Treatment Of Pelvic Floor Dysfunction Research Articles

BMSCs-EVs Alleviate Pelvic Floor Dysfunction in Mice by Reducing Inflammation and Promoting Tissue Regeneration.

Pelvic floor dysfunctions (PFDs), which encompass pelvic organ prolapse (POP), stress urinary incontinence (SUI), and anal incontinence (AI), are common degenerative diseases in women. Bone marrow mesenchymal stem cells (BMSCs) hold promise for the treatment of PFDs. Extracellular vesicles (EVs) derived from BMSCs, have displayed an extensive role in intercellular communication and tissue repair. However, efficacy of the treatment using EVs originated from BMSCs on mouse models of PFD remains unknown. This study investigated the therapeutic potential of BMSC-derived EVs in a female PFD mouse model induced by vaginal distension (VD). Flow cytometry analysis confirmed the positive expression of BMSC-related markers, and successful induction of multilineage differentiation further validated their characteristics. As expected, the EVs extracted from BMSCs exhibited typical cup-shaped and circular-shaped structures. In the PFD model, BMSC-derived EVs significantly reduced the levels of inflammatory cytokines (p<0.05), improved tissue repair, and mitigated neutrophil infiltration. Furthermore, EVs promoted cell proliferation, decreased expression of relaxin receptors, increased expression of elastin, and elevated collagen content in the anterior vaginal wall tissue (p<0.05), suggesting beneficial effects on tissue regeneration and connective tissue restoration in PFD. BMSC-derived EVs effectively reduce tissue inflammation, promote tissue regeneration and connective tissue reconstruction, and improve pelvic support deficiency, thereby alleviating PFD induced by vaginal distension (VD) in vivo.

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

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

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

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

Prevalence, Bother, and Risk Factors Associated With Occurrence of Pelvic Floor Dysfunctions in Young Women: A Cross-Sectional Survey

Purpose: Pelvic floor dysfunctions (PFD) have been increasingly reported in young female athletes, but it is likely that young women, not specific to athletes, might also experience symptoms of PFD. This study investigated the occurrence of PFD symptoms in young women from the general population, their degree of bother and functional and clinical factors associated with these occurrences. Methods: Online survey was conducted with young women from the general population, not specific to athletes. Sociodemographic and clinical data, symptoms of urinary (UI) and anal incontinence (AI), pelvic organ prolapse, dyspareunia, chronic pelvic pain, and functional constipation, as well as their degree of bother were collected using validated questionnaires. Fisher exact and χ2 tests, Student t tests, and logistic regression models were applied (α = .05). Results: A total of 337 women aged 18 to 25 years were investigated. The overall occurrence of PFD was 60.0%. Dyspareunia was the most prevalent symptom (49.2%), followed by UI (44.2%) and constipation (21.7%). Higher degree of bother was reported for UI, AI, and chronic pelvic pain, respectively. Constipation (P &lt; .001) and anxiety (P = .004) were associated with occurrence of PFD, increasing the chances of PFD by 4 and 2 times, respectively. Discussion: The high occurrence, co-occurrence, and bother of PFD in young women suggest impairments in pelvic floor muscle functions that should be investigated by physical therapists. Educational programs including preventive strategies and the role of physical therapists in the treatment of PFD should be provided from early ages.

The properties of absorbable scaffold harvested with human amniotic fluid stem cells on rat model: an innovation for pelvic reconstruction surgery

The current practice of restoring the anatomical structure in the treatment of pelvic floor dysfunction includes implantation of synthetic sling, which carries potential complications. This study aimed to develop biological substitutes to improve tissue function using scaffolds as a support to the host cells, through formation of new tissue. Human amniotic fluid stem cells (hAFSCs) were seeded on synthetic mesh-scaffold of AlloDerm Regenerative Tissue Matrix (RTM), Poly-DL-lactico-glycolic acid (PLGA) mesh (VICRYL) and Polydioxanone (PDS) meshes. In vitro study evaluates the metabolic activity of hAFSCs seeded mesh-scaffolds. In vivo study involving Sprague–Dawley rats was performed by assigning into 7 groups of sham control with fascia operation, AlloDerm implant, PDS implant, PLGA implant, AlloDerm harvest with hAFSC (AlloDerm-SC), PDS harvest with hAFSC(PDS-SC) and PLGS harvest with hAFSC (PGLA-SC). In vitro study reveals cell viability and proliferation of hAFSC on mesh scaffolds varies between meshes, with AlloDerm growing the fastest. The biomechanical properties of tissue-mesh-complex tension strength declined over time, showing highest tension strength on week-1, deteriorated similar to control group on week-12. All hAFSC-seeded mesh provides higher tension strength, compared to without. This study shed the potential of synthetic mesh as a scaffold for hAFSC for the surgical treatment of pelvic floor dysfunction.

