Postpartum Pelvic Floor Muscle Strength Research Articles

Sexually Induced Orgasm to Improve Postpartum Pelvic Floor Muscle Strength and Sexual Function in Primiparous Women After Vaginal Delivery: A Prospective Randomized Two-Arm Study

BackgroundPostpartum pelvic floor dysfunction is known to affect the quality of life of women and the methods to treat it are more complex with majority requiring training under supervision. AimTo compare the efficacy of sexually induced orgasm along with Kegels exercises versus Kegels exercises alone as a treatment method to enhance postpartum pelvic floor muscle strength and sexual function in primiparous women undergoing uncomplicated vaginal deliveries. MethodsThe prospective randomized two-arm study was conducted on sexually active primiparous women who had undergone uncomplicated vaginal deliveries. Those with risk factors for female sexual dysfunction and pelvic floor muscle dysfunction were excluded. Participants in Group 1 were advised daily Kegel's exercises, whereas, those in Group 2 were advised to initiate self-initiated/partnered sexual activity-induced orgasms along with daily Kegel's exercises. Their pelvic floor muscle strength on voluntary contraction, ability to relax pelvic floor voluntarily, and sexual function (using FSFI-6) were assessed monthly for 6 months and the analysis was done using G* Power software (© 2021 Heinrich-Heine-Universität Düsseldorf, Germany). Main Outcome MeasurePostpartum pelvic floor strength and sexual function in 2 groups of women under study. ResultsThe study period was from January 2020 to December 2020. The Group 1 had 26 participants (mean age 29.69 ± 2.2 years) and Group 2 had 29 participants (mean age 30.07 ± 2.57 years). The sexual function as well as ability to relax pelvic floor were significantly better in Group 2 compared to Group 1 at each monthly intervals whereas strength of pelvic floor muscles during voluntary contraction was significantly higher in Group 2 compared to Group 1 at the end of 6 months and it was statistically significant at a P value of .05. Clinical ImplicationsNovel method of using naturally occurring sexually induced orgasms for postpartum pelvic floor rehabilitation can revolutionize postpartum pelvic floor training in women, as it can be practiced at home with ease, along with easily performable Kegel's exercises. Strengths and LimitationsUse of prospective randomization and minimization of confounding factors is the strength of the study. The small sample size is the limitation of the study. ConclusionsPostpartum pelvic floor muscle strength and sexual function in primiparous women who have undergone uncomplicated vaginal deliveries can be significantly improved with the addition of sexually induced orgasm as a therapeutic tool along with physical exercises such as Kegels exercises in these women.Bhat GS, Shastry A. Sexually Induced Orgasm to Improve Postpartum Pelvic Floor Muscle Strength and Sexual Function in Primiparous Women After Vaginal Delivery: A Prospective Randomized Two-Arm Study. J Sex Med 2022;19:1634–1643.

Intraspinal Block Anesthesia on Vaginal Delivery Parturients and Its Effect on Postpartum Pelvic Floor Muscle Strength and Immune Function

Objective: At present, intramural block anesthesia is mostly used clinically for vaginal delivery, but it is unclear whether intraocular block anesthesia has an effect on postpartum pelvic floor muscles and immune function after vaginal delivery. Therefore, this study investigated the effect of intraspinal block anesthesia on vaginal delivery parturients and its effect on postpartum pelvic floor muscle strength and immune function.Patients and Methods:A total of 182 parturients with vaginal delivery were selected as the study subjects. They were admitted in our hospital from March 2015 to January 2017. Among them, 92 parturients receiving intraspinal block anesthesia were enrolled in the study group and 90 parturients without intraspinal block anesthesia in the control group. The pelvic floor muscle damage and muscle strength recovery in the two groups were measured 3 months after delivery. The peripheral blood T lymphocyte subsets of parturients at different time points in the two groups was detected to investigate the effect of intraspinal block anesthesia on pelvic floor muscle strength and immune function after vaginal delivery. Results: The pain degree during delivery in the study group was significantly lower than that in the control group (p<0.05). The pelvic floor muscle damage, pelvic organ prolapse, pelvic floor function damage and stress urinary incontinence in the study group were all lower than those in the control group (p<0.05). The recovery of postpartum pelvic floor muscle strength in the study group was significantly better than that in the control group(p< 0.05). Both the first and second labor durations in the study group were significantly lower than those in the control group (p<0.05).Conclusion:lntraspinal block anesthesia has a better analgesic effect on the vaginal delivery parturients,can effectively shorten the labor. It also has a certain improvement effect on the recovery of postpartum pelvic floor muscle and immune function of parturients.

