Pelvic Floor Problems Research Articles

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.

Breaking barriers: Exploring female-specific health challenges affecting performance in an elite multisport training environment

ObjectivesFemale-specific issues, such as breast injuries, pelvic floor dysfunctions, saddle sores, and menstrual symptoms, can significantly impact female athletes. This study examined the prevalence, perceived impact on performance, and role of the support staff in addressing and managing these issues in elite athletes based at a multisport training centre. DesignAnonymous online questionnaire. MethodsA total of 180 female athletes from various sport disciplines at the Dutch Olympic Training Centre were invited to participate in the study. An anonymous, 39-item questionnaire was developed and hosted on Qualtrics collecting data on respondents' characteristics, breast injuries, pelvic floor dysfunctions, saddle sores, menstrual symptoms, contraceptive use, and communication about these issues. ResultsA total of 105 valid responses were analysed. The findings revealed that athletes regularly experience breast injuries (15.2 %), urinary incontinence (29.5 %), other pelvic floor problems (21.0 %), saddle sores (65.7 %), and menstrual cycle-related symptoms, with negative performance effects. Communication with support staff remained limited, with only 23.8 % of athletes discussing any of these issues, often due to concerns about understanding, shame, or a lack of opportunity for easy communication. ConclusionsThe findings underscore the crucial role of creating a supportive environment, promoting early intervention, and utilising multisport centres to comprehensively address these concerns, emphasising the need for open communication, education, and support to enhance female athletes' performance and well-being.

Influence of Pelvic Floor Disorders on Sleep Quality in Women.

Pelvic floor disorders, the impact of their symptoms, and their association with sleep quality and sleep disorders is a little studied area. The aim of this study was to determine if an association exists between pelvic floor disorders in women and sleep disorders. An observational study was conducted among women in Spain during 2021 and 2022. A self-developed questionnaire was used to collect sociodemographic and employment data, previous medical history and health status, lifestyle and habits, obstetric history, and health problems. A validated questionnaire, the Pittsburgh Sleep Quality Index (PSQI), was used to assess the quality of sleep. The presence and impact of pelvic floor problems was assessed with the Pelvic Floor Distress Inventory (PFDI-20). Odds ratios (OR) and adjusted odds ratios (aOR) with their respective 95% confidence intervals were calculated using logistic regression. A total of 1396 women participated in the study. The total PSQI indicated that 75.36% (1052) of women have altered general sleep quality. Women with pelvic floor disorders have a higher probability of developing sleep alterations (aOR: 1.32; 95% CI: 1.22-1.42; for every 20 points). A high BMI (aOR: 1.04; 95% CI: 1.01-1.07; for each point) and the presence of musculoskeletal disorders (aOR: 3.14; 95% CI: 1.20-8.27) are also associated with sleep quality in women. Women with pelvic floor disorders are more likely to develop sleep disorders, probably due to all the discomfort they entail.

Ab. No. 147 Pelvic Floor Health Literacy in Ahmedabad- A Pilot Study

Introduction: The purpose of the study is to investigate, beliefs and mentalities prevalent in community related to pelvic floor problems. Pelvic floor problems are not discussed because of certain barriers and healthcare personnel remain uninformed about the condition. Literature also mentions that, there are barriers in community. A Physiotherapist, working with diverse population needs knowledge about health literacy levels in community so as to educate, prevent and approach community with acceptable solutions. Methods: Both genders, 18-65 years were included from the community of Ahmedabad using convenience sampling was used. Participants from different socio-cultural, economic, educational backgrounds with/without history of pelvic floor issues were included. Participants belonging to medical background, and not willing to participate were excluded. Close-ended in English language questionnaire, validated by expert panel was prepared to investigate health literacy. A google form was filled by investigator in front of the participant after obtaining verbal consent. Descriptive analysis of 37(25 females,12 males) participants was done using Microsoft excel 2019 and Google spreadsheet. Result: Data collection is on-going. Mean age of participants was (38.41 + 12.06) years. More than 50% participants do not know the term “Pelvic Floor”. 60% participants do not know whom to consult, around 60% participants rely on family and/or friends’ advices. 56% of participants do not want to share these problems. Large number of participants feel cultural/societal barriers in sharing these problems, do not find information in news or social media and do not have an access to sources providing reliable information. Conclusion: Pelvic floor health literacy is low in community. Unawareness about “Pelvic Floor,” not having reliable sources, cultural and societal barriers about these problems keeps health care providers uninformed about the problem. Implication: Findings may help Physiotherapist build a culturally sensitive protocol, develop educational material, improve public awareness, plan early intervention and prevention.

