Floor Strength Research Articles

A physical therapy program to treat late-effect vaginal stenosis in gynecological cancer survivors: An interventional study.

To evaluate the effect of a physical therapy program on vaginal length and diameter, pelvic floor strength, and quality of life among gynecological cancer survivors suffering from late-effect vaginal stenosis. Thirty-four women who were previously diagnosed with gynecological cancer and experiencing vaginal stenosis, at least 12months post-oncological treatment, were enrolled. The intervention program consisted of ten weeks of individualized weekly sessions, each lasting 50min, involving perineal massage, progressive vaginal dilation, and pelvic floor exercises. Pre- and post-treatment evaluations included assessments of pelvic floor muscle strength through digital palpation, measurements of vaginal length and diameter using a silicone vaginal dilator, and classification of stenosis according to the Common Terminology Criteria for Adverse Events (CTCAE v5.0). Health-related quality of life was assessed using the FACT-G and FACT-Cx questionnaires. Twenty-one women completed the physical therapy program. There was a significant increase in vaginal length (p < 0.001), vaginal diameter (p < 0.001) and improvement in pelvic floor muscle strength (p < 0.001), with a large effect size (r = 0.81), a medium effect size (r = -0.77) and a medium effect size (r = -0.78), respectively. This resulted in resolution of vaginal stenosis in 14 participants (66.7%) following intervention. Mean scores for FACT-Cx and FACIT-G, encompassing total scores and physical, social, and functional well-being domains, increased significantly after the treatment. The proposed physical therapy program demonstrated positive effects on vaginal stenosis, pelvic floor muscle strength and health-related quality of life in gynecological cancer survivors.

Optimising Neural Networks for Enhanced Fracture Density Prediction in Surrounding Rock of Coalbed Methane Reservoir

ABSTRACTFractures influence the mechanical strength of coal roof and floor, constraining the design of hydraulic fracturing for coalbed methane production. Currently, the predominant approach involves the integration of petrophysical logging with machine learning for fracture prediction. Nevertheless, challenges exist regarding the model's accuracy. In this study, we present a novel approach to predict fracture density. Our method optimises a back‐propagation (BP) neural network and utilises principal component analysis for feature extraction. We employ logging parameters (density, compensated neutron and acoustic time difference) obtained from Shouyang Block well SY‐1 and fracture density data from electrical imaging logging to construct the FVDC model's dataset. The BP neural network model is optimised using the Sparrow Search algorithm and Tent Chaotic Mapping. The results demonstrate a substantial enhancement over the BP neural network model, with reductions of 80.102% in mean absolute error, 94.182% in mean square error, 75.879% in root mean square error and 79.764% in mean absolute percentage error. When considering accuracy, the optimised model (97.098%) surpasses the support vector regression model (96.478%), the random forest model (94.404%) and the BP neural network model (85.657%). Scalability testing for the optimised model was conducted using data from well SY‐2, yielding a remarkable prediction accuracy of 96.775%. This performance exceeds that of the BP neural network (with an accuracy of 85.102%), as well as the random forest and support vector regression models (with accuracies of 91.234% and 90.384%, respectively). These results underscore the potential of well logging and machine learning in FVDC prediction.

Effect of electromagnetic stimulation combined with visceral manipulation on stress urinary incontinence in postmenopausal women: A randomized controlled trial

ObjectivesThe aim of the study is to determine how electromagnetic stimulation and visceral manipulation can improve pelvic floor strength and reduce the severity of symptoms of postmenopausal stress urinary incontinence (SUI). MethodsThis randomized controlled trial was conducted on 50 postmenopausal female participants aged 50–66 years with a body mass index (BMI) ≥ 30 kg/m2. Participants were equally randomized into the study (A) and control (B) groups. The study group (A) underwent 36 pulsed electromagnetic stimulation (PEMS) sessions (20 min/session; 3 sessions a week/12 weeks), 12 sessions of visceral manipulation therapy (VMT) maneuvers (once weekly/weeks), and 24 supervised pelvic floor muscle training (PFMT) sessions (45–60 min/session; twice weekly/12 weeks), along with general advice. For 12 weeks, the control group (B) received the same PFMT and general advice. Kegel perineometer was used to measure vaginal squeeze pressure (VSP) and the urogenital distress inventory questionnaire-short form (UDI-6) to assess the severity of urinary incontinence (UI) symptoms in both groups before and after the treatment. ResultsThe results revealed statistically significant improvements (p < 0.05) in both VSP and UDI-6 scores in group A compared to group B. ConclusionElectromagnetic stimulation combined with visceral manipulation and supervised PFMT is more efficient than PFMT alone on SUI in postmenopausal women. Therefore, it is advisable to incorporate this combined approach into pelvic floor rehabilitation programs.

