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Zhao H, Liu XN, Liu LN. Effect of structured pelvic floor muscle training on pelvic floor muscle contraction and treatment of pelvic organ prolapse in postpartum women: ultrasound and clinical evaluations. Arch Gynecol Obstet 2024; 309:2177-2182. [PMID: 37755534 DOI: 10.1007/s00404-023-07226-y] [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: 07/11/2023] [Accepted: 09/07/2023] [Indexed: 09/28/2023]
Abstract
OBJECTIVES The purpose of this study is to examine the impact of structured pelvic floor muscle training (PFMT) on pelvic floor muscle (PFM) contraction and the treatment of pelvic organ prolapse (POP) in postpartum women. METHODS Sixty patients who volunteered for a PFMT assessment at 6-8 weeks after delivery were included in this retrospective analysis. For 5 weeks, all patients had structured PFMT, which included supervised daily pelvic muscle contractions, biofeedback therapy, and electrical stimulation. The main outcomes were POP stage assessed by POP quantification (POP-Q), pelvic organ position and hiatus area (HA) assessed by transperineal ultrasound, PFM contraction assessed by Modified Oxford scale (MOS), surface electromyography (EMG), and sensation of PFM graded using visual analog scale (VAS). RESULTS Structured PFMT was associated with better POP-Q scores in Aa, Ba, C, and D (p values were 0.01, 0.001, 0.017, and 0.001 separately). The bladder neck at rest and maximum Valsalva, the cervix position and HA at maximum Valsalva in transperineal ultrasound were significantly better than before (p values were 0.031, < 0.001, 0.043, and < 0.001 separately). PFM contraction assessed by MOS, EMG, and PFM VAS score were significantly improved (all p values were < 0.001). However, no significant improvement was observed in POP-Q stage. CONCLUSIONS Structured PFMT can increase PFM function in postpartum women but cannot modify the POP-Q stage. Transperineal ultrasonography is a useful method for evaluating therapy efficacy objectively. More randomized controlled trials are needed before definitive conclusions can be drawn about the effect of structured PFMT on POP in postpartum women.
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Affiliation(s)
- Hui Zhao
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200072, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
- National Clinical Research Center for Interventional Medicine, 301 Yanchang Middle Road, Jing'an District, Shanghai, China
| | - Xiu-Ni Liu
- Department of Gynecology and Obstetrics, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200072, China
| | - Lin-Na Liu
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200072, China.
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China.
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China.
- National Clinical Research Center for Interventional Medicine, 301 Yanchang Middle Road, Jing'an District, Shanghai, China.
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Stangel-Wójcikiewicz K, Murawski M, Schwarz T, Skotniczny K, Fuchs A, Wolski J, Radwan-Pragłowska J, Janus Ł, Piątkowski M, Kot M, Wróbel A, Wojtysiak D, Urbaniec P. Pelvic Organ Prolapse Reconstruction with the Chitosan-Based Novel Haemostatic Agent in Ovine Model-Preliminary Report. Int J Mol Sci 2024; 25:3801. [PMID: 38612610 PMCID: PMC11011902 DOI: 10.3390/ijms25073801] [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: 01/08/2024] [Revised: 01/29/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
This prospective study aimed to assess the feasibility of chitosan biomaterial and subcutaneous gel implantation in an ovine model, with implications for women with genital prolapse. Twenty-four ewes were divided into four groups (n = 6 per group): chitosan type B, chitosan type C, chitosan unmodified injections, and polypropylene mesh. Ovine models were chosen due to their morphological resemblance to human reproductive organs. Animals were sacrificed after 90 days for macroscopic, pathomorphological, and immunohistochemical analysis. In the chitosan type B group, IL-6 and IL-10 levels decreased after 28 days, while chitosan type C and injection groups exhibited higher IL-6 than IL-10 levels. The polypropylene group displayed the highest IL-6 and lowest IL-10 levels. Histological examination of the polypropylene group revealed no degenerative changes or inflammation, whereas chitosan injection induced local inflammation. Other groups exhibited no degenerative changes. Ewes implanted with chitosan displayed reduced inflammation compared to polypropylene-implanted ewes. Chitosan implantation facilitated vaginal tissue healing, in contrast to polypropylene mesh, which led to extrusion. While chitosan holds promise as an alternative to polypropylene mesh, further research is imperative for comprehensive evaluation. This study suggests the potential of a chitosan biomaterial in pelvic organ prolapse treatment, warranting additional investigation.
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Affiliation(s)
- Klaudia Stangel-Wójcikiewicz
- Department of Gynecology and Oncology, Faculty of Medicine, Jagiellonian University Medical College, ul. Kopernika 23, 31-501 Kraków, Poland; (K.S.-W.); (K.S.)
| | - Maciej Murawski
- Department of Animal Nutrition, Biotechnology and Fisheries, Faculty of Animal Science, University of Agriculture in Kraków, ul. Mickiewicza 21, 31-120 Kraków, Poland;
| | - Tomasz Schwarz
- Department of Genetics, Animal Breeding and Ethology, Faculty of Animal Science, University of Agriculture in Kraków, ul. Mickiewicza 21, 31-120 Kraków, Poland; (T.S.); (D.W.)
| | - Krzysztof Skotniczny
- Department of Gynecology and Oncology, Faculty of Medicine, Jagiellonian University Medical College, ul. Kopernika 23, 31-501 Kraków, Poland; (K.S.-W.); (K.S.)
| | - Agnieszka Fuchs
- Department of Gynecological Endocrinology and Gynecology, Faculty of Medicine, Jagiellonian University Medical College, ul. Kopernika 23, 31-501 Kraków, Poland; (A.F.); (J.W.)
| | - Jan Wolski
- Department of Gynecological Endocrinology and Gynecology, Faculty of Medicine, Jagiellonian University Medical College, ul. Kopernika 23, 31-501 Kraków, Poland; (A.F.); (J.W.)
| | - Julia Radwan-Pragłowska
- Department of Biotechnology and Physical Chemistry, Faculty of Chemical Engineering and Technology, Cracow University of Technology, ul. Warszawska 24, 31-155 Kraków, Poland; (Ł.J.); (M.P.)
| | - Łukasz Janus
- Department of Biotechnology and Physical Chemistry, Faculty of Chemical Engineering and Technology, Cracow University of Technology, ul. Warszawska 24, 31-155 Kraków, Poland; (Ł.J.); (M.P.)
| | - Marek Piątkowski
- Department of Biotechnology and Physical Chemistry, Faculty of Chemical Engineering and Technology, Cracow University of Technology, ul. Warszawska 24, 31-155 Kraków, Poland; (Ł.J.); (M.P.)
| | - Marta Kot
- Department of Transplantation, Institute of Pediatrics, Faculty of Medicine, Jagiellonian University Medical College, ul. Wielicka 265, 30-663 Kraków, Poland;
| | - Andrzej Wróbel
- Second Department of Gynecology, Medical University of Lublin, ul. Jaczewskiego 8, 20-090 Lublin, Poland;
| | - Dorota Wojtysiak
- Department of Genetics, Animal Breeding and Ethology, Faculty of Animal Science, University of Agriculture in Kraków, ul. Mickiewicza 21, 31-120 Kraków, Poland; (T.S.); (D.W.)
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Sidar SS, Skuthan A. Occupational Therapy Practitioners' Perceptions of Providing Services for the Acute Postpartum Population. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2024:15394492241234846. [PMID: 38436257 DOI: 10.1177/15394492241234846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Occupational therapy practitioners' (OTP's) perceptions of their role in working on the acute postpartum hospital unit are unknown. The objective of this research was to determine the perspectives of OTP's enrolled in a continuing education course to gain competency in providing services to acute postpartum patients. Investigators engaged in a phenomenology consisting of semi-structured interviews with six OTP's working in acute care hospitals preparing to work on the postpartum unit. Three themes emerged from transcripts: (a) Its' Not THAT Different; (b) Willing To Try; and (c) Shifting Focus To Mom. OTPs working in hospitals identified existing skills applicable to working with acute postpartum patients, a need for additional learning to enhance competence, and a desire to focus support for the birthing person to improve maternal outcomes. Hospital onboarding and/or entry-level OTP programs should consider including education on the postpartum population. Future research should focus on program implementation on acute postpartum hospital units.
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UGWU EO, DIM CC, ELEJE GU. Urinary and anal incontinence in pregnancy in a Nigerian population: A prospective longitudinal study. SAGE Open Med 2023; 11:20503121231206927. [PMID: 37900970 PMCID: PMC10612434 DOI: 10.1177/20503121231206927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 09/25/2023] [Indexed: 10/31/2023] Open
Abstract
Objectives There are several studies from sub-Saharan Africa on postpartum urinary incontinence and anal incontinence, but very rare in pregnancy. Such data will guide obstetric caregivers in providing appropriate counseling to the women as well as in minimizing the risk factors. This study aimed to determine the comparative effects of different trimesters of pregnancy on urinary incontinence and anal incontinence, and their possible risk factors. Methods The study was longitudinal in design, and the study population consisted of 223 pregnant women receiving care at the two largest tertiary health institutions in Enugu, South-East Nigeria. The recruitment was in the first trimester and the women were followed up to term. Interviews were conducted at specific times in the three trimesters and data regarding urinary incontinence and anal incontinence symptoms were obtained using validated questionnaires. Results The incidence of urinary incontinence increased across the trimesters: 22%, 30.5%, and 48% in the first trimester, second, and third trimesters, respectively, with a cumulative incidence rate of 50.2%. The incidence of anal incontinence also increased across the trimesters but not as high as urinary incontinence: 1.7%, 3.6%, and 5.8%, respectively, with a cumulative incidence rate of 6.7%. The risk factors for urinary incontinence were maternal age >35 years, multiparity, previous prolonged second-stage labor, and previous history of neonatal macrosomia, while that of anal incontinence were previous instrumental vaginal delivery and previous prolonged second stage of labor. Conclusion Our study demonstrated an increase in the incidence of urinary incontinence and anal incontinence as pregnancy advances. Obstetricians are therefore encouraged to discuss these pelvic floor issues during antenatal care services and make more efforts toward reducing the modifying obstetric risk factors.
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Affiliation(s)
- Emmanuel Onyebuchi UGWU
- Institute of Maternal and Child Health, College of Medicine, University of Nigeria Ituku-Ozalla Campus, Enugu, Nigeria
- Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria Ituku- Ozalla, Enugu, Nigeria
| | - Cyril Chukwudi DIM
- Institute of Maternal and Child Health, College of Medicine, University of Nigeria Ituku-Ozalla Campus, Enugu, Nigeria
- Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria Ituku- Ozalla, Enugu, Nigeria
| | - George Uchenna ELEJE
- Institute of Maternal and Child Health, College of Medicine, University of Nigeria Ituku-Ozalla Campus, Enugu, Nigeria
- Department of Obstetrics and Gynaecology, College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, Anambra State, Nigeria
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Yin Y, Zhang Y, Qian C. Association of delivery mode and number of pregnancies with anorectal manometry data in patients with postpartum constipation. BMC Pregnancy Childbirth 2023; 23:160. [PMID: 36899308 PMCID: PMC10007787 DOI: 10.1186/s12884-023-05480-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 03/01/2023] [Indexed: 03/12/2023] Open
Abstract
OBJECTIVE To explore the association of delivery mode and the number of pregnancies with anorectal manometry data in patients with postpartum constipation. METHODS This retrospective study included women with postpartum constipation treated at the pelvic floor rehabilitation department of Huzhou Maternity & Child Health Care Hospital between January 2018 and December 2019. RESULTS Among 127 patients included, 55 (43.3%) had one pregnancy, 72 (56.7%) had two pregnancies, 96 (75.6%) delivered spontaneously, 25 (16.7%) underwent Cesarean section, and six (4.7%) needed a Cesarean section despite spontaneous labor. The median duration of constipation was 12 months (range, 6-12). There were no differences between the two groups for any manometry parameters (all P > 0.05). The patients with a spontaneous delivery had a lower change in maximal contracting sphincter pressure compared with those with Cesarean section (14.3 (4.5-25.0) vs. 19.6 (13.4-40.0), P = 0.023). Only the delivery mode (Cesarean vs. spontaneous) independently affected the changes in contracting sphincter pressure (B = 10.32, 95%CI: 2.95-17.69, P = 0.006); age (P = 0.201), number of pregnancies (P = 0.190), and constipation duration (P = 0.161) were not associated. CONCLUSION The patients with a spontaneous delivery had a lower change in maximal contracting sphincter pressure compared with those with a Cesarean section, suggesting that patients with Cesarean may retain a better "push" function during defecation.
