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Camila Teixeira Moreira Vasconcelos,José Ananias Vasconcelos Neto,Leonardo Robson Pinheiro Sobreira Bezerra,Kathiane Lustosa Augusto
Revista Gest?o & Saúde , 2013,
Abstract: This study aimed to assess the socio-demographic and clinical profile of urogynecologic outpatients of a public tertiary hospital in Fortaleza, Ceará. This is a cross-sectional study whose sample consisted of 85 women with pelvic floor dysfunction. The age ranged from 27 to 86 years old (mean: 53.8±14.2). Most patients were married (54.9%), weren’t working formally (40.0%) and didn’t smoke (82.4%). Approximately half was in postmenopausal period (48.2%). Most of them were multiparous (89.4%) by vaginal delivery (92.9%). The main complaint reported was urinary incontinence (74.1%), and mixed urinary incontinence (MUI) was the most frequent (60.0%). Over half of the patients also had pelvic organ prolapse (75.3%), and the most common defect was from the anterior vaginal wall (55.3%). The majority (57.6%) had some form of anorectal dysfunction: constipation (40%), tenesmus (37.6%), fecal incontinence (16.5%). Most of the patients lost urine several times a day (57.3%), with impact on quality of life. The risk factors found are in agreement with literature data, as well as the prevalence of MUI. Given the concomitant disorders, it’s important to address all pathologies, because they are prevalent conditions with medical, social, psychological and economic implications.
Overview of pelvic floor failure and associated problems
Khaled Refaat,Constanze Fischer-Hammadeh,Mohamad Eid Hammadeh
Urogynaecologia International Journal , 2012, DOI: 10.4081/uij.2012.e2
Abstract: Pelvic organ prolapse POP, including anterior and posterior vaginal prolapse, uterine prolapse, and enterocele, is a common group of clinical conditions affecting millions of women worldwide. The aim of this review is to highlight the clinical importance of prolapse, its pathophysiology, and different modalities for diagnosis and treatment. POP includes a range of disorders, from asymptomatic disturbed vaginal anatomy to complete vaginal eversion associated with considerable degrees of urinary, defecatory, and sexual dysfunction. The pathophysiology of prolapse is multifactorial however genetically susceptible women are more exposed to life events that result in the development of clinically significant prolapse. The evaluation of women with prolapse requires a comprehensive approach, with focusing on the function in all pelvic compartments based on a detailed patient history, physical examination, and investigations. Although prolapse is associated with many symptoms, few are specific for prolapse; it is often a challenge for the clinician to determine which symptoms are prolapse-specific and will therefore improve or resolve after prolapse treatment. Prolapse treatment is based on specific symptoms moreover its management options fall into two broad categories: nonsurgical, which includes pelvic floor muscle training and pessary use; and surgical, which can be reconstructive or obliterative. Associated symptoms require additional management. All women with prolapse can be treated and their symptoms improved, even if not completely resolved.
Effects of pregnancy and childbirth on the pelvic floor  [cached]
Michel Naser,Valentín Manríquez,Mauricio Gómez
Medwave , 2012,
Abstract: The pelvic floor dysfunctions include urinary incontinence, pelvic organ prolapsed and anal incontinence. One in ten women will be subjected to surgery for pelvic floor dysfunction during their lifetime. In addition, between 30% and 50% will have a recurrence of these interventions. Motherhood is a factor that contributes significantly to the submission of pelvic dysfunctions. There is still no proven evidence that vaginal delivery is an absolutely crucial factor for the presence of pelvic floor dysfunction. There is extensive research on pregnancy and child birth and their effects on the pelvic floor and if some of the obstetric action scan be modified in order to protect it from potential damage.
Pelvic Floor Function in the Female  [PDF]
Christos E. Constantinou
Open Journal of Obstetrics and Gynecology (OJOG) , 2014, DOI: 10.4236/ojog.2014.414115
Abstract: Pelvic Floor (PF) disorders, such as urinary incontinence and prolapse accounted for over 400,000 operations in the USA in 1987 [1], and nearly a third of these were re-operations. It is estimated that 30% - 50% of women in Europe and the USA are affected by Urinary incontinence [2]. Stress Urinary Incontinence (SUI), the involuntary leakage of urine on coughing, sneezing, exertion or effort, is the most common form of urinary incontinence in women. The scientific understanding of normal PF function is limited and consequently treatment of these prevalent, disabling conditions is, at best, inefficient.