Pelvic Floor Rehabilitation for Urinary Incontinence after Radical Prostatectomy: Techniques and Recommendations

Introduction: Urinary incontinence is a common complication following radical prostatectomy, significantly impacting patients' quality of life. This systematic review aimed to evaluate the efficacy of various pelvic floor rehabilitation techniques in managing post-prostatectomy urinary incontinence. Methods: A comprehensive literature search was conducted using PubMed and Google Scholar, yielding 34 relevant studies for analysis. Results: The review found that pelvic floor rehabilitation, encompassing techniques such as pelvic floor exercises, biofeedback, electrical stimulation, and behavioral management, offers a non-invasive and cost-effective approach to improving continence outcomes. While the optimal timing and duration of rehabilitation remain debated, evidence supports initiating pelvic floor muscle training preoperatively and continuing postoperatively. Combining multiple rehabilitation techniques, particularly manual therapy with biofeedback or functional electrostimulation, appears to yield the best results in accelerating continence recovery. Preoperative rehabilitation showed mixed outcomes, with some studies reporting improved continence and others finding no additional benefit. Postoperative rehabilitation strategies varied, but generally focused on gradually increasing pelvic floor strength and control. The long-term efficacy of rehabilitation at 12 months post-surgery was comparable to no intervention in some studies. Conclusion: While pelvic floor rehabilitation demonstrates modest effectiveness in managing post-prostatectomy urinary incontinence, particularly in the short term, further research is needed to establish optimal protocols and long-term benefits. These findings underscore the importance of a comprehensive, patient-centered approach to post-prostatectomy care.

A Prediction Model for Pelvic Floor Recovery After Vaginal Birth With Risk Factors.

Although parturients report few postpartum symptoms, birth is clearly associated with future symptom development. The ability to identify asymptomatic at-risk women would facilitate prevention. The aim of the study was to develop a model predicting abnormal recovery in women at risk for childbirth-associated pelvic floor injury. Women undergoing first vaginal birth at high risk of pelvic floor injury underwent examinations and ultrasound imaging and completed 6-week and 6-month postpartum questionnaires. We defined "abnormal" recovery as having ≥1 of the following 3 findings: (1) levator ani injury, (2) decreased objective pelvic floor strength, and (3) Pelvic Organ Prolapse Quantification point Bp ≥0. Descriptive statistics and bivariate analyses compared "normal" and "abnormal" recovery. Birth characteristics, 6-week examinations, and questionnaires potentially predicted abnormal recovery at 6 months. Significant variables were included as candidates in the multivariable logistic regression predicting "abnormal" recovery after birth. Fifty-four women (63.5%) had normal and 31 (36.5%) had abnormal recovery at 6 months. At 6 weeks, women with abnormal recovery had decreased pelvic floor strength by Oxford scores (3 [2-5], 6 [2-8]; P = 0.002), lower point Bp (-1 [-3 to 0], -2 [-3 to -1]; P = 0.02), larger genital hiatus (4 [3 to 4], 3 [3 to 3.5]; P = 0.02), and higher levator ani injury rate (76.7%, 22.4%; P < 0.001). Between-group questionnaire differences were not clinically significant. Our final model included postpartum examination findings or birth characteristics: Oxford Scale, 6-week Pelvic Organ Prolapse Quantification GH strain, infant head circumference, and second stage ≥120 minutes. The area under the curve for predicting abnormal recovery at 6 months was 0.84, indicating a good sensitivity and specificity balance. The model identifies women at risk for an abnormal recovery trajectory.

