Symptoms Of Pelvic Floor Dysfunction Research Articles

Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women.

To describe the principles of pelvic floor physical therapy (PFPT), review the evidence for PFPT as a treatment for pelvic floor dysfunction, and summarize the current recommendations for PFPT as a first-line conservative treatment option for pelvic floor disorders. Pelvic floor dysfunction can cause voiding and defecation problems, pelvic organ prolapse (POP), sexual dysfunction, and pelvic pain. PFPT is a program of functional retraining to improve pelvic floor muscle strength, endurance, power, and relaxation in patients with pelvic floor dysfunction. Based on the available evidence, PFPT with or without supplemental modalities can improve or cure symptoms of urinary incontinence, POP, fecal incontinence, peripartum and postpartum pelvic floor dysfunction, and hypertonic pelvic floor disorders, including pelvic floor myofascial pain, dyspareunia, vaginismus, and vulvodynia. Currently, there is conflicting evidence regarding the effectiveness of perioperative PFPT before or after POP and urinary incontinence surgery. PFPT has robust evidence-based support and clear benefit as a first-line treatment for most pelvic floor disorders. Standards of PFPT treatment protocols, however, vary widely and larger well designed trials are recommended to show long-term effectiveness.

Pelvic Floor and Sexual Dysfunction After Vaginal Birth With Episiotomy in Vietnamese Women.

IntroductionEpisiotomy has been the most common procedure in obstetrical practice; however, its benefits remain controversial, especially in case of postpartum pelvic floor disorder and sexual dysfunction.AimThe aim of this study was to evaluate early complications, pelvic floor, and sexual dysfunction after delivery with episiotomy and their associated factors.Methods158 healthy pregnant women at term (38 weeks 0 days to 41 weeks 6 days), aged above 18 years old, who vaginally delivered a singleton baby with cephalic presentation were recruited. The subjects were evaluated through 3 interviews at 1−3 days, 6 weeks, and 3 months after delivery, respectively.Main Outcome MeasureThe evaluations were accomplished primarily by administration of 2 validated questionnaires: the Pelvic Floor Distress Inventory Short-form 20 to evaluate symptoms of pelvic floor dysfunction, and the Female Sexual Function Index to evaluate effects on the women’s sexual life.ResultsAmong early complications, pain while sitting (30.4%) was the most prominent trouble, other pelvic disorders, such as urinary incontinence (11.4%), urinary retention (10.8%), or flatus incontinence (8.9%), were also observed in a remarkable number of participants. Average Pelvic Floor Distress Inventory Short-form 20 score was 7.0 ± 10.2 after 3 months. At that time, the prevalence of sexual dysfunction was 40.7%. Trouble occurred commonly in the domains of desire (68.9%) and pain (58.5%). Associated factors of sexual dysfunction were maternal age over 30 years and parity. These factors, in combination with birth weight over 3,500 gram (g), were also associated factors of pelvic floor disorders.ConclusionPelvic pain was the most popular postdelivery complication. Urinary and bowel dysfunction were self-limited complications. Despite being considered a simple technique, episiotomy and its repair must be performed rigorously in order to allow the best recovery of pelvic floor and sexual function.Huy Quoc NV, Phuc An LS, Phuong LS, et al. Pelvic Floor and Sexual Dysfunction After Vaginal Birth With Episiotomy in Vietnamese Women. Sex Med 2019;7:514–521.

Pelvic floor dysfunctions in female cheerleaders: a cross-sectional study.