Research progress in female pelvic floor rehabilitation aids.

Pelvic floor dysfunction (PFD) is a common clinical problem that can lead to bladder and bowel dysfunction such as urinary incontinence, urinary retention, fecal incontinence, pelvic organ prolapse, and sexual dysfunction. Pelvic floor rehabilitation aids are essential tools in the treatment of PFD. However, there is limited understanding of the efficacy and mechanisms of these aids, and there is a lack of standardized guidelines for selecting appropriate aids for different types of PFD. To assist patients in choosing suitable pelvic floor rehabilitation aids to their needs, it is necessary to summarize the existing types, mechanisms, and applications of these aids. Based on their mechanisms and target functions, pelvic floor rehabilitation aids can be mainly categorized into 3 main types. The first type includes aids that improve pelvic floor function, such as vaginal dumbbells, vaginal tampons, and vaginal dilators, which aim to strengthen pelvic floor muscles and enhance the contractility of the urethral, vaginal, and anal sphincters, thereby improving incontinence symptoms. The second type consists of aids that mechanically block the outlet, such as pessaries, urethral plugs, incontinence pads, incontinence pants, anal plugs, and vaginal bowel control systems, which directly or indirectly prevent incontinence leakage. The third type includes aids that assist in outlet drainage, such as catheters and anal excreta collection devices, which help patients effectively expel urine, feces, and other waste materials, preventing incontinence leakage. By summarizing the existing pelvic floor rehabilitation aids, personalized guidance can be provided to patients with PFD, helping them select the appropriate aids for their rehabilitation needs.

Sacral neuromodulation therapy for urinary and defecatory disorders: experience in a Latin American public hospital.

To show the experience of a Latin American public hospital, with SNM in the management of either OAB, NOUR or FI, reporting feasibility, short to medium-term success rates, and complications. A retrospective cohort was conducted using data collected prospectively from patients with urogynecological conditions and referred from colorectal surgery and urology services between 2015 and 2022. Advanced or basic trial phases were performed on 35 patients, 33 (94%) of which were successful and opted to move on Implantable Pulse Generator (GG) implantation. The average follow-up time after definitive implantation was 82 months (SD 59). Of the 33 patients undergoing, 27 (81%)reported an improvement of 50% or more in their symptoms at last follow-up. Moreover, 30 patients (90%) with a definitive implant reported subjective improvement, with an average PGI-I "much better" and 9 of them reporting to be "excellent" on PGI-I. SNM is a feasible and effective treatment for pelvic floor dysfunction. Its implementation requires highly trained groups and innovative leadership. At a nation-wide level, greater diffusion of this therapy among professionals is needed to achieve timely referral of patients who require it.

Conservative Treatment Options to Prevent and Manage Pelvic Floor Dysfunction in Women

Background: Pelvic floor dysfunction is a widespread, multifactorial disease that progresses slowly with age and occurs in 77% of postmenopausal women.Objective: To evaluate the effectiveness of conservative treatment of pelvic floor dysfunction in women and the possibility of preventing pelvic organ prolapse.Materials and methods: We analyzed literature data (PubMed, eLibrary, Scopus) on treatment and prevention of pelvic floor dysfunction in women using various conservative treatment options.Results: The conservative approach is the only preventive measure and a first-line treatment of pelvic organ prolapse, especially at the disease onset. It involves lifestyle changes, physical therapy, and pessary insertion. Physical therapy includes pelvic floor muscle training with or without biofeedback, vaginal cones, electrical stimulation, etc.Conclusions: Despite the large number of available conservative treatment options, their effectiveness should be further studied, and preventive measures aimed at strengthening pelvic floor muscles should be actively promoted and included in the routine medical use and daily life of women to prevent pelvic organ prolapse.

