pelvic floor dysfunction

Background Pelvic floor muscles (PFM) and rectus abdominis muscles (RAM) of pregnant diabetic rats exhibit atrophy, co-localization of fast and slow fibers and an increased collagen type I/III ratio. However, the role of similar PFM or RAM hyperglycemic-related myopathy in women with gestational diabetes mellitus (GDM) remains poorly investigated. This study aims to assess the frequency of pelvic floor muscle disorders and pregnancy-specific urinary incontinence (PS-UI) 12 months after the Cesarean (C) section in women with GDM. Specifically, differences in PFM/RAM hyperglycemic myopathy will be evaluated. Methods The Diamater is an ongoing cohort study of four groups of 59 pregnant women each from the Perinatal Diabetes Research Centre (PDRC), Botucatu Medical School (FMB)-UNESP (São Paulo State University), Brazil. Diagnosis of GDM and PS-UI will be made at 24–26 weeks, with a follow-up at 34–38 weeks of gestation. Inclusion in the study will occur at the time of C-section, and pa...

Objectives: Physiotherapy treatment for pelvic floor dysfunction in women produces variable outcomes, and discovering predictors of outcome is important for developing service provision and treatment planning. The study aimed to determine whether patient motivation impacts treatment compliance and outcome for physiotherapy treatment in a cohort of patients with pelvic floor dysfunction. : A prospective observational study of 141 consecutively referred adult female patients to the physiotherapy clinic of an urogynaecological outpatients unit at a UK hospital. Intervention: A 6-month (one group session per month) physiotherapy pelvic floor muscle training programme, which included a home-exercise programme. Main outcome measures: Oxford Grading System and Queensland Pelvic Floor Questionnaire ratings of pelvic floor function were taken pre-and post-intervention, and the University of Rhode Island Change Assessment Scale assessed patient motivation-to-change pre-intervention. Results: Motivation-to-change predicted attendance at the intervention sessions, and also patient-rated pelvic symptoms improvements in function. Patients with higher baseline motivation-to-change also reported greater patient-rated pelvic symptoms improvements, given the same clinician-rated muscle strength improvement in pelvic floor function. Conclusions: Patient motivation impacts physiotherapy treatment adherence and outcomes, and should be considered as part of future assessment/screening procedures. Clinical Trial Registration: NCT02549157.

Hypothesis / aims of study The purpose of the study is to identify the psychological predictors of outcome for physiotherapy treatment for pelvic floor dysfunction in women. This knowledge should enable better-targeted services, and form the foundation for the development of novel psychological adjuncts to physiotherapy treatment that will help to allocate treatment resources more effectively and efficiently.

The Women's Intimate Awareness Training Method is an original system rooted in Eastern somatic wisdom and modern psychosexual education. Designed to enhance female sexual health, pelvic vitality, and emotional embodiment, this method combines breathwork, neuromuscular vaginal training, mindful movement, and trauma-informed body awareness. This unique methodology empowers women to reconnect with their intimate anatomy, regulate nervous system responses, and gain conscious control of the pelvic floor and vaginal musculature. It emphasizes a progressive protocol moving from sensory awareness to strength training and eventually into dynamic, weighted control and emotional integration. Through clinical practice, case studies, and structured curriculum design, the method demonstrates clear benefits in addressing postpartum pelvic dysfunction, pelvic organ prolapse, low libido, dissociation, and emotional blockages.

Laparoscopic Burch colposuspension is a minimally invasive alternative for the treatment of urodynamic stress incontinence. This procedure has been modified by some investigators by using mesh and staples or reducing the number of colposuspension sutures because of technical difficulty of laparoscopic suturing. At our institution, we believe that the laparoscopic Burch colposuspension should be identical to the conventional open Burch procedure. The laparoscopic access for the Burch procedure had been gaining popularity since its inception in 1991 by Vancaillie and Schuessler. 1 However, with rapid adoption of the mid urethral sling procedures and their similar cure rates when compared with open colposuspension, 2 more pelvic surgeons are choosing to forego the steep learning curve associated with laparoscopic suturing. Furthermore, many reconstructive pelvic surgeons prefer the vaginal route alone rather than a combined vaginal-laparoscopic or vaginal-abdominal approach for concurrent treatment of pelvic organ prolapse and stress incontinence. Surgeons who are experienced and adept at laparoscopic suturing may convert all of their pelvic reconstructive procedures, such as sacral colpopexy and paravaginal defect repairs, to the laparoscopic route, thus converting all open Burch colposuspensions to this route. The advantages of laparoscopic surgery are: 1) the improved visualization of anatomy of the space of Retzius and peritoneal cavity because of laparoscopic magnification, insufflation effects, and improved hemostasis; 2) shortened hospitalization; 3) decreased postoperative pain, rapid recovery, and return to work; and 4) cosmetic appearance of smaller incisions. Disadvantages of laparoscopic surgery include: 1) technical difficulty of retroperitoneal dissection and acquiring suturing skills; 2) increased operating time early in the surgeon's experience especially if concomitant procedures are laparoscopically performed; and 3) increased hospital cost secondary to increased operating room time and the use of disposable surgical instruments.

