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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.
Influence of age, mode of delivery and parity on the prevalence of posterior pelvic floor dysfunctions
Murad-Regadas, Sthela Maria;Regadas, Francisco Sergio P;Rodrigues, Lusmar Veras;Furtado, Débora Couto;Gondim, Ana Cecília;Dealcanfreitas, íris Daiana;
Arquivos de Gastroenterologia , 2011, DOI: 10.1590/S0004-28032011000400009
Abstract: context: the correlation between vaginal delivery, age and pelvic floor dysfunctions involving obstructed defecation is still a matter of controversy. objectives: to determine the influence of age, mode of delivery and parity on the prevalence of posterior pelvic floor dysfunctions in women with obstructed defecation syndrome. methods: four hundred sixty-nine females with obstructed defecation syndrome were retrospectively evaluated using dynamic 3d ultrasonography to quantify posterior pelvic floor dysfunctions (rectocele grade ii or iii, rectal intussusception, paradoxical contraction/non-relaxation of the puborectalis and entero/ sigmoidocele grade iii). in addition, sphincter damage was evaluated. patients were grouped according to age (<50y x >50y) and stratified by mode of delivery and parity: group i (<50y): 218 patients, 75 nulliparous, 64 vaginal delivery and 79 only cesarean section and group ii (>50y): 251 patients, 60 nulliparous, 148 vaginal delivery and 43 only caesarean section. additionally, patients were stratified by number of vaginal deliveries: 0 - nulliparous (n = 135), 1 - vaginal (n = 46), >1 - vaginal (n = 166). results: rectocele grade ii or iii, intussusception, rectocele + intussusception and sphincter damage were more prevalent in group ii (p = 0.0432; p = 0.0028; p = 0.0178; p = 0.0001). the stratified groups (nulliparous, vaginal delivery and cesarean) did not differ significantly with regard to rectocele, intussusception or anismus in each age group. entero/sigmoidocele was more prevalent in the vaginal group <50y and in the nulliparous and vaginal groups >50y. no correlation was found between rectocele and the number of vaginal deliveries. conclusion: higher age (>50 years) was shown to influence the prevalence of significant rectocele, intussusception and sphincter damage in women. however, delivery mode and parity were not correlated with the prevalence of rectocele, intussusception and anismus in women with obstructed defecation.
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.
Management of patients with rectocele, multiple pelvic floor dysfunctions and obstructed defecation syndrome
Murad-Regadas, Sthela Maria;Regadas, Francisco Sergio P.;Rodrigues, Lusmar Veras;Fernandes, Graziela Olivia da Silva;Buchen, Guilherme;Kenmoti, Viviane T.;
Arquivos de Gastroenterologia , 2012, DOI: 10.1590/S0004-28032012000200008
Abstract: context: management of patients with obstructed defecation syndrome is still controversial. objective: to analyze the efficacy of clinical, clinical treatment followed by biofeedback, and surgical treatment in patients with obstructed defecation, rectocele and multiple dysfunctions evaluated with echodefecography. methods: the study included 103 females aged 26-84 years with obstructed defecation, grade-ii/iii rectocele and multiple dysfunctions on echodefecography. patients were distributed into three treatment groups and constipation scores were assigned. group i: 34 (33%) patients with significant improvement of symptoms through clinical management only. group ii: 14 (14%) with improvement through clinical treatment plus biofeedback. group iii: 55 (53%) referred to surgery due to treatment failure. results: group i: 20 (59%) patients had grade-ii rectocele, 14 (41%) grade-iii. obstructed defecation syndrome was associated with intussusception (41%), mucosal prolapse (41%), anismus (29%), enterocele (9%) or 2 dysfunctions (23%). the average constipation score decreased significantly from 11 to 5. group ii: 11 (79%) grade-ii rectocele, 3 (21%) grade-iii, associated with intussusception (7%), mucosal prolapse (43%), anismus (71%) or 2 dysfunctions (29%). there was significant decrease in constipation score from 13 to 6. group iii: 8 (15%) grade-ii rectocele, 47 (85%) grade-iii, associated with intussusception (42%), mucosal prolapse (40%) or 2 dysfunctions (32%). the constipation score remained unchanged despite clinical treatment and biofeedback. twenty-three underwent surgery had a significantly decrease in constipation score from 12 to 4. the remaining 32 (31%) patients which 22 refused surgery, 6 had low anal pressure and 4 had slow transit. conclusions: approximately 50% of patients with obstructed defecation, rectocele and multiple dysfunctions presented a satisfactory response to clinical treatment and/or biofeedback. surgical repair was mainly required in pa
Pelvic floor function and advanced maternal age at first vaginal delivery  [PDF]
Mikako Yoshida, Ryoko Murayama, Maki Nakata, Megumi Haruna, Masayo Matsuzaki, Mie Shiraishi, Hiromi Sanada
Open Journal of Obstetrics and Gynecology (OJOG) , 2013, DOI: 10.4236/ojog.2013.34A005

Purpose: The study aimed to show differences in temporal recovery of pelvic floor function within 6 months postpartum between women having their first delivery at an advanced age and those having their first delivery at a younger age. Methods: Seventeen women (age: 35.5 ± 3.5, BMI: 21.1 ± 3.2) were studied at about 6 weeks, 3 months, and 6 months after vaginal delivery. Urinary incontinence was assessed by the International Consultation on Incontinence Questionnaire-Short Form. Pelvic floor function was assessed by the anteroposterior diameter of the levator hiatus using transperineal ultrasound. Women who delivered for the first time at 35 years and/or older were defined as being of advanced maternal age. Results: Nine of 17 women (52.9%) were of advanced maternal age and 5 experienced postpartum stress urinary incontinence. Four of these 5 women (80.0%) were of advanced maternal age. The anteroposterior diameter of the levator hiatus at rest was significantly greater in the advanced maternal age women than in the younger maternal age women at 3 and 6 months postpartum (p < 0.01). Among the continent women, the anteroposterior diameter of the levator hiatus at rest was significantly greater in the advanced maternal age women than in the younger maternal age women at 6 months postpartum (p = 0.004). However, among the advanced maternal age women, all parameters of the anteroposterior diameter of the levator hiatus were not significantly different between the women with and without stress urinary continence. Conclusion: Recovery of pelvic floor function following delivery may be delayed in women of advanced maternal age at first delivery because of the damage to the pelvic floor during pregnancy and vaginal delivery, resulting in increase in the incidence of stress urinary incontinence.