Associations of pelvic floor dysfunction and postnatal mental health: a systematic review

ABSTRACT Background Postpartum mental health conditions are common and can have devastating effects for both mother and infant. Adverse birth outcomes increase the risk of postnatal mental health conditions. Pelvic floor dysfunction (PFD) is a common adverse pregnancy outcome that may be a risk factor for postnatal mental health conditions. There are many studies reporting associations between PFD and postnatal mental health conditions, but no reports have synthesised the current literature as it relates to pregnancy and the postpartum period. Methods A research librarian conducted systematic literature searches using terms concerning PFD, postnatal mental health conditions, and pregnancy. Searches were conducted within PubMed, Embase, CINAHL, Cochrane, and Scopus. Two reviewers independently rated each study for inclusion and study quality. No studies were excluded based on quality. Results A total of 47 studies were included for review. Articles addressed sexual dysfunction (n = 11), incontinence (n = 21), perineal laceration (n = 13), pelvic organ prolapse (n = 2), and general pelvic floor symptoms (n = 2) and associations with postnatal mental health conditions. Two articles addressed more than one type of PFD. The majority (44 studies) reported associations between PFD and adverse postnatal mental health conditions. Discussion Most studies included for review found consistent associations between PFD and adverse mental health conditions. Healthcare providers should screen for PFD and postnatal mental health conditions early in the postpartum period. Future research should investigate whether the treatment of PFD can modify the associations between PFD and postnatal mental health conditions.

Intravaginal electrical stimulation for the treatment of pelvic floor dysfunction: a systematic review and meta-analysis.

Intravaginal electrical stimulation (IVES) has been explored as a potential treatment for pelvic floor disorders (PFDs), although its efficacy remains a subject of debate. We aim to conducted a comprehensive meta-analysis of relevant trials. This meta-analysis was performed under the PRISMA 2020 guideline. We meticulously searched for randomized controlled trial (RCT) studies in various databases, including PubMed, Cochrane Library, EMBASE, and ClinicalTrials.gov, spanning from inception to March 6, 2023. All studies included one treatment group of intravaginal electrical stimulation and the diseases spectrum of the studies involved different kinds of PFDs, including urinary incontinence, overactive bladder, etc. Risk of bias charts were used to assess the risk of bias in the studies and forest plots were used the demonstrate the overall effects. Our analysis encompassed a total of 13 RCT studies. In most of the assessed PFD cure outcomes, the results demonstrated positive effects of IVES therapy, as indicated by the following findings: daily voiding frequency (MD = -1.57, 95% CI = -3.08 to -0.06, I 2 = 68%,), nocturia (MD = -1.07, 95% CI = -2.01 to -0.13, I 2 = 71%), Pad test, and Urinary incontinence. Nevertheless, the data concerning the impact of IVES therapy on the quality of life of individuals with PFDs did not confirm these positive results. In light of the insufficiency in both the quality and quantity of the included studies, it is premature to draw a definitive conclusion regarding the efficacy of IVES therapy for treating PFDs. Nonetheless, our study does provide several pieces of evidence in support of the potential therapeutic effects of electrical stimulation therapy in this context. We recommend that further research in this area be conducted to provide more conclusive insights into the efficacy of IVES therapy for PFDs. https://www.crd.york.ac.uk/prospero/, identifier: CRD42023442171.

Exploring Adherence to Pelvic Floor Muscle Training in Women Using Mobile Apps: Scoping Review.