ABSTRACTBACKGROUNDHigh-tone pelvic floor dysfunction (HTPFD) is a neuromuscular disorder of the pelvic floor characterized by non-relaxing pelvic floor muscles, resulting in lower urinary tract and defecatory symptoms, sexual dysfunction, and pelvic pain. Despite affecting 80% of women with chronic pelvic pain, there are no uniformly accepted guidelines to direct the management of these patients. We sought to develop evidence-and consensus-based clinical practice guidelines for management of HTPFD.METHODS AND FINDINGSA Delphi method of consensus development was used, comprising three survey rounds administered anonymously via web-based platform (Qualtrics® XM) to national experts in the field of HTPFD recruited through targeted invitation between September and December 2021. Twelve experts participated with backgrounds in urology, urogynecology, minimally invasive gynecology, and pelvic floor physical therapy (PFPT) participated. Panelists were asked to rate their agreement with rat...

Background: Urinary incontinence is a prevalent issue for young women during pregnancy and postpartum, affecting their quality of life and leading to mental health issues like depression and poor self-esteem. Providing clear information about postnatal registration and pelvic floor muscle exercises (PFME) can help identify symptoms and take appropriate action. This study assessed the level of knowledge and attitude on PFME for reducing urinary incontinence among the postnatal multiparous pregnant women in selected hospitals in Dhaka city, Bangladesh. Methods: Crosssectional research with 121 participants, using a non-probability sampling approach, was conducted on postnatal mothers at the Maternal and Child Health Training Institute, the Institute of Child & Mother Health, and Dhaka Medical College and Hospital in Bangladesh, using SPSS version 20 for analysis. Results: Most participants (n=84, 69%) are aware of the benefits of exercising the pelvic floor muscle. The findings revealed that 59 (48.8%) of the 121 participants had experienced urinary incontinence, and 37 (30.6%) had followed the Kegel exercise treatment. One hundred and three (85.1%) of postnatal mothers expressed their views on the value of pelvic floor muscle training for expectant mothers. Overall, 78 (64.76%) of participants had this degree of understanding, and 87 (71.96%) had this attitude. Conclusion: This study provides information on PFME, highlighting its benefits for postpartum management and preventing pregnancy complications. It suggests that knowledgeable postpartum mothers can adopt a positive attitude towards pelvic floor workouts, strengthening and relaxing PFMs.

Background: :Urinary  incontinence  is  a  prevalent  issue  for  young  women  during  pregnancy  and  postpartum, affecting their quality of life and leading to mental health issues like depression and poor self-esteem.  Providing  clear  information  about  postnatal  registration  and  pelvic  floor  muscle  exercises  (PFME)  can  help  identify  symptoms  and  take  appropriate  action.

This  study  assessed the level  of  knowledge  and  attitude  on  PFME  for  reducing  urinary  incontinence  among  the  postnatal  multiparous  pregnant  women  in selected  hospitals  in  Dhaka  city,  Bangladesh. 

Methods:  Cross-sectional research with 121 participants, using a non-probability sampling approach, was conducted on  postnatal  mothers  at  the  Maternal  and  Child  Health  Training  Institute,  the  Institute  of  Child  &  Mother  Health,  and  Dhaka  Medical  College  and  Hospital  in  Bangladesh,  using  SPSS  version  20  for  analysis.

Results:  Most  participants  (n=84,  69%)  are  aware  of  the  benefits  of  exercising  the  pelvic  floor muscle. The findings revealed that 59 (48.8%) of the 121 participants had experienced urinary incontinence,  and  37  (30.6%)  had  followed  the  Kegel  exercise  treatment.  One  hundred  and  three  (85.1%) of postnatal mothers expressed their views on the value of pelvic floor muscle training for expectant  mothers.  Overall,  78  (64.76%)  of  participants  had  this  degree  of  understanding,  and  87  (71.96%)  had  this  attitude.
Conclusion:  This  study  provides  information  on  PFME,  highlighting  its  benefits  for  postpartum  management  and  preventing  pregnancy  complications.  It  suggests  that  knowledgeable  postpartum  mothers  can  adopt  a  positive  attitude  towards  pelvic  floor  workouts,  strengthening and relaxing

Date Presented 04/20/2023 Maternal health includes the pre-, peri- and postnatal periods in which women undergo physical, social, and psychosocial stressors. This systematic review explores women’s experiences to note the current and potential role of OT in maternal health. Primary Author and Speaker: Tessann Merkel Additional Authors and Speakers: Madison Beck, Alexis Medva, Faith Wintermantel Contributing Authors: Diana Goodman, Sharon Novalis

Pelvic floor dysfunction (PFD) is a common condition that typically affects women older than 50 years and decreases the quality of life. Weakening of support structures can involve all three pelvic compartments and cause a combination of symptoms, including constipation, urinary and fecal incontinence, obstructed defecation, pelvic pain, perineal bulging, and sexual dysfunction. The causes of PFD are complex and multifactorial; however, vaginal delivery is considered a major predisposing factor. Physical examination alone is limited in the evaluation of PFD; it frequently leads to an underestimation of the involved compartments. Imaging has an important role in the clinical evaluation, yielding invaluable information for patient counseling and surgical planning. Three- and four-dimensional translabial ultrasonography (US) is a relatively new imaging modality with high accuracy in the evaluation of PFD such as urinary incontinence, pelvic organ prolapse, and puborectalis avulsion. Ev...