Stability prediction of roadway surrounding rock using INGO-RF

In order to more accurately classify the stability of roadway surrounding rock and identify dangerous areas in a timely manner to prevent roadway collapse and other disasters, an INGO-RF roadway surrounding rock stability prediction model is proposed. This model combines the improved Northern Gok algorithm (INGO) and Random Forest (RF) based on the analysis of influencing factors of roadway surrounding rock stability. First, three strategies were employed to enhance the Northern Gob algorithm (NGO): Logistic chaotic mapping, refraction reverse learning, and improved sine and cosine. Subsequently, INGO was utilized to optimize the number of decision trees and the minimum number of leaf nodes for RF species in order to improve the prediction accuracy of RF. Secondly, a data set consisting of 34 groups of roadway surrounding rock data is selected. The input indexes of the model include roof strength, two-wall strength, floor strength, burial depth, roadway pillar width, ratio of direct roof thickness to mining height, and surrounding rock integrity. Meanwhile, surrounding rock stability is considered as the output index. Particle swarm optimization backpropagation neural network (PSO-BPNN), genetic algorithm optimization support vector machine (GA-SVM), Sparrow search algorithm optimization RF (SSA-RF) models were introduced to compare the prediction results with the INGO-RF model, and the results showed that: INGO-RF model has the best performance in the comparison of various performance indicators. Compared with other models, the accuracy rate (Ac) in the test set has increased by 0.12∼0.4, the accuracy rate (Pr) has increased by 0.07∼0.65, and the recall rate (Re) has increased by 0.08∼0.37. The harmonic mean (F1-Score) of the recall rate increased by 0.08∼0.52, the mean absolute error (MAE) decreased by 0.1428∼0.4285, the mean absolute percentage error (MAPE) decreased by 7.15%∼28.57%, and the root mean square error (RMSE) decreased by 0.1565∼0.3779. Finally, the data on surrounding rock conditions of roadways in multiple mining areas in Shanxi Province were collected to test the INGO-RF model. The results indicate that the predicted outcomes closely align with the actual results, demonstrating a certain level of reliability and stability. It shows that it can better meet the practical needs of engineering and avoid the occurrence of mine disasters.

Ultimate Bearing Capacity of Weak Foundations under Coal Pillars

In many underground coal mines, a seam is underlain by weak floor material, and the load-carrying capacity of a pillar may be limited not by its own strength but by the bearing capacity of the floor. It has been proposed that bearing capacity may be estimated by formulae such as those of Terzaghi for structural footings on soil, but that approach is generally not valid because, for the slip surfaces assumed in the derivations of the formulae, the rock rises out of the floor beneath adjacent pillars. In the limiting equilibrium analysis proposed here, the distance to the side of a pillar to which a slip surface extends can be constrained according to the roadway or bord width. Examples are shown of the computation of bearing capacities of both homogeneous and multilayer dry and fully saturated floors, and results compared with those of elastoplastic finite element analysis. An approximate comparison with bearing capacities according to Terzaghi's formula for a strip footing is also presented for the hypothetical cases of wider roadways for which the assumed slip surfaces do not extend under adjacent pillars. For the cases considered, there is satisfactory agreement with Terzaghi’s analysis and good agreement with the results of finite element analysis. However, only one finite element analysis was carried out, and it remains to be seen whether such agreement is consistently achieved for ranges of floor strength parameters and horizontal stress.

Effect of pelvic floor fascial mobilization on pelvic floor dysfunction in multiparous pregnant women - A randomized pilot study

BackgroundPelvic floor fascial mobilization (PFFM) is an innovative intravaginal and/or intrarectal manual therapy technique developed to treat pelvic distress by improving fascial gliding and muscle function. AimThe effect of PFFM on pelvic floor distress during pregnancy was compared to conventional pelvic floor muscle training. MethodsA pilot prospective randomized clinical trial. The primary outcome was the strength and function of the pelvic floor muscles measured via the Oxford grading scale, perineometry, and hip range of motion. Each subject was treated twice, one week apart. ResultsForty multiparous pregnant women at 24–30 weeks gestation, with pelvic distress, were allocated to PFFM (study group (n = 20)) vs. pelvic floor muscle training (control group (n = 20)). There was no difference in the severity of pelvic distress between the study and control groups before the interventions (PFDI-20: 27.1 ± 12.2 vs. 26.0 ± 13.5, respectively, p = 0.7). Twenty-six subjects completed the study protocol. PFDI-20 showed significant improvement: 42% improvement in the study group vs. 12% improvement in the controls (p = 0.001 for both groups). Group-by-time interaction (Cohen's d) was significant after the first treatment session for Oxford score, right hip internal rotation range of motion, and cervical length in the PFFM group and for perineometry and right hip internal rotation at the end of the study. ConclusionsBased on this pilot randomized trial, PFFM may potentially and partially 1. Alleviate symptoms, 2. Improve pelvic floor function and strength, and 3. Elongate the cervix after one or two treatment sessions. Further, a more extensive study is needed to confirm these results.