Investigation of the relationship between sexual and pelvic floor dysfunction in female patients with fibromyalgia syndrome

ABSTRACT The aim of the study was to examine the relationship between pelvic floor functions and sexual functions in women with fibromyalgia. The study included 204 women with fibromyalgia, mean aged 43.43 ± 8.61 years. All patients who met the inclusion criteria and applied to the rheumatology outpatient clinic were included in the study. The study was conducted between September 2020 and June 2022. The Female Sexual Function Scale (FSFI) was used to evaluate sexual function, Pelvic Floor Distress Scale-20 (PFDI-20), Pelvic Floor Impact Questionnaire (PFIQ-7) and Pelvic Organ Prolapse/Incontinence Sexual Function Assessment (PSIQ-12) were used to evaluate pelvic floor problems. The relationship between sexual dysfunction and other parameters was analyzed using Spearman correlation analysis. There was a weak negative correlation between many sub-parameters of FSFI and scores of PFDI-20, PFIQ-7, PSIQ-12 (r:−0.165–−0.377 p: 0.02–0.00). According to the results of this study, sexual dysfunction was negatively affected by pelvic floor dysfunction and symptoms related to bladder, bowel, and pelvic organs in women with fibromyalgia. These results may suggest that sexual function and pelvic floor problems in women with fibromyalgia should be considered together and an approach should be planned for such problems in treatment programs.

Homage to Dr. Murray Enkin and the complexity of evidence-based medicine.

Homage to Dr. Murray Enkin and the complexity of evidence-based medicine.

Effect of Kegel Exercises on Lower Urinary Tract Symptoms in Young Gymnasts: A Prospective Cohort Study.

Lower urinary tract symptoms (LUTS) have been shown to exist in young athletes. The use of pelvic floor muscle training as a preventive strategy at an early age may be useful to avoid possible pelvic floor dysfunction in the future. The aim of the study was to describe LUTS in underaged gymnasts. We also aimed to evaluate the effects of a 12-week Kegel exercise intervention for LUTS and urinary incontinence (UI) and their relationship to bother. A quasi-experimental (nonrandomized, noncontrolled) pre-post study was conducted. Nineteen gymnasts with a mean age of 13.21 ± 1.84 were selected from a gymnastics club in Madrid, Spain. Outcomes of LUTS and quality of life were measured using the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms validated questionnaire at baseline and at the end of the 12-week intervention. The participants presented with certain LUTS such as urgency UI (57.7%) or stress UI (47.4%), which negatively affect their daily lives by feeling annoyed in various aspects (when practicing gymnastics, getting up during the night to urinate or feeling bladder pain among others). No significant differences in LUTS and quality of life variables were observed after the exercise intervention ( P > 0.05). A high prevalence of LUTS was observed in a sample of underaged high-level gymnasts. The 12-week Kegel exercise intervention did not significantly reduce the presence of pelvic floor problems and even intensified some of them, probably because of an increased awareness. Pelvic floor muscle training as a preventive strategy at an early age seems to be necessary to avoid possible pelvic floor dysfunction in the future.