Cheerleaders perform high-impact maneuvers that can be associated with pelvic floor dysfunction. We hypothesized that female cheerleaders would report more symptoms of pelvic floor dysfunction and fewer symptoms of premenstrual syndrome than nonathletic women. This cross-sectional study included high-performance female cheerleaders and young nonathletic, nulliparous, and normal-weight females. Demographics, sports practices, and pelvic floor dysfunction data were collected through an electronic questionnaire. Urinary symptoms were collected through the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and King's Health Questionnaire. Intestinal symptoms were collected through the use of Criterion F of item C3, referring to functional constipation of Rome III and Fecal Incontinence Severity Index. Data on sexual function were collected through the Female Sexual Function Index. Data on pelvic organ prolapse were obtained through the International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS). In addition, questions about premenstrual syndrome-dysmenorrhea, irritability, headache, tiredness, fluid retention, and constipation-were collected through the Menstrual Symptom Questionnaire. The comparison between groups of the quantitative variables was performed using the Mann-Whitney U test. Odds ratios (OR) and 95% confidence intervals (CI) were estimated for comparison between groups on the occurrence of pelvic floor muscle dysfunction symptoms. A significance level of 5% was adopted. A total of 156 women (78 cheerleaders and 76 nonathletes) completed the electronic questionnaire. Anal incontinence was the most prevalent symptom of pelvic floor muscle dysfunction. Cheerleaders were 2.3 times more likely to report symptoms regarding anal incontinence than nonathletic women. For the other symptoms of pelvic floor dysfunction, no statistical differences between the groups were found. Cheerleaders reported fewer symptoms of tiredness and constipation during the premenstrual period than did nonathletic women. Pelvic floor dysfunction, particularly anal incontinence, appears to be more prevalent among cheerleaders than among nonathletic women. In addition, cheerleaders demonstrated fewer symptoms of tiredness and constipation during the premenstrual period.

Pelvic floor muscle function and symptoms of dysfunctions in midwifes and nurses of reproductive age with and without pelvic floor dysfunction

ObjectivesThis study aims to compare pelvic floor muscle (PFM) functions in midwifes and nurses of reproductive age with and without pelvic floor dysfunction (PFD) and investigate the relationship between PFM function and the number, type and symptoms of PFDs. Materials and methods82 midwifes and nurses of reproductive age with (n = 51) and without PFD (n = 31) participated in the study. PFM function was assessed by digital palpation using PERFECT scale. Gynecological examination, ultrasonography, disease-specific questionnaires, questions and tests were used to assess symptoms of PFD. PFD was assessed in terms of risk factors, urinary incontinence, fecal incontinence, pelvic organ prolapse (POP), pelvic pain and sexual dysfunctions. ResultsPower parameter of PERFECT scheme was significantly lower in subjects with PFD compared to Non-PFD group (p = 0.002). 41% of the subjects with Power 5 PFM strength in PFD group were diagnosed as stage 1 POP, 5.8% as stage 2 POP, 15.7% of urge incontinence, 23.3% of stress incontinence and 10.5% of mixed incontinence. Both urinary incontinence and POP were detected in 15.7% of them. Among all subjects, incontinence symptoms decreased whereas POP and sexual function did not change as PFM increased. PFM strength was negatively correlated with the number of PFD (p = 0.002, r = −0.34). The type of dysfunction did not correlate with PFM strength (p > 0.05). ConclusionPFM strength only affects of urinary incontinence sypmtoms among all PFDs in midwifes and nurses of reproductive age. PFM strength may not be the main factor in the occurrence of PFDs as pelvic floor does not consist solely of muscle structure. However, it strongly affects the number of dysfunctions. Therefore, PFM training should be performed to prevent the occurrence of extra dysfunctions in addition to the existing ones even if it does not alter the symptoms.

Does levator ani hiatal area configuration affect pelvic organ prolapse?