What is known about changes in pelvic floor muscle strength and tone in women during the childbirth pathway? A scoping review.

This scoping review aims to comprehensively explore the existing research on the changes in pelvic floor function that occur throughout the childbirth pathway (antenatal, intrapartum, and postnatal period). Furthermore, it seeks to identify new opportunities and directions for future research in this field. In particular, this review focuses on investigating pelvic floor muscle strength and tone in women during the childbirth pathway. The following databases were investigated from their inception: PubMed, OVID, Medline, ScienceDirect, The Cochrane Central Library, Scopus, Web of Science, PEDro, Scholar Google, Embase, and CINHAIL. Literature research was carried out from March to October 2022. Records identified through database searching were imported to Covidence. According to Arksey and O'Malley's five-stage scoping review framework, researchers screen titles and abstracts for eligibility and exclude records that do not meet the inclusion criteria. A total of 40 studies were included in the data extraction phase. These articles underwent a review, with a specific emphasis on examining the tone, strength, and distensibility of the pelvic floor throughout the childbirth pathway. Among the selected studies, 22 investigated pelvic floor strength, 7 the distensibility, and 3 articles the tone. This review identified both areas of agreement and disagreement across all three themes examined, with a particular emphasis on labor and the postpartum period. Notably, the review unveiled a significant scarcity of data concerning the tone of pelvic floor muscles throughout the childbirth pathway. Further studies to investigate the relationship between midwifery care and pelvic floor outcomes are required to improve clinical practice.

Optimising Rehabilitation Strategies for Postpartum Elderly Gravida with In Vitro Fertilisation Conception

Optimising Rehabilitation Strategies for Postpartum Elderly Gravida with In Vitro Fertilisation Conception

The Impact of Exercising on Pelvic Symptom Severity, Pelvic Floor Muscle Strength, and Diastasis Recti Abdominis After Pregnancy: A Longitudinal Prospective Cohort Study.

The objective of this study was to evaluate whether early postpartum exercise is associated with changes in pelvic symptom severity, pelvic floor muscle strength, and diastasis recti abdominis (DRA) from 3 to 12months postpartum. In this prospective cohort study, 504 participants with and without pelvic symptoms (pelvic girdle pain, stress urinary incontinence, vaginal heaviness) were followed. At 3, 6, 9, and 12months postpartum, we assessed pelvic symptoms, exercise behavior (by questionnaires), pelvic floor muscle strength (by vaginal palpation), and DRA (by caliper measurement). Based on the 3-months questionnaire, participants were categorized as nonexercisers (n = 105), minimal low-impact exercisers (n = 249), regular low-impact exercisers (n = 117), and high-impact exercisers (n = 32). Between-group differences and within-group changes from 3 to 12months were calculated using Chi-square tests, Kruskal-Wallis tests, and Friedman analysis of variance. At 3months, no differences in symptom prevalence were seen between the groups. Nonexercisers reported higher pelvic girdle pain severity and had weaker pelvic floor muscles. The within-group analysis showed that pelvic girdle pain severity did not change in nonexercisers or high-impact exercisers, but decreased in minimal and regular low-impact exercisers. Stress urinary incontinence increased in nonexercisers from 3 to 12months, while it remained unchanged in regular low-impact and high-impact exercisers, and decreased in minimal low-impact exercisers. Across all groups, vaginal heaviness and DRA decreased, and pelvic floor strength increased from 3 to 12months. The study indicates that early low-impact exercising is associated with reduced pelvic girdle pain severity during the first postpartum year. Minimal low-impact exercisers also showed a slight reduction in stress urinary incontinence. Conversely, nonexercisers reported an increase in stress urinary incontinence between 3 and 12months postpartum. Physical therapists should encourage women to start with low-impact exercise early after pregnancy. This study highlights the positive effects of starting gentle, low-impact exercise early after childbirth to reduce pelvic girdle pain and urinary incontinence.

