Postpartum Pelvic Floor Muscle Research Articles

Management of a Case with Postpartum Pelvic Floor Muscle Dysfunction through Different Clinical Reasoning Process

Management of a Case with Postpartum Pelvic Floor Muscle Dysfunction through Different Clinical Reasoning Process

Association of pre-pregnancy body mass index and gestational weight gain on postpartum pelvic floor muscle morphology and function in Chinese primiparous women: A retrospective cohort study.

Our study aimed to investigate the association between maternal pre-pregnancy body mass index (BMI), gestational weight gain (GWG), and impaired pelvic floor muscle (PFM) morphology and function during the early postpartum period. This retrospective cohort study was conducted at Shanghai First Maternity and Infant Hospital from December 2020 to December 2022. A total of 1118 primiparous women with singleton pregnancies who underwent vaginal deliveries and participated in postpartum PFM assessments were included. Maternal pre-pregnancy BMI and GWG were considered as exposures. PFM morphology and function impairment were the primary outcomes. PFM morphology impairment, defined as levator ani muscle avulsion, was assessed using transperineal ultrasound. PFM function impairment, manifested as diminished PFM fiber strength, was assessed through vaginal manometry. Multivariable logistic regression analysis was employed to calculate adjusted odds ratios (aOR) with 95% confidence intervals (CI). Restricted cubic spline models were used to validate and visualize the relationship. Women with lower pre-pregnancy BMI were at an increased risk of levator ani muscle avulsion (aOR = 1.73, 95% CI: 1.10-2.70, P = 0.017), particularly when combined with excessive GWG during pregnancy (aOR = 3.20, 95% CI: 1.15-8.97, P = 0.027). Lower pre-pregnancy BMI was also identified as an independent predictor of PFM weakness (aOR = 1.53, 95% CI: 1.08-2.16, P = 0.017 for type I fiber injuries). Notably, regardless of the avulsion status, both underweight and overweight/obese women faced an elevated risk of reduced PFM strength (aOR = 1.74, 95% CI: 1.17-2.59, P = 0.006 for underweight women with type I fiber injuries; aOR = 1.67, 95% CI: 1.06-2.64, P = 0.027; and aOR = 1.73, 95% CI: 1.09-2.76, P = 0.021 for overweight/obese women with type I and type II fibers injuries, respectively). Both lower and higher pre-pregnancy BMI, as well as excessive GWG, were strongly associated with PFM impairments. These findings highlighted the critical importance of comprehensive weight management throughout pregnancy to effectively promote women's pelvic health.

The Effect of Postpartum Pelvic Floor Muscle Training on Female Sexual Function: A Randomized Controlled Clinical Trial

According to the high prevalence of sexual disorders, this study was performed to determine the effects of pelvic floor muscle training on sexual function in postpartum women. A pragmatic, multi-center, single-blind, non-inferiority randomized controlled trial (RCT), women with sexual dysfunction at 3 to 6 months postpartum were divided into two groups: the pelvic floor muscle training intervention for two sessions, once a week for two hours (n = 40), and the postpartum usual care (PUC) group (n = 40), who was referred to healthcare centers in Babol from December 2020 to May 2021. They were randomly assigned to the two groups. Demographic information and the Female Sexual Function Index (FSFI) were used. After 8 weeks, all participants completed the FSFI again. Data were analyzed using an analysis of covariance (ANCOVA), with p ≤ 0.05 considered significant. There were no significant differences in baseline characteristics and pre-intervention FSFI scores. But after 8 weeks, the FSFI total scores (p = 0.001) and the scores of subscales such as desire (p = 0.001), arousal (p < 0.001), orgasm (p = 0.009), and satisfaction (p = 0.004) were significantly higher in the intervention group than in the PUC group. Pelvic floor muscle training can improve a woman’s sexual function after childbirth.