Estradiol-17β [E2] stimulates wound healing in a 3D in vitro tissue-engineered vaginal wound model

Childbirth contributes to common pelvic floor problems requiring reconstructive surgery in postmenopausal women. Our aim was to develop a tissue-engineered vaginal wound model to investigate wound healing and the contribution of estradiol to pelvic tissue repair. Partial thickness scalpel wounds were made in tissue models based on decellularized sheep vaginal matrices cultured with primary sheep vaginal epithelial cells and fibroblasts. Models were cultured at an airliquid interface (ALI) for 3 weeks with and without estradiol-17β [E2]. Results showed that E2 significantly increased wound healing and epithelial maturation. Also, E2 led to collagen reorganization after only 14 days with collagen fibers more regularly aligned and compactly arranged Additionally, E2 significantly downregulated α-SMA expression which is involved in fibrotic tissue formation. This model allows one to investigate multiple steps in vaginal wound healing and could be a useful tool in developing therapies for improved tissue healing after reconstructive pelvic floor surgery.

Change in depression predicts change in bladder symptoms for women with urinary incontinence undergoing pelvic-floor muscle training

IntroductionTo examine the relationship between depression and bladder symptoms, especially the impact of change in depression on changes in bladder symptoms, for women with urge and stress urinary incontinence undergoing a course of PFMT. Method106 adult females with pelvic-floor dysfunction (PFD), consecutively referred to an outpatient pelvic-floor muscle training (PFMT) programme for either urge, stress, or mixed incontinence, participated in a prospective observational study. Participants reported subjective views of their pelvic floor problems (Queensland), and their levels of depression (HADS_D), and data relating to age and BMI were collected. The trial was registered on clinicaltrials.gov (NCT02549157). ResultsThere was a positive relationship between depression and bladder symptoms at intake. Levels of initial depression significantly predicted levels of bladder symptoms at completion of PFMT, and ability to complete the PFMT programme. Change in depression significantly predicted change in bladder symptoms, over and above intake patient characteristics and symptoms. DiscussionThese data imply a multidisciplinary focus, including psychological input, for PFD may be a highly effective strategy for its management.

Influencing Pelvic Floor Changes on the Quality of Women’s Life During and Post Pregnancy

Introduction: Pelvic floor dysfunctions are widely acknowledged as one of the most serious public health issues, in terms of frequency, cost, and influence on quality of life of women. Over a third of females are believed to have pelvic floor diseases of varying severity at some point in their lives. Objective: To evaluate the influencing pelvic floor changes on the quality of women’s life during and post pregnancy. Methodology: This Multi-Centre cohort study was carried at the department of Urology &amp; Transplantation, Institute of Kidney Diseases Peshawar, and Department of Gynaecology Jamrud Hospital Peshawar .The study duration was one year from June 2020 to June 2021 after approval of synopsis. A total of 45 women fulfilling the inclusion criteria were enrolled in our study. All the collection of data was carried out through predesigned questionnaire. Vaginal examination, translabial 2D/3D ultrasonography and a POP-Q test was done in the 3rd trimester of gestation and Three months after birth. The statistical analyses were performed using SAS software version 9.4. Results: In the current study, weakness of connective tissues was observed in 23 (51.1%) and Gestational diabetes was observed in 6 (13%). Amongst 45 women, vaginal deliveries were observed in 17 (37.78%), caesarean section in 17 (37.78%) while vacuum extraction deliveries were observed in 11 (24.44%) females. Two subjects were found to have LAM avulsion three months after their VE deliveries. Conclusion: Pelvic floor dysfunction is associated with connective tissue weakening and a larger fetus weight at delivery. To minimize future Pelvic floor problems, more women should seek postpartum care services. Keywords: Pelvic floor changes; Quality of life; Post pregnancy