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Affiliation(s)
- Yan Yin
- General surgery department, Huzhou Maternity and Child Health Care Hospital, 313000, Huzhou, China.
| | - Yumin Zhang
- General surgery department, Huzhou Maternity and Child Health Care Hospital, 313000, Huzhou, China
| | - Cheng Qian
- General surgery department, Huzhou Maternity and Child Health Care Hospital, 313000, Huzhou, China
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Lin C, Huang W, Li X, Wang L, Yan F, Zhou X, Jiang W, Zhao Y. Diagnostic value of combined pelvic floor ultrasound parameters for pelvic floor dysfunction and risk factors. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:465-471. [PMID: 36464839 DOI: 10.1002/jcu.23397] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 10/07/2022] [Accepted: 10/25/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To investigate the diagnostic value of pelvic floor ultrasound parameters in combination for pelvic floor dysfunction (PFD), and to explore the risk factors. METHODS Forty PFD patients treated from April2019to December 2020(case group) and another 40 healthy women (control group) were enrolled. Their clinical data were collected, and both groups received three-dimensional (3D) ultrasound of the pelvic floor. The diagnostic value of pelvic floor ultrasound parameters for PFD was assessed by receiver operating characteristic (ROC) curves. The risk factors of PFD were evaluated by multivariate logistic regression analysis. RESULTS The area under the ROC curve (AUC), sensitivity, and specificity of the parameters in combination for predicting PFD were 0.851 [95% confidence interval (CI): 0.743-0.959], 0.901, and 0.812, respectively, indicating acceptable accuracy. Results of logistic regression analysis revealed that spontaneous delivery, lateral episiotomy/laceration, and large bladder neck rotation angle, posterior urethrovesical angle (PUA), bladder neck tilt angle, bladder neck distance (BND), levator hiatus area (LHA) (at anal contraction), R-LHA and V-LHA were risk factors for PFD (p < 0.05), while physical exercise was a protective factor (p < 0.05). ROC curve analysis revealed that the AUC, sensitivity, and specificity of the forest map model were 0.822 (95% CI: 0.759-0.885), 0.942, and 0.601, respectively, indicating acceptable accuracy of the model. Internal data validation of the model demonstrated consistence of the predicted occurrence of PFD with the actual one. CONCLUSIONS Spontaneous delivery, lateral episiotomy/laceration, and large bladder neck rotation angle, PUA, bladder neck tilt angle, BND, LHA (at anal contraction), R-LHA and V-LHA were risk factors for PFD.
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Affiliation(s)
- Chunhong Lin
- Third Department of Ultrasound, Hengshui People's Hospital, Hengshui, China
| | - Weiyan Huang
- Department of Gynecology, Zhuji People's Hospital, Zhuji, China
| | - Xianguo Li
- Medical Department, The Fifth People's Hospital of Hengshui, Hengshui, China
| | - Linlin Wang
- Third Department of Ultrasound, Hengshui People's Hospital, Hengshui, China
| | - Fengqin Yan
- Third Department of Ultrasound, Hengshui People's Hospital, Hengshui, China
| | - Xiaowen Zhou
- Department of Gynecology, Zhuji People's Hospital, Zhuji, China
| | - Weihong Jiang
- Department of Gynecology, Zhuji People's Hospital, Zhuji, China
| | - Yaoyao Zhao
- Department of Gynecology, Zhuji People's Hospital, Zhuji, China
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Pelvic floor dysfunction and its influencing factors during radiotherapy in cervical cancer survivors: A cross-sectional study. Eur J Oncol Nurs 2023; 64:102307. [PMID: 37141663 DOI: 10.1016/j.ejon.2023.102307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/05/2023] [Accepted: 03/10/2023] [Indexed: 03/22/2023]
Abstract
PURPOSE Radiotherapy can negatively affect the pelvic floor function of patients with cervical cancer; however, the impact of different radiotherapy times and other related factors on pelvic floor function in cervical cancer survivors during radiotherapy remains unclear. We aimed to investigate the status of pelvic floor dysfunction (PFD) in cervical cancer survivors during radiotherapy and to analyze the factors influencing PFD. METHODS In this cross-sectional study, a convenience sampling method was used to recruit cervical cancer survivors undergoing radiotherapy from January 2022 to July 2022 at a tertiary first-class hospital located in northeastern China. The Pelvic Floor Distress Inventory-Short Form 20 was used for participants' self-report of their PFD during radiotherapy. RESULTS Data from 120 cervical cancer survivors were included in this study. The results showed that the mean PFDI-20 total score was 32.69 ± 7.76. Multiple stepwise linear regression analysis showed that 56.9% of the variance in PFD was explained by age (β = 0.25, p < 0.001), body mass index (β = 0.32, p < 0.001), recurrence (β = 0.29, p < 0.001), number of radiotherapy sessions (β = 0.39, p < 0.001), and number of deliveries (β = 0.35, p < 0.001). CONCLUSION It is important to pay more attention to the PFD status of cervical cancer survivors receiving radiotherapy. Future therapeutic approaches should involve early identification of relevant risk factors early to provide patients with personalized care at different stages of radiotherapy for reducing their discomfort and improving their health-related quality of life.
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Chen L, Chen C, Feng J, Peng C, Tang L, Cao X, Liu P. Vaginal delivery effects on 3D morphology of the bladder, urethra, and vagina: a pilot study comparing women with different numbers of deliveries. Arch Gynecol Obstet 2023; 307:473-480. [PMID: 36058944 DOI: 10.1007/s00404-022-06622-0] [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: 05/09/2020] [Accepted: 05/07/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To explore 3D morphological changes of the bladder, urethra, and vagina following different numbers of vaginal deliveries. METHODS Sampled patients had undergone magnetic resonance imaging for gynecological diseases in Nanfang Hospital. A total of 167 patients who met the study inclusion and exclusion criteria were enrolled and divided into four groups. Mimics and UG software packages were used for reconstructions and measurements, and data were compared with one-way analyses of variance. RESULTS A total of 167 3D models were constructed, and eight parameters related to the bladder and urethra were measured (5 angles, 2 lengths, and 1 thickness). No statistically significant differences were found between subgroups, although mean plot figures of urethra pubic and α angles showed trends to increase with more deliveries, and the opposite trend was seen for the urethra tilt angle. There were no obvious trends between other parameters and delivery number. There were seven vaginal parameters (6 lengths and 1 shape). Mid-urethral and vaginal gap measurements tended to become wider as delivery number increased, and the opposite was seen for the distal gap. Mid-vaginal 2D cross-sectional shape and the proportion of shallow concave types also tended to significantly increase with more deliveries, especially after the third birth. CONCLUSION As the number of deliveries through the vagina increases, the lateral support function of this organ and the urethra become relatively weaker. These fine anatomical changes are related to delivery numbers and become most obvious after the third birth.
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Affiliation(s)
- Lan Chen
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou North Avenue, Guangzhou, 510515, China
| | - Chunlin Chen
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou North Avenue, Guangzhou, 510515, China.
| | - Jie Feng
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Cheng Peng
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou North Avenue, Guangzhou, 510515, China
| | - Lian Tang
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou North Avenue, Guangzhou, 510515, China
| | - Xiaojuan Cao
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou North Avenue, Guangzhou, 510515, China
| | - Ping Liu
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou North Avenue, Guangzhou, 510515, China.
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Effects of the Oxytocin Hormone on Pelvic Floor Muscles in Pregnant Rats. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020234. [PMID: 36837436 PMCID: PMC9962430 DOI: 10.3390/medicina59020234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/02/2023] [Accepted: 01/06/2023] [Indexed: 01/28/2023]
Abstract
Background and Objectives: Oxytocin induction is a known risk factor for pelvic floor disorders (PFDs). The aim of the study was to investigate the effects of oxytocin induction on pelvic floor muscles in pregnant rats. Methods: Thirty-two female Wistar rats were included and divided into four groups (n = 8). The groups were as follows: virgin group (group I)-from which muscles were dissected at the beginning of the experiment; spontaneous vaginal delivery (group II) which has delivery spontaneously; saline control group (group III) and oxytocin group (group IV). In groups III and IV, pregnancy was induced on d 21 of pregnancy, with 2.5 mU saline solution or iv oxytocin, respectively, delivered by the intravenous (iv) route in pulses at 10-min intervals for 8 h. Then, the rats were euthanized, the m. coccygeus, m. iliocaudalis and m. pubocaudalis muscles were excised and tissue samples were taken. After histological processing, the vertical and horizontal dimensions of the muscles were analyzed under a light microscope. Results: In group IV; the measurement of the horizontal dimension of the m. pubocaudalis muscles was 50.1 ± 5.4 µm and it was significantly higher than other groups (p < 0.001). In group III; the mean value of the horizontal dimension of m. coccygeus muscle was found to be 49.5 ± 10.9 µm and it was significantly higher than other groups (p < 0.009). Between-group comparisons revealed no difference in mean m. iliocaudalis muscle dimension (p > 0.05). Conclusions: As a result of our study it can say that whether oxytocin induced or not, vaginal birth is a process that affects the pelvic muscles.
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The effectiveness of eHealth interventions on female pelvic floor dysfunction: a systematic review and meta-analysis. Int Urogynecol J 2022; 33:3325-3354. [PMID: 35616695 PMCID: PMC9135393 DOI: 10.1007/s00192-022-05222-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 05/01/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION AND HYPOTHESIS eHealth interventions represent a promising novel strategy in pelvic floor management for women. Nevertheless, the effectiveness of eHealth interventions among women with or at risk of pelvic floor dysfunction (PFD) has not been adequately discussed to date. This study aimed to determine the effectiveness of eHealth interventions in preventing and treating PFD among women. METHODS Eleven electronic databases were searched for randomized controlled trials (RCTs) from inception until August 28, 2021. RESULTS Twenty-four RCTs were included in this meta-analysis that included 3691 women. The meta-analysis showed that eHealth interventions were not only vital for preventing PFD (pregnant women: pooled OR = 0.25, 95% CI: 0.14 to 0.45, p < 0.001; postnatal women: pooled OR = 0.19, 95% CI: 0.06 to 0.60, p = 0.005), but also for reducing the severity of PFD (pooled SMD = -0.63, 95% CI: -1.20 to -0.06, p = 0.031). In addition, compared with traditional care, eHealth interventions showed significant positive effects on several outcome indicators, including quality of life (pooled SMD = 0.49, 95% CI: 0.19 to 0.80, p = 0.002), pelvic floor type I muscle strength (pooled OR = 1.92, 95% CI: 1.30 to 2.82, p = 0.001), pelvic floor type II muscle strength (pooled OR = 2.04, 95% CI: 1.38 to 3.01, p < 0.001), sexual function (pooled SMD = 0.51, 95% CI: 0.29 to 0.73, p < 0.001), satisfaction (pooled OR = 3.93, 95% CI: 2.73 to 5.66, p < 0.001), and self-efficacy (pooled SMD = 2.62, 95% CI: 2.12 to 3.13, p < 0.001). CONCLUSIONS eHealth interventions are an effective emerging treatment and preventive modality for female PFD. Higher quality, larger scale, and strictly designed RCTs are warranted to evaluate the effectiveness of eHealth interventions on female pelvic floor management.