Muscle strength measurement of pelvic floor in women by vaginal dynamometer
Parezanovi?-Ili? Katarina,Jevti? Milorad,Jeremi? Branislav,Arsenijevi? Slobodan
Srpski Arhiv za Celokupno Lekarstvo , 2009, DOI: 10.2298/sarh0910511p
Abstract: Introduction The pelvic floor is made of a mutually connected system that consists of muscles, connecting tissue and nerve components. Damage to any of these elements creates dysfunction which is exerted through stress, urinary incontinence, prolapse of genital organs and faecal incontinence. Objective The primary aim of this study was to present the possibility of objective assessment of pelvic floor muscle force in healthy and sick women using a newly designed instrument, the vaginal dynamometer, as well as to establish the correlation between the values of pelvic floor muscle force obtained by the vaginal dynamometer and digital palpation method. Methods The study included 90 female patients, age 20-58 years. One group of respondents was made of healthy women (who gave birth, and those who have not given birth), while the other one consisted of sick women (who suffered from incontinence or prolapse of genital organs, operated on or not). The pelvic floor muscle strength of every woman was measured with a newly-constructed device for measuring and monitoring of the pelvic floor muscle force in women, the vaginal dynamometer. Then it was compared with the valid clinical digital palpation (palpation with two fingers) based on the scale for measuring muscle contractions with the digital palpation - the digital pelvic assessment rating scale. The vaginal dynamometer consists of a redesigned speculum which is inserted into the vagina and a sensor for measuring the force. Results Statistically significant linear correlation was found in the values of the measured muscle force with the vaginal dynamometer and ratings produced by digital palpation (r=0.92; p<0.001). Mean value of the muscle force of the healthy women measured by the vaginal dynamometer was 1.44±0.38 daN and that value of the sick women was 0.78±0.31 daN (t=8.89 for df=88; p<0.001). Mean value of the ratings produced by digital palpation in healthy women was 4.10 (95% of trust limits 3.83- 4.37), while the value in sick women was 2.41 (95% of trust limits 2.10-4.16) (Z=-6.38; p<0.001). Conclusion The vaginal dynamometer has been presented as an attempt to overcome the limitations of the previously presented techniques for muscle force measurement. The application of the vaginal dynamometer in clinical practice makes objective and numerical assessment of pelvic floor muscle force possible, independent of the subjective assessment of the examiner. The usage of this instrument enables not only the diagnostics of women's pelvic floor muscle problem, but also the objective monitoring of rehabilitat
Effects of pelvic floor muscle training during pregnancy
Oliveira, Claudia de;Lopes, Marco Antonio Borges;Pereira, Luciana Carla Longo e;Zugaib, Marcelo;
Clinics , 2007, DOI: 10.1590/S1807-59322007000400011
Abstract: ojetive: the objective of the present study was to evaluate the effect of pelvic floor muscle training in 46 nulliparous pregnant women. methods: the women were divided into 2 groups: an exercise group and a control group. functional evaluation of the pelvic floor muscle was performed by digital vaginal palpation using the strength scale described by ortiz and by a perineometer (with and without biofeedback). results: the functional evaluation of the pelvic floor muscles showed a significant increase in pelvic floor muscle strength during pregnancy in both groups (p < .001). however, the magnitude of the change was greater in the exercise group than in the control group (47.4% vs. 17.3%, p < .001). the study also showed a significant positive correlation (spearman's test, r = 0.643; p < .001) between perineometry and digital assessment in the strength of pelvic floor muscles. conclusions: pelvic floor muscle training resulted in a significant increase in pelvic floor muscle pressure and strength during pregnancy. a significant positive correlation between functional evaluation of the pelvic floor muscle and perineometry was observed during pregnancy.