DEVELOPMENT OF PELVIC FLOOR HEALTH KNOWLEDGE QUIZ IN TURKISH PEOPLE: VALIDITY AND RELIABILITY

Purpose: Although pelvic floor problems are a wide and important issue, the tools that question individuals’ knowledge level related to these problems are not comprehensive and sufficient. This study aimed to develop a Pelvic Floor Health Knowledge Quiz (PFHKQ) and to determine its validity and reliability. Methods: A 37-item quiz was prepared to comprehensively measure the participants' knowledge of pelvic floor health and administered in 370 participants. Face validity, content validity, construct validity and known-group validity were analyzed. The Person Separation Index (PSI) and the Kuder-Richardson-20 (KR-20) coefficient values were calculated for reliability. Results: The face validity analysis showed that all items of the test were quite understandable (range 83.02%-98.11%). According to the Rasch model, a knowledge quiz with three subscales (function/dysfunction; risk/etiology; diagnosis and treatment) and 29 items were defined. Individuals who were health professionals or students in the health field had more knowledge based on the scores they received from the PFHKQ compared to the other participants (p &amp;lt; 0.05). There were differences between the participants' knowledge scores in terms of previously having heard of any pelvic floor problems and pelvic floor exercises (PFE) (p &amp;lt; 0.05). It was found that the PSI and the KR-20 values were 0.892 and 0.890 for the function/dysfunction subscale, 0.938 and 0.920 for the risk/etiology subscale, 0.912 and 0.924 for the diagnosis and treatment subscale, and 0.952 and 0.926 for the PFHKQ total score, respectively. Conclusion: The PFHKQ was found to be a valid and reliable tool in the Turkish people.

The Effects of Pelvic Floor Muscle Training and Behavioral Training on Sexual Dysfunction, Incontinence, Physical Activity Level and Quality of Life in the Elderly

Alterations in hormonal balance, especially with ageing, cause many pelvic floor problems such as urinary incontinence, lack of interest in or desire for sex and inactivity. The aim of this study was to explore the effects of pelvic floor muscle exercise and behavioral training programs on sexual function, incontinence, quality of life and physical activity level in the elderly. A total of 94 elderly subjects were separated into two groups as the pelvic floor muscle training (PFMT) group and the behavioral training for pelvic floor dysfunctions (BT) group. A (1-h program was applied twice a week for 8 weeks). Evaluations pre and post-training were made using the Female Sexual Function Inventory, the International Index of Erectile Function, International Consultation on Incontinence Questionnaire-Short Form, SEAPI quality of life scale, and Physical Activity Scale for the Elderly. In the post-treatment comparisons, the PFMT group was superior to the BT group in all parameters (z: − 4.21–0.00, p:0.00–0.02). The results of this study suggest that pelvic floor muscle training could be beneficial if added to rehabilitation programs for the elderly to obtain less sexual dysfunction and, incontinence, and better incontinence-related quality of life and physical activity levels.

Investigation of the relationship between the pelvic floor and sexual dysfunction in women with Sjögren's syndrome.

Women with Sjögren's syndrome (SS) may have sexual dysfunctions due to vaginal dryness and may also have pelvic floor problems. The aim of this study was to examine the pelvic floor distress of women with SS with a self-reported questionnaire, to compare this group with healthy individuals, and to examine the relationship between pelvic floor problems and sexual dysfunction. The study included 94 women with SS, aged 47.26±7.56years, and 94 age-matched healthy women, aged 48.15±8.73years. The Pelvic Floor Disease Inventory (PFDI-20), Pelvic Floor Impact Questionnaire (PFIQ-7), and Female Sexual Function Scale (FSFI) were used for assessment. The PFDI-20, PFIQ-7, and FSFI scores of the healthy control group were found to be statistically significantly better than those of the primary SS group (Z=-2.69 to -8.03, P=.00). A moderate-high correlation was found between the total and sub-parameters of PFDI-20 and disease duration, the total and sub-parameters of the PFIQ-7 and the pain sub-parameter and total score of the FSFI (r=-0.66 to 0.78, P=.00-.04). According to the study results, as the disease duration increases, the distress increases and this distress has a negative effect on the health-related quality of life of these women. Pelvic floor distress was associated with poor sexual function and pain. From these results, it can be recommended that the methods of pharmacology, education, exercise, relaxation, lifestyle change, and so on for pelvic floor dysfunction and pain in women with SS should be applied together with a multidisciplinary approach.