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Bhat GS, Shastry A. Sexually Induced Orgasm to Improve Postpartum Pelvic Floor Muscle Strength and Sexual Function in Primiparous Women After Vaginal Delivery: A Prospective Randomized Two-Arm Study. J Sex Med 2022; 19:1634-1643. [PMID: 36167664 DOI: 10.1016/j.jsxm.2022.08.189] [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: 03/11/2022] [Revised: 08/09/2022] [Accepted: 08/17/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Postpartum pelvic floor dysfunction is known to affect the quality of life of women and the methods to treat it are more complex with majority requiring training under supervision. AIM To compare the efficacy of sexually induced orgasm along with Kegels exercises versus Kegels exercises alone as a treatment method to enhance postpartum pelvic floor muscle strength and sexual function in primiparous women undergoing uncomplicated vaginal deliveries. METHODS The prospective randomized two-arm study was conducted on sexually active primiparous women who had undergone uncomplicated vaginal deliveries. Those with risk factors for female sexual dysfunction and pelvic floor muscle dysfunction were excluded. Participants in Group 1 were advised daily Kegel's exercises, whereas, those in Group 2 were advised to initiate self-initiated/partnered sexual activity-induced orgasms along with daily Kegel's exercises. Their pelvic floor muscle strength on voluntary contraction, ability to relax pelvic floor voluntarily, and sexual function (using FSFI-6) were assessed monthly for 6 months and the analysis was done using G* Power software (© 2021 Heinrich-Heine-Universität Düsseldorf, Germany). MAIN OUTCOME MEASURE Postpartum pelvic floor strength and sexual function in 2 groups of women under study. RESULTS The study period was from January 2020 to December 2020. The Group 1 had 26 participants (mean age 29.69 ± 2.2 years) and Group 2 had 29 participants (mean age 30.07 ± 2.57 years). The sexual function as well as ability to relax pelvic floor were significantly better in Group 2 compared to Group 1 at each monthly intervals whereas strength of pelvic floor muscles during voluntary contraction was significantly higher in Group 2 compared to Group 1 at the end of 6 months and it was statistically significant at a P value of .05. CLINICAL IMPLICATIONS Novel method of using naturally occurring sexually induced orgasms for postpartum pelvic floor rehabilitation can revolutionize postpartum pelvic floor training in women, as it can be practiced at home with ease, along with easily performable Kegel's exercises. STRENGTHS AND LIMITATIONS Use of prospective randomization and minimization of confounding factors is the strength of the study. The small sample size is the limitation of the study. CONCLUSIONS Postpartum pelvic floor muscle strength and sexual function in primiparous women who have undergone uncomplicated vaginal deliveries can be significantly improved with the addition of sexually induced orgasm as a therapeutic tool along with physical exercises such as Kegels exercises in these women.
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Affiliation(s)
- Gajanan S Bhat
- Department of UrologyAndrology and Sexual Medicine TSS Shripad Hegde Kadave Institute of Medical Sciences, Sirsi, Uttara Kannada District, Karnataka, India
| | - Anuradha Shastry
- Department of Urology and Sexual Medicine TSS Shripad Hegde Kadave Institute of Medical Sciences, Sirsi, Uttara Kannada District, Karnataka, India
- Departments and institutions where the work was carried outDepartment of UrologyAndrology and Sexual MedicineTSS Shripad Hegde Kadave Institute of Medical Sciences, Sirsi, Uttara Kannada District, Karnataka, India
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12
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Determinants of Pelvic Floor Disorders among Women Visiting the Gynecology Outpatient Department in Wolkite University Specialized Center, Wolkite, Ethiopia. Obstet Gynecol Int 2022; 2022:6949700. [PMID: 35996749 PMCID: PMC9392642 DOI: 10.1155/2022/6949700] [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: 05/10/2022] [Revised: 06/27/2022] [Accepted: 07/22/2022] [Indexed: 12/03/2022] Open
Abstract
Background Pelvic floor disorders encompass a broad range of interrelated clinical conditions. Pelvic floor disorders are a common public health concern that affects the lives of millions of adult females. This disorder is expected to be more widespread and probably more severe among women in low-income countries. However, there is limited knowledge about pelvic floor disorders and their determinants among women in Ethiopia. Objective The purpose of the study was to assess the determinants of pelvic floor disorders among women who visited the gynecology outpatient service at the Wolkite University Specialized Hospital, Wolkite, Ethiopia, in 2021. Methods A cross-sectional hospital study was conducted on 275 randomly chosen women from June 1 to July 1, 2021. A systematic sampling technique was used when selecting the study subjects. The data were gathered using interviewer administered structured questionnaires. The data collected was entered in version 3.1 of EpiData, and version 23 of Statistical Package for Social Sciences was used for the analysis. The variables with a P-value <0.25 in the bivariate analysis were considered for a subsequently built multivariable model, and factors with P < 0.05 in the final model were statistically significant. The results were presented in an adjusted odds ratio with a 95% confidence interval. Result The prevalence of pelvic floor disorder was reported to be 17.8% with 9.3% of the women experiencing urinary incontinence, 8.9% experiencing pelvic organ prolapse, and 5.9% experiencing anal incontinence. Two hundred thirty-two (85.9%) were currently married, while 110 (40.7%) were housewives. Statistically, a significant association was found between age at first pregnancy (AOR = 5.193; 95% CI = 1.905–14.157), many vaginal deliveries (AOR = 15.858; 95% CI = 5.305–47.400), history of episiotomy (AOR = 7.508 95% CI = 1.556–36.224), and menopause (AOR = 7.665; 95% CI = 2.440–24.078) when analyzed with a multivariate logistic regression model. Conclusion In this study, age at first pregnancy, number of vaginal births, history of episiotomy, and menopause were independently associated with pelvic floor disorder. Therefore, educating women about the year of their first pregnancy, promoting family planning, and advice on the prevention of routine episiotomy by a health professional is recommended.
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Huang G, He Y, Hong L, Zhou M, Zuo X, Zhao Z. Restoration of NAD + homeostasis protects C2C12 myoblasts and mouse levator ani muscle from mechanical stress-induced damage. Anim Cells Syst (Seoul) 2022; 26:192-202. [PMID: 36046029 PMCID: PMC9423866 DOI: 10.1080/19768354.2022.2106303] [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] [Indexed: 11/29/2022] Open
Abstract
Excessive mechanical traction damages the levator ani muscle (LAM), increasing the incidence of pelvic floor dysfunction (PFD). In this study, we explored the effects of oxidized nicotinamide adenine dinucleotide (NAD+) on the damage to both muscle cells and LAM tissue induced by mechanical stress (MS) at the cellular and animal levels. The cell damage model was established using a four-point bending system. The LAM damage model was established using vaginal distention and traction. Exogenous addition of PJ34, an inhibitor of poly (ADP-ribose) polymerase-1 (PARP-1), and the nicotinamide mononucleotide (NMN) precursor of NAD+ increased NAD+ levels. ATP content and mitochondrial membrane potential were measured to assess mitochondrial function. NAD+ levels, cell viability, and PARP-1 activity were detected using commercial kits. DNA damage in cells was detected with immunofluorescence staining, and LAM damage was detected with tissue TUNEL staining. PARP-1 activity and DNA damage of LAM were detected by immunohistochemistry. A small amount of DNA damage and PARP-1 activation did not affect NAD+ levels, while excessive DNA damage and PARP-1 activation led to an imbalance of NAD+ homeostasis. Furthermore, increasing NAD+ levels in vivo and in vitro could rescue mitochondrial dysfunction and damage to both muscle cells and LAM tissue induced by MS. In conclusion, MS can induce damage to both C2C12 cells and LAM tissue. Restoring NAD+ homeostasis can rescue this damage by improving mitochondrial function.
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Affiliation(s)
- Guotao Huang
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, People’s Republic of China
| | - Yong He
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, People’s Republic of China
| | - Li Hong
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, People’s Republic of China
| | - Min Zhou
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, People’s Republic of China
| | - Xiaohu Zuo
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, People’s Republic of China
| | - Zhihan Zhao
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, People’s Republic of China
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Bascur-Castillo C, Carrasco-Portiño M, Valenzuela-Peters R, Orellana-Gaete L, Viveros-Allende V, Ruiz Cantero MT. Effect of conservative treatment of pelvic floor dysfunctions in women: An umbrella review. Int J Gynaecol Obstet 2022; 159:372-391. [PMID: 35246849 DOI: 10.1002/ijgo.14172] [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: 11/10/2021] [Revised: 01/20/2022] [Accepted: 03/02/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Due to their high worldwide prevalence, pelvic floor dysfunctions (PFD's) are a public health problem. There is high heterogeneity in the types and effectiveness of conservative treatment. The objective was to analyze the scientific evidence on conservative treatment of PFDs in women. METHODS Umbrella review, covering MEDLINE (1950-2019), Scopus (1960-2019), Web of Science (1980-2019), and Cochrane Library (2000-2019). Inclusion criterion: review on conservative treatments about pelvic floor disorders in the adult women, in Spanish or English; exclusion criterion: studies about other urological, gynecological, and coloproctological pathologies, among others. RESULTS Thirty-two reviews (2000-2019) and 12 meta-analyses were included. 53.1% showed an improvement on urinary incontinence. Pelvic floor muscle training worked on 70.6% of them, followed by electrical stimulation and estrogen (11.7%), and weight loss (5.9%). 6.3% of reviews and meta-analyses fulfilled all items in PRISMA, and 93.7% of them fulfilled more than 60% of the checklist. 60% de los ítems. CONCLUSIONS PFMT and weight loss are the most effective treatments for UI, but there is no evidence for other PFDs. The methodological quality of conservative treatments must be improved for a more effective treatment of PFDs in women. Pelvic floor muscle training and weight loss are the most effective treatments for urinary incontinence. Only the 6.3% of the review fulfilled all PRISMA ítems.