Postpartum Pelvic Floor Muscle Training for Reducing Urinary Incontinence: A Systematic Review of Randomized Control Trials

Postpartum urinary incontinence is an increasingly prevalent problem for women, as it affects about one-third of women. The clinical significance of urine incontinence in relation to deficiencies in the active and passive pelvic floor structures is well recognized. Hence, pelvic floor muscle training (PMFT) treatment for urine incontinence is recommended. Several research studies suggest that PFMT prevents and treats pregnancy- and delivery-related urine incontinence. This study aimed to determine the effectiveness of postpartum PFMT for the treatment of urinary incontinence. Randomized control trials reporting the efficiency of PFMT among postpartum women from 2003–2023 were included. Studies including pregnant women or women who underwent any surgical intervention, along with studies describing pharmacological interventions and others apart from PFMT or PFMT with electrostimulation or biofeedback, were excluded. Additionally, studies with insufficient or unclear data regarding pregnancy outcomes were excluded. A Cochrane bias risk assessment tool was utilized to assess the quality of the studies. Final inclusion resulted in 7 studies that recruited 1398 patients. Four of the included trials assessed the endurance and strength of PFMT, and various rates of strength and endurance were observed among participants in both the intervention and control groups. The prevalence of urinary incontinence in comparison to the control group was observed to be lower in the intervention group, which demonstrates the beneficial role of PFMT in the management of urinary incontinence postpartum. There is strong evidence to suggest the effectiveness of PFMT in the management of postpartum urinary incontinence. However, this beneficial role of PFMT is often overlooked or under-described in clinical practice, for which awareness among clinicians and patients is vital. Additionally, awareness and planning for PFMT execution during antenatal visits can also help prevent urinary incontinence postpartum.

Evaluation of levator ani muscle elasticity after vaginal delivery and cesarean section using shear wave elastography

PurposeThe risk of pelvic floor muscle injury is commonly considered to be higher in vaginal than in cesarean delivery. This study aimed to compare levator ani muscle (LAM) elasticity after vaginal and cesarean delivery using shear wave elastography (SWE).MethodsPostpartum women who underwent a single SWE evaluation 1 month after their first delivery were divided into vaginal and cesarean delivery groups. The elastic moduli of both sides of the LAM were measured in a horizontal section and compared between the groups. In addition, a subgroup analysis was performed to compare LAM elasticity according to the delivery method within the vaginal delivery group—normal vaginal delivery, episiotomy, and operative vaginal delivery.ResultsSixty-two women were included (vaginal delivery, n = 47; elective cesarean section, n = 15). Multiple regression analysis revealed that the LAM elastic modulus was significantly lower in the vaginal delivery group than in the cesarean delivery group (right LAM: 44.2 vs. 72.7 kPa, p = 0.0036; left LAM 40.4 vs. 82.7 kPa, p < 0.0001). In the subgroup analysis, the right LAM elastic modulus was significantly lower in the operative vaginal delivery subgroup than in the normal vaginal delivery subgroup (p = 0.0131). However, there was no significant difference in the left LAM elastic modulus between the three subgroups.ConclusionLAM elasticity was significantly lower after vaginal delivery than after cesarean delivery. Furthermore, the elasticity of the right LAM was lower after operative vaginal delivery than after normal vaginal delivery. SWE has the potential to provide an objective quantitative assessment of postpartum pelvic floor muscle recovery.

Antenatal, Intrapartum and Postpartum Interventions for Preventing Postpartum Urinary and Faecal Incontinence: An Umbrella Overview of Cochrane Systematic Reviews.

Post-partum, women can suffer from urinary and faecal incontinence. It is important to assess interventions to prevent this problem. Cochrane systematic reviews summarize the data available from systematic reviews of randomized trials assessing interventions. We conducted an umbrella overview of Cochrane systematic reviews encompassing antenatal, intrapartum and postpartum interventions for preventing postpartum urinary and faecal incontinence. We searched the Cochrane Database of Systematic Reviews on the 9 May 2023. Results: Our search identified nine Cochrane reviews providing results. Data for urinary and faecal incontinence were available from 77 (72%) trials and included 51,113 women. The reviews assessed antenatal digital perineal massage, pelvic floor muscle training, techniques for repairing anal sphincter tears, routine use of episiotomy, use of endoanal ultrasound prior to repairing perineal tears, caesarean versus vaginal delivery (overall, for breech and for twins), and vaginal delivery with forceps or vacuum. Only the use of a vacuum instead of forceps if an assisted vaginal delivery is needed, the use of an endo-anal ultrasound prior to repairing perineal tears and postpartum pelvic floor muscle training suggest a reduction in postpartum incontinence. Due to the small number of relevant reviews, a consequence of the relatively small number of primary studies, the effect of almost all the tested interventions was found to be imprecise.