Comparison of lateral episiotomy, traditional midwifery without episiotomy, and hands-off techniques delivery on pelvic floor function

BackgroundProlonged vaginal delivery times and episiotomy are associated with damage to the muscles of the pelvic floor, and with complications that include postpartum sexual dysfunction and urinary stress incontinence. This study was to compare the pelvic floor function among postpartum women who underwent three midwifery practices during labor: lateral episiotomy, traditional midwifery without episiotomy, and hands-off techniques delivery. MethodsWe included 320 primipara who were full-term pregnancy and underwent vaginal delivery in Department of Obstetrics, Peking University People’s Hospital, China. 117 women had episiotomy during labor and were classified into the lateral episiotomy group; 103 had traditional midwifery without episiotomy and were classified into the traditional midwifery practice group; and 100 experienced hands-off techniques during labor and were classified into the hands-off techniques delivery group. The duration of the second stage of labor, and postpartum pelvic floor muscle strength were compared between the three study groups. ResultsThere were no significant differences between the three groups for the duration of the second stage of labor and postpartum pelvic floor muscle strength (P ​> ​0.05). However, the incidence of postpartum urinary stress incontinence and sexual dysfunction in the hands-off techniques delivery group was significantly lower than in the lateral episiotomy groups and the traditional midwifery practice group (P ​< ​0.01). ConclusionsHands-off techniques delivery could reduce damage to the pelvic floor and improve the quality of life for women after delivery.

A Mobile Application Penyikang Applied in Postpartum Pelvic Floor Dysfunction: A Cross-Sectional Study to Analyze the Factors Influencing Postpartum Pelvic Floor Muscle Strength and Women's Participation in Treatment.

Objectives Postpartum pelvic floor muscle (PFM) injuries are the result of pregnancy and delivery, which lead to a series of symptoms requiring long-term follow-up. Mobile health platforms are progressively used for monitoring clinical conditions in medical subjects. This survey was a cross-sectional design based on collecting data from an application (Penyikang). We retrospectively analyzed the risk factors for weak postpartum PFM and further analyzed the factors influencing women's participation in the treatment which may help to improve the app's application in the future. Methods We enrolled postpartum women who gave birth at the Women's Hospital, Zhejiang University School of Medicine from August to November 2017; trained them to use the app; and collected the demographic and clinical information. This app requires users to fill questionnaires to assess their knowledge of pelvic floor dysfunction (PFD) and pelvic floor muscle training (PFMT) and experience with PFMT, and each therapy evaluation was restored. The relationship between the knowledge of PFMT/PFD, UI symptoms, and PFM strength was analyzed. Cluster analysis was used to define the degree of participation and identify the factors influencing the patients' participation in intensive therapy and evaluation. Results 1982 postpartum women who enrolled in the app program were defined as weak PFM. Younger maternal age, cesarean section, and without delivery injury were found as the prognostic factors to PFM strength (both type I and type II muscle fibers) (P < 0.05), and higher educational level was also in favor of type II muscle fibers (P < 0.05). Patient-reported UI symptoms were associated with weak PFM strength (P < 0.05); there were no significant differences between knowledge of PFMT or PDF and PFM strength. Finally, patients with a higher degree of participation were more likely to accept the treatment (P < 0.05). Conclusions The mobile app provides a new applicative way to investigate postpartum PFD. The factors influencing women's participation can help us focus on strategies to increase the patients' compliance, and then we will apply the app into more areas to improve the prevention and treatment of postpartum PFD.