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Affiliation(s)
- Carolina Bascur-Castillo
- Department of Obstetrics and Puericulture, Faculty of Medicine, Universidad de Concepción, Concepción, Chile
| | - Mercedes Carrasco-Portiño
- Department of Obstetrics and Puericulture, Faculty of Medicine, Universidad de Concepción, Concepción, Chile.,Public Health Research Group, University of Alicante, Alicante, Spain
| | - Romina Valenzuela-Peters
- Department of Obstetrics and Puericulture, Faculty of Medicine, Universidad de Concepción, Concepción, Chile
| | - Luna Orellana-Gaete
- Department of Obstetrics and Puericulture, Faculty of Medicine, Universidad de Concepción, Concepción, Chile
| | - Vicente Viveros-Allende
- Department of Obstetrics and Puericulture, Faculty of Medicine, Universidad de Concepción, Concepción, Chile
| | - María Teresa Ruiz Cantero
- Public Health Research Group, University of Alicante, Alicante, Spain.,Center for Network-Based Biomedical Research on Epidemiology and Public Health (CIBERESP), Spain
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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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Effect of Epidural Analgesia on Pelvic Floor Dysfunction at 6 Months Postpartum in Primiparous Women: A Prospective Cohort Study. Sex Med 2021; 9:100417. [PMID: 34419692 PMCID: PMC8498962 DOI: 10.1016/j.esxm.2021.100417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/02/2021] [Accepted: 07/07/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Epidural analgesia has become a universal intervention for relieving labor pain, and its effect on the pelvic floor is controversial. AIM To investigate the effect of epidural analgesia on pelvic floor dysfunction (PFD) in primiparous women at 6 months postpartum. METHODS We performed a prospective cohort study involving 150 primiparous women in preparation for vaginal delivery, with 74 (49.3%) receiving epidural analgesia. Baseline demographic and intrapartum data were collected. At 6 months postpartum, PFD symptoms, including stress urinary incontinence, overactive bladder, defecation disorder, pelvic organ prolapse, and 4 kinds of sexual dysfunction (arousal disorder, low sexual desire, dyspareunia, and orgasm disorder), were evaluated. Pelvic floor muscle (PFM) function and postpartum depression were also assessed. Multivariate logistic regression was applied to identify factors associated with the PFD symptoms affected by epidural analgesia. MAIN OUTCOME MEASURE PFD symptoms and sexual dysfunction were evaluated through Pelvic Floor Distress Inventory-20 (PFDI-20) and Female Sexual Function Index (FSFI-12). PFM function was examined with palpation and surface electromyography (sEMG). Postpartum depression was assessed using Self-Rating Depression Scale (SDS). RESULTS At 6 months postpartum, women who delivered with epidural analgesia had a higher incidence of dyspareunia (43.2% vs 26.3%, P <0.05) and longer first, second, and total stage of labor durations (P <0.01) than those who without. No significant difference in other PFD symptoms or PFM function was found between the 2 groups (P >0.05). Multivariate logistic regression revealed that epidural analgesia (OR = 3.056, 95% CI = 1.217-7.671) and SDS scores (OR = 1.066, 95% CI = 1.009-1.127) were independent risk factors for dyspareunia. CONCLUSION At 6 months postpartum in primiparous women, epidural analgesia was associated with an increased risk of postpartum dyspareunia and longer labor durations, which deserves attention for rehabilitation after delivery. Future studies with a larger sample size are needed to evaluate the impact of epidural analgesia on other PFD symptoms. Du J, Ye J, Fei H, et al. Effect of Epidural Analgesia on Pelvic Floor Dysfunction at 6 Months Postpartum in Primiparous Women: A Prospective Cohort Study. Sex Med 2021;9:100417.
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Sweta K, Godbole A, Prajapati S, Awasthi HH. Assessment of the effect of Mulabandha yoga therapy in healthy women, stigmatized for pelvic floor dysfunctions: A randomized controlled trial. J Ayurveda Integr Med 2021; 12:514-520. [PMID: 34364737 PMCID: PMC8377169 DOI: 10.1016/j.jaim.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 04/02/2021] [Accepted: 04/02/2021] [Indexed: 12/03/2022] Open
Abstract
Background In developing countries, women do not reveal their perineum related health issues because most of the time they are stigmatized by the society. Multiparity, mostly found in women of rural areas is one of the major causes of pelvic floor dysfunctions (PFDs) like pelvic organ prolapse, urinary incontinence, rectal incontinence, etc. Usually, they visit health centres in the advanced stage of diseases, and then medical treatment is not the only choice left. Many research studies show that yoga practices promote health conditions, contribute to enhancing endurance, flexibility, and muscular strength, and improving quality of life. Objective(s) The study was conducted to assess the impact of Mulabandha yoga therapy (MYT) in healthy woman participants as a preventive measure. Material and methods The study was a prospective and randomized controlled trial. Fifty healthy woman participants were allocated in two groups viz., MYT group and No MYT group. Mulabandha yoga was conducted for the MYT group for 12 weeks. No MYT group was advised not to do yoga. Pelvic floor muscle strength was internally evaluated by employing the PERFECT scheme score (P = power, E = endurance, R = repetitions, F = fast contractions, ECT = every contraction timed). For eligible samples, MYT sessions were held for 12 weeks. Data interpretation was done with SPSS software 20.0 (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY, USA). Results Fifty healthy woman participants were allocated for analysis. There was no statistically significant difference in between the groups comparison in terms of age, socio-economic status, occupation, education, parity and mode of delivery. PERFECT scheme score significantly improved in participants after 12 weeks of regular MYT. No statistically significant differences were observed between the groups comparison in terms of PERFECT scheme score. Conclusion The current study shows that regular practice of MYT for 12 weeks is a better means to reinforce the strength of pelvic floor muscles in women. This MYT procedure will establish evidence for women who are reluctant towards their pelvic organ-related issues. Women must incorporate the MYT practice in their routine life as a preventive measure to refrain from pelvic floor dysfunctions.
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Affiliation(s)
- Km Sweta
- Uttar Pradesh Public Service Commission, India.
| | - Amrit Godbole
- Department of Kayachikitsa, Faculty of Ayurveda, Institute of Medical Sciences, BHU, Varanasi, 221005, India
| | | | - H H Awasthi
- Department of Rachana sharira, Faculty of Ayurveda, IMS BHU, Varanasi, U.P., 221005, India
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The Effects of the Pilates Method on Pelvic Floor Injuries during Pregnancy and Childbirth: A Quasi-Experimental Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136995. [PMID: 34208859 PMCID: PMC8297105 DOI: 10.3390/ijerph18136995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/10/2021] [Accepted: 06/24/2021] [Indexed: 11/16/2022]
Abstract
The perineal injuries suffered during childbirth have a great impact on the quality of life of the female population. Evidence suggests that the Pilates method is used by pregnant women to improve the physical and psychological outcomes of pregnancy. The aim of this study was to investigate the influence of the Pilates Method during pregnancy on the incidence and degree of intrapartum perineal trauma. A quasi-experimental study was carried out between November 2018 and December 2019 at different health centers in two health districts. Participants were 72 pregnant women attending the antenatal program, who were assigned to a Pilates group or a control group (48 and 24 pregnant women, respectively). The main outcome measurement was perineal trauma during childbirth. After participating in the Pilates program, the women in the experimental group were significantly less likely to suffer perineal trauma in spontaneous deliveries compared to the women in the control group. After evaluating these results, it is concluded that health center managers should promote the training of midwives in the prevention and treatment of pelvic floor injuries during pregnancy and should consider strategies to enhance adhesion and participation with respect to pelvic floor exercise programs throughout pregnancy by means of Apps and other digital media specifically aimed at this phase.
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Effects of Oxytocin for Induction and Augmentation of Labor on Pelvic Floor Symptoms and Support in the Postpartum Period. Female Pelvic Med Reconstr Surg 2021; 27:289-296. [PMID: 32097161 DOI: 10.1097/spv.0000000000000848] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The aim of the study was to determine whether oxytocin for induction or augmentation of labor impacts the incidence or persistence of pelvic floor symptoms and support 5 to 10 weeks after first vaginal delivery. METHODS Participants in this prospective cohort study were nulliparous women 18 years or older that delivered vaginally at 37 weeks gestation or more and completed the Epidemiology of Prolapse and Incontinence Questionnaire (EPIQ) and the Pelvic Organ Prolapse Quantification examination in third trimester and 5 to 10 weeks postpartum. We compared the incidence and persistence of symptomatic EPIQ domains and worse vaginal support (maximal vaginal descent ≥0 cm) between women who received oxytocin with those that did not (with or without prostaglandin or mechanical methods in both groups). We performed modified binomial regression to calculate adjusted relative risks of each outcome with 95% confidence intervals. RESULTS The mean (SD) age of the 722 participants was 28.3 (5.2) years; 20% were Hispanic. There were no significant differences according to oxytocin exposure in either incidence or persistence of symptomatic EPIQ domains or worse vaginal support. We found similar results in sensitivity analyses comparing women who received oxytocin as the sole pharmacologic agent to women who received no pharmacologic agent. After adjusting for demographic and obstetric factors associated with incidence and persistence of symptoms and support, oxytocin exposure continued to have no effect. CONCLUSIONS Oxytocin during labor does not significantly increase the risks for the incidence or persistence of pelvic floor symptoms or worse vaginal support in the early postpartum period, although power for less frequent outcomes was limited.
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20
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Rotstein E, Åhlund S, Lindgren H, Lindén Hirschberg A, Rådestad I, Tegerstedt G. Posterior compartment symptoms in primiparous women 1 year after non-assisted vaginal deliveries: a Swedish cohort study. Int Urogynecol J 2021; 32:1825-1832. [PMID: 33646348 PMCID: PMC8295137 DOI: 10.1007/s00192-021-04700-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/10/2021] [Indexed: 11/26/2022]
Abstract
Introduction and hypothesis This is a prospective cohort follow-up study based on the hypothesis that primiparous women with non-assisted vaginal deliveries and a second-degree perineal tear have more posterior compartment symptoms 1 year after delivery than those with no or first-degree tears. Methods A follow-up questionnaire, including validated questions on pelvic floor dysfunction, was completed 1 year postpartum by 410 healthy primiparas, delivered without instrumental assistance at two maternity wards in Stockholm between 2013 and 2015. Main outcome measures were posterior compartment symptoms in women with second-degree perineal tears compared with women with no or only minor tears. Results Of 410 women, 20.9% had no or only minor tears, 75.4% had a second-degree tear, and 3.7% had a more severe tear. Of women presenting with second-degree tears, 18.9% had bowel-emptying difficulties compared with 20.0% of women with minor tears. Furthermore, almost 3% of them with second-degree tears complained of faecal incontinence (FI) of formed stool, 7.2% of FI of loose stool compared with 1.2% and 3.5% respectively in women with no or only minor tears. Conclusions Symptomatic pelvic floor dysfunction is common among primiparous women within 1 year following uncomplicated vaginal delivery, and there are no significant differences between second-degree perineal tears and minor tears. These symptoms should be addressed in all women after delivery to improve pelvic floor dysfunction and quality of life.
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Affiliation(s)
- Emilia Rotstein
- Karolinska Pelvic Floor Centre, Karolinska University Hospital Huddinge, Stockholm, Sweden.