Pelvic floor dysfunction is a public health issue, with 1 in 3 women experiencing symptoms at some point in their lifetime. The gold standard of treatment for pelvic floor dysfunction is supervised pelvic floor muscle training (PFMT); however, adherence to PFMT in women is poor. Mobile apps are increasingly being used in the National Health Service to enable equity in the distribution of health care and increase accessibility to services. However, it is unclear how PFMT mobile apps influence PFMT adherence in women. We aimed to identify which behavior change techniques (BCTs) have been used in PFMT mobile apps, to distinguish the core "capability, opportunity, and motivation" (COM) behaviors targeted by the BCTs used in PFMT mobile apps, and to compare the levels of PFMT adherence in women between those using PFMT mobile apps and those receiving usual care. We conducted a scoping review of the literature. Published quantitative literature that compared the use of a PFMT mobile app to a control group was included to address the objectives of the study. The electronic bibliographic databases searched included MEDLINE, CINAHL, Scopus, Web of Science, and PEDro, along with CENTRAL. Studies were also identified from reference searching of systematic reviews. Original articles written in English from 2006 onward were included. Nonexperimental quantitative studies, qualitative studies, studies that use male participants, case studies, web-based interventions, and interventions that use vaginal probes were excluded. Narrative synthesis was conducted on eligible articles based on the aims of the study. Of the 114 records retrieved from the search, a total of 6 articles met the eligibility and inclusion criteria. The total number of participants in the studies was 471. All PFMT mobile apps used the BCT "prompts and cues." Opportunity was the core COM behavior targeted by the PFMT mobile apps. Higher levels of adherence to PFMT were observed among women using PFMT mobile apps. Digital "prompts and cues" are a BCT commonly used in PFMT mobile apps, and further research is required to practically assess whether a future randomized controlled trial that investigates the effectiveness of digital "prompts and cues" on PFMT adherence in women can be conducted.

Pelvic floor hypertension: possible factors for pelvic floor tenderness in endometriosis patients—a pilot study

PurposeChronic pelvic pain (CPP) is one of the main problems of endometriosis, leading to a significant impairment of quality of life. Understanding the pain mechanisms and the pelvic floor muscles (PFM) changes in these patients is essential to integrate additional therapeutic strategies. We hypothesize that endometriosis patients have changes in PFM and that targeted vaginal electrostimulation can be a treatment option for CPP in this disease.MethodsFifteen patients with endometriosis and chronic acyclical pelvic pain were included. PFM electromyography with the Multiple Array Probe Leiden (MAPLe) was performed. Mapping of PFM was utilized and targeted electrostimulation of the hypertensive muscles was conducted. Control electromyography was performed afterward to evaluate the electrostimulation therapeutic effect.ResultsIn 12/15 (80%) patients, the myofascial trigger point could be localized by digital examination. The most frequently affected muscle was the puborectalis (10/15—66.7%). Most of the patients showed serious changes in the average resting tone (aRT) of PFM. aRT was significantly increased in all patients and decreased after stimulation, whereby the difference prior to and after stimulation was not significant (p = 0.064). The detailed separated analysis of the hypertensive muscles showed a significant (p = 0.026) reduction in their resting tone (hRT), after targeted stimulation.ConclusionVaginal electrostimulation is a promising and feasible complementary treatment option for CPP in endometriosis patients. Targeted treatment of pelvic floor dysfunction should be included in clinical trials.

Topical issues of surgical treatment of pelvic floor dysfunction. A literature review

This article presents a review of the current literature on the problem of omission and prolapse of the internal genitalia in women. Patients diagnosed with pelvic organ prolapse need pelvic floor plastic surgery. Currently, in spite of the extensive experience in managing this category of patients, there is still no single and unambiguous approach to the choice of surgical treatment tactics.&#x0D; This review describes the latest information on the etiopathogenesis of pelvic floor supporting apparatus lesions, namely, systemic connective tissue dysplasia as the main development factor. Prospective development of genetic and immunohistochemical marker diagnosis is the key to individual selection of treatment options for this multidisciplinary problem. The results of interventions are characterized by extreme variability in terms of both effectiveness and the frequency of intra- and postoperative complications. The treatment of rare forms of prolapse after surgery for rectal cancer also raises many questions. The current multitude of types of surgical interventions for genital prolapse and variants of pelvic floor defect closure is constantly being modified. To date, there is no universal treatment option, and all available techniques have both advantages and disadvantages, as well as limited application due to the risk of somatic complications, high recurrence rate, and the need for expensive equipment and a highly qualified surgeon.&#x0D; New research is needed, taking into account the current knowledge about the cellular and molecular mechanism of the lesion of the pelvic floor supporting apparatus. All of this will improve the methods of correction of pelvic organ prolapse in both typical and rare forms caused by iatrogenic factors. As a result, this may lead to an improvement in the quality of life of such patients.