Association of antepartum vitamin D levels with postpartum pelvic floor muscle strength and symptoms.

Vitamin D affects skeletal muscle strength and functions via various mechanisms. Strength and/or functional dysfunctions of the pelvic floor muscles may be associated with the distortion of pelvic floor functions. We hypothesized that vitamin D deficiency may contribute to pelvic floor dysfunction (PFD) by affecting pelvic floor muscle strength (PFMS). The aim of this study was to assess the effect of vitamin D deficiency during pregnancy on postpartum PFMS. This cross-sectional study was conducted in a university hospital. One hundred and eighty pregnant women were admitted to our hospital in their third trimester and compared with 156 healthy nulliparous women. Venous blood samples for examining vitamin D levels were taken from each participant and stored at -80 °C. At 8-10 weeks postpartum, patients were invited to the hospital, asked about their PFD symptoms, and PFMS was measured using a perineometer. There was no statistical significance among groups regarding mean age, maternal age, and weight at delivery. Postpartum PFMS and duration in vitamin D-deficient women were significantly lower than those without the deficiency. Vitamin D-deficient vaginal delivery cases (group I) had a postpartum PFMS average of 21.96 ± 7.91 cm-H₂O, nonvitamin D-deficient normal delivery cases (group III) had a PFMS of 29.66 ± 10.3 cm-H₂O (p = 0.001). In the cesarean delivery groups, vitamin D-deficient (group II) and nonvitamin D-deficient (group IV) cases had PFMS values of 32.23 ± 9.66 and 35.53 ± 15.58 cm-H₂O respectively (p = 0.258). Lower vitamin D levels in the third trimester correlates with decreased PFMS.

The relationship between postpartum levator ani muscle avulsion and signs and symptoms of pelvic floor dysfunction

To establish the relationship between postpartum levator ani muscle (LAM) avulsion and signs and/or symptoms of pelvic floor dysfunction (PFD). Observational longitudinal cohort study. District General University Hospital, UK. Primigravida at 36weeks' gestation and 3months postpartum. Pelvic floor muscle strength (PFMS) and pelvic organ prolapse were assessed clinically using validated methods. Transperineal ultrasound was performed to identify LAM avulsion and measure hiatus dimensions. Validated questionnaires evaluated sexual function, urinary and faecal incontinence. PFD signs and symptoms related to LAM avulsion. Two hundred and sixty nine primigravida without LAM avulsion participated and 71% (n=191) returned postpartum. LAM avulsion was found in 21% of vaginal deliveries (n=30, 95%CI 15.1-28.4%). Women with minor and major avulsion had worse PFMS (P<0.038) and more anterior compartment prolapse (maximum stage 2; P<0.024). Antenatal hiatus antero-posterior diameter on ultrasound was significantly smaller in women sustaining avulsion (P=0.011). Postnatal measurements were significantly increased following avulsion. Women with major avulsion were less sexually active at both antenatal and postnatal periods (P<0.030). These women had more postnatal urinary incontinence and symptoms such as reduced vaginal sensation and 'too loose vagina'. No postnatal differences were found for faecal incontinence, prolapse symptoms or quality of life. The correlation of differences in variables was only slight-fair with avulsion severity. Twenty one percent of women sustain LAM avulsion during their first vaginal delivery with significant impact on signs and symptoms of PFD. As avulsion has been described as the missing link in the development of prolapse; longer term follow-up is vital.