Levator ani trauma and hiatal overdistension have been shown to be associated with female pelvic organ prolapse (POP); however, the role of the shape of the levator hiatus in POP has not been examined to date. The aim of this study was to investigate the association between the configuration of the levator ani hiatus and POP. This was a retrospective study of 547 women who attended a tertiary urogynecological center for symptoms of pelvic floor and lower urinary tract dysfunction between October 2014 and August 2016. All women underwent a standardized interview and prolapse assessment using the International Continence Society (ICS) Pelvic Organ Prolapse Quantification (POP-Q) method and four-dimensional translabial ultrasound (TLUS). Measurements of the hiatal anteroposterior diameter (APD), coronal diameter (CD) and hiatal area (HA), at rest and on maximal Valsalva maneuver, and those of organ descent were performed offline at a later date by an investigator blinded to all other data. Hiatal configuration was defined as the ratio APD/CD. Associations between HA and HA adjusted by APD/CD at rest and on maximal Valsalva and symptoms and signs of prolapse were analyzed statistically using logistic regression modelling. The mean age of the women was 54 ± 13.6 (range, 16-89) years. Of the 547 women included, 241 (44%) presented with prolapse symptoms. Clinically significant POP was detected in 406 (74%) patients and significant prolapse on TLUS was detected in 331 (61%). Hiatal ballooning was observed in 310 (57%) women and this was strongly associated with signs and symptoms of POP. HA at rest and on Valsalva was associated with significant POP both on clinical examination and on TLUS. Adjusted odds ratios for hiatal shape showed no effect of the hiatal configuration on the association between HA and POP. Hiatal shape does not seem to influence the association between HA and symptoms and signs of prolapse. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Lifestyle and Exercise Interventions for Lumbopelvic Pain and Pelvic Floor Dysfunction: A New Protocol

PURPOSE: The purpose of this study was to evaluate whether a protocol that included the implementation of lifestyle modifications and a specialized exercise program would improve the symptoms of pelvic floor dysfunction and mild pelvic organ prolapse in women. METHODS: The five-week IRB-approved study included 23 female subjects aged 43.0 + 9.0 years (Mean + S.D.) who exhibited symptoms of pelvic floor dysfunction as defined by 3 assessments (the Pelvic Floor Distress Inventory [PFIQ-7], the Oswestry Low Back Pain Disability, and the Pelvic Floor Impact [PFDI-SF20] questionnaires). The study also included InBody570 body composition measurements, pelvic alignment assessments, diastasis recti assessments, and manual external pelvic floor muscle activation assessments. Participants were instructed in specific lifestyle modifications and participated in an exercise program over the course of seven live group sessions, 45 minutes each, led by one or both of the investigator clinicians. They were also taught to perform a home exercise program at least 5 days per week and completed compliance forms that were returned at the next live group session. The clinicians were a licensed physical therapist and a clinical exercise physiologist. RESULTS: IBM SPSS version 24 statistical programming was utilized and non-parametric Wilcoxon “related-items” analyses were employed. A 0.05 level of significance was applied. The study results of the pre- and post- values indicated significant improvements of lower back pain (Oswestry, z(23) = -3.67, p < .05), significant improvements of the quality of life subjective emotional gauge (PFDI -20, z(23) = -4.11, p < .05), and significant improvements of bladder, bowel, and prolapse symptoms (PFIQ - 7, z(23) = -3.74, p < .05). CONCLUSIONS: The study was highly labor- and time-intensive, and the sample was not large enough to eliminate statistical bias. However, the successful results warranted a continuation of the study to include 40 female volunteers with no modifications to the study’s protocol using the same clinicians. Researchers are currently recruiting volunteers to complete the study.

Recovery from pelvic floor dysfunction symptoms in the postpartum is associated with the duration of the second stage of labor.

Pregnancy and labor are known risk factors for pelvic floor dysfunction (PFD). Yet not much is known regarding recovery from PFD. We hypothesized that the recovery from PFD during the postpartum period would be associated with the duration of the second stage of labor (SSL). We conducted a case-control study of patients who gave birth at the Soroka University Medical Center, Beer-Sheva, Israel. Those who consented completed the Pelvic Floor Distress Inventory-20 (PFDI-20), a questionnaire developed to measure the extent of injury to the pelvic floor, after delivery and 3-month postpartum. The difference between the scores was calculated, representing recovery of symptoms. The duration of the SSL, and clinical and obstetrical characteristics were retrieved from the patients' medical records. Wilcoxon rank test was used, assessing the significance of the recovery. The association between the degree of the recovery and the duration of SSL was tested using Mann-Whitney ranking. A total of 92 patients completed the PFDI-20 after delivery and 3-month postpartum. We found a significant difference between PFD symptoms during pregnancy and 3-month postpartum (P < 0.001). This difference remained consistent in all components of the PFDI-20. In addition, a more profound recovery of colorectal and anal dysfunction (CRAD) symptoms was associated with a shorter duration of the SSL (P = 0.03). There is a statistically significant recovery of PFD symptoms in the postpartum period. Furthermore, greater recovery from CRAD symptoms is associated with a shorter duration of the SSL.