Pelvic floor muscle training as a method of prevention and treatment of pelvic floor dysfunction and genital prolapse

Relevance. Pelvic floor dysfunction and pelvic organ prolapse are a significant problem today - even the initial manifestations of pelvic floor dysfunction can lead to reduced quality of sexual life, decreased activity, and then to social isolation and decreased self-esteem of women. Due to the growth of general life expectancy, the incidence rate is also increasing. One of the most popular conservative treatments for pelvic floor dysfunction is pelvic floor muscle training. The aim of this literature review is to consolidate the scattered information about the effectiveness of pelvic floor muscle training as a prevention and treatment of pelvic floor dysfunction. Materials and Methods. In writing the review, publications from the PubMed and Google Scholar databases from January 2019 were analyzed and systematized. Results and Discussion. Pelvic floor muscle training is one of the most prospective methods of non-invasive treatment for pelvic organ prolapse. It can take many forms and is represented by a range of different techniques: from the simple short-term muscle contraction and Kegel exercises to more complex and high-tech methods using electromyostimulation and biofeedback. However, timing of introduction and method for pelvic floor muscle training must be carefully considered in order to gain the maximum result. Conclusion. Based on the study, it can be concluded that the introduction of pelvic floor muscle training as part of prenatal care and in the antenatal period is the most appropriate way to prevent pelvic floor failure and genital prolapse. Further research is required to confirm the hypothesis.

Exosomes derived from mesenchymal stromal cells: a promising treatment for pelvic floor dysfunction.

Pelvic floor dysfunction (PFDs), which include pelvic organ prolapse (POP), stress urinary incontinence (SUI) and anal incontinence (AI), are common degenerative diseases in women that have dramatic effects on quality of life. The pathology of PFDs is based on impaired pelvic connective tissue supportive strength due to an imbalance in extracellular matrix (ECM) metabolism, the loss of a variety of cell types, such as fibroblasts, muscle cells, peripheral nerve cells, and oxidative stress and inflammation in the pelvic environment. Fortunately, exosomes, which are one of the major secretions of mesenchymal stromal cells (MSCs), are involved in intercellular communication and the modulation of molecular activities in recipient cells via their contents, which are bioactive proteins and genetic factors such as mRNAs and miRNAs. These components modify fibroblast activation and secretion, facilitate ECM modelling, and promote cell proliferation to enhance pelvic tissue regeneration. In this review, we focus on the molecular mechanisms and future directions of exosomes derived from MSCs that are of great value in the treatment of PFD.

Multifunctional Evaluation Technology for Diagnosing Malfunctions of Regional Pelvic Floor Muscles Based on Stretchable Electrode Array Probe.

The pelvic floor dysfunction (PFD) has become a serious public health problem. Accurate diagnosis of regional pelvic floor muscle (PFM) malfunctions is vitally important for the prevention and treatment of PFD. However, there is a lack of reliable diagnostic devices to evaluate and diagnose regional PFM abnormality. In this work, we developed a multifunctional evaluation technology (MET) based on a novel airbag-type stretchable electrode array probe (ASEA) for the diagnosis of malfunctions of regional PFM. The inflatable ASEA has specifically distributed 32 electrodes along the muscles, and is able to adapt to different human bodies for tight contact with the muscles. These allow synchronous collection of high-quality multi-channel surface electromyography (MC-sEMG) signals, and then are used to diagnose regional PFM malfunctions and evaluate inter-regional correlation. Clinical trial was conducted on 15 postpartum stress urinary incontinence (PSUI) patients and 15 matched asymptomatic women. Results showed that SUI patients responded slowly to the command and have symptoms of muscle strength degeneration. The results were consistent with the relevant clinical manifestations, and proved the reliability of MET for multifunctional PFM evaluation. Furthermore, the MET can diagnose malfunctions of regional PFM, which is inaccessible with existing technology. The results also showed that the dysfunction of PSUI patients is mainly located in iliococcygeus, pubococcygeus, and urethral sphincter regions, and there is a weak correlation between these specific regions and nearby regions. In conclusion, MET provides a point-of-care diagnostic method for abnormal function of regional PFM, which has a potential for the targeted point-to-point electrical stimulation treatment and PFD pathology research.