Incontinence urinaire par impériosités ; Neuromodulation sacrée ; Toxine botulique A Résumé L'hyperactivité vésicale (HV) affecte négativement la qualité de vie de nombreux patients. Les traitements de première intention tels que la rééducation et les anticholinergiques n'apportent pas toujours de résultats satisfaisants. Qui plus est, le traitement par anticholinergiques est souvent arrêté par les patients suite aux effets secondaires. Des techniques mini-invasives de seconde ligne, telles que la neuromodulation des racines sacrées ou l'injection intradétrusorienne de toxine botulique, sont ou semblent être utilisées par les urologues dans leur pratique clinique sachant néanmoins que la neuromodulation sacrée (Interstim TM ) seule est remboursée par l'assurance maladie et que l'utilisation de la toxine botulique A (TBA) est à ce jour, en France, hors AMM. L'objectif de cet article de revue d'un groupe d'expert européens est donc de faire le point sur les preuves cliniques d'efficacité et de sécurité de la neuromodulation des racines sacrées et de la TBA dans le traitement de seconde intention des adultes souffrant d'HV idiopathique.

Background: Dentists in their practice are daily exposed to work-related vibrations. The important cause of work disability is carpal tunnel syndrome. Methods: In this cross-sectional study data from 100 dentists was collected using convenient sampling technique. Prior to data collection consent form was sent to the respective dental section of government hospitals of Faisalabad. The dentists who met the inclusion criterion were invited to participate in the study. The Diagnosis was made according to clinical tests of Phalen and Tinel. Age, sex, years of experience, working hours per week and the type of procedure were then be considered as dependent variables Results: Overall, prevalence rate of 60% of carpal tunnel syndrome among old aged dentists was observed. Conclusion: The risk of carpel tunnel syndrome increases with age. It also concluded that 60% prevalence rate was found in the dentists. Older dentists of age 35-50 year were included in more risk group than younger 20-25 y...

Introduction and hypothesis Pelvic floor muscle function plays an important role in female sexual functioning. Smaller genital hiatal dimensions have been associated with sexual dysfunction, mainly dyspareunia. On the other hand, trauma of the levator ani muscle sustained during childbirth is associated with increased genital hiatus, which potentially can affect sexual functioning by causing vaginal laxity. This study aims to determine the association between levator hiatal dimensions and female sexual dysfunction after first vaginal delivery. Methods This is a secondary analysis of a prospective observational study. Two hundred four women who had a first, spontaneous vaginal delivery at term between 2012 and 2015 were recruited at a minimum of 6 months postpartum. Thirteen pregnant women were excluded. We analyzed the association of total PISQ-12 score, as well as individual sexual complaints (desire, arousal, orgasm and dyspareunia), with levator hiatal dimensions at rest, with maximum Valsalva and during pelvic floor muscle contraction as measured by 4D transperineal ultrasound. Statistical analysis was performed using linear regression analysis and Mann-Whitney U test. Results One hundred ninety-one women were evaluated at a median of 11 months postpartum. There was no significant association between total PISQ-12 score and levator hiatal dimensions. Looking at individual sexual complaints, women with dyspareunia had significantly smaller levator hiatal area and anterior-posterior diameter on maximum Valsalva. By using multivariate logistic regression analysis however we found dyspareunia was not independently associated with levator hiatal dimensions. Conclusions After first vaginal delivery sexual dysfunction is not associated with levator hiatal dimensions as measured by 4D transperineal ultrasound.

Introduction and hypothesis Pelvic floor muscle function plays an important role in female sexual functioning. Smaller genital hiatal dimensions have been associated with sexual dysfunction, mainly dyspareunia. On the other hand, trauma of the levator ani muscle sustained during childbirth is associated with increased genital hiatus, which potentially can affect sexual functioning by causing vaginal laxity. This study aims to determine the association between levator hiatal dimensions and female sexual dysfunction after first vaginal delivery. Methods This is a secondary analysis of a prospective observational study. Two hundred four women who had a first, spontaneous vaginal delivery at term between 2012 and 2015 were recruited at a minimum of 6 months postpartum. Thirteen pregnant women were excluded. We analyzed the association of total PISQ-12 score, as well as individual sexual complaints (desire, arousal, orgasm and dyspareunia), with levator hiatal dimensions at rest, with maximum Valsalva and during pelvic floor muscle contraction as measured by 4D transperineal ultrasound. Statistical analysis was performed using linear regression analysis and Mann-Whitney U test. Results One hundred ninety-one women were evaluated at a median of 11 months postpartum. There was no significant association between total PISQ-12 score and levator hiatal dimensions. Looking at individual sexual complaints, women with dyspareunia had significantly smaller levator hiatal area and anterior-posterior diameter on maximum Valsalva. By using multivariate logistic regression analysis however we found dyspareunia was not independently associated with levator hiatal dimensions. Conclusions After first vaginal delivery sexual dysfunction is not associated with levator hiatal dimensions as measured by 4D transperineal ultrasound.

