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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.
G. Vignoli
Urogynaecologia International Journal , 2010, DOI: 10.4081/uij.2009.1.5
Abstract: The word “pelvic floor dysfunction” has different meanings in different specialties, i.e. radiology, urology, gynaecology, coloproctology. Despite the fact that the concept of perineology is not exactly new, most clinicians have only slowly adapted their practice to this transversal view. The multidisciplinary approach (several specialists dealing with various pelvic floor problems) still prevails over the interdisciplinary one (one specialist explaining what is happening) with several problems in the choice of therapeutic strategies. Obviously, the interdisciplinary approach requires a wide knowledge of the principles and techniques of each specialty. This monographic issue reviews advanced diagnostic testing for female pelvic floor dysfunctions from the perspective of a single specialist, namely a urologist.
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.
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.
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.
What harm does a second delivery to the pelvic floor?
K Jundt, I Scheer, V von Bodungen, F Krumbachner, K Friese, UM Peschers
European Journal of Medical Research , 2010, DOI: 10.1186/2047-783x-15-8-362
Abstract: A questionnaire evaluating symptoms of urinary and anal incontinence was used in nulliparous women before and 27 months after childbirth. Furthermore these symptoms were correlated with functional changes of the pelvic floor based on a careful gynecologic examination as well as perineal and endoanal ultrasound.112 nulliparous women were included, 49 women returned for follow-up on average 27 months (SD 4.4 months) after the first delivery. 39 women (group A) had just one delivery, 10 women (group B - 10/49) had had a second delivery. Apart from levator ani muscle strength, no significant difference between pelvic floor function of group A vs group B was demonstrable. Furthermore, we could show no significant difference for symptoms of urinary (11 (28.2%) vs. 5 (50.0%)) and anal incontinence (14 (35.9%) vs. 4 (40.0%)) between both groups. However, we found a lasting increase of stress urinary and anal incontinence as well as overactive bladder symptoms after one or more deliveries. The position of the bladder neck at rest was lower in both groups compared to the position before the first delivery and bladder neck mobility increased after one or more deliveries.Our study shows several statistically significant changes of the pelvic floor function even on average 27 months after delivery, but a subsequent delivery did not compromise the pelvic floor any further.Urinary and fecal incontinence as well as genital prolapse in women are problems that frequently occur after childbirth.Women with the onset of stress urinary incontinence during their first pregnancy or puerperal period have an increased risk of long-lasting symptoms. Viktrup and co-workers showed that twelve years after their first delivery the prevalence of stress urinary incontinence is 42% (102 of 241) and that the prevalence of SUI among women with onset during their first pregnancy (56%) and among women with onset shortly after delivery (78%) is significantly higher compared to those without initial sympt
Pelvic floor exercises with biofeedback for stress urinary incontinence
Capelini, Maria V.;Riccetto, Cassio L.;Dambros, Miriam;Tamanini, Jose T.;Herrmann, Viviane;Muller, Virginia;
International braz j urol , 2006, DOI: 10.1590/S1677-55382006000400015
Abstract: objective: prospective study to objectively evaluate the benefits of pelvic floor strengthening exercises associated to biofeedback for the treatment of stress urinary incontinence. materials and methods: fourteen patients diagnosed with stress urinary incontinence (sui) were selected for this study. all patients underwent a pelvic floor training associated to biofeedback for 12 consecutive weeks. urodynamic tests, pad test and bladder diary were analyzed at the beginning of the study, at the end and after 3 months. the king's health questionnaire (khq) was applied before and after treatment to assess the impact in the quality of life. results: there was a significant reduction in the pad weight (from 14.21 g to 1 g), number of urinary leakage episodes (from 8.14 per day to 2.57 per day) and daytime frequency (from 7.93 per day to 5.85 per day). at urodynamics the authors observed a significant increase in valsalva leak-point pressure (from 103.93 cm h2o to 139.14 cm h2o), cistometric capacity (from 249.29 ml to 336.43 ml, p = 0.0015) and bladder volume at first desire to void (from 145 ml to 215.71 ml). those differences were kept during the first 3 months of follow up. the khq revealed significant differences except in the case of "general health perception", which covers health in general and not exclusively urinary incontinence. conclusion: treatment of sui with pelvic floor exercises associated to biofeedback caused significant changes in the parameters analyzed, with maintenance of good results 3 months after treatment.
Three-dimensional Ultrasound Appearance of Pelvic Floor in Nulliparous Women and Pelvic Organ Prolapse Women  [cached]
Tao Ying, Qin Li, Lian Xu, Feifei Liu, Bing Hu
International Journal of Medical Sciences , 2012,
Abstract: The present study investigated the morphology and structure of pelvic floor in 50 nulliparous and 50 pelvic organ prolapse (POP) women using translabial three-dimensional (3D) ultrasound. The levator hiatus in POP women was significantly different from that in nullipara women. In POP women, the size of pelvic floor increased, with a circular shape, and the axis of levator hiatus departed from the normal position in 36 (72%) cases. The puborectalis was avulsed in 18 (36%) cases and the pelvic organs arranged abnormally in 23 (46%) cases. In summary, 3D ultrasound is an effective tool to detect the pelvic floor in POP women who presented with abnormalities in the morphology and structure of pelvic floor.
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
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