Effectiveness of Antenatal Motor Relearning Approach of Diaphragm, Deep Abdominal and Pelvic Floor Muscles Versus Kegels Exercises on Postpartum Pelvic Floor Muscle Strength

Objective: To compare the effect of antenatal motor relearning approach of diaphragm, deep abdominal and pelvic floor exercises versus kegels exercises on postpartum pelvic floor muscle strength. Design: Quasi experimental, Post test only design with a comparison group Setting: Department of Obstetrics and Gynecology, PSG Hospitals. Participants: 78 antenatal women randomly selected. Among the 78 women, 39 each were assigned to Group A (interventional group) and to Group B (control group). Finally 21 women in each group continued the treatment program. • Group A- antenatal motor relearning approach of diaphragmatic, deep abdominal and pelvic floor muscles • Group B - kegels exercises Outcome Measure: The pelvic floor muscle strength was measured using Perineometer on the third postnatal day. Results: Data from 42 women were analyzed. Independent 't' test was used as statistical tool. It has been found that there is significant difference in the postpartum pelvic floor muscle strength between the interventional and control group. The mean difference between the interventional and control group were 1.762mm hg. The calculated 't' value using independent 't' test was 3.584 which was greater than tabulated test statistic value of the 1.960 at (p<0.05). Conclusion: The pelvic floor muscle strength was comparatively greater among the women who performed antenatal motor relearning approach than kegels exercise group. Hence antenatal Motor Relearning approach of diaphragmatic, deep abdominal and pelvic floor exercises can be implemented during a normal pregnancy unless precluded by additional risk factors.

Prevalence and treatment of post partum urinary incontinence

SUMMARYChildbirth is often considered the main etiological factor in the development of female urinary incontinence(UI). For that reason women in the western countries have been encouraged to engage in post partumpelvic floor muscle (PFM) exercise in order to strengthen the pelvic floor. However, the effect of post partumPFM exercise has been sparsely documented. The aim of this article is to review and discuss literaturerelated to prevalence of post partum UI and effect of post partum PFM exercise in the treatment of UI. Thereported prevalence of UI post partum varies from 0.7% to 44%. The variation may be explained bydifferent definitions of UI used in the questionnaires and that the registration of incontinence was done atdifferent intervals after delivery. A few studies have tried to evaluate the effect of post natal PFM exercise.Some have evaluated PFM strength, others the frequency of UI. PFM strength is difficult to measure andthe reliability and validity of the methods used is open to question. Another flaw in some of the previousstudies is the training protocol applied to improve PFM strength. Mørkved and Bø tried to take intoaccount the above mentioned methodological considerations, in a study aiming to evaluate the effect ofpost partum PFM exercise. The results demonstrate that post partum PFM exercise is effective instrengthening the PFM and in the treatment of UI. However, success of PFM exercise is dependent uponboth the training frequency and intensity. This requires a closer follow up of the post partum women, thanthe written information that usually serves this purpose at the present time.Key words : physiotherapy, pelvic floor muscles, urinary incontinence, post partum exercise, prevalence

Prevalence of urinary incontinence during pregnancy and postpartum.

The purpose of the study was to investigate the prevalence of urinary incontinence during pregnancy and the postpartum, and to examine postpartum pelvic floor muscle strength. Eight weeks postpartum the prevalence of urinary incontinence and pelvic floor muscle strength was registered. All women in a Norwegian community, delivering at the local hospital during a 1-year period, were included in the study. The final study group consisted of 144 women (72%). Data concerning the prevalence of urinary incontinence was collected by a structured interview and clinical assessment (pad test) 8 weeks postpartum. Pelvic floor muscle strength was also measured. The prevalence of urinary incontinence during pregnancy was 42%. Eight weeks after delivery the prevalence of self-reported urinary incontinence was 38%. There was a difference between self-reported symptoms and urinary incontinence as assessed by the pad test. Symptoms of fecal incontinence postpartum were reported by 6 women (4.2%). The prevalence of urinary incontinence was found to be nearly the same 8 weeks postpartum as during pregnancy. This documents the need for a strategy to prevent and treat urinary incontinence during these periods.