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Gallo-Galán LM, Gallo-Vallejo MA, Gallo-Vallejo JL. [Medical recommendations from primary care on physical exercise in the postpartum]. Semergen 2024; 50:102148. [PMID: 38064768 DOI: 10.1016/j.semerg.2023.102148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/05/2023] [Accepted: 11/08/2023] [Indexed: 04/01/2024]
Abstract
There is evidence that demonstrates the benefits of practicing physical activity/exercise for the mother after childbirth. However, this postpartum period (PP) is often a missed opportunity in a lifetime for women to start or resume physical exercise and get the great benefits that it can bring them. The objective of this article was to analyze the benefits of physical exercise during PP; the prescription of physical exercise; recommendations on when to resume your practice; barriers and facilitators; physical exercise during breastfeeding; as well as its role in the most frequent illnesses and discomforts in this period, always keeping in mind that the work of the primary care doctor is essential to motivate and encourage women to perform physical exercise in the PP.
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Affiliation(s)
- L M Gallo-Galán
- Servicio de Obstetricia y Ginecología, Hospital Universitario Sanitas La Moraleja, Madrid, España
| | - M A Gallo-Vallejo
- Centro de Medicina Deportiva, Concejalía de Deportes del Ayuntamiento de Granada, Granada, España
| | - J L Gallo-Vallejo
- Servicio de Obstetricia y Ginecología, Hospital Universitario Virgen de las Nieves, Granada, España; Departamento de Obstetricia y Ginecología de la Universidad de Granada, Granada, España.
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Dai J, Jin Z, Zhang X, Lian F, Tu J. Efficacy of Warm Acupuncture Therapy Combined with Kegel Exercise on Postpartum Pelvic Floor Dysfunction in Women. Int Urogynecol J 2024; 35:599-608. [PMID: 38236284 PMCID: PMC11023953 DOI: 10.1007/s00192-023-05698-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/12/2023] [Indexed: 01/19/2024]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to observe the clinical efficacy of warm acupuncture combined with Kegel exercise in treating postpartum pelvic floor dysfunction in women. METHODS A total of 70 primiparous women with postpartum pelvic floor muscle (PFM) injury were randomly divided into a combination group (n = 35, receiving warm acupuncture at Zhibian (BL54) acupoint and Kegel exercise) and a sham control group (n = 35, receiving sham warm acupuncture and Kegel exercise). Both groups were treated three times a week for 4 consecutive weeks. The recovery of PFM strength and changes in Urethral Rotation Angle (URA), Bladder Neck Descent (BND), and Retrovesical Angle (RVA) in pelvic floor ultrasound reports, the scores of pelvic floor dysfunction-related questionnaires, and the efficacy of urinary incontinence treatment of the two groups were compared before and after treatment. RESULTS After treatment, the recovery rates of type I and II PFM strength, pelvic floor ultrasound parameters, pelvic floor dysfunction-related scale scores, and urinary incontinence treatment efficacy in the combination group were significantly better than those in the sham control group (p < 0.05). CONCLUSION Warm acupuncture combined with Kegel exercise can significantly improve PFM strength and promote the recovery of postpartum pelvic floor function in women.
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Affiliation(s)
- Jinling Dai
- Shanghai University of Traditional Chinese Medicine, City Seven Clinical Medical College, Shanghai, 201203, China
| | - Zhu Jin
- Department of Acupuncture, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, 200137, China.
| | - Xiaojin Zhang
- Department of Acupuncture, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, 200137, China
| | - Feng Lian
- Department of Ultrasound, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, 200137, China
| | - Jie Tu
- Shanghai University of Traditional Chinese Medicine, City Seven Clinical Medical College, Shanghai, 201203, China
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Chu L, Jin X, Wu S, Tong X, Li H, Chen X. Effect of Pelvic Floor Muscle Training With Smartphone Reminders on Women in the Postpartum Period: A Randomized Controlled Trial. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:138-146. [PMID: 37556387 DOI: 10.1097/spv.0000000000001401] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
IMPORTANCE Standard postpartum pelvic floor muscle training (PFMT) can effectively reduce the incidence of pelvic floor dysfunction diseases. OBJECTIVE This study aimed to evaluate the adherence of PFMT with smartphone application reminders on women in the postpartum period. STUDY DESIGN We conducted a randomized controlled trial. This single-center randomized (1:1) controlled study included primiparous women admitted to Tongji Hospital between March 2022 and June 2022 (ChiCTR2200059157). Every puerpera was given pelvic floor muscle (PFM) assessment and PFMT guidance at 6 weeks after delivery. After randomization, women in the intervention group received daily training reminders from the smartphone application WeChat. Adherence to PFMT, a symptom of stress urinary incontinence, and PFM characteristics were measured 3 months later. RESULTS A total of 148 participants were included in the final analysis (76 in the intervention group and 72 in the control group). The adherence rate of daily PFMT was higher in the intervention group than in the control group (53.9% vs 20.8%, P = 0.00) at 3-month follow-up. In addition, participants in the intervention group showed higher peak surface electromyography of PFMs (39.8 ± 6.2 vs 37.5 ± 5.9 μV, P = 0.03) and longer PFM endurance (8.1 ± 2.0 vs 7.3 ± 2.0 seconds, P = 0.01) than in the control group, whereas there was no difference between the 2 groups in International Consultation on Incontinence Questionnaire-Short Form ( P = 0.60) and the Patient Global Impression of Improvement scores ( P = 1.00). CONCLUSIONS Smartphone application-based PFMT could increase adherence and improves electromyography of PFMs in the short term but did not affect stress urinary incontinence symptoms in women in the postpartum period.
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Affiliation(s)
| | - Xia Jin
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji University School of Medicine, Shanghai, PR China
| | - Siyu Wu
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji University School of Medicine, Shanghai, PR China
| | - Xiaowen Tong
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji University School of Medicine, Shanghai, PR China
| | - Huaifang Li
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji University School of Medicine, Shanghai, PR China
| | - Xinliang Chen
- From the Department of Gynecology, the International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University
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Huang L, Zhang ZY, Liu H, Gao M, Wang XQ, Duan XQ, Liu ZL. Most of the pelvic floor muscle functions in women differ in different body positions, yet others remain similar: systematic review with meta-analysis. Front Med (Lausanne) 2023; 10:1252779. [PMID: 38020153 PMCID: PMC10662015 DOI: 10.3389/fmed.2023.1252779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives This systematic literature review and meta-analysis aimed to determine the effect of body position on the measurement of pelvic floor muscle (PFM) contractility and to analyze the influential factors. Data sources Five databases (PubMed, Web of Science, EMBASE, Cochrane Library and Scopus) were searched for relevant studies published up to 12nd October 2023. Study selection or eligibility criteria Included cross-sectional studies had to involve the assessment of pelvic floor muscle function in at least two positions. Study appraisal and synthesis methods We calculated standardized mean difference (SMD) with 95% confidence intervals (CI) to ascertain the potential effect of body position on outcomes. Results In total, we included 11 cross-sectional studies to ascertain the potential effect of body position on outcomes. There was no statistical difference in the results of maximum voluntary contraction (MVC) of the pelvic floor muscles when assessed in between supine and standing positions (SMD -0.22; 95% CI -0.72 to 0.28; p = 0.38). The results of the meta-analysis showed significantly larger values of resting voluntary contractions (RVC) measured in the standing position compared to the supine position (SMD -1.76; 95% CI -2.55 to -0.97; p < 0.001). Moreover, pelvic floor muscle movement during pelvic floor muscle contraction in the standing position was significantly better than that measured in the supine position (SMD -0.47; 95% CI -0.73 to 0.20; P < 0.001). Conclusion The results of this study showed that the RVC and PFM movement varied with the position of the assessment. In contrast, MVC values are independent of the assessment position and can be selected according to clinical needs. Systematic review registration PROSPERO, identifier CRD42022363734, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022363734.