Is vitamin D replacement effective in the treatment of postpartum urinary incontinence?

The main objective of this study was to compare the effectiveness of pelvic floor muscle training, and vitamin D replacement in the treatment of urinary incontinence in the postpartum period of pregnant women with vitamin D deficiency. The study was planned as an ancillary study of a study on the determination of the relationship between vitamin D deficiency and urinary incontinence in third-trimester pregnant women. Total 61 women who defined urinary incontinence at postpartum 8th week were included in the study. The participants were divided into two groups: the vitamin D replacement group and the pelvic floor muscle training (PFMT) group. Participants in both groups received appropriate treatment for 12 weeks. İnitial evaluations of which Pelvic Organ Prolapse-Quantification stage, International Consultation on Incontinence Modular Questionnaire on Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) query, and pelvic floor muscle strength were repeated after 12 weeks of treatment for each patient. In the vitamin D replacement group, there was a significant increase in Oxford scores measured after treatment compared with pre-treatment and a significant decrease in ICIQ-FLUTS scores. In the comparison of the groups, it was determined that the changes in the Oxford and ICIQ-FLUTS scores of the vitamin D group after treatment were significantly higher than those of the PFMT group. In this pilot study, it was determined that the effectiveness of vitamin D replacement in the treatment of pelvic floor dysfunction in pregnant women with hypovitaminosis D was significantly higher than PFMT. Vitamin D replacement may be useful in the treatment of urinary incontinence in pregnant women with hypovitaminosis D.

Impact of MRI Defectography on Surgical Approach in Patients with Pelvic Floor Dysfunction

Background: Surgical treatment of pelvic floor dysfunctions carries frequent recurrences. The aim of the study was to evaluate the role dynamic MRI defecography in demonstrating the underlying anatomic and pathophysiologic background of pelvic floor disorders in these patients to guide surgical approach and minimize failure. Methods: Patients underwent perineal examination, conventional defecography, anorectal manometry, colonoscopy, and MRI defecography. The different pelvic floor morphologies were recorded. The type of treatment, whether conservative or surgical, was also recorded. Results: In total, 33 patients were included, with mean age 46.78 ± 10.51 years and the majority (69.7 %) of patients were female. 31 patients (93.9 %) with perineal descent, 21 patients (63.6 %) with rectoceles , 19 patients (57.57 %) with cystoceles, 4 patients (12.1 %) with enteroceles, 15 patients (45.4 %) with intussusceptions, 14 patients (42.2 %) with uterine prolapse and 12 patients with dyskinetic puborectalis muscle. The findings of dynamic MRI defecography were consistent with clinical results in 54.54 % with additional diagnostic parameters in 45.45 % of patients. Dynamic MRI findings changed treatment decision in 15 (45.5 %) patients with surgical treatment performed in 21 patients (63.6 %) and conservative treatment in 12 patients (36.3 %). Conclusion: Dynamic MRI defecography represents an essential diagnostic procedure in females and to a lesser extent in males, especially in terms of dynamic imaging of the pelvic floor organs during defecation. In addition to the clinical assessment, dynamic MRI defecography had clinical impact in pelvic floor dysfunction and interdisciplinary treatment decisions