Effects of an 8-week pelvic core stability and nutrition community programme on maternal health outcomes.

Women, during the antenatal and post-partum period, report pelvic, low back pain, stress and urge urinary incontinence, colorectal dysfunction, and other co-morbidities that negatively affect health-related quality of life. Exercise and nutrition are important considerations for improving maternal health in this period. The purpose of this study was to examine the effects of a community-driven nutrition and exercise programme focused on pelvic floor and core stability, healthy nutrition, and breastfeeding counselling over an 8-week period on pelvic floor and urinary distress (UDI), prolapse and colorectal distress for antenatal and post-partum women with limited access to health care, and low socio-economic resources from a Midwestern Region of the United States. Purposive sample of 35 females, ages 18-44, were recruited for this prospective, preintervention to postintervention study, following ethical approval from Institutional Review Board and voluntary written consent from participants. The Health History Questionnaire, SF-36, Food Frequency Questionnaire, report of pelvic organ prolapse dysfunction (POPDI), colorectal-anal dysfunction (CRADI), and UDI as measured by the Pelvic Floor Distress Inventory (PFDI) were completed before and after intervention. Thirty-five women (n=35) 18 to 44years old (mean age of 22.72±3.45years) completed the study. A significant difference was found from preintervention to postintervention scores means for PFDI total scores, CRADI individual scores, and UDI individual scores (p<.05). POPDI scores decreased preintervention to postintervention but were not significant. A significant improvement in healthy nutrition and breastfeeding postintervention was also found (z=3.21, p=.001). Further analysis showed significant, but weak, correlation between parity and POPDI (r=.366, p=.033); between parity and UDI (r=.384, p=.03); and between parity and PFDI (r=.419, p=.014). Our study found a significant reduction in pelvic floor dysfunction, urinary, and colorectal-anal distress symptoms and improvement in breastfeeding and healthy nutrition following an 8-week community-driven nutrition and exercise programme focused on pelvic floor and core stability, healthy nutrition, and breastfeeding counselling.

Role of Radiofrequency (Votiva, InMode) in Pelvic Floor Restoration.

Postpartum pelvic floor disorders are estimated to impact 24% of women in the United States. This study describes the use of a radiofrequency device (Votiva, InMode) for postpartum pelvic floor restoration using an electrostimulator to objectively measure treatment effect. A retrospective evaluation was conducted between April 2017 and May 2018 of consecutive patients undergoing vaginal radiofrequency treatment. Inclusion criteria were patients at least 6 weeks postvaginal delivery with symptoms of pelvic floor dysfunction. Resting pelvic floor muscle tone and maximal pelvic floor contraction were measured. Fifty women were included in the study with an average age of 32 (29-40) years old, average of 2.6 pregnancies, and 1.8 vaginal deliveries. Two patients were lost to follow-up and excluded. Three complete radiofrequency treatments were performed in 31/50 patients, whereas 19 patients received 1-2 treatments. There were no adverse events from the radiofrequency treatment. No changes were found in resting pelvic muscle tone after Votiva treatment [Wilks' lambda = 0.98, F (1, 45) = 0.86, P = 0.36]. The quantity of treatments seemed to impact mean values of maximal pelvic floor contraction [F (1, 45) = 105.14, P < 0.001]. On the patient questionnaire, patients felt subjective improvement correlated to number of treatments. Radiofrequency is safe for the treatment of pelvic floor dysfunction. This study showed no changes in resting pelvic muscle tone but an improvement in maximal pelvic floor contraction. A prospective randomized study is being conducted to further evaluate the efficacy of this technology.