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Affiliation(s)
- Lu Huang
- School of Nursing, Jilin University, Changchun, China
| | | | - Hong Liu
- Department of Rehabilitation, The Second Hospital of Jilin University, Changchun, China
| | - Min Gao
- School of Nursing, Jilin University, Changchun, China
| | - Xiao-Qi Wang
- Department of Rehabilitation, The Second Hospital of Jilin University, Changchun, China
| | - Xiao-Qin Duan
- Department of Rehabilitation, The Second Hospital of Jilin University, Changchun, China
| | - Zhong-Liang Liu
- Department of Rehabilitation, The Second Hospital of Jilin University, Changchun, China
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Luo L, Xie H. Review of self-efficacy assessment scales for geriatric patients with urinary incontinence. Int Urol Nephrol 2023; 55:2133-2138. [PMID: 37330933 DOI: 10.1007/s11255-023-03661-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/03/2023] [Indexed: 06/20/2023]
Abstract
Urinary incontinence is a common condition in the elderly, which can be improved with rehabilitation. However, compliance with the rehabilitation regimen is influenced by the level of self-efficacy. Self-efficacy of elderly patients in dealing with urinary incontinence can be clinically assessed and understood by using a suitable scale, to implement specific improvement measures. At present, the tools used for assessing the self-efficacy of elderly patients with urinary incontinence include the General Self-Efficacy Scale (GSES), the Pelvic Floor Muscle Self-efficacy Scale, the Geriatric Self-efficacy Index for Urinary Incontinence, and the Yoga Self-Efficacy Scale. Most of these tools are suitable for female patients with urinary incontinence, but lack relevance to the disease characteristics of geriatric patients. In this study, we reviewed the self-efficacy assessment tools for geriatric patients with urinary incontinence, to provide a reference for related research. It is important to accurately assess the self-efficacy of patients with geriatric UI to effectively enhance their level of self-efficacy, so that patients with geriatric UI can avail early help and quickly reintegrate with family and society.
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Affiliation(s)
- Liumei Luo
- Department of Scientific Research, Hainan General Hospital, Haikou, 570311, China
| | - Huifang Xie
- Department of International Nursing School, Hainan Medical University, No.3 of Xueyuan Road, Longhua District, Haikou, 570100, China.
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Chen L, Zhang D, Li T, Liu S, Hua J, Cai W. Effect of a Mobile App-Based Urinary Incontinence Self-Management Intervention Among Pregnant Women in China: Pragmatic Randomized Controlled Trial. J Med Internet Res 2023; 25:e43528. [PMID: 37368465 DOI: 10.2196/43528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 03/30/2023] [Accepted: 05/27/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Urinary incontinence (UI) is a highly prevalent health concern commonly observed during and after pregnancy that can substantially impact women's physical and psychological well-being and quality of life. Owing to its numerous advantages, mobile health may be a promising solution; however, it is unclear whether the app-based intervention can effectively improve UI symptoms during and after pregnancy. OBJECTIVE This study aimed to evaluate the effectiveness of the Urinary Incontinence for Women (UIW) app-based intervention for UI symptom improvement among pregnant women in China. METHODS Singleton pregnant women without incontinence before pregnancy who were aged ≥18 years and between 24 and 28 weeks of gestation were recruited from a tertiary public hospital in China and were randomly allocated (1:1) to either an experimental group (n=63) or a control group (n=63). The experimental group received the UIW app intervention and oral pelvic floor muscle training (PFMT) instructions, whereas the control group received oral PFMT instructions alone. Neither the participants nor the researchers were blinded to the intervention. The primary outcome was UI severity. The secondary outcomes included quality of life, self-efficacy with PFMT, and knowledge of UI. All data were collected at baseline, 2 months after randomization, and 6 weeks post partum through electronic questionnaires or by checking the electronic medical record system. Data analysis followed the intention-to-treat principle. A linear mixed model was used to examine the intervention effect on primary and secondary outcomes. RESULTS Participants in the experimental and control groups were comparable at baseline. Of the 126 overall participants, 117 (92.9%) and 103 (81.7%) women completed follow-up visits at 2 months after randomization and 6 weeks after delivery, respectively. A statistically significant difference in UI symptom severity was observed between the experimental group and control group (2 months after randomization: mean difference -2.86, 95% CI -4.09 to -1.64, P<.001; 6 weeks post partum: mean difference -2.68, 95% CI -3.87 to -1.49, P<.001). For the secondary outcomes, a statistically significant intervention effect on the quality of life, self-efficacy, and UI knowledge was found at the 2-month follow-up (all P<.05) and 6 weeks post partum (all P<.001). CONCLUSIONS The app-based UI self-management intervention (UIW) effectively improved UI symptom severity, quality of life, self-efficacy with PFMT, and knowledge of UI during the late pregnancy and early postnatal periods. Larger multicenter studies with a longer postpartum follow-up are required to further extend these findings. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR1800016171; http://www.chictr.org.cn/showproj.aspx?proj=27455. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/22771.
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Affiliation(s)
- Ling Chen
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, China
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Danli Zhang
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, China
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Tiantian Li
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Sha Liu
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, China
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Jie Hua
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, China
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Wenzhi Cai
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, China
- School of Nursing, Southern Medical University, Guangzhou, China
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Luo L, Chen X, Xie H, Zhou J, Li L. Development and evaluation of a rehabilitation training compliance scale for patients with urinary incontinence. BMC Nurs 2023; 22:147. [PMID: 37138310 PMCID: PMC10156580 DOI: 10.1186/s12912-023-01326-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 04/30/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Urinary incontinence treatment includes conservative treatment, physical devices, medication, and surgery. Pelvic floor muscle training combined with bladder training is among the most effective, non-invasive, and economical ways to treat urinary incontinence, and compliance with training is essential in urinary incontinence treatment. Several instruments assess pelvic floor muscle training and bladder training. However, no tool has been found that assesses compliance with pelvic floor muscle training when combined with bladder training for urinary incontinence. This study aimed to develop a rehabilitation training compliance scale for patients with urinary incontinence and to evaluate its validity and reliability. METHODS This study was performed in two tertiary hospitals in Hainan, China between December 2020 and July 2021, 123 patients were included. A literature review, group discussions, and two rounds of letter consultations were performed to acquire the item pool and finalise the 12 items for this scale. Exploratory and confirmatory factor analysis, Cronbach's α, split-half reliability, test-retest reliability, content validity, construct validity, convergent and discriminant validity, and criterion-related validity were used to examine the items in the scale. RESULTS A 12-item scale comprising three factors accounted for 85.99% of the variance in the data. The Cronbach's α, split-half reliability, test-retest reliability, and content validity index of the scale were 0.95, 0.89, 0.86, and 0.93, respectively. Comparison with the Chen pelvic floor muscle exercise self-efficacy scale showed high calibration correlation validity (coefficient = 0.89). CONCLUSIONS The training compliance scale developed in this study is a valid and reliable measurement tool to assess pelvic floor muscle training and bladder training compliance in patients with urinary incontinence.
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Affiliation(s)
- Liumei Luo
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, 410008, China
- Department of Scientific Research, Hainan General Hospital, Haikou, 570311, China
| | - Xi Chen
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, 410008, China
| | - Huifang Xie
- Department of Scientific Research, Hainan General Hospital, Haikou, 570311, China
| | - Jiaquan Zhou
- Department of Scientific Research, Hainan General Hospital, Haikou, 570311, China
| | - Li Li
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, 410008, China.