Design procedure for a timber-based seismic retrofit applied to masonry buildings

An innovative timber retrofit was investigated at the EUCENTRE and at the University of Pavia, Italy, as part of a comprehensive research campaign on the seismic vulnerability of existing unreinforced masonry buildings subjected to induced seismicity in The Netherlands. The retrofit system consists of timber frames, connected to the masonry piers and to the floor diaphragms, and oriented-strand board sheathing nailed to the frames and to flexible timber diaphragms. Starting from the main critical aspects observed in experimental tests, the proposed solution was conceived to enhance the in-plane and out-of-plane capacities of masonry piers, improve the overall wall-to-diaphragm connections, increase the floor diaphragm stiffness and strength, and allow possible integration with energy efficiency upgrades. This paper, the first of a series of two, focuses on the conceptual bases of the seismic retrofit system and on the analytical equations that can be used for the design of its components. Moreover, a step-by-step design procedure is presented to guide the reader through the application of these equations. A companion paper [1] will discuss the validation of the analytical formulation with the experimental data from quasi-static cyclic and dynamic shake-table tests on building components and complete specimens.

Flexural behavior of modular steel channel–concrete composite floor systems with bolted connections

This paper presents an innovative modular steel channel–concrete composite floor system designed for rapid assembly. This system, compared to traditional steel–concrete composite floors, connects adjacent modules solely through the use of high-strength bolts. This design eliminates the need for on-site wet construction, thereby yielding superior economic benefits. To investigate the proposed system’s mechanical behavior, bending tests were conducted on four composite floors with various support conditions, the numbers of bolts, and the degrees of shear connection. The load–displacement responses, torsional behavior of the channel beams, interfacial slip, and strain development of the composite floor systems were analyzed. The test results show that the simply supported composite floor, without bolted connections, undergoes flexural failure. In contrast, the semi-continuous composite floors, with bolted connections, display punching shear-flexural failure. The pre-tension forces applied to the bolts can effectively mitigate the torsional deformation of the channels and module separation, ensuring that the system maintains excellent structural integrity, sufficient load-bearing capacity, and adequate ductility. The semi-continuous composite floors, when fitted with high-strength bolts, demonstrate an increase in ultimate load-bearing capacity by 13–15%. However, there is a corresponding decrease in ductility by 18–23% when compared to the simply supported composite floor without bolts. The use of perforated steel plates as shear connectors offers efficient shear resistance between the steel channels and concrete slabs, facilitating full composite action of the system throughout the loading process. The paper concludes with the development of a model that calculates the flexural strength and punching shear strength of the composite floors based on the yield-line theory.

The Effect of Giving Human Umbilical Cord Mesenchymal Stem Cells (HUMSC) on the Expression of Collagen I in Menopause Model Mice

Background: Patients with pelvic floor dysfunction (PFD) who fail conservative treatment will undergo surgery. In recent years, various therapeutic approaches for PFD using stem cells have been investigated in vivo. One component of stem cells is the human umbilical cord mesenchymal stem cell (HUMSC). It is hoped that HUMSC can modify the collagen and elastin content in the extracellular matrix, leading to improvements in pelvic floor strength and PFD.&#x0D; Methods: This research is an experimental study with a randomized posttest-only controlled group design with the aim of determining the effect of giving HUMSC on the expression of Collagen I in a female mouse model of menopause. There are inclusion criteria, namely female Balb/c mice, healthy, never mated, aged 8 - 12 weeks, and body weight 18 - 22 grams. The research will be carried out with statistical analysis using SPSS; a p-value &lt;0.05 is considered significant.&#x0D; Results: The results of the analysis of the distribution of sample means show that there are significant differences between the two groups. The treatment group had a higher mean expression of type I collagen compared to the control group. In addition, variation in the control group was lower compared with the treatment group, which could be interpreted as higher consistency in the response to HUMSC treatment.&#x0D; Conclusion: Human umbilical cord (HUMSC) has a positive impact on type I collagen expression in menopausal model mice.

The association between postpartum perineal laceration with anatomy and pelvic floor muscle strength