&lt;p&gt;Depression symptoms in women with pelvic floor dysfunction: a case-control study&lt;/p&gt;

PurposeIn this study, we aimed to estimate the prevalence of depression symptoms in women with pelvic floor dysfunction (PFD) and to assess their quality of life (QOL).Patients and methodsA case-control study assessing depression and its severity in women with PFD (urinary incontinence, pelvic organ prolapse, and fecal incontinence) was conducted. Patients attending the Urogynecology Department of the Women’s Specialized Hospital, King Fahad Medical City, were requested to complete the self-reported Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire, and Beck Inventory Scale for Depression. Women presenting with no PFD symptoms were recruited from other clinics as controls.ResultsData of 100 women diagnosed with PFD (mean age, 45.18±10.50 years) and 100 control participants (mean age, 45.14±13.03 years; P=0.644) were collected. Patients with PFD showed significantly higher (7.3%) body mass index (BMI) (32.59±6.22 kg/m2) than controls (30.37±8.08 kg/m2) (OR, 1.044, 95% CI: 1.001–1.091; P=0.043). Patients with PFD exhibited a threefold higher prevalence of depression symptoms than controls (43% vs 14%, respectively; P<0.001). QOL scores in patients with PFD were significantly higher in patients with depression (P-values, 0.024 to <0.001).ConclusionThere is a significant association between depression and PFD, and QOL scores in patients with PFD were significantly higher in patients with depression.

Pelvic Floor Dysfunction in the Female Athlete

Pelvic floor dysfunction (PFD) is a term used to describe a variety of disorders involving moderate to severe impairment of the pelvic floor muscles. It can be divided into two broad categories. Relaxing PFD is more common, presenting with urinary incontinence, fecal incontinence, or pelvic organ prolapse. Nonrelaxing PFD symptoms include impaired ability to evacuate urine or stool, sexual dysfunction, and pelvic pain. Unfamiliarity with this diagnosis among medical providers along with nonspecific symptoms often lead to a delayed or missed diagnosis for patients. Here, we present the case of a collegiate soccer player with PFD to illustrate the severity of presentation and progression of this disorder. We review the current literature regarding nonrelaxing PFD and all types of PFD in female athletes to raise awareness and recognition of this condition.

Urogynecology Service at a District General Hospital in the United Kingdom - Changing Needs or a Better Understanding?

Context:The urogynecological problems in women increase with age. The National Health Services (NHS) is experiencing an increase in the demand for and costs of health and social care for women in midlife. It is a relatively new subspecialty which requires a holistic approach to a patient symptoms and expert skills to overcome demands from aging female population and fulfilling patient expectations.Aims:The aim of the study was to analyze the referral pattern in relation to urogynecological symptoms referred to district general hospital in the United Kingdom and in turn to understand the gravity of the situation for improving the care of these women.Subjects and Methods:This was a retrospective study of case notes of women attending the gynecological outpatient clinic led by an urogynecology subspecialist at district general hospital in the United Kingdom having attended the clinic with symptoms suggestive of pelvic floor dysfunction.Results:We identified 777 women who attended the clinic with symptoms of pelvic floor dysfunction. The most frequently stated reason for referral was pelvic organ prolapse, followed by primary urinary incontinence. Majority of the patients (44%) had prolapse at diagnosis and 26% of the patients had multiple symptoms related to pelvic floor dysfunction after a urogynecologist's consultation, 5% of the patients had combined symptoms diagnosed at urogynaecology clinic. Majority of the referrals were from the general practitioners (43%).Conclusions:The study revealed that health practitioner referring the women needs better understanding of the urogynecological symptoms and with a better understanding and a thorough symptom treatment can be initiated for various symptoms at the same time. This allows patients' multiple symptoms improvement, avoids repeat referrals from primary care, avoids repeat visits to the clinics, avoids repeat interventions, and improves patients' satisfaction and therefore saves NHS resources.