The novel finding of this study is that stool consistency and constipation play a significant role in symptoms of anal incontinence after OASI in short term follow-up. During follow-up of OASI you should actively inquire after symptoms of constipation and altered stool consistency. If abnormal, management should focus on achievement of normal defecation and stool consistency.

Introduction and hypothesis Pelvic floor muscle function plays an important role in female sexual functioning. Smaller genital hiatal dimensions have been associated with sexual dysfunction, mainly dyspareunia. On the other hand, trauma of the levator ani muscle sustained during childbirth is associated with increased genital hiatus, which potentially can affect sexual functioning by causing vaginal laxity. This study aims to determine the association between levator hiatal dimensions and female sexual dysfunction after first vaginal delivery. Methods This is a secondary analysis of a prospective observational study. Two hundred four women who had a first, spontaneous vaginal delivery at term between 2012 and 2015 were recruited at a minimum of 6 months postpartum. Thirteen pregnant women were excluded. We analyzed the association of total PISQ-12 score, as well as individual sexual complaints (desire, arousal, orgasm and dyspareunia), with levator hiatal dimensions at rest, with ma...

Introduction and hypothesis Pelvic floor muscle function plays an important role in female sexual functioning. Smaller genital hiatal dimensions have been associated with sexual dysfunction, mainly dyspareunia. On the other hand, trauma of the levator ani muscle sustained during childbirth is associated with increased genital hiatus, which potentially can affect sexual functioning by causing vaginal laxity. This study aims to determine the association between levator hiatal dimensions and female sexual dysfunction after first vaginal delivery. Methods This is a secondary analysis of a prospective observational study. Two hundred four women who had a first, spontaneous vaginal delivery at term between 2012 and 2015 were recruited at a minimum of 6 months postpartum. Thirteen pregnant women were excluded. We analyzed the association of total PISQ-12 score, as well as individual sexual complaints (desire, arousal, orgasm and dyspareunia), with levator hiatal dimensions at rest, with ma...

Pelvic pain is a prevalent and multifaceted symptom that presents diagnostic challenges due to its diverse etiology. Ultrasound has emerged as a valuable diagnostic tool for evaluating pelvic pain, offering non-invasive visualization of pelvic structures. This retrospective study aims to identify common ultrasound findings in patients with pelvic pain, correlate findings with gender, and determine the main reasons for referral for pelvic ultrasound scans. Data were retrieved from ultrasound reports of 1044 patients at Faith dome Medical Centre, Ekpoma, Edo State, over one year (2023). The study included patients with pelvic discomfort who had pelvic ultrasound imaging. Data were analyzed using descriptive statistics. The results revealed that females constituted the majority of patients with pelvic pain (78.35%), with the uterus being the most common site of pathology (42.34%). Uterine fibroids were the predominant finding in the uterus (52.04%), while ovarian cysts were most frequently observed in the ovaries (27.11%). Benign prostatic hyperplasia was the leading finding in male patients (44.78%). Colitis was the most common finding in the colon, occurring predominantly in males. Cystitis was the primary finding in the bladder, more prevalent in males. These findings underscore the importance of ultrasound in diagnosing pelvic pain, highlighting gender-specific differences in pathology distribution. Understanding these findings can aid clinicians in the accurate diagnosis and management of patients with pelvic pain. Further research is needed to explore additional factors influencing ultrasound findings in pelvic pain patients.

Background: Female sexual dysfunction is a real worldwide health problem during their reproductive period, often undiagnosed and untreated in women and are associated with decreased quality of life. Sexual well-being depends on pelvic floor muscles that are strong enough to maintain their function. Aim: evaluate the effects of pelvic floor muscle training program on sexual life and quality of life of woman with urinary incontinence and sexual dysfunction. Method: This study used a quasiexperimental design and convenience sample technique at El-Fayoum General Hospital's obstetric and gynecological outpatient clinic. It involved 72 adult females aged 20-45, divided into a control group and a study group, receiving traditional treatment and educational training program. Tools: (1) A Structured interviewing questionnaire, comprised of three parts: Socio-demographic characteristics', Medical history and Obstetric history of female, (2) Female Sexual function Index (FSFI), (3) Female Practice questionnaire for pelvic floor muscle exercise, (4) Female knowledge questionnaire for pelvic floor muscle exercise, (5) WHOQOL-BREF quality of life scale. Results: revealed that positive correlation between female sexual function and their practice, knowledge score level and all aspect of quality of life in study group post educational training program. Conclusions: pelvic floor muscle training is an effective treatment for improving sexual dysfunction in female through increases pelvic floor muscle strength, which leads to significant improvement in female's sexual function and their quality of life. Recommendations: Mothers should be informed and trained to kegel exercises properly by educational courses. Increase public awareness through mass media about sexual dysfunction and its relation with pelvic floor exercise among women.