- National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Changsha, 410008, China.
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França DCH, França EL, Sobrevia L, Barbosa AMP, Honorio-França AC, Rudge MVC. Integration of nutrigenomics, melatonin, serotonin and inflammatory cytokines in the pathophysiology of pregnancy-specific urinary incontinence in women with gestational diabetes mellitus. Biochim Biophys Acta Mol Basis Dis 2023; 1869:166737. [PMID: 37146917 DOI: 10.1016/j.bbadis.2023.166737] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/12/2023] [Accepted: 04/27/2023] [Indexed: 05/07/2023]
Abstract
Gestational diabetes mellitus is an important public health problem and has been associated with the development of pregnancy-specific urinary incontinence. The interaction is related to hyperglycemia, and inflammatory and hormonal patterns, which favor functional alterations in different organs and systems. Several genes associated with human diseases have been identified and partially characterized. Most of these genes are known to cause monogenic diseases. However, about 3 % of diseases do not fit the monogenic theory due to the complex interactions between multiple genes and environmental factors, as in chronic metabolic diseases such as diabetes. The nutritional, immunological, and hormonal patterns associated with changes in maternal metabolism may influence and contribute to greater susceptibility to urinary tract disorders. However, early systematic reviews have not yielded consistent findings for these associations. This literature review summarizes important new findings from integrating nutrigenomics, hormones, and cytokines in women with Gestational diabetes mellitus and pregnancy-specific urinary incontinence. Changes in maternal metabolism due to hyperglycemia can generate an inflammatory environment with increased inflammatory cytokines. This environment modulated by inflammation can alter tryptophan uptake through food and thus influence the production of serotonin and melatonin. As these hormones seem to have protective effects against smooth muscle dysfunction and to restore the impaired contractility of the detrusor muscle, it is assumed that these changes may favor the onset of urinary incontinence specific to pregnancy.
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Affiliation(s)
- Danielle Cristina Honorio França
- Department of Gynecology and Obstetrics, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu 18618-687, Brazil.
| | - Eduardo Luzía França
- Institute of Biological and Health Science, Federal University of Mato Grosso (UFMT), Barra do Garças 78605-091, Brazil.
| | - Luis Sobrevia
- Department of Gynecology and Obstetrics, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu 18618-687, Brazil; Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Department of Physiology, Faculty of Pharmacy, Universidad de Sevilla, E-41012 Seville, Spain; Faculty of Medicine and Biomedical Sciences, University of Queensland, Herston, QLD 4029, Australia; Department of Pathology and Medical Biology, University of Groningen, 9713GZ Groningen, the Netherlands; Tecnologico de Monterrey, Eutra, The Institute for Obesity Research (IOR), School of Medicine and Health Sciences, Monterrey 64710, Mexico.
| | - Angélica Mércia Pascon Barbosa
- Department of Gynecology and Obstetrics, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu 18618-687, Brazil; Department of Physiotherapy and Occupational Therapy, School of Philosophy and Sciences, São Paulo State University (UNESP), Marilia 17525-900, Brazil
| | | | - Marilza Vieira Cunha Rudge
- Department of Gynecology and Obstetrics, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu 18618-687, Brazil.
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Wang X, Sun Z, Xu T, Fan G. Efficacy of supervised pelvic floor muscle training with a home-based biofeedback device for urinary incontinence in postpartum women: protocol for a multicentre randomised controlled trial. BMJ Open 2023; 13:e069874. [PMID: 37185188 PMCID: PMC10151990 DOI: 10.1136/bmjopen-2022-069874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION Supervised pelvic floor muscle training (PFMT) of at least 3 months duration has been strongly recommended as a first-line treatment for women with stress urinary incontinence (SUI) or SUI-predominant mixed urinary incontinence (MUI), including elderly and postnatal women. However, for the treatment of SUI and MUI in postpartum women, it is currently uncertain whether supervised PFMT combined with a biofeedback device is superior to PFMT alone. Despite some supportive results, more reliable evidence is lacking. METHODS AND ANALYSIS The study is designed as a multicentre assessor-blinded parallel-group randomised controlled trial comparing the efficacy of PFMT with a home-based pressure-mediated biofeedback device (intervention group) and that of at-home PFMT alone (control group) for women with new-onset SUI or SUI-predominant MUI after delivery. Five hundred eligible women from the obstetric outpatient clinics of five tertiary hospitals will be randomly allocated (1:1) and evaluated with repeated questionnaires, physical examinations and pelvic floor assessments at baseline (pretest), 3 months, 6 months and 12 months (postintervention) during the study period. Both groups will be instructed to follow the same training protocol under 3-month supervision after randomisation. The use of a biofeedback device with a self-assessment function will be added to the PFMT regime for patients in the intervention group. The primary outcome is the self-reported severity of urinary incontinence assessed through the short form of the International Consultation on Incontinence Questionnaire-Urinary Incontinence. Secondary outcomes include pelvic muscle support and strength, symptoms of pelvic organ prolapse, quality of life, sexual function, self-efficacy and adherence. ETHICS AND DISSEMINATION Ethical approval has been received from the Peking Union Medical College Hospital ethics committee (JS-3192D). All results from the study will be submitted to international journals and international conferences. TRIAL REGISTRATION NUMBER NCT05115864.
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Affiliation(s)
- Xiuqi Wang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Zhijing Sun
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Tao Xu
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Guorong Fan
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
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Tanaka JRV, Sousa KHJF, Alves PJP, Guerra MJJ, Gonçalves PDB. Educational Technology on Urinary Incontinence during Pregnancy: Development and Validation of an Online Course for the Brazilian Population. AQUICHAN 2023. [DOI: 10.5294/aqui.2023.23.1.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
Objective: To describe the development and validation process of an online course on urinary incontinence during pregnancy in Brazil. Materials and methods: This methodological study followed an online course’s literature search, development, and validation steps. A total of 22 specialists participated in the validation step, and the content validity index (CVI) was used. Fifty-one Physical Therapy students (target audience) also participated in the Suitability Assessment of Materials. Results: The synthesis reached in the integrative review provided the basis for the course’s theoretical content, which was regarded as suitable by the specialists regarding its content, language, presentation, stimulation/motivation, and cultural adequacy (CVI = 0.99). The target audience considered the course organized, easily understandable, engaging, and motivational, with a positive response index ranging from 84.3 % to 100 %. Conclusions: The Brazilian version of the online course was considered sufficiently adequate in content and interface quality by both specialists and the target audience.
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Establishment and validation of a risk prediction model for postpartum stress urinary incontinence based on pelvic floor ultrasound and clinical data. Int Urogynecol J 2022; 33:3491-3497. [PMID: 36278986 PMCID: PMC9666322 DOI: 10.1007/s00192-022-05395-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/06/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This study aimed to establish a risk prediction model for postpartum stress urinary incontinence (SUI) based on pelvic floor ultrasound measurement data and certain clinical data. METHODS Singleton pregnant women aged ≥ 18 years who underwent delivery were selected. All participants were followed up to determine the symptoms of SUI, and pregnancy-related data were collected at the time of registration. Pelvic floor ultrasound was performed at 6-12 weeks postpartum to obtain ultrasonic measurement data. Logistic regression analysis was used to select predictors and establish a nomogram to predict the risk of postpartum SUI. Area under the ROC curve (AUC) values and calibration curves were used for discrimination and calibration, respectively. Finally, external verification of the model was carried out. RESULTS A total of 255 participants were included in the analysis, comprising 105 in the postpartum SUI group and 150 in the non-SUI group. Logistic regression analysis identified age, parity, vaginal delivery, bladder neck descent (BND), and angle of internal urethral orifice funnel as risk factors for postpartum SUI (all P < 0.05). CONCLUSIONS We constructed a prediction model for postpartum SUI based on pelvic floor ultrasound measurement data and certain clinical data. In clinical practice, this convenient and reliable tool can provide a basis for formulation of treatment strategies for patients with postpartum SUI.