Новые маркеры генитального пролапса

Pelvic organ prolapse (POP) is a very considerable problem not only due to its high prevalence, but also because of the significant decrease in the quality of life of women suffering from this disease. Given the high prevalence, pelvic floor disorders requiring plastic surgery are becoming an economic problem for public health. In recent decades, techniques for the treatment of pelvic floor dysfunction (PFD) have evolved rapidly. However, the pathophysiology of this disease is still poorly understood, which may be the reason for inadequate, untimely, and sometimes ineffective treatment of POP. One of the important findings when analyzing the results of morphological and morphometric studies of the levator ani muscle in PFD and clinical forms of POP became the detection of significant fibrous degradation of the pelvic floor muscular compartment in all the examined samples. Objective. To search for promising biomarkers of muscular and connective tissue remodeling and the interaction of the muscular and fascial compartments of the pelvic floor to predict pelvic organ prolapse. According to the literature, we found at least three candidate markers for assessing the condition of the muscular-fascial compartment of the pelvic floor: tenascin C, hyaluronic acid (HA), and myofibroblasts (MFB). Tenascin C is a non-structural component of the extracellular matrix of both muscular and connective tissue. Its role in the regulation of inflammation pathways has been discovered in recent studies, but in our study, this protein is of interest as a marker of tissue remodeling in case of tissue damage. Hyaluronic acid is one of the most abundant glycosaminoglycans in the connective tissue of vertebrates. HA is ubiquitous in fascial tissue, but its content is particularly high in loose connective tissue and between muscles and deep fascia. In the fascia, HA is not only a key structural component of the extracellular matrix, but also a functional one. The qualitative and quantitative analysis of HA content in pelvic floor fasciae is likely to help more accurately assess the tissue state, identify the nature of myofascial interaction during the formation of the hernia gate and may be the key to determining the treatment tactics for the initial signs of PFD. Myofibroblasts are connective tissue cells that represent an intermediate link between fibroblasts and smooth muscle cells. Their main task is to increase the basal tone and rigidity of the fascia and ensure proper muscular-skeletal dynamics. Normally, this tension is not enough for significant changes in musculature biomechanics, but persistent “hypertonicity” of the fascia quite quickly led to the formation of pathological contractures, which limited the motor activity of the underlying muscles. Thus, it can be assumed that myofibroblasts participate in the process of healing and remodeling of the fascial compartment. And the search for MFB in biopsy specimens of the levator ani muscle in patients with PFD can shed light on connective tissue dysplasia as the most controversial component of POP development. Conclusion. To date, the problem of pelvic organ prolapse remains unresolved in modern gynecology. When studying the literature, it became evident that determining the biochemical and biomechanical properties of the myofascial complex of the pelvic floor is necessary to gain a comprehensive picture of the disease. Although the significance of markers in predicting pelvic organ prolapse has not yet been investigated, we express optimistic expectations to find an ideal biomarker of the rate of PFD and POP development, improving knowledge about the pathogenesis of the disease. Key words: biomarkers, hyaluronic acid, myofibroblasts, pelvic organ prolapse, connective tissue, tenascin C

Conservative non-pharmacological interventions in women with pelvic floor dysfunction: a systematic review of qualitative studies

BackgroundWomen’s adherence is essential to physiotherapeutic treatment of pelvic floor dysfunction, but its related factors are not usually considered in the development of treatment approaches. This study aims to understand how women with pelvic floor dysfunction experience pelvic floor conservative non-pharmacological treatment options.MethodsA systematic review of qualitative studies. The electronic search was performed in MEDLINE/PubMed, CINAHL, Lilacs, SCOPUS, and Web of Science databases. Primary articles on qualitative methods focused on the experience of women regarding pelvic floor conservative non-pharmacological interventions, i.e., pelvic floor muscle training (PFMT), either associated or not with biofeedback, perineal massage, vaginal dilators, and others. A meta-aggregation was performed.ResultsIt was included 22 manuscripts in this review. It was found seven studies about the use of vaginal devices, two about manual intervention and 14 studies on women’s experience with PFMT. The findings were synthesized as follows: I) women’s experience of manual interventions; II) women’s experience using vaginal devices changes according to health professional attitudes; III) women’s experiences using vaginal devices varied depending on their pelvic floor dysfunction; IV) reported side effects due to the use of vaginal devices; V) external factors influencing PFMT performance; VI) women’s perception of their own personal factors influencing PFMT performance; VII) PFMT characteristics influencing women’s adherence; VIII) strategies used by women to include PFMT in their routine.ConclusionWomen’s experience with pelvic floor conservative non-pharmacological treatment options is a complex phenomenon that involves many more variables than simply personal aspects. This is a systematic review of qualitative studies registered in the PROSPERO (CRD42018080244).