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 171 77, Solna, Sweden.
| | - Susanne Åhlund
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Helena Lindgren
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Angelica Lindén Hirschberg
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Gynaecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | | | - Gunilla Tegerstedt
- Karolinska Pelvic Floor Centre, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 171 77, Solna, Sweden
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21
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Pardo E, Rotem R, Glinter H, Erenberg M, Yahav L, Yohay Z, Yohay D, Weintraub AY. Is there a correlation between pelvic floor dysfunction symptoms during pregnancy and the duration of the second stage of labor? J Matern Fetal Neonatal Med 2021; 35:4418-4423. [PMID: 33455478 DOI: 10.1080/14767058.2020.1850679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Pelvic floor dysfunction (PFD) most commonly results from weakened or injured muscles and ligaments whose purpose is to support the pelvic floor. Many studies have placed vaginal delivery and prolonged second stage of labor (SSL) as major risk factors for PFD, supposedly through generating enhanced pressure in the pelvic area. Although many studies describe the effects of vaginal delivery and labor on structure and function of the pelvic floor, not much is known regarding PFD deriving from pregnancy and its prevalence and severity in the postpartum. We aimed to evaluate whether a correlation exists between PFD symptoms during pregnancy and the duration of the SSL. METHODS We conducted a cross sectional study of 200 women who gave birth at Soroka University Medical Center, Beer-Sheva, Israel. Those who had consented completed the Pelvic Floor Distress Inventory-20 (PFDI-20), a condition specific questionnaire developed to measure quality-of-life and the extent of injury to the pelvic floor in women with all forms of PFD. The duration of the SSL and clinical and obstetrical characteristics were retrieved from the participants' medical records. We assessed correlations using Spearman's correlation coefficient. RESULTS PFD during pregnancy was found to be correlated to the duration of the SSL (R = -0.183, p = .021). When evaluating each component of the PFDI-20 separately, CRAD was significantly correlated with the duration of the SSL (R = -0.195, p = .014). CONCLUSIONS There is a correlation between PFD symptoms during pregnancy, specifically symptoms of CRAD and the duration of the SSL.
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Affiliation(s)
- Ella Pardo
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Beer Sheva, Israel.,Joyce Irving Goldman Medical School, Ben Gurion University of the Negev, Jerusalem, Israel
| | - Reut Rotem
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University Medical School of Jerusalem, Beer Sheva, Israel
| | - Hannah Glinter
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Beer Sheva, Israel
| | - Miriam Erenberg
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Beer Sheva, Israel
| | - Lior Yahav
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Beer Sheva, Israel
| | - Zehava Yohay
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Beer Sheva, Israel
| | - David Yohay
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Beer Sheva, Israel.,Joyce Irving Goldman Medical School, Ben Gurion University of the Negev, Jerusalem, Israel
| | - Adi Y Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Beer Sheva, Israel.,Joyce Irving Goldman Medical School, Ben Gurion University of the Negev, Jerusalem, Israel
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The Effect of Pelvic Floor Muscle Training on Pelvic Floor Dysfunction in Pregnant and Postpartum Women. PHYSICAL ACTIVITY AND HEALTH 2020. [DOI: 10.5334/paah.64] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Xiong R, Deng A. Incidence and risk factors associated with postpartum depression among women of advanced maternal age from Guangzhou, China. Perspect Psychiatr Care 2020; 56:316-320. [PMID: 31364779 DOI: 10.1111/ppc.12430] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 07/02/2019] [Accepted: 07/20/2019] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To investigate whether advanced maternal age (AMA) increases the risk of postpartum depression (PPD) at 6 weeks after birth and to explore the risk factors. DESIGN AND METHODS A cross-sectional study was conducted at 6 weeks postpartum. The Edinburgh Postnatal Depression Scale and a self-designed questionnaire were administered to participants. Multivariate logistic regression was used to determine risk factors. FINDINGS The prevalence of PPD in women of AMA was 18.0%. Poor relationships with mothers-in-law, female fetus, inconsistency between expected sex and actual sex and primiparae were identified as risk factors. PRACTICE IMPLICATIONS Mothers of AMA require specialized care and support to alleviate their concerns.
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Affiliation(s)
- Ribo Xiong
- Department of Rehabilitation, Nanhai Hospital, Southern Medical University, Foshan, China
| | - Aiwen Deng
- Department of Rehabilitation, Nanhai Hospital, Southern Medical University, Foshan, China
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Dasikan Z, Ozturk R, Ozturk A. Pelvic floor dysfunction symptoms and risk factors at the first year of postpartum women: a cross-sectional study. Contemp Nurse 2020; 56:132-145. [PMID: 32216721 DOI: 10.1080/10376178.2020.1749099] [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] [Indexed: 10/24/2022]
Abstract
Objective: The aim of this study was to determine the frequency of pelvic floor dysfunction (PFD) symptoms experienced the first year of postpartum and obstetric risk factors. Methods: This research was a cross-sectional descriptive study. The study was conducted with 408 women between 3 and 12 months postpartum, in İzmir. Results: It was found that urinary incontinence had been experienced by 33.3% of the women during pregnancy and 25.2% postpartum and 2.9% had experienced fecal incontinence. Other frequently experienced symptoms of PFD were in the order of frequency, perineal pain (53.4%), constipation (40.7%), flatulence (34.1%), dyspareunia (27.7%) and fecal incontinence (2.9%). Conclusion: PFD symptoms are common in postpartum women. Early diagnosis, treatment and preventive approaches should be made by healthcare professionals for perinatal pelvic floor health. Impact statement: Healthcare professionals should acknowledge the importance of PFD after birth and identify the problems early period. Our study emphasizes the size of the problem and improvement for PFD.
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Affiliation(s)
- Zeynep Dasikan
- Department of Women's Health and Disease, Faculty of Nursing, Ege University, Izmir, Turkey
| | - Rusen Ozturk
- Department of Women's Health and Disease, Faculty of Nursing, Ege University, Izmir, Turkey
| | - Aslihan Ozturk
- Department of Oncology Nursing, Faculty of Health Sciences, Bakırçay University, Izmir, Turkey
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Are there differences in short-term pelvic floor muscle function after cesarean section or vaginal delivery in primiparous women? A systematic review with meta-analysis. Int Urogynecol J 2020; 31:1497-1506. [PMID: 32062680 DOI: 10.1007/s00192-020-04231-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 01/14/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The literature presents controversial results regarding the role of delivery mode in pelvic floor muscle (PFM) function after birth. Some studies showed a greater impairment of PFM function after vaginal delivery compared with cesarean section, while others have not identified a significant difference between these two modes of delivery. This study aimed to investigate whether there was a difference in short-term PFM function after childbirth in primiparous women who underwent cesarean section compared with those who underwent vaginal delivery. METHODS Up to December 2018, the PubMed-MEDLINE, CINAHL, Embase, Bireme, Scopus, Web of Science, and Science Direct databases were searched. Two independent reviewers performed the selection process based on titles, abstracts, and full-text reading. Observational studies comparing PFM function after cesarean section versus vaginal delivery in primiparous women were included. PRISMA guidelines and Cochrane recommendations were followed. Methodological quality of the primary studies was assessed through the checklist proposed by the Joanna Briggs Institute for cross-sectional studies. Random effects meta-analysis was performed to synthesize evidence regarding PFM strength in primiparous woman after vaginal delivery compared with cesarean section. The GRADE approach was applied to classify the quality of the evidence. RESULTS Eleven studies met the inclusion criteria and were included in this review. A total of 1726 primiparous women were analyzed after childbirth. Five studies were included in the meta-analysis. No difference in PFM strength after childbirth was identified when cesarean section was compared with vaginal delivery [standardized mean difference (SMD): -0.15, 95% confidence interval (CI): -0.85 to 0.56]. Differences in PFM strength were identified when patients who underwent cesarean section were compared with those with an episiotomy or instrumented vaginal delivery (SMD: -12.51, CI 95%: -24.57 to -0.44), favoring the cesarean section group. In both cases, the quality of evidence was classified as very low because of the observational design of the included studies and population heterogeneity. CONCLUSION There was no difference in short-term PFM strength after childbirth between primiparous women who underwent cesarean section or vaginal delivery, as assessed through vaginal manometry. However, we identified reduced PFM strength in women who underwent an episiotomy or instrumented vaginal delivery compared with those who underwent cesarean section. Nevertheless, this conclusion should be cautiously considered as the observational design of the primary studies and possible heterogeneity among the primiparous women included in the studies contributed to reducing the quality of the evidence synthesized. Future primary studies with longitudinal designs and long-term follow-up periods are needed to strengthen the quality of evidence and provide more conclusive evidence to guide clinical practice.
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Artymuk NV, Khapacheva SY. Device-assisted pelvic floor muscle postpartum exercise programme for the management of pelvic floor dysfunction after delivery. J Matern Fetal Neonatal Med 2020; 35:481-485. [PMID: 32019378 DOI: 10.1080/14767058.2020.1723541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Pelvic floor dysfunction (PFD) is a multifactorial condition that clinically manifests as the pelvic prolapse, urinary and/or rectal incontinence, and sexual dysfunction.Aim: We aimed to evaluate the efficacy of two pelvic floor trainers for the prevention of PFD in women during the postpartum period.Materials and methods: This was a prospective, randomized, open-label study in 70 women in the postpartum period. Participants were randomized to complete a daily, 20-min set of pelvic floor muscle exercises using the EmbaGYN (UK; Group 1, n = 40) or the Magic Kegel Master device (China; Group 2, n = 40) for 4 weeks. All participants anonymously completed the PFDI-20 questionnaire and FSFI form at baseline and last visit. Pelvic floor muscle strength was measured using the XFT-0010 device.Results: After the completion of the 4-week pelvic floor muscle exercise program, there was a significant decrease in the rates of all PFD symptoms including pelvic organ prolapse and urinary and/or fecal incontinence in both groups. The rates of sexual dysfunction after the exercise program decreased significantly only in Group II (69.4 versus 25.0%; р =.001). After the program, Group I showed a significant reduction in the number of women with symptoms of urgent urinary incontinence versus baseline (35.3 versus 8.8% p = .009). Similarly, the rates of urine loss associated with coughing, sneezing or laughing in Group I decreased from 41.2% at baseline to 11.8% after the program (р =.006) and the rates of urine leakage independent of physical activity from 23.5 to 5.9% (p = .040), respectively.Conclusion: The 4-week postpartum pelvic floor muscle exercise program utilizing the EmbaGYN or Magic Kegel Master device has significantly increased the pelvic floor muscle strength and decreased the symptoms of pelvic organ prolapse, urinary and fecal incontinence. The use of the Magic Kegel Master device significantly reduced the symptoms of sexual dysfunction. The use of the EmbaGYN device was effective in addressing the individual symptoms of urinary incontinence.
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Effects of mechanical trauma on the differentiation and ArfGAP3 expression of C2C12 myoblast and mouse levator ani muscle. Int Urogynecol J 2020; 31:1913-1924. [PMID: 31989201 DOI: 10.1007/s00192-019-04212-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 12/12/2019] [Indexed: 12/16/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Severe mechanical injury or inadequate repair of the levator ani muscle (LAM) is a key contributor to the development of pelvic floor dysfunction (PFD). We explored the effects of mechanical stress on myoblasts and LAM at the cellular and animal level and the possible mechanism of PFD induced by mechanical trauma. METHODS A C2C12 cell mechanical injury model was established with a four-point bending device, and a LAM injury mouse model was established via vaginal distention and distal traction, a common way of simulating the birth injury. The cells were divided into control, 1333 μ strain for 4-h cyclic mechanical strain (CMS), 1333 μ strain for 8-h CMS, and 5333 μ strain for 4-h CMS groups. Mice were divided into control and injury groups. After treatment, mitochondrial membrane potential (ΔΨm), reactive oxygen species (ROS) levels, indicators of oxidative damage, cell apoptosis, muscle and cell morphology, cell differentiation, and expression of adenosine diphosphate (ADP)-ribosylation factor GTPase activating protein 3 (ArfGAP3) were detected. RESULTS 5333 μ strain for 4-h CMS loading could induce myoblast injury with a reduction of ΔΨm, increased ROS levels, aggravation of oxidative damage-associated proteins NADPH oxidase 2 (NOX2) and xanthine oxidase (XO), and an increased apoptosis rate of C2C12 cells. At the same time, the injury CMS loading can promote the differentiation of myoblasts and increase the expression of ArfGAP3, a factor regulating intracellular transport. Mechanical trauma could also lead to the oxidative damage of LAM, indicated by 8-hydroxy-2'-deoxyguanosine(8-OHdG), NOX2 and XO protein accumulation, and increase the expression of ArfGAP3 in LAM. CONCLUSIONS Oxidative stress caused by mechanical trauma induces dysfunction and damage repairing of LAM and C2C12 myoblast, and ArfGAP3 may promote the repairing process.