Correlation of Pelvic Organ Prolapse Quantification Technique with Pelvic Floor Dysfunction Symptoms

Introduction: Assessment of POP by POP-Q gives anatomical site-specific measurement, which helps in surgery, follow-up and reduces inter-observer variation. The Pelvic Floor Distress Inventory (PFDI) is condition-specific health-related quality of life questionnaires for women with pelvic floor disorders.&#x0D; Objective: To assess pelvic organ prolapse by POP-Q technique and to correlate pelvic floor distress inventory questionnaire with POP-Q segments. Methodology A prospective study was done from March 2014 to February 2015 after ethical approval from IRC, B.P. Koirala Institute of Health Sciences. All patients with pelvic organ prolapse were included after informed verbal consent. The patients were then asked questions as in pelvic floor distress inventory questionnaire (PFDI) and noted in performa. The patients were then examined by POP-Q technique and noted. The informations were entered in the MS excel chart and statistical analysis done using SPSS 11.5.&#x0D; Results: There were 72 patients enrolled. The mean age of patients was 53.65 years. Majority of patients were found to have stage 4 prolapse (43.1%). POP-Q examination showed majority of patients had anterior and apical compartment defect. Correlation between POP-Q points and urinary symptoms showed significant relation with points in anterior compartment, genital hiatus and perineal bodies. Correlation with POP-Q points with colorectal symptoms showed involvement of genital hiatus significantly with strain stool and incomplete bowel movement. Correlation with pelvic distress symptoms with POP-Q sites showed significant relation with bulging, push up vagina for urination and defecation.&#x0D; Conclusion: POP-Q site specific points showed significant correlation with symptoms from Pelvic Floor Distress Inventry (PFDI) questionnaires.

Распространенность симптомов дисфункции тазового дна у женщин репродуктивного возраста

Распространенность симптомов дисфункции тазового дна у женщин репродуктивного возраста

How Valid Is Tomographic Ultrasound Imaging in Diagnosing Levator and Anal Sphincter Trauma?

Three-/four-dimensional translabial ultrasound (US) is increasingly used to image the levator ani and anal sphincters, especially in the form of tomographic US. The aim of the study was to evaluate the validity of these published methods. This work was a retrospective analysis of datasets of 172 nulliparous women who attended 2 tertiary urogynecologic centers for symptoms of pelvic floor dysfunction between June 2012 and September 2016. All patients had a standardized interview, clinical examination, and 4-dimensional translabial US examination. An evaluation of volume data was performed by the first author, who was blinded against all clinical data, including parity. An assessment for levator avulsion and anal sphincter defects was performed using stored US volume data. Data sets of 162 and 153 nulliparous women were available for levator and anal sphincter assessments, respectively. On the assessment by the first author, a complete avulsion was diagnosed in 3 nulliparas. On a review by 2 senior authors, 1 was judged as positive and the other 2 as normal. On the sphincter assessment, 2 significant external anal sphincter defects were detected. On the review, 1 was judged as false-positive. The second was judged as highly abnormal by all authors. Therefore, 1 nullipara each was diagnosed with avulsion and a significant external anal sphincter defect. Published diagnostic criteria for levator avulsion and external anal sphincter trauma on tomographic US imaging are highly unlikely to result in false-positive findings. This finding supports the clinical validity of this method.

Does Patient Posture Affect the Ultrasound Evaluation of Pelvic Organ Prolapse?