Introduction and Hypothesis Pelvic floor (PF) dysfunction in patients with cystic fibrosis (CF) is poorly understood due to lack of research. The aim of this study was to examine the prevalence, risk factors and bothersomeness of PF dysfunction and its implications for the clinical management of CF. Methods Of 64 adults with CF approached at a tertiary hospital, 60 were surveyed. A clinically meaningful score on the Australian Pelvic Floor Questionnaire (APFQ) is ≥1 in each of the bladder, bowel, sexual function and prolapse sections or a global PF score of ≥3. A frequency Likert scale was used to analyse the impact of PF dysfunction on the ability to perform physiotherapy lung management when well and unwell. Results The prevalence of clinically meaningful bladder dysfunction was 39 % in women and 12 % in men, the prevalence of bowel dysfunction was 54 % in women and 44 % in men, and the prevalence of sexual dysfunction was 43 % in women and 65 % in men. APFQ scores were clinically meaningful only for bowel dysfunction in women (median 1.47, IQR 0.59 -2.28). PF dysfunction constrains lung management in up to 22 % of patients when well and in 37 % of patients when unwell. Conclusions PF dysfunction affects the adult CF population, with PF symptoms limiting the ability of up to one in three patients to participate in physiotherapy management.

Introduction and Hypothesis Pelvic floor (PF) dysfunction in patients with cystic fibrosis (CF) is poorly understood due to lack of research. The aim of this study was to examine the prevalence, risk factors and bothersomeness of PF dysfunction and its implications for the clinical management of CF. Methods Of 64 adults with CF approached at a tertiary hospital, 60 were surveyed. A clinically meaningful score on the Australian Pelvic Floor Questionnaire (APFQ) is ≥1 in each of the bladder, bowel, sexual function and prolapse sections or a global PF score of ≥3. A frequency Likert scale was used to analyse the impact of PF dysfunction on the ability to perform physiotherapy lung management when well and unwell. Results The prevalence of clinically meaningful bladder dysfunction was 39 % in women and 12 % in men, the prevalence of bowel dysfunction was 54 % in women and 44 % in men, and the prevalence of sexual dysfunction was 43 % in women and 65 % in men. APFQ scores were clinically meaningful only for bowel dysfunction in women (median 1.47, IQR 0.59 -2.28). PF dysfunction constrains lung management in up to 22 % of patients when well and in 37 % of patients when unwell. Conclusions PF dysfunction affects the adult CF population, with PF symptoms limiting the ability of up to one in three patients to participate in physiotherapy management.

BACKGROUND: Defecography is an established method of evaluating dynamic anorectal dysfunction, but conventional defecography does not allow for visualization of anatomic structures. OBJECTIVE: The purpose of this study was to describe the use of dynamic 3-dimensional endovaginal ultrasonography for evaluating perineal descent in comparison with echodefecography (3-dimensional anorectal ultrasonography) and to study the relationship between perineal descent and symptoms and anatomic/functional abnormalities of the pelvic floor. DESIGN: This was a prospective study. SETTING: The study was conducted at a large university tertiary care hospital. PATIENTS: Consecutive female patients were eligible if they had pelvic floor dysfunction, obstructed defecation symptoms, and a score >6 on the Cleveland Clinic Florida Constipation Scale. INTERVENTIONS: Each patient underwent both echodefecography and dynamic 3-dimensional endovaginal ultrasonography to evaluate posterior pelvic floor dysfun...

Background: The study analyses clinical characteristics of histologically defined head and neck (H&N) lymphoma to raise the awareness of ENT specialists to the leading symptoms. Method: From 2003 to 2011, all patients with histologically defined H&N lymphoma from our clinic were evaluated. Results: This study identified 221 patients with H&N lymphoma comprising 193 non-Hodgkin lymphomas (NHL) and 28 Hodgkin lymphomas (HL). Among NHL there were 77 indolent (iNHL), 110 aggressive (aNHL), six highly aggressive NHL and further 28 HL. Patients with highly aggressive NHL and HL were significantly younger (p < 0.0001). Corresponding to the leading symptoms, we found nodal and extranodal involvement. NHL demonstrated manifestation in neck lymph nodes, tonsils, major salivary glands, sinonasal-system and hypopharynx/larynx. HL showed exclusive manifestation in lymph nodes of the neck and the tonsils (p < 0.0001). The mean time from first symptoms to diagnosis ranged from 1.5 ± 0.7 months in highly aggressive lymphoma to 7.5 ± 11.5 months in iNHL. Conclusions: The variable clinical presentation of lymphoma is a challenge for the ENT specialist. Fast diagnosis is crucial for rapid treatment, especially in highly aggressive NHL like the Burkitt-lymphoma and HL. A standardized medical history, clinical examination and imaging evaluations paired with patient's signs, symptoms and demographic knowledge might indicate lymphoma. Biopsies in the H&N region should always be immediately performed in suspicious findings.

