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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.
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
Biofeedback and the electromyographic activity of pelvic floor muscles in pregnant women
Batista, Roberta L. A.;Franco, Maira M.;Naldoni, Luciane M. V.;Duarte, Geraldo;Oliveira, Anamaria S.;Ferreira, Cristine H. J.;
Brazilian Journal of Physical Therapy , 2011, DOI: 10.1590/S1413-35552011005000026
Abstract: background: maintaining continence is among the functions of the pelvic floor muscles (pfm) and their dysfunction can cause urinary incontinence (ui), which is a common occurrence during pregnancy and the puerperal period. pelvic floor muscle training (pfmt), therefore, is important during pregnancy, although most women perform the muscle contractions unsatisfactorily. objectives: this study is an exploratory analysis of the results of three electromyographic (emg) activity biofeedback sessions in pregnant women. methods: the study sample included 19 nulliparous women with low risk pregnancies. the participants performed three sessions of emg biofeedback consisting of slow and fast contractions. the average value of the normalized amplitudes of surface electromyography was used to evaluate the results. the linear regression model with mixed effects was used for statistical analysis, with the emg data normalized by maximum voluntary contraction (mvc). results: a steady increase in emg amplitude was observed during each contraction and by the end of the biofeedback sessions, although this difference was only significant when comparing the first tonic contraction of each session (p=0.03). conclusions: the results indicate that three sessions of training with biofeedback improved pfm emg activity during the second trimester in women with low-risk pregnancies. the effectiveness of this protocol should be further investigated in randomized controlled trials.
A Suspected Pelvic Aneurysmal Bone Cyst in Pregnancy  [PDF]
Rayan Elkattah,Brooke Foulk
Case Reports in Obstetrics and Gynecology , 2013, DOI: 10.1155/2013/676087
Abstract: Albeit rare, the majority of identified bone lesions in pregnancy spare the pelvis. Once encountered with a pelvic bone lesion in pregnancy, the obstetrician may face a challenging situation as it is difficult to determine and predict the effects that labor and parturition impart on the pelvic bones. Bone changes and pelvic bone fractures have been well documented during childbirth. The data regarding clinical outcomes and management of pregnancies complicated by pelvic ABCs is scant. Highly suspected to represent an aneurysmal bone cyst, the clinical evaluation of a pelvic lesion in the ilium of a pregnant individual is presented, and modes of delivery in such a scenario are discussed. 1. Case Illustration Our patient is a 26-year-old primigravid, obese, otherwise healthy female. She had originally presented to our obstetrics clinic as a transfer of care by recommendations from her primary obstetrician. The patient had been diagnosed with a left ilium bone lesion 2 years prior to pregnancy. This was discovered as an incidental finding on computed tomography (CT) and plain radiography imaging of the pelvis performed during a work-up for low abdominal and pelvic pain in an emergency department visit. On CT without contrast, this bone lesion was in the superomedial aspect of the posterior left ilium, had mixed lytic and sclerotic components, was enlarged, and abutted but spared the sacroiliac (SI) joint. Plain radiography of the pelvis (Figure 1) revealed that the lesion measured ?cm, had well-defined margins, had neither cortical destruction nor any periosteal elevation, and was free of any acute fracture lines. The patient established follow-up care with an orthopedic surgeon who recommended a noncontrast magnetic resonance (MR) image of her pelvis. The MR image reaffirmed the prior imaging results, with the lesion having dimensions of , abutting but not crossing the SI joint, had an intact cortex, and had mixed signals on different MR imaging modes (Figures 2 and 3). The findings were highly suggestive of an aneurysmal bone cyst (ABC). The differential diagnosis made at that time included fibrous dysplasia and benign or low-grade malignancy. After proper counseling, the patient decided to follow up the lesion annually with MR imaging since it was asymptomatic. She was advised against getting pregnant as the effects of a gestation could not be predicted, and it would be prudent to minimize the possibility of fracturing the thin cortical aspect of the ilium, a scenario that could theoretically happen with the expulsive forces of labor and thus predispose
Abnormal expression of p27kip1 protein in levator ani muscle of aging women with pelvic floor disorders – a relationship to the cellular differentiation and degeneration
Antonin Bukovsky, Pleas Copas, Michael R Caudle, Maria Cekanova, Tamara Dassanayake, Bridgett Asbury, Stuart E Van Meter, Robert F Elder, Jeffrey B Brown, Stephanie B Cross
BMC Clinical Pathology , 2001, DOI: 10.1186/1472-6890-1-4
Abstract: Biopsy samples of levator ani muscle were obtained from 22 symptomatic patients with stress urinary incontinence, pelvic organ prolapse, and overlaps (age range 38–74), and nine asymptomatic women (age 31–49). Cryostat sections were investigated for p27 protein expression and type I (slow twitch) and type II (fast twitch) fibers.All fibers exhibited strong plasma membrane (and nuclear) p27 protein expression. cytoplasmic p27 expression was virtually absent in asymptomatic women. In perimenopausal symptomatic patients (ages 38–55), muscle fibers showed hypertrophy and moderate cytoplasmic p27 staining accompanied by diminution of type II fibers. Older symptomatic patients (ages 57–74) showed cytoplasmic p27 overexpression accompanied by shrinking, cytoplasmic vacuolization and fragmentation of muscle cells. The plasma membrane and cytoplasmic p27 expression was not unique to the muscle cells. Under certain circumstances, it was also detected in other cell types (epithelium of ectocervix and luteal cells).This is the first report on the unusual (plasma membrane and cytoplasmic) expression of p27 protein in normal and abnormal human striated muscle cells in vivo. Our data indicate that pelvic floor disorders are in perimenopausal patients associated with an appearance of moderate cytoplasmic p27 expression, accompanying hypertrophy and transition of type II into type I fibers. The patients in advanced postmenopause show shrinking and fragmentation of muscle fibers associated with strong cytoplasmic p27 expression.Pelvic floor disorders (PFD) are highly prevalent among elderly women. Many surgical reports attempt to determine the best surgical treatment for PFD, yet do not address the pathophysiology. The etiology of PFD is probably multifactorial, including a genetic predisposition to connective tissue abnormalities, vaginal childbirth with damage to the innervation of the pelvic floor muscles, estrogen deficiency, and aging effects [1]. The pelvic floor, situated at t
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.