The Frequency of Pelvic Floor Dysfunctions and their Risk Factors in Women Aged 40-55
Tahereh Eftekhar,Zinat Ghanbari,Farbod Kalantari,Mamak Shariat
Journal of Family and Reproductive Health , 2012,
Abstract: Objective: The aims of this study were to determine the frequency of urinary and fecal incontinence and their determinants in pre-menopausal and menopausal women in Iran.Materials and methods: This one-year cross-sectional study was performed on 304 women aged 40-55 who were admitted to s clinic at Imam Khomeini Hospital. Symptoms of urinary, gas, and fecal incontinence and pelvic organs prolapse were diagnosed by a specialist through examination and a questionnaire. Patients were divided into two groups of with and without (urinary, gas, and fecal) incontinence symptoms. The probable risk factors of these disorders were studied and registered in the questionnaire and compared using t-test, chi-squared test, and regression of quantitative and qualitative variables.Results: Generally, 129 (42%) out of 304 women had pelvic floor dysfunction (urinary and fecal incontinence, and pelvic organs prolapse). Risk factors including menopause, hormone therapy, history of hysterectomy, inactivity, age, BMI, and first childs birth weight were compared between the two groups using chi-squared and t tests. There was a statistically significant difference between the two groups (P=0.000) as risk factors were more frequently observed in women with incontinence symptoms.Conclusion: Some risk factors of pelvic floor dysfunction are menopause, hormone therapy, history of hysterectomy, inactivity, age, BMI, and first childs birth weight. Therefore, some strategies should be included in womens health education programs to prevent the above-mentioned risk factors.
Tactile Imaging Markers to Characterize Female Pelvic Floor Conditions  [PDF]
Heather van Raalte, Vladimir Egorov
Open Journal of Obstetrics and Gynecology (OJOG) , 2015, DOI: 10.4236/ojog.2015.59073
Abstract: The Vaginal Tactile Imager (VTI) records pressure patterns from vaginal walls under an applied tissue deformation and during pelvic floor muscle contractions. The objective of this study is to validate tactile imaging and muscle contraction parameters (markers) sensitive to the female pelvic floor conditions. Twenty-two women with normal and prolapse conditions were examined by a vaginal tactile imaging probe. We identified 9 parameters which were sensitive to prolapse conditions (p < 0.05 for one-way ANOVA and/or p < 0.05 for t-test with correlation factor r from -0.73 to -0.56). The list of parameters includes pressure, pressure gradient and dynamic pressure response during muscle contraction at identified locations. These parameters may be used for biomechanical characterization of female pelvic floor conditions to support an effective management of pelvic floor prolapse.
Biomechanical Mapping of the Female Pelvic Floor: Prolapse versus Normal Conditions  [PDF]
Vladimir Egorov, S. Abbas Shobeiri, Peter Takacs, Lennox Hoyte, Vincent Lucente, Heather van Raalte
Open Journal of Obstetrics and Gynecology (OJOG) , 2018, DOI: 10.4236/ojog.2018.810093
Abstract: Background: Quantitative biomechanical characterization of pelvic supportive structures and functions in vivo is thought to provide insight into pathophysiology of pelvic organ prolapse (POP). An innovative approach—vaginal tactile imaging—allows biomechanical mapping of the female pelvic floor to quantify tissue elasticity, pelvic support, and pelvic muscle functions. The Vaginal Tactile Imager (VTI) records high definition pressure patterns from vaginal walls under an applied tissue deformation and during pelvic floor muscle contractions. Objective: To explore an extended set of 52 biomechanical parameters for differentiation and characterization of POP relative to normal pelvic floor conditions. Methods: 96 subjects with normal and POP conditions were included in the data analysis from multi-site observational, case-controlled studies; 42 subjects had normal pelvic floor conditions and 54 subjects had POP. The VTI, model 2S, was used with an analytical software package to calculate automatically 52 biomechanical parameters for 8 VTI test procedures (probe insertion, elevation, rotation, Valsalva maneuver, voluntary muscle contractions in 2 planes, relaxation, and reflex contraction). The groups were equalized for subject age and parity. Results: The ranges, mean values, and standard deviations for all 52 VTI parameters were established. 33 of 52 parameters were identified as statistically sensitive (p < 0.05; t-test) to the POP development. Among these 33 parameters, 11 parameters show changes (decrease) in tissue elasticity, 8 parameters
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.
Clinical anatomy of the pelvic floor  [PDF]
Aigner Felix
Acta Chirurgica Iugoslavica , 2006, DOI: 10.2298/aci0602011a
Abstract: The pelvic floor forms the supportive and caudal border of the human’s abdominopelvic cavity. A detailed anatomical understanding of its complex architecture is mandatory for the pelvic floor surgeon (general surgeon, gynaecologist and urologist) and for fundamental mechanisms of anorectal as well as urogenital dysfunctions as different anatomical systems join here. The diagnosis and treatment of complex anorectal disorders, however, require a multidisciplinary approach.
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