with a diagnosis of both FI and a rectocele have different anorectal manometry pressures compared to patients with FI alone. Methods: All women diagnosed with FI and/or rectocele at our institution between July 2004 and March 2011 were identified using ICD-9 codes. A chart review of the most recent 150 patients was performed. Variables abstracted included severity of rectocele, severity of FI, and anorectal manometry results. The subjects were divided into two groups for analysis: women with FI and a concurrent rectocele, and women with FI alone. Results: Among the total population screened during the time period, 2,945 had FI and 915 had rectocele diagnoses. Of all patients with a rectocele, 13.2% also had FI. However among all patients with FI, only 4.1% had a concurrent rectocele. Of the 150 patients reviewed, 111 subjects had complete data, with 68 (61.3%) of these having both FI and a rectocele. 16.2% of the rectoceles were stage II or greater. Of the stage I rectoceles, 15.8% had a rectocele confirmed by defecogram. The anorectal manometry findings among patients with FI and a concurrent rectocele as compared to those without a rectocele were the following: mean resting pressures (32.9 mmHg vs. 35.6 mmHg, p=0.398), mean sensory urge threshold (147.3 ml vs. 125.6 ml vs, p=0.373), and mean maximum tolerable volume (231.9 ml vs. 202.1 ml, p=0.355), respectively. Conclusions: This study demonstrates a strong association between fecal incontinence and rectocele. Patients with a rectocele have a higher prevalence of fecal incontinence. Patients with a rectocele tend to have weaker resting pressures, higher sensory thresholds, and increased rectal compliance, but none of these trends were statistically significant. Further study involving more severe rectoceles of stage II or greater is warranted. [Supported by the Division of Urogynecology and R01 DK31369] Tu2009

with a diagnosis of both FI and a rectocele have different anorectal manometry pressures compared to patients with FI alone. Methods: All women diagnosed with FI and/or rectocele at our institution between July 2004 and March 2011 were identified using ICD-9 codes. A chart review of the most recent 150 patients was performed. Variables abstracted included severity of rectocele, severity of FI, and anorectal manometry results. The subjects were divided into two groups for analysis: women with FI and a concurrent rectocele, and women with FI alone. Results: Among the total population screened during the time period, 2,945 had FI and 915 had rectocele diagnoses. Of all patients with a rectocele, 13.2% also had FI. However among all patients with FI, only 4.1% had a concurrent rectocele. Of the 150 patients reviewed, 111 subjects had complete data, with 68 (61.3%) of these having both FI and a rectocele. 16.2% of the rectoceles were stage II or greater. Of the stage I rectoceles, 15.8% had a rectocele confirmed by defecogram. The anorectal manometry findings among patients with FI and a concurrent rectocele as compared to those without a rectocele were the following: mean resting pressures (32.9 mmHg vs. 35.6 mmHg, p=0.398), mean sensory urge threshold (147.3 ml vs. 125.6 ml vs, p=0.373), and mean maximum tolerable volume (231.9 ml vs. 202.1 ml, p=0.355), respectively. Conclusions: This study demonstrates a strong association between fecal incontinence and rectocele. Patients with a rectocele have a higher prevalence of fecal incontinence. Patients with a rectocele tend to have weaker resting pressures, higher sensory thresholds, and increased rectal compliance, but none of these trends were statistically significant. Further study involving more severe rectoceles of stage II or greater is warranted. [Supported by the Division of Urogynecology and R01 DK31369] Tu2009

Background Pelvic floor dysfunction in women encompasses a wide range of clinical disorders: urinary incontinence, pelvic organ prolapse, fecal incontinence, and pelvic-perineal region pain syndrome. A literature review did not identify any articles addressing the prevalence of all pelvic floor dysfunctions. Objective Determine the prevalence of the group of pelvic floor disorders and the factors associated with the development of these disorders in women. Material and methods This observational study was conducted with women during 2021 and 2022 in Spain. Sociodemographic and employment data, previous medical history and health status, lifestyle and habits, obstetric history, and health problems were collected through a self-developed questionnaire. The Pelvic Floor Distress Inventory (PFDI-20) was used to assess the presence and impact of pelvic floor disorders. Pearson&#39;s Chi-Square, Odds Ratio (OR) and adjusted Odds Ratio (aOR) with their respective 95% confidence intervals (...

Introduction and hypothesis Pelvic floor dysfunction (PFD) affects many women and participation in elite sport and highimpact exercise has been reported as a potential risk. However, few studies have investigated the effects of exercising at recreational levels on PFD. Our aim was to investigate levels of PFD in women exercising at, or above, UK guidelines for health and compare them with levels in non-exercisers. Method Data on levels of PFD and potential risk factors (age, hormonal status, body mass index, constipation, parity, forceps delivery, and recreational exercise) were collected using a cross-sectional survey distributed via social media. The International Consultation Incontinence Questionnaire (ICIQ) Urinary Incontinence Short Form was used to estimate prevalence of urinary incontinence (UI). Selected questions from the ICIQ vaginal symptom and bowel symptom questionnaires were used to estimate prevalence of anal incontinence (AI) and pelvic organ prolapse (POP). Logistic regression analysis was used to compare exercisers and non-exercisers after adjusting for potential confounders. We recruited 1,598 adult women (1,141 exercisers and 457 non-exercisers). The majority were parous. High prevalence of UI (70%), AI (52%) and POP (18%) was reported. No significant association was found between recreational exercise and PFD despite adjustment for confounders, or further investigation regarding exercise involving impact, although some increased reporting of AI was seen in those exercising for over 10 hours per week. Conclusion High levels of all PFD were reported but no significant association was found between recreational exercise and symptoms. However, data suggest that women modify their exercise regimes as required. Few symptomatic women sought professional help.