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Błudnicka M, Piernicka M, Kortas J, Bojar D, Duda-Biernacka B, Szumilewicz A. The influence of one-time biofeedback electromyography session on the firing order in the pelvic floor muscle contraction in pregnant woman–A randomized controlled trial. Front Hum Neurosci 2022; 16:944792. [PMID: 36248694 PMCID: PMC9559232 DOI: 10.3389/fnhum.2022.944792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 09/12/2022] [Indexed: 11/15/2022] Open
Abstract
Many women are initially unable to contract the pelvic floor muscles (PFMs) properly, activating other muscle groups before, or instead of, PFM. Numerous authors have proved that biofeedback can be an ideal tool supporting learning of the PFM contraction. However, there is currently a lack of scientific data on how many biofeedback sessions are necessary in this educational process. In this study we aimed at assessing the effects of one-time electromyography (EMG) biofeedback session on the order in which PFM are activated (so called firing order) during conscious contractions in relation to selected synergistic muscles in pregnant, continent women. A randomized controlled trial was conducted in 90 healthy nulliparous women with uncomplicated pregnancies and without diagnosed urinary incontinence. We divided the participants into a biofeedback group (50) and a control group (40). They were, respectively: 30 ± 4 and 30 ± 4 years old, at their 23 ± 5 or 25 ± 7 week of gestation and presented 23 ± 5 or 24 ± 5 kg/m2 BMI value (M + SD). Surface EMG with vaginal probes has been used to assess the PFM firing order in selected tasks: in five 3-s maximal contractions (quick flicks), five 10-s contractions, and in a 60-s contraction (static hold). We used the 1–5 scale, where “1” meant the best score, awarded when PFM was activated first in order. The most important finding of our study is that a single EMG biofeedback substantially improved the PFM contractions in pregnant women. First, when applying one-time biofeedback session, more women maintained correct technique or improved it in the second assessment, compared to the control group (73 vs. 65%). Secondly, using the quantitative and qualitative analysis with the Chi-square McNamara B/C test, in the biofeedback group we observed a statistically significant improvement of PFM firing order in four tasks: in the first quick flicks (p = 0.016), third quick flicks (p = 0.027), fifth quick flicks (p = 0.008), and in the first 10-s contractions (p = 0.046). In the control group we observed better outcome only in one motor task: in the fourth 10-s contraction (p = 0.009). Given the positive effects of a single session of EMG biofeedback on the firing order in the PFM contractions, it should be recommended for pregnant women without urinary incontinence to teach them how to perform PFM exercises correctly.
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Affiliation(s)
- Monika Błudnicka
- Department of Clinical Physiotherapy and Professional Practices, Gdansk University of Physical Education and Sport, Gdańsk, Poland
- *Correspondence: Monika Błudnicka, ;
| | - Magdalena Piernicka
- Department of Sport, Gdansk University of Physical Education and Sport, Gdańsk, Poland
| | - Jakub Kortas
- Department of Health and Life Sciences, Gdansk University of Physical Education and Sport, Gdańsk, Poland
| | - Damian Bojar
- Department of Sport, Gdansk University of Physical Education and Sport, Gdańsk, Poland
| | - Barbara Duda-Biernacka
- Department of Health and Life Sciences, Gdansk University of Physical Education and Sport, Gdańsk, Poland
| | - Anna Szumilewicz
- Department of Sport, Gdansk University of Physical Education and Sport, Gdańsk, Poland
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Löjdahl E, Lindam A, Asklund I. App‐based pelvic floor muscle training in pregnant and postnatal women: A prospective cohort study exploring factors associated with prevention and improvement of urinary incontinence. Health Sci Rep 2022; 5:e781. [PMID: 36000079 PMCID: PMC9387900 DOI: 10.1002/hsr2.781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/02/2022] [Accepted: 06/30/2022] [Indexed: 12/03/2022] Open
Abstract
Background and Aims Pelvic floor muscle training (PFMT) is recommended for continent pregnant women and postnatal women experiencing urinary incontinence (UI). The app Tät® has been developed for the treatment of stress UI with a focus on PFMT. The aim of this study was to investigate factors associated with the improvement of incontinence symptoms and retained continence in pregnant and postnatal women who used the app. Methods A prospective cohort study was carried out based on user questionnaires from the app Tät®. We included pregnant and postnatal women who answered the inclusion questionnaire between June 19, 2019 and September 19, 2020. The questionnaire included questions about the frequency and amount of leakage, the impact that UI has on everyday life, and experienced improvements at follow‐up. We analyzed factors associated with improvement and retained continence using logistic regression. Results We included 10,307 pregnant and 13,670 postnatal women, and 44% of the pregnant women and 52% of the postnatal women were incontinent. A total of 3680 women were included in the follow‐up analysis, and 52% of the pregnant incontinent women and 73% of the postnatal incontinent women experienced improvement. Pregnant women who performed PFMT and used the app at least once per week had increased odds of improvement (odds ratio [OR]: 1.83, 95% confidence interval [CI]: 1.01–3.29 and OR: 3.38, 95% CI: 1.94–5.90, respectively) compared to those who performed no training and had no app usage. Postnatal women who used the app at least once per week and had more severe incontinence had increased odds of improvement (OR: 4.26, 95% CI: 2.37–7.64 and OR: 1.11, 95% CI: 1.05–1.16, respectively). Conclusions The app Tät® is widely used by pregnant and postnatal women in Sweden for the prevention and treatment of UI. Majority of the women with incontinence experienced improvement after using the app. Regular PFMT and app use seemed to be important factors for experiencing improvement.
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Affiliation(s)
- Erika Löjdahl
- Department of Public Health and Clinical Medicine Umeå University Umeå Sweden
| | - Anna Lindam
- Department of Public Health and Clinical Medicine, Unit of Research, Education and Development, Östersund Hospital Umeå University Umeå Sweden
| | - Ina Asklund
- Department of Public Health and Clinical Medicine Umeå University Umeå Sweden
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Schütze S, Heinloth M, Uhde M, Schütze J, Hüner B, Janni W, Deniz M. The effect of pelvic floor muscle training on pelvic floor function and sexuality postpartum. A randomized study including 300 primiparous. Arch Gynecol Obstet 2022; 306:785-793. [PMID: 35377043 PMCID: PMC8977567 DOI: 10.1007/s00404-022-06542-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/16/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE Although pregnancy and childbirth are physiological processes they may be associated with pelvic floor disorders. The aim of this study was to evaluate the influence of pelvic floor muscle training on postpartum pelvic floor and sexual function of primiparous. METHODS This is a randomized prospective study including 300 primiparous women. Due to the dropout 200 women were analyzed. Inclusion criteria were the delivery of the first, mature baby, the ability to speak and understand German. The participants were evaluated by clinical examinations and questionnaires after 6 and 12 months postpartum. After 6 months, the women were randomized in two groups. Compared to the control group the intervention groups participated in 45-min pelvic floor muscle training and pelvic floor perception once a week over 6 weeks. RESULTS The results of the questionnaires showed no significant differences between the groups after 12 months. A significant stronger pelvic floor muscle strength was found for the intervention group after 12 months. The improvement of the pelvic floor and sexual function over the time showed a significant improvement in both groups. CONCLUSION Supervised pelvic floor muscle training did not improve both the pelvic floor and the female sexual function in comparison to the control group. After 12 months, the pelvic floor and sexual function improved significant in all women. TRIAL REGISTRATION German Clinical Trials Register (DRKS00024725), retrospectively registrated.
