Pelvic Floor Dysfunction Research Articles

313 - Levator ani deficiency and pelvic floor dysfunction one year postpartum: a prospective nested case-control study

313 - Levator ani deficiency and pelvic floor dysfunction one year postpartum: a prospective nested case-control study

Development of an educational program in pelvic floor health for women: A consensus using the Delphi method

ObjectivePelvic floor health education workshops for women appear to improve women's knowledge and pelvic floor symptoms. Our aim was to obtain expert consensus on the content and format of a pelvic floor health education program using the Delphi method. Material and methodsA two-round Delphi study was conducted involving French-speaking multidisciplinary experts in pelvic floor dysfunction management. The first round questionnaire contained 44 items (31 about the program's content and 13 about the materials). They were also consulted about the optimal format of the program (duration and number of workshops) as open questions. Participants rated their level of agreement with each item on a Likert scale from 1–9. Consensus was defined by a level of agreement≥80% and a median≥7. Non-consensus items were reworked and resubmitted to the experts for the second round. ResultsOf the 110 experts contacted, 52 responded for the first and second rounds. Sixty-one percent of the proposed items met with consensus in the first round and 60% in the second. The final program comprises 33 items: eight on anatomy, four on biomechanics, nine on urinary and defecatory physiology, seven on risk factors, and five on materials. The format selected by the experts consisted of four or five 75-minute health education sessions with a paper summary hand out at the end of the program. ConclusionsThis study defined the content of a pelvic floor health education program for the general population of adult women validated by a consensus of experts. After validation of an English version, it should be evaluated in international interventional studies.

Innovative use of physical therapy for pediatric bowel and bladder dysfunction: Not just biofeedback!

Biofeedback has been shown to be an effective tool in the treatment of pelvic floor dysfunction in patients with bowel and bladder dysfunction, and commonly, biofeedback is provided within a physical therapy plan of care. In building a pelvic floor physical therapy program at our institution, we have found that physical therapy extends beyond biofeedback. Our preliminary experience demonstrates that patients experience more rapid symptomatic improvement when biofeedback is combined with additional therapy to address abnormal core and respiratory function.

332 - Predictors of missed hospital appointments in patients with posterior compartment pelvic floor disorders in a tertiary referral center

332 - Predictors of missed hospital appointments in patients with posterior compartment pelvic floor disorders in a tertiary referral center

52 - Postpartum pelvic floor disorders among 1371 Norwegian women

52 - Postpartum pelvic floor disorders among 1371 Norwegian women

106 - Inter-ethnic differences in anatomical abnormalities observed on pelvic floor ultrasound in patients with multi-compartment pelvic floor disorders

106 - Inter-ethnic differences in anatomical abnormalities observed on pelvic floor ultrasound in patients with multi-compartment pelvic floor disorders

The Integral Theory, Pelvic Floor Biomechanics, and Binary Innervation.

The pelvic floor biomechanics and sphincter functioning are essential for understanding pelvic floor dysfunction and the pathophysiology of the pelvic organs. The pelvic floor consists of muscles, fascial connections and ligaments. The Integral Theory Paradigm (ITP) explains the musculoskeletal entity of the sphincter mechanism and the pathophysiology of pelvic organ function. The ITP explains the pelvic floor function determined by 3 directional muscle forces: forward, backwards and downward-acting muscle vector forces that form an anterior and posterior resultant. The resultant equilibrium is essential for urinary continence, voiding and defecation. Loose ligaments disturb the equilibrium of the pelvic floor's muscular function with consequences for the organ function's continence, evacuation, and sensory perception.

The "Ins and Outs" of Dynamic Magnetic Resonance Imaging for Female Pelvic Organ Prolapse.

Concurrent pelvic organ and rectal prolapse have an incidence of 38%. Dynamic pelvic magnetic resonance imaging (MRI) is the modality of choice for workup. We discuss dynamic pelvic MRI indications, interpretation, and clinical application to pelvic floor disorders. The pubococcygeal line (PCL) extends from the pubic symphysis to the last coccygeal joint. The "H line" demonstrates the levator hiatus size, drawn from the inferior pubic symphysis to the posterior rectal wall at the anorectal junction. The "M line" represents vertical descent of the levator hiatus and extends perpendicularly from the PCL to the posterior aspect of the H line. With rectovaginal fascial defects, the small bowel, the peritoneum, and the sigmoid colon can prolapse. Posterior compartment abnormalities include rectocele, rectal prolapse, and descending perineal syndrome. Pelvic MRI can evaluate functional disorders such as anismus, where the anorectal angle is narrowed and associated with lack of pelvic floor descent and incomplete evacuation. Particularly for patients with concurrent urogynecological and colorectal complaints, previous pelvic reconstructive surgery, or when clinical symptomatology does not correlate with physical examination, dynamic pelvic MRI can impact management. It is critical for pelvic reconstructive surgeons to be familiar with this imaging modality to counsel patients and interpret radiographic findings.