Effects of Different Indications for Forceps Delivery on Pelvic Floor Muscle Surface Electromyography and Early Postpartum Pelvic Floor Function in Primiparas

Background: Forceps-assisted vaginal delivery is closely associated with postpartum pelvic floor muscle (PFM) injury and postpartum pelvic floor dysfunction. The present study utilized Glazer PFM surface electromyography (sEMG) and International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF) for the objective assessment of postpartum PFM function to determine the effects of different forceps delivery indications on early postpartum pelvic floor function in primiparas. Methods: Four hundred primiparas whose pregnancies had been terminated by forceps delivery were divided into three groups based on the indication for forceps delivery: fetal distress (FD) (n = 260), prolonged second stage of labor (PSSL) (n = 30), and intrapartum fever combined with fetal distress (IFFD) (n = 110). Pelvic floor muscle surface electromyography (EMG) performed according to the Glazer protocol at 42–60 days postpartum was the primary outcome measure. Results: The overall Glazer assessment scores of the PSSL (54.4 ± 18.6) and IFFD (54.6 ± 15.8) groups were significantly lower than that of the FD group (59.3 ± 17.0) (p = 0.019). The peak EMG value during the fast-twitch stage for the FD, PSSL, and IFFD groups was 32.4 ± 17.7, 31.7 ± 26.1, and 26.5 ± 12.2 μV, respectively; the IFFD and FD groups were significantly different (p &lt; 0.05). The incidence of postpartum stress urinary incontinence (SUI) was significantly higher in the IFFD and PSSL groups; the IFFD and FD groups were significantly different (p &lt; 0.05). Conclusions: Intrapartum fever probably affects the early postpartum pelvic floor function of primiparas who underwent forceps delivery, which mainly manifests in the short term as reduced fast-twitch muscle strength and SUI.

Postpartum pelvic floor muscle training, levator ani avulsion and levator hiatus area: a randomized trial

Introduction and hypothesisVaginal delivery may lead to tearing of the levator ani (LA) muscle from its bony insertions (complete LA avulsion) and increased levator hiatus (LH) area, both risk factors for pelvic floor dysfunctions. Early active rehabilitation is standard treatment after musculo-skeletal injury. We hypothesized that pelvic floor muscle training (PFMT) early postpartum would reduce the presence of LA avulsions and reduce LH area.MethodsWe carried out a planned secondary analysis from a randomized controlled study. Primiparous women (n=175) giving birth vaginally were included 6 weeks postpartum, stratified on complete LA avulsion, and thereafter randomized to PFMT or control. The training participants (n=87) attended a supervised PFMT class once a week and performed home-based PFMT daily for 16 weeks. The control participants (n=88) received no intervention. Presence of complete LA avulsion, LH area at rest, maximal contraction, and maximal Valsalva maneuver were assessed by transperineal ultrasound. Between-group comparisons were analyzed by analysis of covariance for continuous data, and relative risk (RR) for categorical data.ResultsSix months postpartum, the number of women who had complete LA avulsion was reduced from 27 to 14 within the PFMT group (44% reduction) and from 28 to 17 within the control group (39% reduction). The between-group difference was not significant, RR 0.85 (95% CI 0.53 to 1.37). Further, no significant between-group differences were found for LH area at rest, during contraction, or Valsalva.ConclusionsSupervised PFMT class combined with home exercise early postpartum did not reduce the presence of complete LA avulsion or LH area more than natural remission.

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.