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Affiliation(s)
- Sabine Schütze
- Department of Obstetrics and Gynecology, University Hospital of Ulm, Prittwitzstr. 43, 89075, Ulm, Germany.
| | - Marlen Heinloth
- Department of Obstetrics and Gynecology, University Hospital of Ulm, Prittwitzstr. 43, 89075, Ulm, Germany
| | - Miriam Uhde
- Department of Obstetrics and Gynecology, University Hospital of Ulm, Prittwitzstr. 43, 89075, Ulm, Germany
| | - Juliane Schütze
- Department of Basic Science, University of Applied Sciences Jena, Jena, Germany
| | - Beate Hüner
- Department of Obstetrics and Gynecology, University Hospital of Ulm, Prittwitzstr. 43, 89075, Ulm, Germany
| | - Wolfgang Janni
- Department of Obstetrics and Gynecology, University Hospital of Ulm, Prittwitzstr. 43, 89075, Ulm, Germany
| | - Miriam Deniz
- Department of Obstetrics and Gynecology, University Hospital of Ulm, Prittwitzstr. 43, 89075, Ulm, Germany
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Pelvic Floor Muscle Strength in the First Trimester of Primipara: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063568. [PMID: 35329251 PMCID: PMC8954683 DOI: 10.3390/ijerph19063568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/09/2022] [Accepted: 03/14/2022] [Indexed: 01/20/2023]
Abstract
Background: Pelvic floor muscle (PFM) weakness is associated with stress urinary incontinence. Pregnancy is an important risk factor for PFM weakness. Studies evaluating PFM strength in the first trimester of pregnancy are still lacking. Our study aimed to describe pelvic floor function of the primipara in the first trimester of gestation and investigate the risk factors for PFM weakness. Methods: Primiparas aged 20~40 years with a singleton pregnancy less than 14 weeks of gestation were recruited, and data were collected via questionnaires on items that were suggested as associated with PFM weakness, followed by Modified Oxford Scale (MOS) on genital hiatus and perineal body and pelvic floor ultrasound evaluation for the thickness of the left and right levator ani muscles (LAM), right−left diameter of the levator hiatus (LH), and LH area. Participants were divided into three groups by MOS >3, =3, and <3 for data analysis. Results: A total of 380 participants completed the questionnaires and examinational analysis, of whom, 228, 98, and 54 were divided into Group 1, Group 2, and Group 3, respectively. The three groups were significantly different in the number of gestations and abortions, toilet types, and the right−left diameter of the LH (p < 0.05). Logistic regressive analysis showed that squatting toilet dominant (OR = 3.025; 95% CI: 1.623~5.638; p < 0.001) and a larger right−left diameter of the LH (OR = 1.065; 95% CI: 1.026~1.105; p = 0.001) were significantly associated with PFM weakness. Conclusions: Squatting toilet dominancy and longer right−left diameter of the LH are significantly associated with PFM weakness in primiparas in the first trimester. Sitting toilets should be recommended to women, especially pregnant women. Trial registration: The trial has been registered at Chinese Clinical Trial Registry (registration number: ChiCTR2000029618).
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Effect of the App-Based Video Guidance on Prenatal Pelvic Floor Muscle Training Combined with Global Postural Re-education for Stress Urinary Incontinence Prevention: A Protocol for a Multicenter, Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182412929. [PMID: 34948546 PMCID: PMC8700899 DOI: 10.3390/ijerph182412929] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/15/2021] [Accepted: 12/01/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND As the effectiveness on stress urinary incontinence (SUI) prevention of pelvic floor muscle training (PFMT) for pregnant women has been inconclusive, we are planning to conduct a trial to evaluate a video program designed for prevention of SUI developed through combining PFMT with global postural reeducation (GPR). METHODS As a randomized controlled trial, eligible participants will be randomized (1:1) into an exercise group and a control group to perform PFMT regularly following video guidance or with no intervention, respectively. The experimental stage will be from the 16th gestation week (GW) to the 12th month postpartum, with eight appointments at the 16th, 28th, 37th GW, delivery, the 6th week and the 3rd, 6th, and 12th month postpartum. Data will be collected regarding urinary leakage symptoms, the stress test, the modified Oxford Scale, pelvic floor ultrasound, perineal laceration classification at delivery, neonatal Apgar score, and questionnaires (PISQ-12, ICIQ-UI SF, I-QOL, OABSS). The primary outcome is the occurrence of the symptomatic SUI and positive stress test at the 6th week postpartum. DISCUSSION This protocol is anticipated to evaluate the efficacy of the intervention via video app for the design of a future randomized control trial (RCT). TRIAL REGISTRATION The trial has been registered at Chinese Clinical Trial Registry (registration number: ChiCTR2000029618).
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17
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Rajavuori A, Repo JP, Häkkinen A, Palonen P, Multanen J, Aukee P. Maternal risk factors of urinary incontinence during pregnancy and postpartum: A prospective cohort study. Eur J Obstet Gynecol Reprod Biol X 2021; 13:100138. [PMID: 34825175 PMCID: PMC8605044 DOI: 10.1016/j.eurox.2021.100138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/30/2021] [Accepted: 11/04/2021] [Indexed: 11/18/2022] Open
Abstract
Urinary incontinence after delivery affects every fifth woman. Urinary incontinence before pregnancy is a risk factor of postpartum incontinence. Primiparous women are at a greater risk of urinary incontinence after birth.
Introduction Urinary incontinence (UI) during pregnancy is a common health problem. Vaginal delivery in particular affects the pelvic floor and increases the risk of pelvic floor dysfunctions. This prospective cohort study was conducted to investigate the incidence of UI during pregnancy and three months postpartum and determine the risk factors underlying UI. Methods In total, 547 volunteer women were recruited from the maternity clinic of a tertiary hospital. The participants filled out a questionnaire twice, one in the second trimester and the other three months after delivery. A multivariate logistic regression model with forward stepwise selection was used to analyze known risk factors for UI. Results The prevalence of UI during pregnancy was 39.5% and three months after childbirth 16.1%. Twenty-two percent of participants had pre-existing UI compared to 41.0% of the 88 women with UI three months postpartum. UI before pregnancy (OR 2.2), during pregnancy (OR 3.8) and primiparity (OR 2.3) were significantly associated with postpartum UI. Conclusions Women with UI before or during pregnancy and who are primiparous are at increased risk for postpartum UI. To prevent and reduce the risk factors contributing to UI, pregnant women should be routinely counseled.