Translabial ultrasound (US) imaging is an emerging method for the evaluation of pelvic organ prolapse (POP). Normative data to date are limited to imaging in the supine position. The purpose of this study was to evaluate the effect of posture changes on US pelvic organ mobility. This work was a retrospective study of 175 women seen in a tertiary urogynecologic center for symptoms of lower urinary tract and pelvic floor dysfunction. All underwent a standardized interview, POP quantification prolapse assessment, and 4-dimensional translabial US examination in supine and standing positions. Offline measurement of organ descent on the Valsalva maneuver was undertaken at a later date and was blinded against all other data. The mean age was 58 (SD, 13.5; range, 17 to 89) years, with a mean body mass index of 29 (SD, 6.1; range, 18 to 53) kg/m2 . In total, 58.9% (n = 103) presented with symptoms of prolapse. Clinically, 82.8% (n = 145) had substantial prolapse on the POP quantification assessment. On imaging, bladder, uterine, and rectal ampulla positions were significantly lower, and the hiatal area on the Valsalva maneuver was larger in the standing position (P < .03). On receiver operating characteristic statistics assessing correlations between POP symptoms and US pelvic organ descent, the area under the curve was higher in the standing position, but the difference was not statistically significant. Measurements of organ descent and hiatal dimensions are generally higher in the standing position. However, they are not reflected in a stronger association between symptoms and organ descent. Hence, imaging in the standing position can be limited to those patients in whom a false-negative assessment result is suspected.

Dutch translation and validation of the pelvic organ prolapse/incontinence sexual questionnaire-IUGA revised (PISQ-IR).

Condition-specific sexual questionnaires are important patient-reported outcome measures. The aim of this study was to translate and validate the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire-International Urogynecology Association Revised (PISQ-IR) into Dutch. The translated PISQ-IR was linguistically validated, followed by psychometrical validation among women presenting with symptoms of pelvic floor dysfunction in urogynecology clinics. For analysis of the criterion validity, the Pelvic Floor Dysfunction Inventory-20 (PFDI-20) and Female Sexual Function Index (FSFI) were used. Descriptive statistics, floor and ceiling effects, internal consistency using Cronbach's alpha coefficient and Pearson's and Spearman's correlations were calculated for all PISQ-IR subscales. The PISQ-IR was completed by 220 women, of whom 61 (27.7%) considered themselves not sexually active (NSA) and 159 (72.3%) sexually active (SA). The mean age of participating women was 57years; 49.5% reported symptoms of pelvic organ prolapse (POP), 66.8% urinary incontinence and 2.3% anal incontinence. The PISQ-IR subscales were analyzed separately for SA and NSA women with Cronbach's alpha coefficient ranging from 0.61 to 0.87. Moderate to high correlations were observed between PISQ-IR subscales and corresponding FSFI subscales and a moderate correlation between urinary distress and the condition impact (CI) subscale among NSA subjects. The Dutch PISQ-IR demonstrated a good internal consistency and criterion validity compared with the FSFI, but criterion validity compared with the PFDI-20 was poor except for urinary distress in NSA women and needs further attention.

Should Genital Hiatus/Perineal Body Be Measured at Rest or on Valsalva?

Genital hiatus (Gh) and perineal body (Pb) are part of the Pelvic Organ Prolapse Quantification assessment system, but it is unclear whether measurements should be taken at rest or on Valsalva. This study was designed to assess the predictive value of Gh and Pb measurements obtained at rest and on Valsalva for signs and symptoms of pelvic organ prolapse (POP). This is a retrospective study involving 416 women who presented to a tertiary urogynecology unit with symptoms of pelvic floor dysfunction. Genital hiatus and Pb were measured at rest and on maximal Valsalva. The strength of association between binary markers of POP and measurements of Gh/Pb was estimated using logistic regression analysis. Receiver operator characteristic statistics were used to compare predictive values of Gh and Pb measurements obtained at rest and on Valsalva. A total of 451 women were seen during the study period. Thirty-five were excluded owing to missing data, leaving 416. Fifty-four percent (n = 223) complained of POP symptoms. On examination, 80% (n = 332) had significant POP (stage 2+ in anterior or posterior compartments or stage 1+ in the central compartment). On imaging, significant POP was diagnosed in 66% (n = 275). Mean hiatal area was 22 cm (SD, 7; range, 5-49 cm) at rest and 30 cm (SD, 10; range, 11-69 cm) on Valsalva. Genital hiatus and Pb measured on Valsalva were consistently stronger predictors of prolapse symptoms and objective prolapse (by clinician examination and by ultrasound) than at Gh and Pb measured at rest. The corresponding area under the curve values were significantly larger for Gh/Pb measures on Valsalva after adjusting for multiple confounders. Genital hiatus/Pb measured on maximal Valsalva is a superior predictor of symptoms and signs of POP compared with Gh/Pb at rest.