Interpretation of results Two multiple linear regression analyses were performed to obtain 2 best-fit models predicting physical and mental SF-12 scores including independent variables found to be significant during bivariate analysis.A 14.9% of the physical SF-12 variance was explained by years since the menopause and ICQ-SF scores; whereas a 5% of the mental SF-12 variance was explained by hormone replacement therapy.In a third model,a 35.5% of the ICQ-SF variance was explained by physical SF-12 (B:-0.221) and pelvic organ prolapse(B. -7.351)

In particular, I would like to express my sincere gratitude to my advisor, Professor James A. Ashton-Miller for his support, encouragement and guidance in all my years as a graduate student. I have always admired his patience, passion for research, and character. He truly is the epitome of a mentor. I would also like to thank Dr. John O. L. DeLancey, a surgeon but I think engineer at heart, who has acted as a second mentor to me. He generously spent many hours providing invaluable clinical insights and feedback that helped refine my work. I have been inspired by his dedication to conducting exceptionally high quality research. I want to thank them both for treating me kindly with all my many shortcomings. I also want to thank the rest of my committee members: Professor Alan S. Wineman, for his enthusiasm and gift for explaining complicated modelling concepts simply, and Professor Grant H. Kruger, for his innovative solutions to improve the design of the Personal Uroflowmeter (PUF) device. This work would not have been possible without the financial support from Procter & Gamble (P&G) and their FemCare Group, the National Institute of Diabetes and Digestive and Kidney Diseases, the Wallace H. Coulter Foundation and the Michigan Translational Research and Commercialization (MTRAC) program. I would also like to acknowledge a number of gifted iv individuals at P&G, in particular Tana Kirkbride and Alexzandra Ramachandran, for so ably leading our UM-P&G joint collaboration, and my other co-inventors on the PUF device. I also want to thank all the U-M ME Department staff for their assistance in smoothing my journey over the years. I want to extend my thanks to the members of the U-M Pelvic Floor Research Group (PFRG) and particularly Dr. Carolyn Swenson for providing access to the MR scans that helped facilitate Chapter 2 of this dissertation. I also thank all the patients who participated in our studies with the hope that one day their contributions will provide a cure of others. I want to acknowledge Dr. William D. Chey and (now Dr.) Jason Baker in his GI Physiology Laboratory in the U-M Division of Gastroenterology for their wonderful help and enthusiasm during the development and clinical testing of the Digital Manometry (DM) device. I also thank Professor Mark A. Burns and his group in Chemical Engineering for their generous technical assistance in developing the PUF sensors. In that regard, I especially thank Dr. Wen-chi Lin, Dr.

To identify and assess postpartum pelvic floor dysfunction (PFD) between vaginal delivery, elective cesarean delivery (ECD), and intrapartum cesarean delivery (ICD). The present prospective observational study included women aged at least 18 years with no history of pelvic surgery or lower urinary tract malformation, and who had not undergone pelvic floor muscle (PFM) training in the preceding 12 months, who underwent delivery at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil between August 1, 2016, and May 31, 2017. Participants were assessed at 48 hours (phase 1), 1 month (phase 2), and 3 months (phase 3) after delivery. Assessments included the International Consultation on Incontinence Questionnaire, Short Form (ICIQ-SF); the Jorge-Wexner anal incontinence scale; a self-rated visual analog scale for pelvic pain; the pelvic organ prolapse quantification (POP-Q) system; and a PFM perineometer. A total of 227 women were assessed in phase 1 (141 vaginal deliveries...

Introduction Episiotomy 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. Aim The aim of this study was to evaluate early complications, pelvic floor, and sexual dysfunction after delivery with episiotomy and their associated factors. Methods 158 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 Measure The 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. Results Among early compli...