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Hou Y, Hou D. Validation of the Australian Pelvic Floor Questionnaire in Chinese pregnant and postpartum women. Eur J Obstet Gynecol Reprod Biol 2020; 245:102-106. [PMID: 31891892 DOI: 10.1016/j.ejogrb.2019.12.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 12/17/2019] [Accepted: 12/23/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To test the psychometric properties of the culturally adapted Chinese version of the self-administered Australian Pelvic Floor Questionnaire (APFQ) in pregnant and postpartum women. STUDY DESIGN Between November 2018 and December 2018, a total of 316 pregnant women who met the inclusion criteria in an outpatient setting were enrolled. The participants completed the questionnaire during the third trimester and twice after delivery. The test for validity was composed of face/content validity and construct validity. Reliability testing included internal consistency and test-retest reliability. The degree of responsiveness was assessed using effect size (ES) and standardized response mean (SRM). RESULTS Two hundred and seventy-four women completed all questionnaires. Content validity, missing data did not exceed 4 % for any questions in the Chinese version of the self-administered APFQ. Construct validity, there was statistically significant difference in the symptoms scores of women with and without subjective suffering bothersome symptoms in bladder function, bowel function, prolapse and sexual function during pregnancy and postpartum periods. Reliability, the total Cronbach's alpha coefficients of the questionnaire in pregnancy and postpartum periods were 0.8, 0.9 and 0.9, respectively, and the intraclass correlation coefficient (ICC) of the total questionnaire was 0.8 during the test-retest. Responsiveness, the Chinese version of APFQ can track changes in bladder function domain and bowel function domain for the women with standardized response mean equal to 0.6 and 0.2, respectively. CONCLUSIONS The Chinese version of the self-administered APFQ had satisfactory reliability and validity, and can longitudinally monitor changes in pelvic floor symptoms during pregnancy and postpartum periods.
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Affiliation(s)
- Yuqing Hou
- School of Nursing, China Medical University, Shenyang 110122, China.
| | - Dan Hou
- Health Management Center, General Hospital of Northern Theater Command, Shenyang 110003, China.
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Azzam H, Halim M, El-Assaly H, Heiba A. MRI comparative study of levator ani muscle changes in nulliparous and multiparous females. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2019. [DOI: 10.1186/s43055-019-0065-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Pelvic floor dysfunction is known to be among the principal factors influencing public health, regarding frequency, cost and effect on women’s quality of life. Radiographic assessment of the pelvic floor function and anatomy plays a vital role in the recognition of pelvic floor defects. The aim of this study is to detect the postpartum-related levator ani muscle changes thus defining the relationship between the vaginal deliveries and the etiology of pelvic floor dysfunction in order to provide guidelines to decrease the incidence of pelvic floor injuries during parturition and guide the treatment plan.
Results
There was a significant difference in the puborectalis muscle thickness between the case and control groups in the right puborectalis (P value ≤ 0.001) and in the left puborectalis (P value (≤ 0.001) as well as significant midpoint thickness (P value = 0.03) with 46.2% puborectalis muscle injury in the case group compared with none in the control group.
Conclusion
Pelvic floor MRI is highly recommended as it is a contrast-free modality that allows for both anatomical and functional analysis. Its incorporation in the routine postpartum assessment will allow early detection of abnormalities even in asymptomatic cases thus ensuring proper management and preventing the development of pelvic floor dysfunction predisposed to by repeated vaginal deliveries.
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Symptoms of Discomfort and Problems Associated with Mode of Delivery During the Puerperium: An Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224564. [PMID: 31752197 PMCID: PMC6888009 DOI: 10.3390/ijerph16224564] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/13/2019] [Accepted: 11/15/2019] [Indexed: 12/19/2022]
Abstract
Despite abundant literature on antenatal and delivery care received by pregnant women, there is a wide knowledge gap on the prevalence of symptoms of discomfort or problems during the postpartum period and their relationship with the mode of delivery. This cross-sectional study, carried out with 3324 participants in Spain in 2017, aimed to investigate the association between the mode of delivery and self-reported postpartum symptoms of discomfort and maternal problems during the puerperium. An ad hoc online questionnaire was used to collect data on socio-demographic and obstetric variables, symptoms of discomfort, and maternal problems during the puerperium. The crude odds ratios (OR) and adjusted OR (aOR) and their 95% confidence intervals (95%CI) were calculated using binary logistic regression. In total, 3324 women participated. Compared to a normal vaginal delivery, having a cesarean section was associated with increased odds of an infected surgical wound (aOR: 11.62, 95%CI: 6.77–19.95), feeling sad (aOR: 1.31, 23 95%CI: 1.03–1.68), and symptoms of post-traumatic stress (aOR: 4.64, 95%CI: 2.94–7.32). Instrumental delivery vs. normal vaginal delivery was a risk factor for constipation (aOR: 1.35 95%CI: 25 1.10–1.66), hemorrhoids (aOR: 1.28, 95%CI: 1.04–1.57), urinary incontinence (aOR: 1.30, 95%CI: 26 1.05–1.61), and fecal incontinence (aOR: 1.94, 95%CI: 1.29–2.92) during the puerperium. Women who gave delivery via cesarean section or instrumental delivery had higher incidences of infection and psychological alterations than those who had a normal vaginal delivery. Identifying women at risk of giving birth by cesarean section and informing them about subsequent symptoms of discomfort and maternal problems during the puerperium must be included in pregnancy health program policies and protocols to allow women to make informed decisions regarding their birthing plan.
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Pelvic floor muscles after birth: Do unstable shoes have an effect on pelvic floor activity and can this be measured reliably? – A feasibility study / Der Beckenboden nach der Geburt: Verändern instabile Schuhe die Aktivität und kann diese reliabel gemessen werden? – Eine Machbarkeitsstudie. INTERNATIONAL JOURNAL OF HEALTH PROFESSIONS 2019. [DOI: 10.2478/ijhp-2019-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background
Women often suffer from urinary incontinence after childbirth. Pelvic floor muscle training is an evidenced-based intervention to prevent urinary incontinence and improve its symptoms
Aim
The primary purpose of this study was to determine if there is a change in the activation of the pelvic floor muscles with different extrinsic parameters (barefoot versus unstable shoe). Second, we wanted to define variables that can be measured reliably and correlated with pelvic floor activity.
Methods
Data of 15 women who were 8 weeks to 6 months postpartum were analyzed. Two conditions (“barefoot” and “kyBoot”) were tested, with each participant performing three different tasks: walking, standing with an active pelvic floor, and standing with a passive pelvic floor. Three-dimensional kinematics of the body were recorded. Activity of the abdominal, back, and gluteal muscles was measured using surface electromyography (EMG). The activity of the pelvic floor was recorded using a vaginal electrode. Maximum pelvic floor activity was compared for each condition, and correlations among pelvic floor activity, kinematic variables, and skeletal muscle activity were determined.
Results
The maximum activity of the pelvic floor while walking was significantly higher when participants were barefoot than when they were wearing kyBoot shoes. For the standing trials, no significant differences between the conditions were detected. No surrogate marker was found to measure the pelvic floor activity.
Conclusion
With regard to the pelvic floor musculature, no recommendation is possible in favor of or against wearing unstable shoes. Technical developments are necessary to provide solutions to reliably measure the pelvic floor activity.
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Pardo E, Rotem R, Glinter H, Erenberg M, Yahav L, Yohay Z, Yohay D, Weintraub AY. Recovery from pelvic floor dysfunction symptoms in the postpartum is associated with the duration of the second stage of labor. Arch Gynecol Obstet 2019; 300:127-133. [DOI: 10.1007/s00404-019-05173-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 04/24/2019] [Indexed: 10/26/2022]
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Lin HY, Tsai HW, Tsui KH, An YF, Lo CC, Lin ZH, Liou WS, Wang PH. The short-term outcome of laser in the management of female pelvic floor disorders: Focus on stress urine incontinence and sexual dysfunction. Taiwan J Obstet Gynecol 2018; 57:825-829. [DOI: 10.1016/j.tjog.2018.10.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2018] [Indexed: 12/11/2022] Open
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Dheresa M, Worku A, Oljira L, Mengistie B, Assefa N, Berhane Y. Factors associated with pelvic floor disorders in Kersa District, eastern Ethiopia: a community-based study. Int Urogynecol J 2018; 30:1559-1564. [PMID: 30259062 DOI: 10.1007/s00192-018-3776-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 09/19/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Pelvic floor disorders, which diminish the quality of life, disproportionally affect women in developing countries. However, there is a knowledge gap in the understanding of the factors associated with the problem in many countries including Ethiopia. Therefore, we aimed to assess the factors associated with pelvic floor disorders in Ethiopia. MATERIALS AND METHODS A community-based cross-sectional study was conducted among 3432 ever-married women selected through a stratified multistage sampling procedure from the Kersa Health and Demography Surveillance System. Data were collected using structured questionnaires through face-to-face interviews. A Poisson regression model with robust variance estimation was used to investigate the association of the independent variable with pelvic floor disorder. The results are reported in adjusted prevalence ratios with 95% confidence intervals. RESULTS Overall, the prevalence of pelvic floor disorders was 20.5% (95% CI: 19%-22%). Women who had no education (APR = 1.47; 95% CI: 1.06, 2.04) or had undergone five or more vaginal deliveries (APR = 1.56; 95% CI: 1.18, 2.05), an abortion (APR = 1.85; 95% CI: 1.43, 2.38) or episiotomy (APR = 1.39; 95% CI: 1.02, 1.90) were independently associated with having pelvic floor disorders. CONCLUSION Obstetric events are strongly associated with pelvic floor disorders. This finding highlights the greater need for policies to focus on prevention, diagnosis and treatment services to mitigate women's suffering from pelvic floor disorders.