Pelvic floor dysfunction in women with fibromyalgia and control subjects: Prevalence and impact on overall symptomatology and psychosocial function.

To evaluate the prevalence, distress, and impact of pelvic floor dysfunction (PFD) symptomatology in women with fibromyalgia and control women. We also aimed to evaluate the impact of PFD symptomatology on several psychosocial measures such as mood, sleep, pain, and quality of life. We conducted a cross-sectional study in women with fibromyalgia and control women from the general population. Using a structured survey, we collected sociodemographic and clinical data, assessed the prevalence of PFD and evaluated the distress (PFDI-20) and the impact (PFIQ-7) caused by its symptomatology. Using Spanish-validated questionnaires, we also evaluated mood and sleep disturbances, bodily pain, and quality of life in subjects with and without PFD. In participants with fibromyalgia, we assessed the severity and impact of the disease using the Fibromyalgia Impact Questionnaire (FIQR). Two hundred and twenty-six patients with fibromyalgia and 222 control women completed the surveys. Two hundred and twenty patients (93%) and 140 controls (63%) reported PFD-related symptoms. Both the scores of distress (143.1 ± 5.7 vs 96.1 ± 4.8, P < 0.0001) and impact (122.4 ± 5.6 vs 100.6 ± 6.4, P < 0.0001) caused by PFD symptoms were significantly higher in women with fibromyalgia than in controls. There was a significant positive relationship between fibromyalgia severity and both PFDI-20 (r2 = 0.32, P < 0.0001) and PFIQ-7 scores (r2 = 0.375, P < 0.0001). Depression severity, sleep disturbances, bodily pain, and low quality of life were highest in women with fibromyalgia and PFD and lowest in control women without PFD. PFD-related symptoms were significantly more frequent in women with fibromyalgia than in controls. PFD symptomatology, when present, negatively influenced mood, sleep quality, and quality of life of both patients with fibromyalgia and controls.

Help-seeking behaviour for pelvic floor dysfunction in women over 55: drivers and barriers.

Our aim was to identify drivers of and barriers to help-seeking behaviour of older women with pelvic floor dysfunction (PFD) living independently in Australia . Women aged ≥55years were recruited to this cross-sectional study during July and August 2016. Bladder, bowel, pelvic organ prolapse (POP) and sexual dysfunction were assessed with the Australian Pelvic Floor Questionnaire (APFQ). Drivers and barriers were based on the Barriers to Incontinence Care Seeking Questionnaire. Univariate analyses were used to assess any significant relationships between PFD, age, education level, self-reported PFD, barriers and drivers. Of the 376 study participants [mean, standard deviation (SD) age 68.6 (10.5) years], 67% reported symptoms of PFD and 98.7% scored >0 on the APFQ. Women were more likely to seek help if they scored higher on the APFQ (p < 0.001). The main barrier to seeking help was the perception that PFD was a normal part of ageing (22.4%). Of those who did seek help (50%), the main factor was increased level of symptom bother (51.4%). There was no difference in age or education level between women who did and did not seek help. Women are more likely to seek help for PFD if scoring higher on the APFQ or symptoms are becoming more bothersome. They are less likely to seek help if they view their symptoms as normal. Future direction should be taken to raise awareness of normal pelvic floor function as well as the availability of help for PFD.