Prolapse Treatment-Related Decisional Conflict After New Patient Visits.

Patients with pelvic organ prolapse are often tasked with deciding between treatments. Decisional conflict is a measure of factors that go into effective decision making. This study aimed to compare prolapse treatment-related decisional conflict reported by underrepresented patients (URPs) to non-URPs after new patient visits. A multicenter cohort study of new patients counseled regarding management of prolapse from July 2021 to December 2022 was performed. Participants completed the Decisional Conflict Scale (DCS), a validated measure of modifiable factors in decision making. Higher scores indicate feeling less comfortable with decisions. Race and ethnicity were viewed as social constructs. A URP was defined as self-identification with a non-White race or Hispanic ethnicity. Alpha was set at 0.05, power 80%, to detect an effect size of 0.4 between mean DCS scores. A total of 207 participants (103 URPs, 49.8%), with a mean age of 63.4 ± 11.9 years and mean body mass index of 29.7 ± 6.9 (calculated as weight in kilograms divided by height in meters squared), completed the study. Much of the URP group self-identified as Hispanic (50/103, 48.5%) and/or Black (39/103, 37.9%), and 30 of 103 (29.1%) had an interpreter at their visit. A greater proportion of non-URPs had a prior hysterectomy (16.1% difference; P = 0.017) and prolapse surgery (18/204, 10.5% difference; P = 0.020). A greater proportion of URPs had hypertension (23.6% difference; P = <0.001). There were no differences in the other pelvic floor disorders, prolapse stage, or treatments selected (all P > 0.05). The mean DCS scores were not different between groups (URP, 12.9 ± 12.3 vs non-URP, 11.6 ± 14.9; P = 0.31). Household income, education, and insurance were not associated with DCS scores (all P > 0.05). Decisional Conflict Scale scores were not significantly different between groups. Possible differences between subgroups warrant further investigation.

Telehealth exercise for continence after gynaecological cancer treatment (TELE-CONNECT): a protocol for a co-designed pragmatic randomised controlled trial

BackgroundUrinary incontinence (UI) is the most prevalent pelvic floor disorder following treatment for gynaecological cancer with a distressing impact on quality-of-life in survivors. Physiotherapist-supervised pelvic floor muscle (PFM) training is recommended as the first-line intervention for UI in community-dwelling women. However, it is not known if this intervention is effective in women following treatment for gynaecological cancer, nor whether PFM training can be delivered entirely remotely. The primary aim of this study is to investigate if a telehealth-delivered PFM training program incorporating a novel biofeedback device reduces UI compared with usual care, following gynaecological cancer.MethodsThis is a pragmatic, two-arm parallel-group, stratified superiority randomised controlled trial recruiting 72 participants (ACTRN12622000580774). Recruitment sites include gynaecology-oncology outpatient clinics, supplemented by advertisements through community foundations/social media/care groups. Participants must have completed primary cancer treatment at least 6 months prior or adjuvant therapy at least 3 months prior, for Stage I, II or III uterine, cervical, fallopian tube, primary peritoneal or ovarian cancer or borderline ovarian tumour, and have UI occurring at least weekly. Participants randomised to the usual care group will receive bladder and bowel advice handouts and one audio telehealth physiotherapist consultation to answer any queries about the handouts. Participants randomised to the intervention group will receive the same handouts plus eight video telehealth physiotherapist consultations for PFM training with a biofeedback device (femfit®), alongside a home-based program over 16 weeks. The primary outcome measure is a patient-reported outcome of UI frequency, amount and interference with everyday life (measured using the International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form), immediately post-intervention compared with baseline. Secondary outcomes include quality-of-life measures, bother of pelvic floor symptoms, leakage episodes, use of continence pads and global impression of change. We will also investigate if the intervention improves intra-vaginal resting and squeeze pressure in women in the intervention arm, using data from the biofeedback device.DiscussionIf clinical effectiveness of telehealth-delivered physiotherapist-supervised PFM training, supplemented with home biofeedback is shown, this will allow this therapy to enter pathways of care, and provide an evidence-based option for treatment of post-cancer UI not currently available.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR), ID 12622000580774. Registered 20 April 2022.