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Affiliation(s)
- Merga Dheresa
- Health and Medical Sciences College, Haramaya University, P.O. Box 235, Harar, Ethiopia.
| | - Alemayehu Worku
- Addis Continental Institutes of Public Health, Addis Ababa, Ethiopia.,School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Lemessa Oljira
- Health and Medical Sciences College, Haramaya University, P.O. Box 235, Harar, Ethiopia
| | - Bezatu Mengistie
- Health and Medical Sciences College, Haramaya University, P.O. Box 235, Harar, Ethiopia
| | - Nega Assefa
- Health and Medical Sciences College, Haramaya University, P.O. Box 235, Harar, Ethiopia
| | - Yemane Berhane
- Addis Continental Institutes of Public Health, Addis Ababa, Ethiopia
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Liu YJ, Wu WY, Hsiao SM, Ting SWH, Hsu HP, Huang CM. Efficacy of pelvic floor training with surface electromyography feedback for female stress urinary incontinence. Int J Nurs Pract 2018; 24:e12698. [DOI: 10.1111/ijn.12698] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 04/16/2018] [Accepted: 06/30/2018] [Indexed: 01/07/2023]
Affiliation(s)
- Ying-Ju Liu
- Department of Obstetrics and Gynecology; Far Eastern Memorial Hospital; New Taipei Taiwan
- Cardinal Tien Junior College of Healthcare and Management; New Taipei Taiwan
| | - Wen-Yih Wu
- Department of Obstetrics and Gynecology; Far Eastern Memorial Hospital; New Taipei Taiwan
| | - Sheng-Mou Hsiao
- Department of Obstetrics and Gynecology; Far Eastern Memorial Hospital; New Taipei Taiwan
- College of Medicine; National Taiwan University; Taipei Taiwan
- Graduate school of Biotechnology and Bioengineering; Yuan Ze University; Taoyuan Taiwan
| | - Stella Wan-Hua Ting
- Department of Obstetrics and Gynecology; Far Eastern Memorial Hospital; New Taipei Taiwan
| | - Hsiao-Pei Hsu
- School of Nursing; National Yang-Ming University; Taipei Taiwan
| | - Chiu-Mieh Huang
- Institute of Clinical Nursing; National Yang-Ming University; Taipei Taiwan
- Department of Nursing; National Yang-Ming University Hospital; Yilan Taiwan
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Dheresa M, Worku A, Oljira L, Mengiste B, Assefa N, Berhane Y. One in five women suffer from pelvic floor disorders in Kersa district Eastern Ethiopia: a community-based study. BMC WOMENS HEALTH 2018; 18:95. [PMID: 29902997 PMCID: PMC6003007 DOI: 10.1186/s12905-018-0585-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 06/05/2018] [Indexed: 12/16/2022]
Abstract
Background Hundreds of millions of women suffer from pelvic floor disorders globally, often in silence. Women in developing countries do not disclose their problems due to associated social stigma or lack of access to services. Thus, the extent of the problem remains largely unknown. This study was conducted to assess the magnitude of pelvic floor disorders in Kersa district Eastern Ethiopia. Method We conducted a community-based cross-sectional study among ever married women who reside in Kersa district, Eastern Ethiopia. The study subjects were selected through stratified multistage probability sampling. The data were collected using a structured questionnaire through face-to-face interviews. The prevalence of various pelvic floor disorders are presented along with the 95% Confidence Intervals (CI). Results A total of 3432 women participated in the study, of which 704 (20.5%; 95% CI; 19.2, 21.8) reported at least one type of pelvic floor disorder and 349 (49.6%; 95% CI: 46.0, 53.0) reported two or more pelvic floor disorders. The most common pelvic floor disorders included an over active bladder (15.5%; 95% CI: 14.4, 16.8), pelvic organ prolapse (9.5%; 95% CI: 8.5,10.4), stress urinary incontinence (8.3%; 95% CI: 7.4, 9.2) and anal incontinence (1.9%; 95% CI: 1.5, 2.4). More than two-thirds of the women with pelvic floor disorders (68.0%; 95% CI:64.4, 71.3) reported having severe distress but had never sought health care. Conclusions The magnitude of the health problem and the low level of health seeking behavior indicates the silent suffering of many women in the study area. Extrapolating these figure to national statistics would indicate the staggering number of women suffering from pelvic floor disorders in the country. This calls for urgent action to improve prevention, diagnosis and treatment services to mitigate the suffering of women from pelvic floor disorders.
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Affiliation(s)
- Merga Dheresa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia. .,, Harar, Ethiopia.
| | - Alemayehu Worku
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia.,School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.,, Addis Ababa, Ethiopia
| | - Lemessa Oljira
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.,, Harar, Ethiopia
| | - Bizatu Mengiste
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.,, Harar, Ethiopia
| | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.,, Harar, Ethiopia
| | - Yemane Berhane
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia.,, Addis Ababa, Ethiopia
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Pelvic Floor Muscle Training Versus Watchful Waiting and Pelvic Floor Disorders in Postpartum Women. Female Pelvic Med Reconstr Surg 2018; 24:142-149. [DOI: 10.1097/spv.0000000000000513] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Han W, Wang Y, Qi S, Li T, Cao J, Zheng T, Su Y. Observation of the effect of physical rehabilitation therapy combined with the medication on pelvic floor dysfunction. Exp Ther Med 2017; 15:1211-1216. [PMID: 29399117 PMCID: PMC5774529 DOI: 10.3892/etm.2017.5583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 05/18/2017] [Indexed: 12/13/2022] Open
Abstract
We observed the effects of physical rehabilitation therapy combined with medication on pelvic floor dysfunction (PFD). We collected the medical records of 84 maternal patients with PFD who received treatment at the Affiliated Hospital of Hebei University between May 2015 and October 2016. These patients were randomly divided into two groups, the control group (n=42) and observation group (n=42). In the control group, patients received conventional physical rehabilitation therapy while in observation group, patients received the shixiao powder combined with siwu decoction in addition to the physical rehabilitation. The therapeutic effects were compared between the two groups. The total effective rate of the observation group was 97.6%, which was significantly higher than 78.6% in the control group (P<0.05). In observation group, the index scores of pelvic floor function under rest state, such as electromyo-graphy amplitude, contraction force, coordinate strength and urine flow rate, were significantly higher than those in control group (P<0.05). The rate of Grade II perineal muscle strength in the observation group was 7.32%, which was significantly lower than 47.62% in control group (P<0.05). In observation group, the rates of Grade III and Grade IV muscle strength were respectively 43.91 and 29.26%, which were significantly higher than those in control group (P<0.05). Before the administration of treatment, there were no significant differences in the comparison of the urinary incontinence and sexual life quality of patients between the two groups (P>0.05). In observation group, after treatment, the rehabilitation effects of urinary incontinence and sexual life quality at 3 months post-delivery were significantly better than those in control group (P<0.05). Before treatment, there were no significant differences in the comparison of levels of C-reactive protein (CRP) and interleukin-10 (IL-10) between the two groups (P>0.05), however, after treatment, the levels of CRP and IL-10 of patients in observation group were significantly lower than those in control group (P<0.05). In the observation group, the incidence rate of complications (7.14%) were significantly lower than that in control group (23.81%; P<0.05). Therefore, physical rehabilitation therapy combined with the shixiao powder and siwu decoction exhibits significant efficacy in the treatment of PFD by effectively improving the pelvic floor functions, increasing perineal muscle strength, and decreasing expression levels of inflammatory factors, which can significantly ameliorate life quality and reduce the incidence rate of complications. Thus, this treatment method shows great application value in clinical practice.
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Affiliation(s)
- Wei Han
- Maternity and Child Care Among Perinatal Care Clinic, Tangshan, Hebei 063000, P.R. China
| | - Yongmei Wang
- Department of Gynecology and Obstetrics, The Fourth Hospital of Hebei Medical University (Tumor Hospital of Hebei) Shijiazhuang, Hebei 050011, P.R. China
| | - Shengbo Qi
- Hospital of Gastrointestinal Surgery, Weifang, Shandong 261042, P.R. China
| | - Tingting Li
- Department of Thoracic Surgery, Affiliated Hospital of Hebei University, Baoding, Hebei 071000, P.R. China
| | - Jiang Cao
- Hospital of Gastrointestinal Surgery, Weifang, Shandong 261042, P.R. China
| | - Tinghua Zheng
- Maternity and Child Care Department of Obstetrics and Gynecology, Tangshan, Hebei 063000, P.R. China
| | - Yan Su
- Maternal and Child Health Care Medicine, Tangshan, Hebei 063000, P.R. China
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Chen HY, Chen CJ, Chen WC, Wang SJ, Chen YH. A promising protein responsible for overactive bladder in ovariectomized mice. Taiwan J Obstet Gynecol 2017; 56:196-203. [PMID: 28420508 DOI: 10.1016/j.tjog.2016.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2016] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Ovariectomy (OVX) in mice is a model mimicking a neuro-electronic proof of an overactive bladder in postmenopausal women. Overactive bladder (OAB) was recently found to be due to an altered gap junction protein in a rat model. Thus, this study was conducted to evaluate changes in cell junction protein expression and composition in the bladder of OVX mice. MATERIALS AND METHODS Thirty-six virgin female mice were randomized into three groups: mice with a sham operation only (control), OVX mice without estradiol (E2) replacement, and OVX mice with E2 replacement (OVX + E2). Cystometry assessment was conducted and cell junction-associated protein zonula occludens-2 (ZO-2) expression was measured after 8 weeks. Voiding interval values (time between voids) were assessed in mice under anesthesia. After measurements, the bladders were removed for proteomic analysis using the label-free quantitative proteomics and liquid chromatography-mass spectrometry technology. Lastly, immunohistochemistry (IHC) and Western blot were used to confirm the location and level, respectively, of ZO-2 expression. RESULTS We identified 73 differentially expressed proteins in the bladder of OVX mice. The OVX mice showed significantly lower voiding interval values. Voiding interval values were significantly higher in the OVX + E2 group than in the OVX group. Urothelial thicknesses in the bladder were also significantly lower in the OVX group than in the control group. E2 replacement reversed the urothelium layers. Additionally, the expression of ZO-2, a tight junction protein, was the most affected by OVX treatment. IHC and Western blot confirmed the downregulation of ZO-2 in the bladder of OVX mice. Expression of ZO-2 protein was significantly increased in OVX + E2 group compared with OVX group. CONCLUSION This exploratory study estimated changes in protein expression and composition in the bladder of OVX mice. These changes may be associated with the molecular mechanisms of OAB.
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Affiliation(s)
- Huey-Yi Chen
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, Proteomics Core Laboratory, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung, Taiwan; Departments of Obstetrics and Gynecology, Medical Research, and Urology, Sex Hormone Research Center, China Medical University Hospital, Taichung, Taiwan
| | - Chao-Jung Chen
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, Proteomics Core Laboratory, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung, Taiwan; Departments of Obstetrics and Gynecology, Medical Research, and Urology, Sex Hormone Research Center, China Medical University Hospital, Taichung, Taiwan
| | - Wen-Chi Chen
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, Proteomics Core Laboratory, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung, Taiwan; Departments of Obstetrics and Gynecology, Medical Research, and Urology, Sex Hormone Research Center, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Jing Wang
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, Proteomics Core Laboratory, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung, Taiwan
| | - Yung-Hsiang Chen
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, Proteomics Core Laboratory, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung, Taiwan; Departments of Obstetrics and Gynecology, Medical Research, and Urology, Sex Hormone Research Center, China Medical University Hospital, Taichung, Taiwan; Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan.
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Neels H, Mortiers X, de Graaf S, Tjalma WAA, De Wachter S, Vermandel A. Vaginal wind: A literature review. Eur J Obstet Gynecol Reprod Biol 2017; 214:97-103. [PMID: 28494270 DOI: 10.1016/j.ejogrb.2017.04.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 04/05/2017] [Accepted: 04/15/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE In the medical literature, there is little known about vaginal wind, though from clinical expertise, it turns out to be a consistent and underreported problem. The aim of this review was to collect the available literature about the different aspects of vaginal wind. STUDY DESIGN A systematic literature search was conducted using three databases until December 2015. The search strategy was built using relevant synonyms of vaginal wind. Study characteristics were extracted. Risk of bias, the quality of the relevant studies and the level of evidence was judged. RESULTS Eleven studies met the inclusion criteria. Vaginal wind occurs on random movements and during or after coitus. The prevalence ranges from one to 69%. The pathophysiology is unclear and the incidence unknown. Known risk factors are vaginal delivery and urinary incontinence. Provoking factors are coitus, digital stimulation, cunnilingus and exercising. Female sexual function is decreased. The sexual function of male partners with vaginal wind is not influenced. Overall vaginal wind leads to a decrease in the quality of live and can have cause social isolation. The treatment is related to the cause and mainly not successful. Tampons can be used for treatment as well as prevention. CONCLUSION Vaginal wind is an underestimated health issue with a severe impact on sexual functioning. Adequate research is needed regarding the influence of sexual activity, weight, age, parity, the underlying pathophysiological mechanisms, prevention and treatment.