Link of Video Abstract: https://youtu.be/lrnQiVZyH8Q Background: Perineal lacerations damage the tissues around the vagina and rectum and can cause disruption of the anatomy and function of the pelvic floor. The incidence of perineal lacerations after vaginal delivery ranges from 53-89%. This anatomical damage and muscle dysfunction can cause urinary incontinence, anal incontinence, and uterovaginal prolapse. This study aims to evaluate the effects of postpartum perineal lacerations on the anatomy and strength of the pelvic floor muscles. Methods: The sample of this study is primiparous women who experienced perineal lacerations. Sampling was carried out prospectively using the consecutive sampling method. Pelvic floor anatomy and strength were measured using a POP-Q system and a perineometer. The 1st and 2nd degree laceration group measurements will be compared using the chi-square, and Mann-Whitney tests will be carried out. Results: Of the 123 research samples that met the criteria, a significant difference was found in the strength of the pelvic floor muscles in the first-degree perineal laceration and second-degree perineal laceration groups at 1st day and 12 weeks postpartum (p = 0.000 and p = 0.042). The only significant difference found for pelvic floor muscle anatomy is in perineal body length at 12 weeks postpartum. Conclusion: The degree of perineal laceration is related to the strength of the pelvic floor muscles after delivery and the length of the perineal body 12 weeks postpartum.

(087) Why Should Pelvic Floor Physical Therapy be Included in Treatment of Vestibulodynia?

Abstract Introduction Vestibulodynia, vulvar pain localized to the vestibule without an identifiable cause, has a multifactorial etiology including neurologic, hormonal, inflammatory, psychologic, and musculoskeletal factors. Key pathophysiologic drivers likely vary from patient to patient. Published studies demonstrate that compared to controls, patients with provoked vestibulodynia are more likely to have pelvic floor hypertonicity and decreased pelvic floor strength, as measured by dynamometric speculum and ultrasound. Further, observational studies describe improvement of vestibulodynia symptoms with pelvic floor physical therapy, suggesting a causal relationship between pelvic floor hypertonicity and vestibulodynia. Objective To describe the pathophysiologic mechanism by which pelvic floor dysfunction and myofascial trigger point development could cause vestibuoldynia, with a focus on pelvic floor anatomy. Methods Literature about vestibulodynia, pelvic floor dysfunction, and pelvic floor anatomy was reviewed and synthesized in conjunction with expert clinical experience of pelvic floor physical therapists and gynecologists. Results The pelvic floor consists of the levator ani muscles (iliococcygeus, pubococcygeus, and puborectalis) and ischiococcygeus, which form a basket to support the pelvic organs. The puborectalis inserts in the posterior vestibule, and hypertonicity can cause allodynia in this region. The levator ani are innervated by the levator ani nerve, which originates from S3-S5 and traverses the visceral surface of the muscles. Some cadaveric studies suggest dual innervation of the levator ani by the pudendal nerve, which originates from S2-S4 and courses over the inferior surface of the muscles. Pelvic floor hypertonicity, increased resting tone of the pelvic floor muscles, can result from many factors including stress, bladder and rectum voiding habits, and painful pelvic processes (i.e. interstitial cystitis, endometriosis). Increased muscle tone can promote sensitization of muscle afferent fibers and neuropathic upregulation. This may be perceived as vestibulodynia because the vestibule contains visceral and somatic sensory nerve fibers, whose signals are integrated at the same spinal levels as those from the levator ani. This anatomy allows for somatovisceral convergence of afferent signals, and thus perception of vestibular pain. Hypertonicity of the pelvic floor muscles decreases circulation creating localized hypoxia that can promote development of myofascial trigger points (tender nodules) in the pelvic floor. These trigger points can cause allodynia, perceived in the vestibule. In some cases, vestibulodynia may develop first and promote pelvic floor hypertonicity. Conclusions As pelvic floor hypertonicity can contribute to the pathogenesis of vestibulodynia, it is imperative for clinicians to include pelvic floor tone evaluation in their assessment of vestibulodynia. If pelvic floor hypertonicity is present, it should be treated concurrently with vestibular pain through a combination of pelvic floor physical therapy, trigger point injections, and botulinum toxin injections as pelvic floor hypertonicity and vestibulodynia may each perpetuate the other. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Johnson &amp; Johnson.

Web-Based Yoga-Pilates: A Prospective Cohort Study.