Contribution of Primary Pelvic Organ Prolapse to Micturition and Defecation Symptoms  [PDF]
Annette G. Groenendijk,Erwin Birnie,Jan-Paul W. Roovers,Gouke J. Bonsel
Obstetrics and Gynecology International , 2012, DOI: 10.1155/2012/798035
Abstract: Objective. To investigate the contribution of Pelvic Organ Prolapse (POP) to micturition and defecation symptoms. Method. Cross-sectional study including 64 women presenting with POP symptoms and 50 controls without POP complaints. Subjects were evaluated using POP-Quantification system, Urinary Distress Inventory, and Defecation Distress Inventory. The MOS SF-36 health survey and the Center for Epidemiological Studies Depression scale were used to measure self-perceived health status and depressive symptoms, respectively. Results. POP in terms of POP-Q had a moderate impact on the symptom observing vaginal protrusion (explained variance 0.31). It contributed modestly to obstructive voiding and overactive bladder symptoms (explained variance 0.09, resp., 0.14) but not to urinary incontinence. Constipation was more likely explained by clinical depression than by pelvic floor defects (explained variance 0.13, resp., 0.05). Conclusion. Stage of POP and specific prolapse symptoms are associated but such a strong association does not exist between POP and micturition or defecation symptoms. 1. Introduction Pelvic organ prolapse (POP) is a common disorder often associated with symptoms such as a vaginal bulging, pelvic heaviness, bothersome micturition, and defecation symptoms as well as sexual dysfunction, often with a negative impact on quality of life [1, 2]. It is unclear whether the anatomical position of the bladder, bowel, and uterus compromises the bladder and bowel function directly, or whether abnormal anatomy and dysfunction of the pelvic floor share a common etiology. Moreover, it is unclear to what extent micturition and defecation symptoms can be explained by the presence and degree of anatomical abnormalities involved in POP. With the exception of vaginal bulging, none of these symptoms are specific to vaginal prolapse since they also exist in women without POP [3]. Whether or not the symptoms are related to POP is critical to patient management. POP patients in whom defecation symptoms dominate might be primarily referred to the gastroenterologist, but if these patients present with a vaginal prolapse, these patients are usually referred to the gynecologist. The latter commonly offers POP surgery with the correction of the anatomy as well as restoration of the pelvic floor function as treatment aims. This treatment policy assumes a causal rather than indirect relation between POP and these symptoms. However, surgical results frequently are disappointing in terms of pelvic floor function and symptoms [4, 5]. In this study we address the unclear
Primary perineal posterior hernia: an abdominoperineal approach for mesh repair of the pelvic floor
Salum, Mara R.;Prado-Kobata, Marisa H.;Saad, Sarhan S.;Matos, Delcio;
Clinics , 2005, DOI: 10.1590/S1807-59322005000100013
Abstract: spontaneous development of perineal hernias is a very rare condition and many techniques have been described for repairing the floor defect. the authors describe the use of a combined approach in the surgical treatment of primary perineal hernias, by reconstructing the muscle pelvic floor and restoring the rectum to its sacral position with mesh repair. the case of one patient with a huge primary perineal hernia is reported, with clinical manifestations of progressive bulging in the buttock area, obstipation and fecal incontinence. long-term follow-up has shown no recurrence of the condition and normal bowel function. it is concluded that primary perineal hernia can be repaired by a combined surgical approach, by using prosthetic material.