Evaluation of Factors Affecting the Reduction in Postpartum Pelvic Floor Muscle Tension and The Therapeutic Effect

Purpose: This study investigated the risk factors associated with reductions in postpartum pel-vic floor muscle tension and evaluated improvements in pelvic floor muscle tension with electrical stimulation combined with biofeedback technology and Kegel exercis-es. Methods: We conducted a case-control study of 170 women with postpartum follow-up at Ningbo Li Huili Hospital from April 2019 to May 2020. According to the Oxford modified scale assessment(MOS), 94 and 76 women were included in the abnormal pelvic floor muscle tension group and control group, respectively. The two groups were trained by pelvic floor training. The changes in pelvic floor muscle tension before and after treatment in the two groups were analyzed to evaluate the effect of postpartum pelvic floor rehabilitation training. Results: The EMG value of the fast muscle contraction stage was negatively correlated with age and neonatal weight (P &lt;0.05). The EMG values of slow muscle contraction and endurance were negatively correlated with weight gain during pregnancy but posi-tively correlated with age and BMI at delivery (P &lt;0.05). The muscle tension of the abnormal muscle tension group was significantly improved and significantly higher than that of the control group (P &lt;0.05) after the two groups received the intervention. Conclusion: The factors affecting postpartum pelvic floor muscle tension include age, delivery times, BMI at delivery and neonatal weight. Electrical stimulation combined with the biofeedback technique and Kegel exercises in the early postpartum period are effec-tive means to reduce the incidence of Pelvic floor disorders.

Prevalence of Planned Abdominal Binder Use after Vaginal Delivery.

Pregnancy and vaginal delivery are risk factors for pelvic floor dysfunction. Abdominal binder use may increase intraabdominal pressure, affecting pelvic floor healing or function in recently traumatized postpartum pelvic floor muscle. This study assesses the prevalence of postpartum abdominal binder use, timing, and reasons for use. In this cross-sectional observational survey study, women who underwent a vaginal delivery at our institution were enrolled. Participants were excluded if they did not speak Spanish or English. Participants were recruited on the postpartum unit. Data were deidentified and analyzed as appropriate for each variable. In total, 673 surveys were completed. Seven were excluded because they had cesarean deliveries. The average age was 26 years. Median gravidity and parity were 2 and 2. In total, 549 women (82%) planned to wear an abdominal binder postpartum. In all, 335 women provided a specific time when they would start use: 240 women (71%) would start at ≤2 days postpartum, 60 women (18%) would start at 3 to 7 days postpartum, and 35 women (11%) would start after 1 week postpartum. Common reasons reported for use included appearance, support, pain, swelling, weight loss, and recommendation. Among women delivering at our institution, planned abdominal binder use postvaginal delivery is common. The reasons cited include health and desire to return to prior body shape. The effects of using an abdominal binder in the postpartum period are unknown. More research is needed to better elucidate how increased postpartum intraabdominal pressure affects healing in traumatized pelvic floor muscles.

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&lt;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&lt;0.05). The recovery of postpartum pelvic floor muscle strength in the study group was significantly better than that in the control group(p&lt; 0.05). Both the first and second labor durations in the study group were significantly lower than those in the control group (p&lt;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.

Comparing Motor Control of the Lumbosacral Region and Pelvic Floor Muscle Strength and Performance in Women with C-Section and Vaginal Birth

Background: Delivery is a physiological process that may cause neurophysiological changes in the lumbosacral region. Objectives: The current study aimed to compare motor control of the lumbosacral region and pelvic floor muscle strength and performance in women with C-section and vaginal birth. Methods: In this cross-sectional study, 120 prim parous women referring to healthcare centers in Karaj (Iran) during 2019 are studied. The participants were selected using convenience sampling. The motor control of the lumbosacral region was examined by four clinical tests (standing bent, active straight leg raising, bent knee fall out, and knee lift abdominal test) using a pressure biofeedback unit. Muscle strength and performance were measured using the Oxford scoring system and the PFPI-20 questionnaire, respectively. Data were analyzed using independent t-test, Mann-Whitney, and Chi-square tests. Statistical significance was considered when P value &lt; 0.05. Results: Based on the standing bent test, a significant difference was found between those in vaginal delivery and C-section groups (P = 0.011). Also, the mean scores of muscular strengths (P = 0.009) and pelvic floor muscular function (P = 0.01) in the vaginal delivery group were significantly higher than the C-section group. Conclusions: the mean scores of pelvic floor motor control, pelvic floor muscular strength, and function in the C-section group were higher than those in the vaginal delivery group. This study demonstrated the necessity of postpartum pelvic floor muscle rehabilitation, especially in vaginal 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.