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Affiliation(s)
- Hedwig Neels
- Faculty of Medicine and Health Sciences, University of Antwerp, Belgium; Department of Urology and Urological Rehabilitation, Antwerp University Hospital, Belgium.
| | - Xavier Mortiers
- Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - Sybrich de Graaf
- Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - Wiebren A A Tjalma
- Faculty of Medicine and Health Sciences, University of Antwerp, Belgium; Multidisciplinary Breast Clinic - Unit of Gynaecologic Oncology, Antwerp University Hospital, University of Antwerp, Belgium Hospital, Belgium; Department of Obstetrics and Gynaecology, Antwerp University Hospital, Belgium
| | - Stefan De Wachter
- Faculty of Medicine and Health Sciences, University of Antwerp, Belgium; Department of Urology and Urological Rehabilitation, Antwerp University Hospital, Belgium
| | - Alexandra Vermandel
- Faculty of Medicine and Health Sciences, University of Antwerp, Belgium; Department of Urology and Urological Rehabilitation, Antwerp University Hospital, Belgium
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Wang H, Ghoniem G. Postpartum stress urinary incontinence, is it related to vaginal delivery? J Matern Fetal Neonatal Med 2017; 30:1552-1555. [DOI: 10.1080/14767058.2016.1209648] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Hong Wang
- Department of Obstetrics and Gynecology, Beijing Chaoyang Hospital, Affiliated Hospital of Capital Medical University, Beijing, China
- Department of Urology, University of California, Irvine, Orange, CA, USA
| | - Gamal Ghoniem
- Department of Urology, University of California, Irvine, Orange, CA, USA
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Huser M, Janku P, Hudecek R, Zbozinkova Z, Bursa M, Unzeitig V, Ventruba P. Pelvic floor dysfunction after vaginal and cesarean delivery among singleton primiparas. Int J Gynaecol Obstet 2017; 137:170-173. [PMID: 28171703 DOI: 10.1002/ijgo.12116] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 12/09/2016] [Accepted: 02/03/2017] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To compare the prevalence of pelvic floor dysfunction symptoms, including pelvic organ prolapse (POP), urinary incontinence (UI), and fecal incontinence (FI) among primiparous women after vaginal and cesarean delivery. METHODS In a prospective cohort study at a University hospital in the Czech Republic, singleton primiparas with cephalic presentation who delivered at term were enrolled between 2002 and 2007. In 2013, 5-10 years after delivery, women who had not delivered again completed an internet-based survey about current symptoms of POP, UI, and FI, which were evaluated using validated questionnaires. The relative risk (RR) of POP, UI, and FI symptoms was calculated. RESULTS Complete questionnaire data were obtained from 641 women who delivered vaginally and 224 who delivered by cesarean. The mean UI score (ICIQ-SF) was 2.3 ± 3.6 in the vaginal group and 1.0 ± 2.7 in the cesarean group (P=0.005). The mean POP scores (POPDI-6) were 2.2 ± 2.3 and 2.1 ± 2.0, respectively (P=0.944). The mean Wexner scores to evaluate FI were 1.3 ± 1.7 and 1.0 ± 1.5, respectively (P=0.220). The RR of pelvic floor dysfunction after vaginal delivery was highest for women with UI symptoms (RR 1.15, 95% confidence interval 0.92-1.42). CONCLUSION Significant differences in the occurrence of symptoms of UI were observed after vaginal delivery as compared with cesarean delivery. ClinicalTrials.gov: NCT02661867.
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Affiliation(s)
- Martin Huser
- Department of Obstetrics and Gynecology, Brno University Hospital and Masaryk University Medical School, Brno, Czech Republic
| | - Petr Janku
- Department of Obstetrics and Gynecology, Brno University Hospital and Masaryk University Medical School, Brno, Czech Republic
| | - Robert Hudecek
- Department of Obstetrics and Gynecology, Brno University Hospital and Masaryk University Medical School, Brno, Czech Republic
| | - Zuzana Zbozinkova
- Institute of Biostatistics and Analyses, Masaryk University Medical School, Brno, Czech Republic
| | - Miroslav Bursa
- Czech Institute of Informatics, Robotics and Cybernetics, Czech Technical University, Prague, Czech Republic
| | - Vit Unzeitig
- Department of Obstetrics and Gynecology, University Hospital Ostrava and University of Ostrava Medical School, Ostrava, Czech Republic
| | - Pavel Ventruba
- Department of Obstetrics and Gynecology, Brno University Hospital and Masaryk University Medical School, Brno, Czech Republic
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Asresie A, Admassu E, Setegn T. Determinants of pelvic organ prolapse among gynecologic patients in Bahir Dar, North West Ethiopia: a case-control study. Int J Womens Health 2016; 8:713-719. [PMID: 28003773 PMCID: PMC5161336 DOI: 10.2147/ijwh.s122459] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Introduction Pelvic organ prolapse (POP) is a significant public health problem in developing countries including Ethiopia. However, less has been documented on risk factors of POP. Therefore, the aim of this study was to identify the determinants factors of POP. Methods An unmatched case–control study was conducted among gynecologic patients in Bahir Dar city, North West Ethiopia, from July to October 2014. A total of 370 women (selected from outpatient departments) were included in the study. Cases (clients with stage III or IV POP) and controls (who declared free of any stages of POP) were identified by physicians using the Pelvic Organ Prolapse Quantitative Examination tool. Data analysis was carried out by SPSS version 20.0. Descriptive, bivariate, and multivariable logistic regression analyses were performed. Statistical differences were considered at P<0.05, and the strength of association was assessed by odds ratio (OR) and respective confidence intervals (CIs). Results This study revealed that determinants such as age of women (>40 years) (adjusted OR [AOR] =3.0 [95% CI: 1.59–5.89]), sphincter damage (AOR =8.1 [95% CI: 1.67–39.7]), family history of POP (AOR =4.9 [95% CI: 1.94–12.63]), parity (≥4) (AOR =4.5 [95% CI: 2.26–9.10]), nonattendance of formal education (AOR =4.3 [95% CI: 1.25–14.8]), carrying heavy objects (AOR =3.1 [95% CI: 1.56–6.30]), body mass index (BMI) <18.5 kg/m2 (AOR =3.1 [95% CI: 1.22–7.82]), and delivery assisted by nonhealth professionals (AOR =2.6 [95% CI: 1.24–5.56]) were significantly associated with POP. Conclusion In our study, sphincter damage, family history of POP, being uneducated, having ≥4 vaginal deliveries, carrying heavy objects, BMI <18.5 kg/m2, age ≥40 years, and having delivery assisted by nonhealth professional were the independent determinants of POP. Therefore, skilled delivery, further promoting family planning and girls’ education, early pelvic floor assessment, and counseling on avoidance of carrying heavy objects are recommended.
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Affiliation(s)
- Ayalnesh Asresie
- Hamlin Fistula Center, Amhara National Regional State, Bahir Dar, Ethiopia
| | - Eleni Admassu
- Bahir Dar University, College of Medicine and Health Sciences, School of Public Health, Reproductive Health Department, Amhara National Regional State, Bahir Dar, Ethiopia
| | - Tesfaye Setegn
- Bahir Dar University, College of Medicine and Health Sciences, School of Public Health, Reproductive Health Department, Amhara National Regional State, Bahir Dar, Ethiopia
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Aparicio VA, Ocón O, Padilla-Vinuesa C, Soriano-Maldonado A, Romero-Gallardo L, Borges-Cósic M, Coll-Risco I, Ruiz-Cabello P, Acosta-Manzano P, Estévez-López F, Álvarez-Gallardo IC, Delgado-Fernández M, Ruiz JR, Van Poppel MN, Ochoa-Herrera JJ. Effects of supervised aerobic and strength training in overweight and grade I obese pregnant women on maternal and foetal health markers: the GESTAFIT randomized controlled trial. BMC Pregnancy Childbirth 2016; 16:290. [PMID: 27680325 PMCID: PMC5041398 DOI: 10.1186/s12884-016-1081-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 09/22/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND During pregnancy, a sedentary lifestyle may have negative consequences on maternal and foetal health status. The main objective of this project is to assess the effects of an exercise intervention in overweight and grade I obese pregnant on maternal and foetal health markers. METHODS/DESIGN The present study aims to recruit 60 overweight and grade I obese women interested in participating in an exercise intervention program from the 17th gestational week until delivery. Women will be randomized to either an exercise (three 60-min sessions/week of combined aerobic and strength training and pelvic floor exercises), or usual care (control) group (30 women per group). The primary outcome measures are maternal weight gain, and maternal and neonatal glycaemic profile. Secondary outcome measures are: i) perinatal obstetric records; i) body composition; iii) dietary patterns; iv) physical fitness; v) low-back pain; vi) objectively measured physical activity and sedentary behaviour; vii) haematology and biochemical analyses; viii) oxidative stress; ix) pro- and anti-inflammatory markers; x) bone health biomarkers; xi) sleep quality; xii) mental health, quality of life and positive health. DISCUSSION The findings of this project will help to identify strategies for primary prevention and health promotion based on this exercise-based intervention program among overweight and grade I obese pregnant women. TRIAL REGISTRATION NCT02582567 ; Date of registration: 20/10/2015.
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Affiliation(s)
- Virginia A. Aparicio
- Department of Physiology, Faculty of Pharmacy and Institute of Nutrition and Food Technology, University of Granada, Granada, Spain
- Department of Public and Occupational Health, and EMGO+ Institute for Health and Care Research, VU University medical center, Amsterdam, The Netherlands
| | - Olga Ocón
- Department of Obstetrics and Gynecology, University of Granada, Granada, Spain
| | - Carmen Padilla-Vinuesa
- Department of Obstetrics and Gynecology, University of Granada, Granada, Spain
- Obstetrics and Gynecology Service, University Hospital Complex, Granada, Spain
| | - Alberto Soriano-Maldonado
- Department of Education, Faculty of Education Sciences, University of Almería, Almería, Spain
- Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Lidia Romero-Gallardo
- Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Milkana Borges-Cósic
- Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Irene Coll-Risco
- Department of Physiology, Faculty of Pharmacy and Institute of Nutrition and Food Technology, University of Granada, Granada, Spain
| | - Pilar Ruiz-Cabello
- Department of Physiology, Faculty of Pharmacy and Institute of Nutrition and Food Technology, University of Granada, Granada, Spain
| | - Pedro Acosta-Manzano
- Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Fernando Estévez-López
- Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
- Department of Clinical and Health Psychology, Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, The Netherlands
| | | | - Manuel Delgado-Fernández
- Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Jonatan R. Ruiz
- Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Mireille N. Van Poppel
- Department of Public and Occupational Health, and EMGO+ Institute for Health and Care Research, VU University medical center, Amsterdam, The Netherlands
- Institute of Sport Science, University of Graz, Graz, Austria
| | - Julio J. Ochoa-Herrera
- Department of Physiology, Faculty of Pharmacy and Institute of Nutrition and Food Technology, University of Granada, Granada, Spain
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Low compliance bladder. Taiwan J Obstet Gynecol 2016; 55:457-8. [PMID: 27343340 DOI: 10.1016/j.tjog.2016.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2016] [Indexed: 11/20/2022] Open
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