For a dos músculos do assoalho pélvico e fun o sexual em gestantes Strength of pelvic floor muscles and sexual function during pregnancy  [cached]
Joseli Franceschet,Cinara Sacomori,Fernando L. Cardoso
Brazilian Journal of Physical Therapy , 2009,
Abstract: CONTEXTUALIZA O: O bem-estar sexual depende de músculos do assoalho pélvico (MAP) fortes o suficiente para manter a sua fun o. Durante a gesta o, tanto a fun o sexual como a for a dos MAP podem modificar-se. OBJETIVOS: Comparar o grau de for a dos MAP e a fun o sexual em gestantes do segundo e terceiro trimestres. MéTODOS: Pesquisa descritiva causal comparativa realizada com 37 gestantes de Florianópolis (18 do segundo e 19 do terceiro trimestre), com média de idade de 25,22 anos (±5,7 anos). Os instrumentos utilizados foram o Questionário Female Sexual Function Index (FSFI) e o Teste Manual da Musculatura do Assoalho Pélvico, utilizando a escala de Oxford modificada para gradua o da for a. Os dados foram analisados por meio de estatística descritiva e inferencial (teste t independente, teste U de Mann Whitney, correla o de Spearman), nível de significancia de 0,05. RESULTADOS: N o houve diferen a significativa entre a média dos valores dos postos do grau de contra o dos MAP de gestantes do segundo e do terceiro trimestre (U=150,5; p=0,512). Todavia, a fun o sexual das gestantes do segundo trimestre de gesta o foi melhor que as do terceiro (U=104; p=0,042), e o grau de contra o dos MAP apresentou correla es estatisticamente significativas com a idade (ρ=0,320, p=0,041) e com o escore do FSFI (ρ=0,540, p<0,001). CONCLUS ES: A fun o sexual diminuiu significativamente do segundo para o terceiro trimestre, enquanto que a for a dos MAP n o apresentou diferen a entre os trimestres. BACKGROUND: Sexual well-being depends on pelvic floor muscles (PFMs) that are strong enough to maintain their function. During pregnancy, both the sexual function and the strength of the PFMs may be altered. OBJECTIVES: to compare the degree of PFM strength and the sexual function of pregnant women in the second and the third trimesters. METHODS: a descriptive, causal-comparative study was carried out with 37 pregnant women in Florianópolis (18 in the second trimester and 19 in the third trimester) with a mean age of 25.22 years (±5.7 years). The instruments used were the Female Sexual Function Index (FSFI) Questionnaire and the Manual Test of Pelvic Floor Muscle Strength, using the modified Oxford scale to grade strength. The data were analyzed using descriptive and inferential statistics (independent t test, the Mann-Whitney U test, Spearman's correlation) with a significance level of 0.05. RESULTS: There was no significant difference between the mean rank values of PFM strength of pregnant women in the second and third trimester (U=150.5; p=0.512). However, the sexu
Efeitos da cirurgia bariátrica na fun o do assoalho pélvico Effects of bariatric surgery on pelvic floor function
Larissa Araújo de Castro,Wagner Sobottka,Giorgio Baretta,Alexandre Coutinho Teixeira de Freitas
ABCD. Arquivos Brasileiros de Cirurgia Digestiva (S?o Paulo) , 2012,
Abstract: RACIONAL: A incontinência urinária é bem documentada como comorbidade da obesidade. Estudos demonstram resolu o ou atenua o da incontinência após a perda de peso. Porém, os mecanismos pelos quais isso ocorre ainda n o est o claros. OBJETIVO: Avaliar os efeitos da cirurgia bariátrica na fun o do assoalho pélvico em mulheres. MéTODOS: Foram avaliadas 30 mulheres que estavam em lista de espera para realizar a opera o. Foi verificada a prevalência de incontinência urinária no pré e no pós-operatório e seu impacto na qualidade de vida através do King's Health Questionnaire. A qualidade da contra o muscular do assoalho pélvico foi avaliada através da Escala de Oxford Modificada e da perineometria. RESULTADOS: Vinte e quatro mulheres finalizaram o estudo. O índice de massa corporal passou de 46,96±5,77 kg/m2 no pré-operatório para 29,97±3,48 kg/m2 no pós-operatório, e a perda percentual do excesso de peso média foi de 70,77±13,26%. A prevalência de incontinência urinária passou de 70,8% no pré-operatório para 20,8% no pós-operatório. Após um ano da cirurgia bariátrica, houve redu o do