Device-assisted pelvic floor muscle postpartum exercise programme for the management of pelvic floor dysfunction after delivery

Background Pelvic floor dysfunction (PFD) is a multifactorial condition that clinically manifests as the pelvic prolapse, urinary and/or rectal incontinence, and sexual dysfunction. Aim We aimed to evaluate the efficacy of two pelvic floor trainers for the prevention of PFD in women during the postpartum period. Materials and methods This was a prospective, randomized, open-label study in 70 women in the postpartum period. Participants were randomized to complete a daily, 20-min set of pelvic floor muscle exercises using the EmbaGYN (UK; Group 1, n = 40) or the Magic Kegel Master device (China; Group 2, n = 40) for 4 weeks. All participants anonymously completed the PFDI-20 questionnaire and FSFI form at baseline and last visit. Pelvic floor muscle strength was measured using the XFT-0010 device. Results After the completion of the 4-week pelvic floor muscle exercise program, there was a significant decrease in the rates of all PFD symptoms including pelvic organ prolapse and urinary and/or fecal incontinence in both groups. The rates of sexual dysfunction after the exercise program decreased significantly only in Group II (69.4 versus 25.0%; р =.001). After the program, Group I showed a significant reduction in the number of women with symptoms of urgent urinary incontinence versus baseline (35.3 versus 8.8% p = .009). Similarly, the rates of urine loss associated with coughing, sneezing or laughing in Group I decreased from 41.2% at baseline to 11.8% after the program (р =.006) and the rates of urine leakage independent of physical activity from 23.5 to 5.9% (p = .040), respectively. Conclusion The 4-week postpartum pelvic floor muscle exercise program utilizing the EmbaGYN or Magic Kegel Master device has significantly increased the pelvic floor muscle strength and decreased the symptoms of pelvic organ prolapse, urinary and fecal incontinence. The use of the Magic Kegel Master device significantly reduced the symptoms of sexual dysfunction. The use of the EmbaGYN device was effective in addressing the individual symptoms of urinary incontinence.

Prevention of Stress Urinary Incontinence in Women

Lower urinary tract dysfunction (LUTD), including stress urinary incontinence (SUI), is increasingly recognized as a public health issue due to the prevalence, individual burden, and societal impact. Women are disproportionately affected by UI and are exposed to unique events that affect LUT function including higher rates of LUT infection, childbirth, pelvic floor anatomic changes, and hormonal milieu. The majority of LUTD research and clinical practice has focused on treatment of the most affected subset of women, but there are millions of women living with urinary incontinence that do not seek advice or treatment, and the evidence base for prevention or detection of early symptoms is lacking. Individual factors such as sociodemographic elements, medical history, physical exam, and comorbidities have been well studied; however, the contribution of family and environmental factors is less well understood. Emerging data suggests that some types of high-impact physical activity in adolescence can confer increased UI risk later in life. Prenatal and postpartum pelvic floor muscle training appears to be beneficial in preventing SUI in some women. While certain individual risk factors for SUI have been identified, sociocontextual factors also affect health outcomes and can mediate an individual’s risk of disease. The social ecological model considers factors within the family/peer, community, and societal levels that can affect an individual’s health behaviors. Prevention research that investigates these multiple levels of influence on individual biology and behavior is a fundamental step to better understand the complex factors that impact bladder health and inform LUTS prevention agendas. In addition, strategies to educate girls and women and engage communities in bladder health promotion are essential in order to effectively disseminate scientific findings and implement intervention programs.

Exploring the Impact of a Mobile Health Solution for Postpartum Pelvic Floor Muscle Training: Pilot Randomized Controlled Feasibility Study.