Perineal Rehabilitation in Pelvic Floor Dysfunction: The Benefits of Vaginal Cone Training

Pelvic floor dysfunctions (PFD) are prevalent conditions that affect millions of women worldwide, encompassing a range of issues severely affecting women's quality of life. Pelvic floor muscle strength and function are fundamental to the management and prevention of PFD, and pelvic rehabilitation is a non-invasive approach that effectively improves symptoms, restores function, and prevents complications. This study aimed to evaluate the impact of pelvic floor muscle training program using weighted vaginal cones, on pelvic floor muscle function and quality of life in women with pelvic floor dysfunction (PFD). Fifty-four women aged 26-62 years, with different type of urinary incontinence, cystocele, and prolapse participated in this pre-post intervention comparative analysis. Pelvic floor muscle function was assessed using the PC test, which measures strength, endurance and fatigability, while the impact on patients' quality of life was assessed with the Pelvic Floor Impact Questionnaire - Short Form 7 (PFIQ-7). A three-month vaginal cone training regimen was implemented, with as-sessments conducted before the intervention (T0), one month later (T1), and three months later (T2). Data analysis showed a change with significant differences between the PC test score values at the level of each parameter and at each assessment (p&lt;0.05, ES=0.254-511). The scores for bladder and urinary problems Urinary Impact Questionnaire (UIQ-7) significantly de-creased from 38.901 ± 1.268 at T0 to 29.366 ± 2.493 at T2 (W = 1082.000, p &lt; 0.001, ES=0.570). In contrast, the scores for vaginal or pelvic problems (POPIQ-7) showed a slight, insignificant decrease from 12.699 ± 1.128 at T0 to 10.499 ± 2.362 at T2 (W = 278.000, p = 0.800, ES=0.053). fVaginal cone training significantly improves pelvic floor mus-cle function and reduces urynary symptoms in women with PFD.

Characteristics and Management Outcome of Vaginismus

Vaginismus, a common pelvic floor dysfunction characterized by involuntary vaginal muscle spasms, often impedes sexual intercourse and is exacerbated by cultural barriers in Indonesia, where sexual issues are taboo. Healthcare providers' lack of knowledge contributes to patient dissatisfaction with treatments. This study aimed to evaluate risk factors and management outcomes in 36 Indonesian women with vaginismus. Primary data, including demographic details, vaginismus history, severity, and FSFI-6 scores, were collected through interviews and medical records. Results showed that 94.4% of participants were under 40 years old, 66.7% had been married for over two years, and 94.5% were university graduates. Most had normal BMI and no significant illness history. Among them, 77.8% had no history of penetration, with the majority having no medical, social, or psychological risk factor yet reporting good sexual satisfaction. Self-dilation was the primary treatment, with a 29.41% success rate in achieving penetration. Younger age and higher education were notable characteristics among cases, suggesting a need for increased disease awareness. The study highlights that while traditional risk factors were not predominant, self-dilation therapy yielded moderate success, and patient satisfaction with sexual and interpersonal relationships remained high.

Multi-Regional Pelvic Floor Muscle Function Diagnosis System Based on Inflatable Stretchable Electrode Array.

Effective prevention and treatment of pelvic floor dysfunction (PFD) necessitates the identification of lesions within the complex pelvic floor muscle (PFM) groups associated with various symptoms. Here, we developed a multi-region pelvic floor muscle functional diagnosis system (MPDS) based on an inflatable stretchable electrode array, which aids in accurately locating areas related to PFD. Clinical diagnostic experiments were conducted on 56 patients with postpartum stress urinary incontinence (PSUI) and 73 postpartum asymptomatic controls. MPDS collects pelvic floor electromyography from all participants. By assessing EMG parameters such as activation time differences (ATD) and using Jensen-Shannon (JS) divergence to verify, with the aim of locating target muscle groups with functional abnormalities. Clinical test results showed that by observing the AT sequence of the PSUI group and the control group, muscle groups with functional abnormalities in the Pubococcygeus muscle (PC) and Puborectalis muscle (PR) regions could be preliminarily diagnosed. In the assessment of regional muscle contribution values based on JS divergence, it was verified that the contribution values of rapid contraction in the PC and PR regions of the PSUI group were relatively lower compared to those of the control group, which correlated with urinary control dysfunction. These experiments demonstrate that the MPDS helps in accurately locating target muscle groups with functional abnormalities, showcasing its potential in precise assessment of complex muscle groups such as PFM, which may improve diagnostic precision and reliability.