We aimed to explore the correlation between perioperative symptoms of depression and anxiety with pelvic floor symptoms after urogynecologic surgery. Postoperative pain, goal attainment, quality of life, and satisfaction were assessed. : Prospective cohort study of women undergoing inpatient urogynecologic surgery. Preoperative questionnaires included Beck Depression and Beck Anxiety Inventories (BDI-II, BAI), Pain Catastrophizing Scale, Pelvic Floor Distress Inventory (PFDI-20), Pelvic Floor Impact Questionnaire (PFIQ-7), and a detailed goals and perioperative supports questionnaire. Postoperative pain was assessed via the Short-Form McGill Pain Questionnaire. Questionnaires were re-administered 6 weeks postoperatively. Descriptive statistics were obtained. Spearman correlation determined the relationship between pre-and postoperative questionnaire scores. Quantile regression assessed the potential moderating effect of patient characteristics on these relationships. Results: Sixty women (mean age 58.5) were recruited. Fifty-seven (95%) completed follow-up. Most common surgical indication was pelvic organ prolapse (59/60; 98%). Depression and anxiety symptoms were minimal in most women. There was significant median change in pre-to postoperative scores for BAI (-2.0, p=0.011), PFDI-20 (-69.4, p<0.001) and PFIQ-7 (-23.8, p=0.001). Baseline depression and anxiety symptoms were correlated with higher immediate postoperative pain, but not other outcomes. The most common goal, achieved by 47/51(92%), was to reduce condition-specific symptoms. Postoperative depression and anxiety symptoms, and pelvic floor distress and impact, were significantly correlated. Conclusions: Baseline depression and anxiety symptoms were not significantly associated with postoperative pelvic floor symptom burden, or surgical satisfaction. Bothersome postoperative pelvic floor symptoms were associated with postoperative depressive symptoms.

As the US population continues to age, the impact of pelvic floor trauma and the sequelae of these injuries will continue to be a common place for the practicing gynecologist. In this review, the authors will highlight pertinent pelvic floor muscular anatomy, explain basic pelvic floor biomechanics, identify mechanisms of pelvic floor birth injury, discuss pelvic floor muscle recovery and birth injury sequelae, review methods of birth injury prevention, and specify future directions of birth related pelvic floor injury research.

The aim of our study was to assess the performance of levator ani muscle deficiency (LAD) evaluated by 3D endovaginal ultrasound (EVUS) to detect pelvic floor muscle function as assessed by digital examination. This cross-sectional study was conducted among 77 patients referred to our urogynecology clinic for pelvic floor dysfunction symptoms. Patients underwent physical examinations including digital pelvic muscle strength assessment using the Modified Oxford scale (MOS). EVUS volumes were evaluated and levator ani muscles were scored according to a validated LAD scoring system. MOS scores were categorized as nonfunctional (scores 0-1) and functional (scores 2-5). Mean age of participants was 56 (SD ± 12.5) and 71% were menopausal. Overall, 32.5% had nonfunctional muscle strength and 44.2% were classified as having significant LAD. LAD identified by ultrasound had a sensitivity of 60% (95% CI 41 -79%) for detecting nonfunctional muscle and a specificity of 63% (95% CI 50 -77%) for ...

Introduction and hypothesis Vaginal noise (VN) is a symptom of pelvic floor (PF) dysfunction and has been described in a few studies. No other risk factors have been described besides parity and pelvic organ prolapse (POP). Underlying mechanisms of VN are unclear. Aims of this study were to describe prevalence, bother and relation between VN and PF (muscle)(dys)function. Methods A cross-sectional study was performed on a general population of 2,921 women (aged 45-85 years). Questionnaires were filled in by 1,397 women, and 800 were selected at random to undergo vaginal examination for POP Quantification and PF muscle function assessment. Chi-square tests, Student's t test and multivariate logistic regression were performed (P<0.05). Results Response rate was 62.7%. Prevalence of VN was 12.8%; 72.1% reported only a little bother. Odds ratios for parity and solid stool were high. Conclusions VN was strongly related to many symptoms of pelvic floor dysfunction, but it was only causing a little bother.

Background: Functional anorectal disorders are difficult to diagnose and often require clinical tests that study the function beyond the anatomy of the pelvic floor. Manometry is one of the most used. Recently, THD Anopress manometer has been introduced to facilitate these measurements. Aim: The aim of this study is to provide standard and pathological values observed in people with anorectal pathology due to functional disorders in order to facilitate interpretating results. Methods: This is a retrospective observational study conducted from 2020-2022 involving 300 patients with functional anorectal disorders that had access to our coloproctological and pelvic department. Inclusion criteria are patient with obstructed defecation syndrome, anal fissures and fecal incontinence. Exclusion criteria are: psychiatric disorders, inflammatory bowel diseases and age lower than 18 years. Results: In our experience the normal sphincteric tone in a healthy patient is between 30 to 40 mmHg. Anal reflex in a healthy patient is attested from 40 to 50 mmHg and the cough reflex under from 50 to 60 mmHg. The squeeze value is almost 100% higher than the basal one. The anorectal reflex normally is lower than the resting value but we obtained higher values even in asymptomatic patients. From our data we have noticed that in patients suffering from anal fissure the resting pressure mostly was normal but squeeze pressure usually was 200% higher than the resting. In patient with obstructed defecation syndrome the anorectal reflex is usually higher than the normal values. Conclusion: THD Anopress manometer is portable and allows you to use a normal clinical room to perform the functional study despite the use needs special expertise, in comparison to the traditional water perfused manometer, Anopress can be easily used. This study is intended to help other physicians to interpret the results due to insufficient experience with this new device.