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Affiliation(s)
- Anna Rajavuori
- Department of Obstetrics and Gynecology, Turku University Hospital, PL 52, 20521 Turku, Finland
- Correspondence to: TYKS Obstetrics and Gynecology, PL 52, 20521 Turku, Finland.
| | - Jussi P. Repo
- Department of Orthopedics and Traumatology, Tampere University Hospital, PL 2000, 33521 Tampere, Finland
| | - Arja Häkkinen
- Faculty of Sport and Health Sciences, University of Jyväskylä, PL 35, FI-40014 Jyväskylän yliopisto, Finland
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Hoitajantie 3, 40620 Jyväskylä, Finland
| | - Pirkko Palonen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Hoitajantie 3, 40620 Jyväskylä, Finland
| | - Juhani Multanen
- Faculty of Sport and Health Sciences, University of Jyväskylä, PL 35, FI-40014 Jyväskylän yliopisto, Finland
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Hoitajantie 3, 40620 Jyväskylä, Finland
| | - Pauliina Aukee
- Department of Obstetrics and Gynecology and Pelvic Floor Research and Therapy Unit, Central Finland Health Care Center, Hoitajantie 3, 40620 Jyväskylä, Finland
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18
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Śnieżek A, Czechowska D, Curyło M, Głodzik J, Szymanowski P, Rojek A, Marchewka A. Physiotherapy according to the BeBo Concept as prophylaxis and treatment of urinary incontinence in women after natural childbirth. Sci Rep 2021; 11:18096. [PMID: 34508116 PMCID: PMC8433362 DOI: 10.1038/s41598-021-96550-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 08/09/2021] [Indexed: 11/09/2022] Open
Abstract
Pelvic floor muscle dysfunctions can lead to urinary incontinence, a condition which often affects women both during pregnancy and after childbirth. As a result of this, certain exercises are recommended during and after pregnancy to prevent and treat this incontinence, and the BeBo Concept is one of these methods used to prevent pelvic floor muscle dysfunction. The aim of the present study was to evaluate the effects of a 6-week course of physical therapy according to the BeBo Concept on the improvement of perineal muscle strength and endurance as well as urinary continence in women after their first vaginal delivery. The study was conducted on a group of 56 women who were randomly assigned to the exercise (n = 30) or control (n = 26) group. The exercising group participated in a 6-week physical therapy program according to the BeBo Concept. Pelvic floor muscles were assessed using the perineometer and palpation Perfect Test. UDI6 and ICIQ-SF questionnaires were used to obtain information about the symptoms of urinary incontinence, evaluate the frequency, severity and impact of urine leakage on the quality of life. In all women after natural childbirth, regardless of treatment, it was observed that measured parameters improved, but the improvement was slightly more explicit in those who participated in the Bebo Concept exercise group (e.g. ICIQ-SF exercise group p = 0.001, control group p = 0.035). Due to its positive impact on the pelvic floor, this exercise program should be recommended to women after natural childbirth.
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Affiliation(s)
- Aneta Śnieżek
- Department of Clinical Rehabilitation, University of Physical Education in Krakow, Krakow, Poland.
| | - Dorota Czechowska
- Department of Clinical Rehabilitation, University of Physical Education in Krakow, Krakow, Poland
| | - Marta Curyło
- Department of Clinical Rehabilitation, University of Physical Education in Krakow, Krakow, Poland
| | - Jacek Głodzik
- Department of Physical Medicine and Biological Recovery, University of Physical Education in Krakow, Krakow, Poland
| | - Paweł Szymanowski
- Department of Gynecology and Obstetrics, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
| | - Anna Rojek
- Gabinet Fizjoterapii ReSport, Tarnów, Poland
| | - Anna Marchewka
- Department of Clinical Rehabilitation, University of Physical Education in Krakow, Krakow, Poland
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19
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Effects of a One-Time Biofeedback EMG Session on Neuromuscular Activity of the Pelvic Floor Muscles in Pregnant Women. NEUROPHYSIOLOGY+ 2021. [DOI: 10.1007/s11062-021-09902-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Wang X, Yang F, Chen W, Yuan X. Ultrasonic Diagnosis and Analysis of the Effect of Labor Analgesia on Early Pelvic Floor Function and Pelvic Floor Dysfunction. JOURNAL OF MEDICAL IMAGING AND HEALTH INFORMATICS 2021. [DOI: 10.1166/jmihi.2021.3585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Pelvic floor dysfunction disease (PFD) is a common pelvic organ dysfunction disease in the clinic of obstetrics and gynecology. Its cause is mainly the damage, defects and dysfunction of the pelvic floor support structure. Not only is the pathogenesis complicated, but also various symptoms
coexist, which seriously affects the physical and mental health of female patients. Mechanical injury of the pelvic floor fascia tissue and levator ani muscles is the anatomical basis of PFD after birth; early postpartum pelvic floor examination and treatment can prevent and control the occurrence
or development of PFD. Spinal canal anesthesia has good analgesic effect during labor and delivery, has little effect on mothers and infants, and is widely used. However, there are few domestic and foreign reports on the effect of labor analgesia on the pelvic floor. Labor analgesia relaxes
the pelvic floor muscles, unblocks the birth canal, and the influence on the pelvic floor muscles is worth exploring. Based on the pelvic floor muscle strength screening to understand the changes in the function of the pelvic floor muscles, combined with the three-dimensional pelvic floor
ultrasound examination, the pelvic floor structure and the levator ani muscle are clearly imaged, and the pelvic floor muscle structure is evaluated in the natural state and the analgesic muscle relaxation state. This study used a combination of the two to evaluate the effect of labor analgesia
on pelvic floor function of primiparous women; provide individualized intervention treatment for high-risk groups screened; provide clinical basis for the prevention and treatment of PFD.
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Affiliation(s)
- Xiaolan Wang
- Department of Obstetrics, Maternal and Children's Health Care Hospital, Jiujiang, Jiangxi, 332000, China
| | - Fan Yang
- Department of Obstetrics, Maternal and Children's Health Care Hospital, Jiujiang, Jiangxi, 332000, China
| | - Wenjuan Chen
- Department of Ultrasound, Maternal and Children's Health Care Hospital, Jiujiang, Jiangxi, 332000, China
| | - Xiaohong Yuan
- Department of Pelvic Floor Rehabilitation, Maternal and Children's Health Care Hospital, Jiujiang, Jiangxi, 332000, China
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21
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Gao J, Liu X, Zuo Y, Li X. Risk factors of postpartum stress urinary incontinence in primiparas: What should we care. Medicine (Baltimore) 2021; 100:e25796. [PMID: 34011042 PMCID: PMC8137028 DOI: 10.1097/md.0000000000025796] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/14/2021] [Indexed: 01/05/2023] Open
Abstract
Stress urinary incontinence (SUI) is a common clinical postpartum complication. It is necessary to explore the risk factors of postpartum SUI in primiparas to provide evidence support for preventing and reducing the occurrence of SUI.Primiparas who were delivered in our hospital from March 2019 to October 2020 were identified, the personal information and related treatment details of SUI and no-SUI primiparas were collected and analyzed. Logistic regression analyses were conducted to identify the risk factors of postpartum SUI in primiparas.A total of 612 primiparas were included, the incidence of SUI in primiparas was 32.03%. There were significant differences in the body mass index (BMI) before pregnancy, diabetes, abortion, delivery method, newborn's weight, epidural anesthesia, and duration of second stage of labor (all P < .05) between SUI and no-SUI group, and there were no significant differences in the age, BMI at admission, hypertension and hyperlipidemia SUI and no-SUI group (all P > .05). Logistic regression analyses indicated that BMI before pregnancy ≥24 kg/m2 (odds ratio [OR]: 2.109, 95% confidence interval [CI]: 1.042-4.394), diabetes (OR: 2.250, 95% CI: 1.891-3.544), abortion history (OR: 3.909, 95% CI: 1.187-5.739), vaginal delivery (OR: 2.262, 95% CI: 1.042-4.011), newborn's weight ≥3 kg (OR: 1.613, 95% CI: 1.095-2.316), epidural anesthesia (OR: 2.015, 95% CI: 1.226-3.372), and duration of second stage of labor ≥90 minutes (OR: 1.726, 95% CI: 1.084-2.147) were the risk factors of postpartum SUI in primiparas (all P < .05).The clinical incidence of SUI in primiparas is relatively high. In clinical practice, medical staff should conduct individualized early screening for those risk factors, and take prevention measures to reduce the occurrence of SUI.