Pelvic Organ Distribution of Mesenchymal Stem Cells Injected Intravenously after Simulated Childbirth Injury in Female Rats  [PDF]
Michelle Cruz,Charuspong Dissaranan,Anne Cotleur,Matthew Kiedrowski,Marc Penn,Margot Damaser
Obstetrics and Gynecology International , 2012, DOI: 10.1155/2012/612946
Abstract: The local route of stem cell administration utilized presently in clinical trials for stress incontinence may not take full advantage of the capabilities of these cells. The goal of this study was to evaluate if intravenously injected mesenchymal stem cells (MSCs) home to pelvic organs after simulated childbirth injury in a rat model. Female rats underwent either vaginal distension (VD) or sham VD. All rats received 2 million GFP-labeled MSCs intravenously 1 hour after injury. Four or 10 days later pelvic organs and muscles were imaged for visualization of GFP-positive cells. Significantly more MSCs home to the urethra, vagina, rectum, and levator ani muscle 4 days after VD than after sham VD. MSCs were present 10 days after injection but GFP intensity had decreased. This study provides basic science evidence that intravenous administration of MSCs could provide an effective route for cell-based therapy to facilitate repair after injury and treat stress incontinence. 1. Introduction During the second stage of vaginal delivery, pressure of the fetal head on the pelvic floor causes direct trauma to the pelvic muscles, pelvic floor organs including the urethra, and the nerves that innervate them [1]. These injuries can lead to development of pelvic floor disorders (PFDs), including pelvic organ prolapse, stress urinary incontinence (SUI) and fecal incontinence. Available treatment options for SUI and fecal incontinence include fluid and dietary manipulation, electrical stimulation, physiotherapy, and pessaries or vaginal cones [2–4]. Surgery remains the mainstay of treatment for severe cases of SUI and fecal incontinence as well as for pelvic organ prolapse. The lifetime risk of undergoing surgery for PFD has been estimated as 11% [5]. Although several therapeutic options exist, no current therapy is able to fully correct the underlying pathophysiology. Stem cells have been investigated in both animal and clinical studies as a potential treatment for SUI and have been demonstrated to improve both function and anatomy [6–11]. Most of these studies utilized autologous muscle-derived progenitor cells injected into the urethra to treat SUI and have demonstrated their potential for clinical utility; however, long-term outcomes are not yet available [12]. After vaginal delivery, the pelvic organs, their innervating nerves, and connective tissue in the region are injured, which later can lead to PFD. These diffuse injuries in multiple organs may not be successfully treated with local administration of stem cells to the urethra. Hematopoetic and mesenchymal stem
Quality of life in women with pelvic floor dysfunction  [PDF]
Mladenovi?-Segedi Ljiljana,Parezanovi?-Ili? Katarina,?ur?i? Aleksandar,Vi?njevac Nemanja
Vojnosanitetski Pregled , 2011, DOI: 10.2298/vsp1111940m
Abstract: Background/Aim. Pelvic floor dysfunction is a frequent problem affecting more than 50% of women in peri- and postmenopause. Considering that ageing and menopause befall in the significant factors causing this issue, as well as the expected longevity of women in the world and in our country, pelvic floor dysfunction prevelence is foreseen to be even higher. The aim of the study was to evaluate impact of the symptoms of pelvic dysfunction on quality of life and examine body image satisfaction in adult women with pelvic organ prolapse presenting to tertiary care clinic for surgical treatment. Methods. This prospective case-control study included 50 patients who presented to tertiary care gynecology clinic for surgical treatment and 50 controls with normal pelvic floor support and without urinary incontinence who presented tertiary care gynecology clinic for other reasons. Both, patients and controls, completed two quastionnaires recommended for the evaluation of symptoms (Pelvic floor distress inventory - short forms) and quality of life impact (Pelvic floor impact questionnaire - short form) of pelvic organ prolapse, and Body Image Scale. Results. The patients scored significantly worse on the prolapse, urinary, colorectal scales and overall score of Pelvic floor distress inventory - 20 than controls subjects (134.91 vs 78.08; p < 0.01). The patients also measured significant decrease in condition- specific quality of life (89.23 vs 3.1; p < 0.01). They were more likely to feel self-conscious (78% vs 42%; p < 0.01), less likely to feel physically attractive (78% vs 22%; p < 0.01), more likely to have difficulty looking at themselves naked (70% vs 42%; p < 0.01), less likely to feel sexually attractive (64% vs 32%; p < 0.01), and less likely to feel feminine (56% vs 16%; p < 0.05), than controls. There were no differencies in their feeling of dissatisfaction with appearance when dressed, avoiding people because of appereance and overall dissatisfaction with their body. There was a positive correlation between decreased quality of life and body image in women with pelvic dysfunction. Conclusion. Women with pelvic floor dysfunction have decreased quality of life and body image.
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