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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.
ADVANCED DIAGNOSTIC TESTING FOR FEMALE PELVIC FLOOR DYSFUNCTIONS
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.
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
Impact of supervised physiotherapeutic pelvic floor exercises for treating female stress urinary incontinence
Zanetti, Míriam Raquel Diniz;Castro, Rodrigo de Aquino;Rotta, Adriana Lyvio;Santos, Patrícia Diniz dos;Sartori, Marair;Gir?o, Manoel Jo?o Batista Castello;
Sao Paulo Medical Journal , 2007, DOI: 10.1590/S1516-31802007000500003
Abstract: context and objective: urinary incontinence is a public health problem that affects more than 200 million people worldwide. stress incontinence is the most prevalent type. pelvic floor muscle exercises have been used for treating it, although there is no consensus regarding their application. the aim of this study was to compare the results from treating female stress urinary incontinence with pelvic floor muscle exercises with or without physiotherapist supervision. design and setting: this was a randomized, prospective, controlled trial in the urogynecology and vaginal surgery sector, universidade federal de s?o paulo. methods: forty-four women were randomized to be treated for stress urinary incontinence with pelvic floor exercises for three consecutive months, into two groups: one with and the other without physiotherapist supervision. they were evaluated before and after treatment using a quality-of-life questionnaire, pad test, micturition diary and subjective evaluation. descriptive analysis was used to evaluate the population. the homogeneity of the two groups was evaluated using the kruskal-wallis and chi-squared tests. the success of the two groups after treatment was evaluated using the wilcoxon test. results: the supervised group showed statistically greater improvement in the pad test, micturition diary and quality of life than did the control group. in the subjective evaluation, only 23.8% of the control group patients were satised with their treatment. in the supervised group, 66.8% of patients did not want any other treatment. conclusion: supervised pelvic floor muscle exercises presented better results in objective and subjective evaluations than did unsupervised exercises.
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.
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.
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.
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.
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.
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