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22
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Chen Z, Wang X, Jin Y, Feng S. Knowledge, attitude and practice of pelvic floor dysfunction among obstetrical healthcare workers in China: A cross-sectional study. J Gynecol Obstet Hum Reprod 2021; 50:102068. [PMID: 33484932 DOI: 10.1016/j.jogoh.2021.102068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 01/02/2021] [Accepted: 01/14/2021] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Many women experience pelvic floor dysfunction (PFD) during the perinatal period. Knowledge of PFD among women is poor, which may reflect inadequate provision of information by healthcare workers. The aim of this study was to explore obstetrical healthcare workers' knowledge, attitude, and practice regarding PFD. MATERIAL AND METHODS This study had a cross-sectional design. We developed a 65-question survey to explore obstetrical healthcare workers' knowledge, attitude, and practice regarding PFD. An electronic version of the questionnaire was distributed to healthcare workers from 31 provinces in the People's Republic of China by convenience sampling in July and August 2019. This research complied with the guidelines of the Strengthening of the Reporting of Observational Studies in Epidemiology checklist. RESULTS In total, 1545 valid questionnaires were collected. The mean scores for the knowledge, attitude, and practice of obstetrical healthcare workers were 23.67 ± 4.70 out of 30, 31.91 ± 6.68 out of 40, and 47.88 ± 9.17 out of 65, respectively. Approximately 50 % of the respondents reported providing practical pelvic floor muscle training (PFMT) guidance and evaluation of its correct performance only "sometimes" or even "never". Nearly 30 % of respondents denied asking patients about PFD-related symptoms. Respondents' PFD-related practice were affected not only by their knowledge and attitude but also by their age, treatment or nursing experience of PFD, own PFD history and that of relatives or friends, and the PFD-related departmental setup of their hospital (P < 0.001). CONCLUSION Most obstetrical healthcare workers have knowledge of PFD and hold a positive attitude but fail to routinely provide PFD counseling and mentoring to patients. Many factors affect the respondents' PFD-related practice.
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Affiliation(s)
- Zhengfei Chen
- Zhejiang University School of Medicine Women's Hospital, No.1 Xueshi Road, Hangzhou 310006, Zhejiang Province, China.
| | - Xiaojuan Wang
- Zhejiang University School of Medicine Women's Hospital, No.1 Xueshi Road, Hangzhou 310006, Zhejiang Province, China.
| | - Ying Jin
- Zhejiang University School of Medicine Women's Hospital, No.1 Xueshi Road, Hangzhou 310006, Zhejiang Province, China.
| | - Suwen Feng
- Zhejiang University School of Medicine Women's Hospital, No.1 Xueshi Road, Hangzhou 310006, Zhejiang Province, China.
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Wang S, Wang R, Wen H, Gao Y, Lv Q, Li H, Wang S, Wang Y, Liu Q, Han J, Wang H, Li Y, Wang Q, Cao T, Wang S, Sun H, Wang Z, Sun X, Wang J. Association of pelvic floor function with postoperative urinary incontinence in cervical cancer patients after the radical hysterectomy. Neurourol Urodyn 2020; 40:483-492. [PMID: 33305849 DOI: 10.1002/nau.24587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 11/10/2020] [Accepted: 11/14/2020] [Indexed: 12/21/2022]
Abstract
AIMS To assess the pelvic floor function in cervical cancer patients after radical hysterectomy and its relationship with urinary incontinence (UI). METHODS Cervical cancer patients who underwent radical hysterectomy were recruited from 18 hospitals in China from January 2012 to March 2015. Pelvic floor examinations were conducted by measuring the pelvic floor muscle strength, fatigue of pelvic floor muscle fatigue, dynamic pressure of vaginal, nerve injury, A3 feedback, muscle potential, static tension, and dynamic tension. Postoperative urinary incontinence (UI) was identified using the International Consultation on Incontinence Questionnaire. Multivariable logistic regression analysis was used to assess the association of pelvic floor function examination results with postoperative UI. RESULTS Totally 169 patients were included in this study. The prevalence of UI was 39.6% (67/169). The proportion of abnormal fatigue of Type I muscle (64% vs. 36%, p = .04) and abnormal A3 feedback (53.9% vs. 46.1%, p = .03) were higher among patients with postoperative UI compared to those without UI. In the multivariable analysis, abnormal fatigue of Type I muscle (odds ratio [OR] = 3.73, 95% confidence interval [CI]: 1.42-9.84), abnormal A3 feedback (OR = 2.40, 95% CI: 1.04-5.51), and length of resected vagina > 3 cm (OR = 3.44, 95% CI: 1.27-9.31) were associated with postoperative UI. Compared to laparoscopy, laparotomy was less likely to cause postoperative UI (OR = 0.12, 95% CI:0.04-0.33). CONCLUSIONS The abnormal function of the pelvic floor muscle is related to postoperative UI. Early assessment among these patients is needed to prevent the development of pelvic floor disorder postoperatively.
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Affiliation(s)
- Shiyan Wang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China.,Beijing Key Laboratory of Female Pelvic Floor Disorders, Beijing, China
| | - Runzhi Wang
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hongwu Wen
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Yunong Gao
- Department of Gynecology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Qiubo Lv
- Department of Obstetrics and Gynecology, Beijing Hospital, Beijing, China
| | - Hongyu Li
- Department of Obstetrics and Gynecology, Zhengzhou University Third Hospital, Zhengzhou, China
| | - Sumei Wang
- Department of Obstetrics and Gynecology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yanlong Wang
- Department of Obstetrics and Gynecology, Women and Children Health Hospital of Xiamen, Xiamen, China
| | - Qing Liu
- Department of Obstetrics and Gynecology, Women and Children Health Hospital of Gansu, Lanzhou, China
| | - Jinsong Han
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Haibo Wang
- Peking University Clinical Research Institute, Peking University Medical Department, Beijing, China
| | - Yi Li
- Medical Informatics Center, Peking University Medical Department, Beijing, China
| | - Qing Wang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China.,Beijing Key Laboratory of Female Pelvic Floor Disorders, Beijing, China
| | - Tingting Cao
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China.,Beijing Key Laboratory of Female Pelvic Floor Disorders, Beijing, China
| | - Sha Wang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China.,Beijing Key Laboratory of Female Pelvic Floor Disorders, Beijing, China
| | - Huaxin Sun
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China.,Beijing Key Laboratory of Female Pelvic Floor Disorders, Beijing, China
| | - Zhiqi Wang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China.,Beijing Key Laboratory of Female Pelvic Floor Disorders, Beijing, China
| | - Xiuli Sun
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China.,Beijing Key Laboratory of Female Pelvic Floor Disorders, Beijing, China
| | - Jianliu Wang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China.,Beijing Key Laboratory of Female Pelvic Floor Disorders, Beijing, China
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Abstract
Objective: The aim is to verify the effectiveness of the pelvic floor muscle training (PFMT) program in pregnant women, by analyzing the amount of urine leakage. Design: Experimental study. Location: Care units in the Vila Real district, Portugal. Participants: Forty-three pregnant women divided into an experimental group (EG) (n = 22) and a control group (CG) (n = 21). Interventions: Both groups were evaluated in a predelivery stage (initial) and 6 months after delivery (final). The EG was given a PFMT exercise protocol with a duration of 6 weeks, applicable in classes and at home, another PFMT protocol for 9 weeks. Main measurements: The strength of the pelvic floor muscle was measured by the Oxford Grading Scale and the amount of urine was assessed with a Pad test. Quality of life was measured by the King's Health Questionnaire and self-efficacy by the Broome Pelvic Muscle Self-Efficacy Scale. Results: The loss of urine, significantly reduced from 0.86 ± 0.83 to 0.50 ± 0.67 in the EG (P = .021), whereas in the CG no significant change was observed. The degree of muscle contraction increased by 4.82 ± 0.39 in EG and 3.95 ± 0.67 in CG. The quality of life observed significant improvements in both groups (P < .05). As for self-efficacy, for the EG it improved significantly – initial (P = .001), final (P = .031), and for the CG the values remained the same. Conclusions: This PFMT protocol reduced urinary incontinence in pregnant women. The program allowed significant improvement in the quantity of urinary leakage and an increase in the strength of the pelvic floor muscle.