BackgroundThe postpartum period is a vulnerable time for the pelvic floor. Early implementation of pelvic floor muscle exercises, appropriately termed as pelvic floor muscle training (PFMT), in the postpartum period has been advocated because of its established effectiveness. The popularity of mobile health (mHealth) devices highlights their perceived utility. The effectiveness of various mHealth technologies with claims to support pelvic floor health and fitness is yet to be substantiated through systematic inquiry.ObjectiveThe aim of this study was to determine the acceptability, feasibility, and potential effect on outcomes of an mHealth device purposed to facilitate pelvic floor muscle training among postpartum women.MethodsA 16-week mixed methods pilot study was conducted to evaluate outcomes and determine aspects of acceptability and feasibility of an mHealth device. All participants received standardized examination of their pelvic floor muscles and associated instruction on the correct performance of PFMT. Those randomized to the iBall intervention received instructions on its use. Schedules for utilization of the iBall and PFMT were not prescribed, but all participants were informed of the standard established recommendation of PFMT, which includes 3 sets of 10 exercises, 3 to 4 times a week, for the duration of the intervention period. Quantitative data included the measurement of pelvic floor muscle parameters (strength, endurance, and coordination) following the PERFECT assessment scheme: Incontinence Impact Questionnaire scores and the Urogenital Distress Inventory (UDI-6) scores. Aspects of acceptability and feasibility were collected through one-to-one interviews. Interview transcripts were analyzed using Thorne’s interpretive description approach.ResultsA total of 23 women with a mean age of 32.2 years were randomized to an intervention group (n=13) or a control group (n=10). Both groups improved on all measures. The only statistically significant change was the UDI-6 score within both groups at 16 weeks compared with baseline. There was no statistically significant difference between the intervention group and control group on any outcomes. Most participants using the iBall (n=10, 77%) indicated value in the concept of the mHealth solution. Technical difficulties (n=10, 77%), a cumbersome initiation process (n=8, 61%), and discomfort from the device (n=8, 61%) were reasons impeding intervention acceptability. Most participants (n=17, 74%) indicated that the initial assessment and training was more useful than the mHealth solution, a tenet that was echoed by all control group participants.ConclusionsOur pilot study demonstrated the potential for mHealth solution–enhanced PFMT in the early postpartum period. Usability issues in hardware and software hindered feasibility and acceptance by the participants. Our findings can inform the redesign of mHealth solutions that may be of value if acceptability and feasibility issues can be overcome.Trial RegistrationClinicalTrials.gov NCT02865954; https://clinicaltrials.gov/ct2/show/NCT02865954

A feasibility study of the postpartum pelvic floor muscle training program using vaginal palpation by midwives

A feasibility study of the postpartum pelvic floor muscle training program using vaginal palpation by midwives

Multiple factors analysis of early postpartum pelvic floor muscles injury in regenerated parturients

Objective: To investigate the risk factors for multiparous pelvic floor muscles injury during 6-8 weeks after delivery. Method: From June 2015 to April 2017, 1917 women (1 523 primigravidas and 294 multiparas) were accepted postpartum pelvic floor function screening during 6-8 weeks after delivery in Beijing Hospital.Pelvic examination and pelvic floor muscle strength testing were carried out in these women.All the data were analyzed with multivariate logistic regression method to explore the related factors for postpartum pelvic floor muscle injury. Result: The incidence of muscle strength grades less than third grade was 63.60 % (type Ⅰ muscle fiber) and 24.83 % (type Ⅱ muscle fiber). Multivariate analysis showed that time interval, between two deliveries, less than 3 years (OR=2.16, 95%CI 1.21-3.86), and maternal BMI<18.5 (OR=3.04, 95%CI 1.10-9.30) and BMI≥28 (OR=3.04, 95%CI 1.10-9.30) before pregnancy were risk factors for postpartum injury of type Ⅰ muscle fiber. Gestational age more than 40 weeks increased the risk of damaging type Ⅱ muscle fiber (OR=2.79, 95%CI 1.156-6.76). Compared with cesarean section, vaginal delivery significantly increased the risk of injury of type Ⅰ and Ⅱ pelvic floor muscle fibers (P<0.05). Conclusion: The incidence of multiparous pelvic floor muscle injury was high in early postpartum period.Several factors are related to the pelvic floor muscle injury.Pelvic floor rehabilitation in early postpartum and maternal education may be helpful to reduce the radio of injury.