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Selman R, Early KS. A Pre and Postnatal Physical Therapy Protocol for Recreational Athletes: A Case Series. Int J Sports Phys Ther 2024; 19:1012-1019. [PMID: 39100934 PMCID: PMC11297362 DOI: 10.26603/001c.121421] [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: 01/09/2024] [Accepted: 06/21/2024] [Indexed: 08/06/2024] Open
Abstract
Background and Purpose Recent changes to medical recommendations for exercise in pregnancy and postpartum have expanded to include recreational athletes. While women are transitioning into motherhood at the height of their athletic careers, there is limited guidance on musculoskeletal training from pregnancy through safe return to activity. The lack of education and support in this population may lead to increased prevalence of symptoms and delay of treatment, ultimately hindering athletic performance. The purpose of this case series is to assess pelvic floor symptoms through implementing a new pre- and postnatal exercise training paradigm in a group of women aiming to return to recreational athletics. Study Design Case series. Methods Six recreationally athletic women between 25-35 years of age were referred to physical therapy during pregnancy to participate in this protocol. The women completed a standardized pregnancy and postpartum rehabilitation plan focused on core and pelvic floor control in addition to specific strength and mobility training. Results Pain, urinary dysfunction, and pelvic floor muscle strength were assessed at six weeks postpartum and at discharge. Meaningful improvement was noted in pain, urinary dysfunction, and muscle strength by the time of discharge. Conclusion The decrease in symptoms and improvements in measures of musculoskeletal health suggests that a physical therapist guided rehabilitation protocol may be useful as part of the standard of care to reduce prevalence of pain and dysfunction, particularly in the recreational athlete population. Improving understanding of exercise training in this population may minimize musculoskeletal symptoms and encourage additional research to improve the standard of care for this group of patients. Level of Evidence Level 4.
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Affiliation(s)
| | - Kate S. Early
- Kinesiology and Health SciencesColumbus State University
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2
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Namazi G, Chauhan N, Handler S. Myofascial pelvic pain: the forgotten player in chronic pelvic pain. Curr Opin Obstet Gynecol 2024; 36:273-281. [PMID: 38837702 DOI: 10.1097/gco.0000000000000966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
PURPOSE OF REVIEW In this review article, we discuss myofascial-related chronic pelvic pain, pathophysiology, symptomology, and management options. RECENT FINDINGS Despite high prevalence of myofascial pelvic pain, screening is not routinely performed by providers. Treatment modalities include pelvic floor physical therapy, pelvic floor trigger point injections with anesthetics or botulinum toxin A and cryotherapy. Other adjunct modalities, such as muscle relaxants and intravaginal benzodiazepines, are used, but data regarding their effectiveness is sparse. SUMMARY Myofascial pelvic pain is an important, though overlooked component of chronic pelvic pain. Multimodal, multidisciplinary approach including patient education, pelvic floor physical therapy, and trigger point injections is the mainstay of the management of myofascial pelvic pain.
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Affiliation(s)
- Golnaz Namazi
- Minimally Invasive Gynecologic Surgery, University of California Riverside
| | - Navya Chauhan
- University of California Riverside School of Medicine
| | - Stephanie Handler
- Female Pelvic Medicine and Reconstructive Surgery, University of California Riverside, Riverside, California, USA
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3
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Zhou W, Guo H. Curative effect of hydrogen peroxide combined with silver ion disinfection on pelvic floor dysfunction. World J Clin Cases 2024; 12:4508-4517. [PMID: 39070827 PMCID: PMC11235482 DOI: 10.12998/wjcc.v12.i21.4508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/06/2024] [Accepted: 06/06/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND Pelvic floor dysfunction (PFD) is related to muscle fiber tearing during childbirth, negatively impacting postpartum quality of life of parturient. Appropriate and effective intervention is necessary to promote PFD recovery. AIM To analyze the use of hydrogen peroxide and silver ion disinfection for vaginal electrodes in conjunction with comprehensive rehabilitation therapy for postpartum women with PFD. METHODS A total of 59 women with PFD who were admitted to the hospital from May 2019 to July 2022 were divided into two groups: Control group (n = 27) received comprehensive rehabilitation therapy and observation group (n = 32) received intervention with pelvic floor biostimulation feedback instrument in addition to comprehensive rehabilitation therapy. The vaginal electrodes were disinfected with hydrogen peroxide and silver ion before treatment. Intervention for both groups was started 6 weeks postpartum, and rehabilitation lasted for 3 months. Pelvic floor muscle voltage, pelvic floor muscle strength, vaginal muscle voltage, vaginal muscle tone, pelvic floor function, quality of life, and incidence of postpartum PFD were compared between the two groups. RESULTS Before comprehensive rehabilitation treatment, basic data and pelvic floor function were not significantly different between the two groups. After treatment, the observation group showed significant improvements in the maximum voltage and average voltage of pelvic floor muscles, contraction time of type I and type II fibers, pelvic floor muscle strength, vaginal muscle tone, vaginal muscle voltage, and quality of life (GQOLI-74 reports), compared with the control group. The observation group had lower scores on the pelvic floor distress inventory (PFDI-20) and a lower incidence of postpartum PFD, indicating the effectiveness of the pelvic floor biostimulation feedback instrument in promoting the recovery of maternal pelvic floor function. CONCLUSION The combination of the pelvic floor biostimulation feedback instrument and comprehensive rehabilitation nursing can improve pelvic floor muscle strength, promote the recovery of vaginal muscle tone, and improve pelvic floor function and quality of life. The use of hydrogen peroxide and silver ion disinfectant demonstrated favorable antibacterial efficacy and is worthy of clinical application.