Urogynecologic pelvic floor problems: Across the entire spectrum of women's lives.

Urogynecology is considered to be a field that addresses health problems that occur during a woman’s reproductive and immediate post‐reproductive years. Therefore, much of the focus in urogynecology centers on genital fistula, stress incontinence, and pelvic organ prolapse. However, women on either end of the age spectrum—from childhood to advanced adulthood—also suffer from well‐recognized and troublesome urogynecologic problems.

Level of awareness among trained Accredited Social Health Activist workers in the field of women's health and child development – A survey

BACKGROUND: Currently, the Government of India is providing comprehensive integrated health care to the rural people under the umbrella of National Rural Health Mission. A village level community health worker “Accredited Social Health Activist (ASHA)” acts as an interface between the community and the public health system. A time-to-time assessment of the knowledge of ASHAs is essential as the success of government's health programs in rural areas depends on them, and hence, this research is conducted to identify the knowledge that ASHA has in the field of preventive women's health and childcare. SETTINGS AND DESIGN: A cross-sectional study was done at Panvel Taluka in Raigad District of Maharashtra. The study participants were Trained ASHA workers. MATERIALS AND METHODS: A cross-sectional study was conducted in rural field practice area of the department of preventive and community physiotherapy. The study participants were trained ASHA workers. All 100 ASHA workers were included as per the eligibility criteria. After obtaining prior consent, all ASHAs were interviewed using a self-designed, semi-structured questionnaire. STATISTICAL ANALYSIS USED: Data were analyzed in Excel and valid result and conclusion were drawn. RESULTS: Majority of ASHA workers had correct knowledge about problems faced by women during breastfeeding (91%), breastfeeding positions (97%), and delivery positions (96%). They were lacking in knowledge about pelvic floor problems such as uterine prolapse and urinary incontinence. This research is conducted to identify the knowledge that ASHA has in the field of preventive women's health and childcare. CONCLUSION: Despite the training given to ASHA workers, they are hardly aware about preventive measures for women's health and child development.

What if there were no tapes?

It is possible that the controversy involving prostheses implanted into women with pelvic floor problems might result in the majority of, or even all such products being restricted, banned or withdrawn in certain jurisdictions. A clear distinction between "tapes" for urinary incontinence and "mesh" for prolapse has been made in the enquiries and subsequent rulings in Australia and New Zealand. Transvaginal "mesh" will be unavailable with the range of "tapes" much more restricted in those countries from January 2018. The Chair of the all-party parliamentary group on surgical mesh implants in the United Kingdom was reported as describing the New Zealand announcement as "hugely significant" and "it's precisely what we've been calling for the UK." The title of this article has changed from a hypothetical piece to a potential reality review. Where does that leave the clinicians treating stress urinary incontinence (SUI) and the large number of female sufferers? "Tapes" (synthetic midurethral slings-MUS) have become very popular over the last 20 years since their original development and introduction in Scandanavia. Evidence-based medicine has shown their advantages over previous surgeries, in terms of ease of use, safety and efficacy. This article outlines the options which countries potentially rejecting the use of tapes, must now resort to for women with SUI. Those countries considering such action need the note of caution that none of the options are as good as tapes.

The patient’s voice: What are the views of women on living with pelvic floor problems following successful treatment for pelvic cancers?

The patient’s voice: What are the views of women on living with pelvic floor problems following successful treatment for pelvic cancers?

