.54, p < 0.01). The PPPC, a novel single-item patient-reported measure of prolapse condition, demonstrated good criterion validity, test/re-test reliability and responsiveness. These findings support the use of the PPPC as a global assessment of prolapse condition.

Self-efficacy and social support enable women to protect their pelvic floor health: A nonrandomized controlled trial in rural Nepal.

Carrying heavy loads increases the risk of pelvic organ disorders, particularly in low-income countries. Low self-efficacy hampers adoption of pelvic-floor-protective behaviors. The enabling hypothesis suggests that social support may strengthen women's behavioral self-efficacy. A three-arm parallel non-randomized controlled trial with 300 women and their social partners experimentally examined whether self-efficacy and social support can enable women's pelvic-floor-protective behaviors in rural Nepal. Three villages received (1) self-efficacy (2) self-efficacy and social support promotion, or (3) information only control. The co-primary outcomes were reduced weight carried and using protective lifting techniques at 2-month follow-up. Self-efficacy promotion increased the use of protective lifting techniques 9% more than information only (d = 0.28). Weight was reduced by 3 kg more when additionally promoting social support compared to self-efficacy alone (d = 0.39). Self-efficacy and social support promotion enable women to better protect their pelvic floor health and may complement educational approaches to health behavior change in low-resource populations.

Sexual health in menopausal women with symptoms of pelvic floor disorders.

Sexual dysfunction in women is usually associated with the menopausal transition and menopause; however, there are factors that can also influence the sexual function of women in menopause. The aim of this study is to determine the association between pelvic floor disorders and sexual dysfunction in women in menopause. A cross-sectional study was carried out in Spain with menopausal women recruited by convenience sampling. Data were collected on background and health status. To evaluate the presence of pelvic floor problems, the Pelvic Floor Distress Inventory (PFDI-20) was used. Regarding the evaluation of female sexual function, the validated Sexual Function of Women (FSM-2) tool was used. Crude (OR) and adjusted odds ratios (AOR) were obtained using the SPSS 28.0 statistical program. A total of 197 women participated. The mean age was 57.7 years (SD=8.4), 51.3% (101 women) reported experiencing some form of sexual dysfunction. Despite this, the majority (79.5%; 155 women) indicated that they were satisfied with their sexual health. However, 25.5% (50 women) mentioned they faced difficulties when trying to initiate sexual intercourse. Additionally, 22.9% (45 women) reported having moderate to severe issues achieving orgasm. Furthermore, 29% (57 women) stated that they had never or only occasionally felt arousal in the past month. Women who experienced urinary incontinence and pelvic pain had a higher frequency of sexual dysfunction. The main associated factor observed was the risk of pelvic floor dysfunction through the PFDI-20 scale. For each point of this instrument, there was a small but increased risk of sexual dysfunction (OR=1.01; p<0.001). Type of birth or maternal disorders, such mental illness or gastrointestinal disorder, did not show any statistical association with sexual dysfunction. Pelvic floor dysfunctions symptoms in menopausal women are associated with their sexual health. Pelvic floor dysfunctions that influence sexual function are colorectal, urinary, and prolapse. Pelvic floor disorders such as urinary incontinence and pelvic pain are those that most influence sexual function.

Improving Pelvic Floor Muscle Training with AI: A Novel Quality Assessment System for Pelvic Floor Dysfunction