Impact of physical activity on pelvic floor dysfunction in older women: A cross-sectional study in type D hospital, Khanpur, Khyber Pakhtunkhwa

This longitudinal research investigates the effect of physical activity on abdominal disorders, resulting in incontinence of urine (UI) and sexual dysfunction (FSD), among older women. Conducted at Type D Hospital, Khanpur, District Haripur, Khyber Pakhtunkhwa, the study involved women aged 60 and above, divided into physically active and non-active groups. Data was collected using information about physical activity, The Worldwide Conference on Female Incontinence Questionnaire - Short Form (ICIQ-UI-SF) for UI evaluation, and the Female Sexual Function Index (FSFI) for evaluating reproductive activity. The abdominal muscle contraction was evaluated using the Perfect Scheme. Results revealed that physical activity did not significantly influence UI or FSD severity in the study population. Despite high prevalence rates of UI (48.6%) and FSD (45.7%) and some variations in PFM function, no substantial differences were observed between physically active and non-active groups regarding UI frequency, severity, or sexual function. These findings suggest that while physical activity may improve PFM functionality, its impact on UI and FSD in older women may be limited. Further research is needed to explore integrated treatment approaches and validate these results.

Fortifying the foundation: assessing the role of uterine ligament integrity in uterine prolapse and beyond.

Pelvic floor stability is influenced by various biomechanical, anatomical, and physiological factors. Understanding these dynamics is crucial for improving the treatment of pelvic organ prolapse (POP) and related conditions. To analyze the key factors affecting pelvic floor integrity and explore both non-surgical and surgical interventions to enhance stability and treatment outcomes. This review draws from biomechanical research to assess the role of the uterosacral ligament in pelvic support, while also examining the potential of both traditional and emerging therapeutic approaches, including non-surgical interventions like vitamin C supplementation. - The uterosacral ligament demonstrates superior strength and stiffness, making it essential for structural support of pelvic organs. - Non-surgical interventions, such as vitamin C supplementation, show potential in improving ligament integrity and preventing pelvic floor disorders. - Emerging surgical techniques, including tendon-based procedures and injectable fibrous hydrogel composites, offer promising improvements in outcomes for patients with pelvic organ prolapse. - Additional factors such as muscle strength and neural deficiencies contribute to the complexity of pelvic floor biomechanics, indicating the need for multifaceted treatment approaches. This analysis provides a comprehensive framework for understanding and managing pelvic floor stability by integrating biomechanical, physiological, and anatomical insights. The findings highlight the potential for personalized treatment strategies to improve patient outcomes in pelvic floor disorders.

Pelvic Floor Disorders Due to Anal Sexual Activity in Men and Women: A Narrative Review.

Recent evidence shows that consensual anal penetrative intercourse has become more prevalent, not only limited to gay, bisexual, and other men who have sex with men but also for women who are in a sexual relationship with men. The aim of this review was to study the influence of consensual anal intercourse on pelvic floor function and the role of pelvic floor physical therapy treatment in preventing or treating consensual anal intercourse-induced anodyspareunia and/or fecal incontinence. We reviewed 68 references that showed that anal penetrative intercourse is a risk factor for anodyspareunia and fecal incontinence in both men and women. This risk of anal intercourse may increase with emotional discomfort, an overactive pelvic floor, lack of lubrication, frequency of anal penetrative intercourse, and hard practice (BDSM: bondage and discipline, dominance and submission, sadism, and masochism). It seems that pelvic floor physical therapists play an essential role in preventing and treating pelvic floor dysfunctions due to anal intercourse, which can lead to anodyspareunia and fecal incontinence; the treatment includes education, pelvic floor training with and without biofeedback, electric stimulation, manual therapy, and dilatators. Further studies are warranted to enhance our understanding of the causes and treatment efficacy of pelvic floor dysfunctions due to anal penetrative intercourse.

Effects of Inspiratory Muscle Training on Stress Urinary Incontinence in North African Women: A Randomized Controlled Trial.