There are limited data to determine the change in severity, efficacy, and mechanism of action of yoga-Pilates in the treatment of stress urinary incontinence (SUI). The primary objective was to evaluate the effect of an 8-week web-based home yoga-Pilates exercise program on SUI severity and to evaluate the potential mechanism of action through ultrasound examination of the urethral rhabdosphincter cross-sectional area. This was a prospective cohort study of women with SUI. Participants underwent visits pre- and post-intervention, completed quality of life/severity surveys, and underwent pelvic examination and 3-dimensional transperineal ultrasonography to determine the urethral cross-sectional area. Pre- and post-intervention 24-hour voiding diaries were also collected. The intervention was an 8-week online yoga-Pilates video that tracked and prompted participation. Sixty women completed the study; they were predominantly premenopausal (67%) and vaginally parous (65%) and had done yoga (76%) and/or Pilates (44%). Seventy-three percent performed the exercises ≥3 times per week. For the primary outcome, the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form score improved from 9.5 (95% confidence interval [CI], 8.7-10.4) to 7.1 (95% CI, 6.3-7.9) (P < 0.001). The median (interquartile range) number of incontinence episodes per 24 hours decreased from 1 (1-3) to 1 (0-1) (P < 0.001). The Brink pelvic floor strength score improved from 7.1 (95% CI, 6.6-7.7) to 7.7 (95% CI, 7.2-8.2) (P = 0.01). Eighty-three percent reported that they were "better" on Patient Global impression of Improvement. There were no significant changes in urethral measurements. Although it did not meet the minimal clinically important difference, this 8-week web-based yoga-Pilates exercise program improved SUI symptoms and decreased the number of incontinence episodes in women with SUI.

Sintomas geniturinários e qualidade de vida de mulheres com câncer de mama em tratamento quimioterápico

ABSTRACT This study aimed to compare genitourinary symptoms and quality of life in women with breast cancer before and after chemotherapy treatment. This is a prospective and analytical study carried out with 60 women treated at a hospital in the state of Paraná. Sociodemographic data, menopausal status, climacteric symptoms, quality of life, and pelvic floor strength and resistance were collected. Descriptive statistics, t-tests, Shapiro-Wilk, Cochran, Factorial Analysis of Variance for Repeated Measures and Fishers least significance difference were used for data analysis. Participants suffered genitourinary alterations, such as reduced strength and resistance of the pelvic floor muscles, urinary incontinence and vulvovaginal atrophy, regardless of the evaluated factors (type of chemotherapy, parity, and menopausal status). Therefore, greater attention and discussion by multidisciplinary health teams is necessary, as these symptoms can be reduced and managed if recognized early.

Management of full thickness rectal prolapse

Rectal prolapse occurs when the rectum invaginates and descends into the anal canal or beyond the anal sphincter muscles. Patients often report fecal incontinence, obstructed defecation, pain, and urgency and of patients who present with rectal prolapse, up to 30% will also have anterior or middle compartment prolapse. This review describes the preoperative management of patients with rectal prolapse and principles for determining the operative approach.All patients should be optimized ahead of surgery with attention to bowel habits, pelvic floor strength and coordination, and baseline nutrition and fitness. If multi-compartment prolapse is identified, those patients should be referred for multidisciplinary management. Determining the best operation for an individual patient is best done through a shared decision-making model weighing the risks and benefits of abdominal versus perineal operations. Many patients can tolerate minimally invasive abdominal operations, but for those who cannot, perineal operations are a safe and effective option.

Effects of Iyengar Yoga on Pelvic Floor Muscle Strength and Endurance among Young Females with Stress Urinary Incontinence

Objectives: To determine the effects of yoga therapy on pelvic floor muscle strength, endurance, and health-related quality of life in young women with stress urinary incontinence.&#x0D; Study Design: Interventional study (ClinicalTrials.gov Identifier: NCT04428853).&#x0D; Place and Duration of Study: Rehabilitation Department, Secondary Care Hospital, Karachi Pakistan, from Aug 2020 and Mar 2021.&#x0D; Methodology: A total of 44 young married females aged between 17 and 40 years, diagnosed with stress urinary incontinence due to pelvic floor muscle weakness, were included. Perineometer was used to assess the strength and endurance of pelvic floor muscles. In addition, the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) was used to assess the impact of incontinence symptoms on quality of life and the outcome of treatment at baseline and after eight weeks of intervention.&#x0D; Results: Iyengar yoga significantly improved pelvic floor strength and endurance. There was statistically significance the impact of Iyengar yoga on pelvic floor muscle strength for the endurance of pelvic floor musculature (p &lt; 0.001). Similarly,Iyengar yoga was also found significantly effective in decreasing frequency, severity and overall quality of life (QoL) by improving scores of ICIQ-UI-SF questionnaires showing a pre-post mean difference of 10 (p &lt; 0.001).&#x0D; Conclusion: The current study indicated the important role of yoga in improving pelvic muscle strength and endurance and decreasing urinary incontinence symptoms and distress hence improving the quality of life.