impacto da incontinência urinária na qualidade de vida em sete dos nove domínios avaliados no questionário. A mediana da Escala de Oxford Modificada aumentou de três no pré-operatório para quatro no pós-operatório. A perineometria apresentou aumento significativo na média das três contra es solicitadas, passou de 21,32±12,80 sauers para 28,83±16,17 sauers na compara o pré e pós-operatória. O pico de contra o também aumentou significativamente no pós-operatório em rela o ao pré-operatório, passou de 25,29±14,49 sauers para 30,92±16,20 sauers. CONCLUS O: A perda massiva de peso através da cirurgia bariátrica repercute positivamente na fun o do assoalho pélvico e na qualidade de vida das mulheres com obesidade mórbida. BACKGROUND: Urinary incontinence is well documented as a comorbidity of obesity. Studies demonstrate improvement of incontinency after weight loss. However, the mechanisms are still not clear. AIM: To analyze the effects of bariatric surgery on pelvic floor function in women. METHODS: Thirty women were invited to participate. They were waiting for bariatric surgery. Evaluations were done on pre-operative period and one year after surgery. It comprehended: body mass index, urinary incontinence prevalence, quality of life through the King's Health Questionnaire, quality of pelvic floor muscular contraction through the Oxford Modified Scale and perineometry. RESULTS: Twenty four women were included in the study. The body mass index reduced from 46.96±5.77 kg/m
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.
Multiple luteinizing hormone receptor (LHR) protein variants, interspecies reactivity of anti-LHR mAb clone 3B5, subcellular localization of LHR in human placenta, pelvic floor and brain, and possible role for LHR in the development of abnormal pregnancy, pelvic floor disorders and Alzheimer's disease
Antonin Bukovsky, Korakod Indrapichate, Hiroshi Fujiwara, Maria Cekanova, Maria E Ayala, Roberto Dominguez, Michael R Caudle, Jay Wimalsena, Robert F Elder, Pleas Copas, James S Foster, Romaine I Fernando, Donald C Henley, Nirmala B Upadhyaya
Reproductive Biology and Endocrinology , 2003, DOI: 10.1186/1477-7827-1-46
Abstract: The luteinizing hormone receptor (LHR) plays a fundamental role in ovarian responsiveness to pituitary LH. The LHR consists of a 335 residue extracellular domain which contains six N-linked glycosylation sites [1]. Posttranslational changes in glycosylation and phosphorylation result in several LHR variants migrating between ~93 and 44 kDa [2-17]. Lower molecular weight forms (48 and 44 kDa species) appear to represent a glycosylated extracellular domain expressed in mammalian cells (truncated receptor) and retain hormone binding specificity. They are not secreted from cells, but remain trapped intracellularly [18]. In addition to various glycosylated LHR variants, western blotting also yielded a 170 kDa band representing an LHR dimer [19]. LH binds to LHR variants with different affinities, and highest affinity appears to be associated with the fully glycosylated receptor (~90 kDa) [19]. Chorionic gonadotropin (CG), which is important for corpus luteum (CL) rescue and maintenance of pregnancy, also binds to LHR, although with a 10-fold lower binding affinity compared with that of LH [20].The mouse anti-rat LHR monoclonal antibody (mAb), clone 3B5, was developed against purified rat LHR [21]. The antibody showed immunoreactivity with rat granulosa cells of mature (preovulatory) follicles, ovarian thecal and interstitial cells, granulosa-lutein cells of developing, mature and regressing CL, and with testicular Leydig cells, and no reactivity with rat kidneys [22]. During the last ten years, affinity purified 3B5 antibody has been used in several immunohistochemical studies [23-26]. To our knowledge, however, no analysis of the 3B5 antibody by western blot has been reported.In porcine ovaries, LHR expression was detected in granulosa and theca cells of preovulatory follicles, but not in granulosa lutein cells of the mature CL [27]. In human ovaries, LHR expression was also detected in granulosa and theca cells of preovulatory follicles, but mature CL showed strong exp
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