Pelvic floor muscles (PFMs) are involved in respiratory mechanisms. Additionally, stress urinary incontinence (SUI) can affect physical function. This randomized controlled trial was aimed at investigating the effects of inspiratory muscle training (IMT) on SUI severity, PFM function, and physical function in Tunisian women with SUI. Twenty-seven incontinent women were randomly assigned to either the experimental group or the control group. The following parameters were assessed: respiratory muscle strength (RMS; maximal inspiratory and expiratory pressures), SUI severity (Urogenital Distress Inventory-6; Incontinence Impact Questionnaire-7; pad test), PFM function (Modified Oxford Scale, electromyography, and endurance), and physical function (Timed Up & Go test; 6-min walk test; incremental shuttle walking test). IMT was conducted using threshold IMT. The IMT program significantly reduced the severity of SUI (p < 0.01), improved PFM function (p < 0.001), enhanced physical function (p < 0.01), and increased RMS (p < 0.001). Inspiratory muscle training could be an effective method for improving pelvic floor disorders and physical function in women with SUI.

Etiology and pathogenesis of pelvic floor dysfunction (literature review)

Pelvic floor dysfunction (PFD) in women includes conditions such as vaginal relaxation syndrome (VRS), pelvic organ prolapse (POP), urinary and fecal incontinence, obstructed defecation, and sexual dysfunction. Etiopathogenesis is associated with disorders of the pelvic floor fixing apparatus that arise due to traumatic childbirth, genetic changes in the structure of connective tissue (polymorphism of the gene for connective tissue enzymes NAT2). Techniques used to diagnose pelvic floor injuries include x-rays, computed tomography, magnetic resonance imaging (MRI), and ultrasound. In this publication, we presented an overview of the most relevant and recent data on the etiopathogenesis, diagnosis of DTD.

Non-invasive central nervous system stimulation to improve bladder and pelvic floor function in the aging population.

The literature was reviewed for all noninvasive central nervous system (CNS) stimulation techniques, which includes transcranial brain or trans-spinal stimulation, in the aging population. Given the rising ubiquity of this technology, noninvasive nature, and low side-effect profile reported, this technology can have a big impact on the aging population. As patients afflicted with neurogenic disorders are living longer lives, a special emphasis is placed on the aging neurogenic population. Noninvasive CNS stimulation techniques have been applied to major bladder and pelvic floor disorders such as voiding dysfunction, chronic pelvic pain, urgency and urge incontinence, lower urinary tract dysfunction, and situational urge incontinence in both the idiopathic and neurogenic populations. Overall, these noninvasive technologies demonstrate effectiveness for the treatment of these conditions with some studies showing effectiveness with longer-term follow-up suggesting lasting CNS remodeling. Most manuscripts had a generally small number of patients and an even smaller number of geriatric patients represented. No studies were specifically designed to investigate geriatric outcomes. It is the hope of this systematic review to help model future studies according to existing literature, but with a focus on the geriatric population as they stand to gain the most from noninvasive technologies with limited adverse events.

Knowledge and Awareness of Pelvic Floor Disorders and Rehabilitation in Postpartum Women: An Observational Study

Abstract Background The prevalence of pelvic floor disorders (PFDs) is considerably high, yet, only a handful of women seek help as most of them accept it as a consequence of pregnancy, childbirth, and as a part of aging process. Pelvic floor physiotherapy is considered primary treatment for management of PFDs. Inadequate knowledge is a major obstacle in seeking appropriate treatment. The present study intends to evaluate the knowledge and awareness of PFDs and rehabilitation in postpartum women. Methodology The study comprised of 316 postpartum women from a tertiary care center in Belagavi district. Data was collected through an interviewer-administered questionnaire about PFDs and questions to assess awareness of pelvic floor physiotherapy. Outcome Measures Australian Pelvic Floor Questionnaire which comprises of 42 questions, divided in 4 domains, about bladder, bowel, prolapse, and sexual function was used along with 6 self-designed questions about pelvic floor physiotherapy, to evaluate the knowledge of PFDs and rehabilitation. Results The statistical analysis was done using the SPSS software version 26. The prevalence of PFDs was 63.6% with bladder component affected in 54.11%, bowel in 26.8%, prolapse symptoms in 2.21%, and sexual function in 22% postpartum women. They lacked knowledge regarding PFDs and rehabilitation with 84.4% considering the symptoms as normal and only 5.69% aware about pelvic floor physiotherapy. Conclusion The study concludes that there is a high prevalence of PFDs and a substantial lack of knowledge and awareness regarding PFDs and its rehabilitation.