Randomized Controlled Trial of the Effect of a Brief Telephone Support Intervention on Initial Attendance at Physiotherapy Group Sessions for Pelvic Floor Problems

ObjectiveTo assess the efficacy of a brief telephone call to patients on a waiting list for physiotherapy treatment of pelvic floor dysfunction on initial attendance. DesignThree-armed randomized controlled trial. SettingOutpatient physiotherapy clinic at a hospital. ParticipantsFemale patients (N=130; mean age, 51.47±13.33y; range, 26–84y) with various pelvic floor dysfunction problems. InterventionsTelephone support call (2–10min) 3 days before or 3 days after receiving an invitation letter to physiotherapy sessions. Main Outcome MeasuresAttendance at the initial physiotherapy group session. ResultsGroups receiving a telephone call demonstrated 80% attendance at the session, with no significant difference between these groups. The group receiving no call had significantly lower attendance rates (50%) than did the call groups. The telephone support was more effective in those people who were older, came from less economically deprived areas, and had been on the waiting list for less time. ConclusionsA brief telephone support call may be an effective method to enhance patient attendance at treatment, but it may work best when targeted at certain groups of individuals.

Prevalence of anxiety and depressive symptoms and their association with pelvic floor dysfunctions-A cross sectional cohort study at a Pelvic Care Centre.

Pelvic floor dysfunctions (PFDs), like voiding complaints, urinary and fecal incontinence, and prolapse, are prevalent and associated with decrease in quality of life. PFDs are often complex and multifactorial in origin showing interrelationships between different PFD and with affective conditions. The primary aim of this study is to describe the prevalence of affective complaints in a cohort of Pelvic Care Centre (PCC) patients. The secondary aim is to describe associations between PFDs and depression or anxiety. A cross sectional cohort study at an University Hospital's PCC. First contact patients were included in a triage system and filled out questionnaires regarding pelvic floor complaints and Hospital Anxiety and Depression Scale (HADS) scores. Linear (dummy-) regression analysis of HADS scales was performed to test the effects of relevant clinical predictors related, and not directly related, to pelvic floor problems, and demographic characteristics of the patients. From 1862 eligible first-contact PCC patients, 1510 (mean age 57.1) had completed the questionnaire (352 missing, 18.9%). The prevalence of anxiety and depression complaints was 30.9% and 20.3%, respectively. The variance explained for depression score by PFDs was 0.12 and 0.074 for anxiety. Anxiety and depression are prevalent (30.9% and 20.3%, respectively) in a cohort of PFDs. PFDs can explain variance within anxiety and depression complaints. Corrected for other contributing variables, 12% of depression and 7.4% of anxiety was directly related to PFDs. We advocate a multidisciplinary approach, containing psychometric assessment for PFDs in order to obtain better diagnostic results and personalized treatment options.

Knowledge of pelvic floor problems: a study of third trimester, primiparous women.

Pelvic floor problems in women (urinary incontinence, faecal incontinence, uterovaginal prolapse) are common, and have an adverse effect on quality of life. We hypothesized that there is low knowledge of these problems amongst primiparous women in their third trimester of pregnancy. We conducted a cross-sectional study in antenatal clinics of three hospitals in London, UK, from 2011 to 2013. Primiparous women aged ≥18years and in the third trimester of pregnancy answered questions on pelvic floor problems. Knowledge scores were calculated based on the proportion of questions answered correctly. A total of 249 women completed the question set. The average knowledge score across all domains was low at 45%. Scores were lowest for the less common problems of faecal incontinence (35%) and prolapse (36%). The score for urinary incontinence was higher at 63%, but low when questions explored more detailed levels of knowledge (41%). Knowledge scores were positively associated with both education to tertiary level and the use of books as the information source on pregnancy and delivery. Only 35% of women cited antenatal classes as a source. Knowledge of pelvic floor problems is low amongst third-trimester, primiparous women in this London-based population. Adequate knowledge of these problems is important for women to be able to make informed choices about their antenatal care and to seek help if problems arise. The data suggest scope for health-care professionals to raise these issues early during pregnancy, and to help women access accurate sources of information.