The first line of treatment for urinary incontinence is pelvic floor muscle (PFM) training, aimed at reducing leakage episodes by strengthening these muscles. However, many women struggle with performing correct PFM contractions or have misconceptions about their contractions. To address this issue, we present a novel PFM contraction quality assessment system. This system combines a PFM contraction detector with a maximal PFM contraction performance classifier. The contraction detector first identifies whether or not a PFM contraction was performed. Then, the contraction classifier autonomously quantifies the quality of maximal PFM contractions across different features, which are also combined into an overall rating. Both algorithms are based on artificial intelligence (AI) methods. The detector relies on a convolutional neural network, while the contraction classifier uses a custom feature extractor followed by a random forest classifier to predict the strength rating based on the modified Oxford scale. The AI algorithms were trained and tested using datasets measured by vaginal dynamometry, combined in some cases with digital assessment results from expert physiotherapists. The contraction detector was trained on one dataset and then tested on two datasets measured with different dynamometers, achieving 97% accuracy on the first dataset and 100% accuracy on the second. For the contraction performance classifier, the results demonstrate that important clinical features can be extracted automatically with an acceptable error. Furthermore, the contraction classifier is able to predict the strength rating within a ±1 scale point with 97% accuracy. These results demonstrate the system’s potential to enhance PFM training and rehabilitation by enabling women to monitor and improve their PFM contractions autonomously.

BMSCs-EVs Alleviate Pelvic Floor Dysfunction in Mice by Reducing Inflammation and Promoting Tissue Regeneration.

Pelvic floor dysfunctions (PFDs), which encompass pelvic organ prolapse (POP), stress urinary incontinence (SUI), and anal incontinence (AI), are common degenerative diseases in women. Bone marrow mesenchymal stem cells (BMSCs) hold promise for the treatment of PFDs. Extracellular vesicles (EVs) derived from BMSCs, have displayed an extensive role in intercellular communication and tissue repair. However, efficacy of the treatment using EVs originated from BMSCs on mouse models of PFD remains unknown. This study investigated the therapeutic potential of BMSC-derived EVs in a female PFD mouse model induced by vaginal distension (VD). Flow cytometry analysis confirmed the positive expression of BMSC-related markers, and successful induction of multilineage differentiation further validated their characteristics. As expected, the EVs extracted from BMSCs exhibited typical cup-shaped and circular-shaped structures. In the PFD model, BMSC-derived EVs significantly reduced the levels of inflammatory cytokines (p<0.05), improved tissue repair, and mitigated neutrophil infiltration. Furthermore, EVs promoted cell proliferation, decreased expression of relaxin receptors, increased expression of elastin, and elevated collagen content in the anterior vaginal wall tissue (p<0.05), suggesting beneficial effects on tissue regeneration and connective tissue restoration in PFD. BMSC-derived EVs effectively reduce tissue inflammation, promote tissue regeneration and connective tissue reconstruction, and improve pelvic support deficiency, thereby alleviating PFD induced by vaginal distension (VD) in vivo.

Investigation of lower urinary system symptoms in patients with isolated posterior compartment prolapsus: a cross-sectional study.

The effects of posterior vaginal wall prolapse on pelvic floor function have not been adequately investigated, particularly for lower urinary tract symptoms (LUTS). We aimed to investigate the effects of isolated posterior compartment prolapse on LUTS. The study was conducted as a PROSPECTIVE: cross-sectional study with female patients with isolated posterior prolapse who presented with any LUTS. All patients were evaluated according to the POP-Q system. A total of 41 patients with stage 2-3 isolated pelvic organ prolapse were included in the study group. The control group consisted of a total of 41 patients without significant pelvic organ prolapse. Study and control groups were compared in terms of demographic data and UDI-6, IIQ-7, ICIQ-FLUTS, LUTS QoL, FLUT Sex scales. The incidence of SUI, UI, frequency, nocturia, abnormal evacuation, difficulty in passage and vaginal farting in the study group was found to be statistically significantly higher than the control group. In the study group, the total scores on the UDI-6, IIQ-7, and LUTS QoL measures were significantly higher. While the total scores of the ICIQ-FLUTS Scale "Filling" and "Incontinence" subgroups were significantly higher in the study group, no significant difference was found in the "voiding" subgroup. There was no statistically significant difference between the two groups in terms of their total FLUT Sex scores. It has been shown that isolated posterior prolapse may be associated with an increase in lower urinary tract system symptoms and a decrease in quality of life.