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Jaffar A, Mohd-Sidik S, Nien FC, Fu GQ, Talib NH. Urinary incontinence and its association with pelvic floor muscle exercise among pregnant women attending a primary care clinic in Selangor, Malaysia. PLoS One 2020; 15:e0236140. [PMID: 32667936 PMCID: PMC7363082 DOI: 10.1371/journal.pone.0236140] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/29/2020] [Indexed: 12/02/2022] Open
Abstract
Background Urinary Incontinence (UI) is when a person is unable to hold his/her urine effectively. This is a common problem which can develop and worsen during pregnancy. An effective way to manage UI is to educate patients on the Pelvic Floor Muscle Exercise (PFME) regularly. The present study aimed to ascertain the pregnant women’s knowledge, attitudes, and practices (KAP) related to PFME. Methods This was a cross-sectional study done in a one primary care clinic located in a semi-urban area in Selangor, Malaysia. Simple random sampling was conducted among pregnant women aged 18 years old and above at any gestation. The validated study instruments used consisted of questions on socio-demography, KAP on UI, and also the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form to determine UI among the respondents. Results The response rate for this study was 72.1%, where 440 pregnant women consented to take part in the study. The median age of study respondents was 30 years old and majority of the study respondents was from the Malay ethnicity (80.9%). The prevalence of UI was 40.9%. The proportion of pregnant women with good knowledge, attitude and practice scores were 58.0%, 46.6% and 45.2% respectively. There was a significant association between UI and age (p = .03), body mass index (p = .03), ethnicity (p = .04), gravida. (p = .001), knowledge on PFME (p = .007) and attitude towards PFME (p = .006). Conclusions Findings from this study fill a gap in the prevalence and KAP concerning PFME at the primary care level. The foundation areas for future education and health promotion on UI should address the importance of correct PFME. This education can be delivered through a pragmatic way to ensure its effectiveness and sustainability of the health promotion program.
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Affiliation(s)
- Aida Jaffar
- Primary Care Unit, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia, Sg Besi, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Sherina Mohd-Sidik
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM Serdang, Selangor, Malaysia
- * E-mail:
| | - Foo Chai Nien
- Department of Population Medicine, Universiti Tunku Abdul Rahman, Kajang, Selangor, Malaysia
| | - Gan Quan Fu
- Pre-clinical Department, Universiti Tunku Abdul Rahman, Kajang, Selangor, Malaysia
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Chen L, Chen X, Luo D, Jin M, Hu Y, Cai W. Performance of self-reported and unsupervised antenatal pelvic floor muscle training and its effects on postpartum stress urinary incontinence among Chinese women: a cohort study. J Int Med Res 2020; 48:300060520914226. [PMID: 32496162 PMCID: PMC7273567 DOI: 10.1177/0300060520914226] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 02/27/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES We investigated performance of antenatal pelvic floor muscle training (PFMT) among Chinese pregnant women, to explore its effects on postpartum stress urinary incontinence (SUI). METHODS We conducted a prospective cohort study in Shenzhen, China among 815 singleton pregnant women age ≥18 years, who were continent before pregnancy. Telephone follow-up was conducted at 6 weeks postpartum. Logistic univariable and multivariable regression analyses were used to estimate effects of antenatal PFMT (frequency and duration) on SUI postpartum among subgroups defined by SUI during pregnancy. The interactions of antenatal PFMT and PFMT duration on SUI postpartum were tested. RESULTS Among 798 women included in the analysis, 127 (15.91%) had SUI at 6 weeks postpartum. Only 157 (19.67%) women performed antenatal PFMT, none under supervision. After adjusting potential confounders, neither frequency (odds ratio (OR) = 1.08, 95% confidence interval (CI) 0.89-1.32) nor duration (OR = 1.03, 95% CI 0.87-1.23) of antenatal PFMT was a significant factor in postpartum SUI. No interactions of antenatal PFMT and PFMT duration on SUI postpartum were found in any participants or subgroups. CONCLUSION No effect of self-reported, unsupervised, self-initiated antenatal PFMT on SUI 6 weeks postpartum was found. Low doses and no supervision may have contributed to the negative results.
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Affiliation(s)
| | | | - Dan Luo
- Nursing Department, Shenzhen Hospital, Southern
Medical University, Shenzhen, Guangdong, China
| | - Mei Jin
- Nursing Department, Shenzhen Hospital, Southern
Medical University, Shenzhen, Guangdong, China
| | - Yingjie Hu
- Nursing Department, Shenzhen Hospital, Southern
Medical University, Shenzhen, Guangdong, China
| | - Wenzhi Cai
- Nursing Department, Shenzhen Hospital, Southern
Medical University, Shenzhen, Guangdong, China
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Takaoka S, Kobayashi Y, Taniguchi T. Effect of pelvic floor muscle training program in reducing postpartum levator hiatus area in Japanese women: A prospective cohort study using three-dimensional ultrasonography. Jpn J Nurs Sci 2020; 17:e12346. [PMID: 32391650 DOI: 10.1111/jjns.12346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 02/10/2020] [Accepted: 03/28/2020] [Indexed: 11/30/2022]
Abstract
AIM To assess the effect of a pelvic floor muscle training (PFMT) program on postpartum levator hiatus area. METHODS A prospective cohort study was conducted at a clinic in Japan. Training and control groups were recruited from outpatient pregnant women at two separate time periods. Only the training group underwent the PFMT program, including education for home PFMT, home PFMT, and follow-up instructions. Education for home PFMT was held by 1 month postpartum to acquire the correct contraction of the pelvic floor muscle. Home PFMT was prescribed between 1 and 5 months postpartum; during this period, follow-up instructions were provided to keep the women motivated. Before and after home PFMT, the levator hiatus area was measured using ultrasonography. RESULTS In total, 44 women in the training group and 45 in the control group were analyzed. There were 36 women who reached a high adherence to three daily sets of home PFMT. The reduction in the levator hiatus area at rest was not statistically higher in the training group than that in the control group. For the subgroup with high adherence, the reduction in the area at rest was significantly higher by 4.43% in the training group than that in the control group (19.90% vs. 15.49%). CONCLUSIONS Although the PFMT program did not significantly reduce the postpartum levator hiatus area at rest, performing at least three sets of home PFMT each day significantly reduced the levator hiatus area by 4.43%. CLINICAL TRIAL REGISTRATION UMIN Clinical Trials Registry (ID; UMIN 000026188, Date; 17 February 2017).
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Affiliation(s)
- Satoko Takaoka
- Integrated Graduate School of Medicine, Engineering, and Agricultural Sciences, University of Yamanashi, Yamanashi, Japan
| | - Yasue Kobayashi
- Division of Nursing Science, Graduate Faculty of Interdisciplinary Research, University of Yamanashi, Yamanashi, Japan
| | - Tamami Taniguchi
- Division of Nursing Science, Graduate Faculty of Interdisciplinary Research, University of Yamanashi, Yamanashi, Japan
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