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Affiliation(s)
- Wei Zhou
- Department of Outpatient, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- West China School of Nursing, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Hua Guo
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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4
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Ding A, Noga H, Bouchard KN, Bedaiwy MA, Lee C, Allaire C, Orr NL, Yong PJ. Pain with orgasm in endometriosis: potential etiologic factors and clinical correlates. J Sex Med 2024:qdae084. [PMID: 39039031 DOI: 10.1093/jsxmed/qdae084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 05/05/2024] [Accepted: 07/10/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND Pelvic pain worsened by orgasm is a poorly understood symptom in patients with endometriosis. AIM To assess the prevalence of pelvic pain worsened by orgasm in patients with endometriosis and explore its association with potential etiologic factors, including pelvic floor myalgia, uterine tenderness and adenomyosis, and central nervous system sensitization. METHODS An analysis was done of a prospective data registry based at a tertiary referral center for endometriosis. Eligible participants were patients aged 18 to 50 years who were referred between January 1, 2018, and December 31, 2019, diagnosed with endometriosis, and subsequently underwent surgery at the center. Clinical features were compared between participants reporting worsening pelvic pain with orgasm and those without worsening pain with orgasm, including patient-reported variables, physical examination findings, and anatomic phenotyping at the time of surgery. Pelvic floor myalgia and uterine tenderness were assessed by palpation on pelvic examination, adenomyosis by ultrasound, and central nervous system sensitization via the Central Sensitization Inventory (range, 0-100). OUTCOMES Outcomes included pelvic or lower abdominal pain in the last 3 months that worsened with orgasm (yes/no). RESULTS Among 358 participants with endometriosis, 14% (49/358) reported pain worsened by orgasm while 86% (309/358) did not. Pain with orgasm was significantly associated with pelvic floor myalgia (55% [27/49] vs 35% [109/309]; Cohen's h = 0.40, P = .01) and higher scores on the Central Sensitization Inventory (mean ± SD, 53.3 ± 17.0 vs 42.7 ± 18.2; Cohen's d = 0.60, P < .001) but not with uterine tenderness or adenomyosis. Other clinical features associated with pain with orgasm were poorer sexual health (higher scores: deep dyspareunia, Cohen's h = 0.60; superficial dyspareunia, Cohen's h = 0.34; and Female Sexual Distress Scale-Revised, Cohen's d = 0.68; all P < .05) and poorer mental health (higher scores: Patient Health Questionnaire-9, 12.9 ± 6.7 vs 9.1 ± 6.3, Cohen's d = 0.59, P < .001; Generalized Anxiety Disorder-7, 9.4 ± 5.6 vs 6.8 ± 5.5, Cohen's d = 0.48, P = .002). Anatomic findings at the time of surgery did not significantly differ between the groups. CLINICAL IMPLICATIONS Interventions targeting pelvic floor myalgia and central nervous system sensitization may help alleviate pain worsened by orgasm in patients with endometriosis. STRENGTHS AND LIMITATIONS A strength is that pain worsened by orgasm was differentiated from dyspareunia. However, pain with orgasm was assessed by only a binary question (yes/no). Also, the study is limited to a single center, and there were limited data on sexual function. CONCLUSION Pelvic pain exacerbated by orgasm in people with endometriosis may be related to concurrent pelvic floor myalgia and central sensitization.
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Affiliation(s)
- Avrilynn Ding
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver V5H 3N1, Canada
| | - Heather Noga
- Women's Health Research Institute, Vancouver V5H 3N1, Canada
- Center for Pelvic Pain and Endometriosis, BC Women's Hospital, Vancouver V5H 3N1, Canada
| | - Katrina N Bouchard
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver V5H 3N1, Canada
| | - Mohamed A Bedaiwy
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver V5H 3N1, Canada
- Center for Pelvic Pain and Endometriosis, BC Women's Hospital, Vancouver V5H 3N1, Canada
| | - Caroline Lee
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver V5H 3N1, Canada
- Center for Pelvic Pain and Endometriosis, BC Women's Hospital, Vancouver V5H 3N1, Canada
| | - Catherine Allaire
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver V5H 3N1, Canada
- Center for Pelvic Pain and Endometriosis, BC Women's Hospital, Vancouver V5H 3N1, Canada
| | - Natasha L Orr
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver V5H 3N1, Canada
- Center for Pelvic Pain and Endometriosis, BC Women's Hospital, Vancouver V5H 3N1, Canada
| | - Paul J Yong
- Women's Health Research Institute, Vancouver V5H 3N1, Canada
- Center for Pelvic Pain and Endometriosis, BC Women's Hospital, Vancouver V5H 3N1, Canada
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5
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Wu H, Zhong X, He L, Li X, Zeng Y, Jia Y. Clinical effect and prognostic factor of electric stimulation and biofeedback therapy on postpartum pelvic organ prolapse. Rev Esc Enferm USP 2024; 58:e20230421. [PMID: 39115220 PMCID: PMC11308478 DOI: 10.1590/1980-220x-reeusp-2023-0421en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 05/10/2024] [Indexed: 08/11/2024] Open
Abstract
OBJECTIVE To explore the effects of electric stimulation and biofeedback therapy in patients with postpartum pelvic organ prolapse and to identify factors that can affect therapeutic efficacy outcomes. METHOD This retrospective study analysed clinical data about patients with postpartum pelvic organ prolapse. A total of 328 women with pelvic organ prolapse at 6 weeks postpartum were recruited from one tertiary hospitals in Sichuan province in China, between March 2019 and March 2022. The prognostic factors of therapeutic efficacy were analysed using logistic regression and decision tree model. RESULTS Overall, 259 women showed clinical benefits from the treatment. The logistic regression model showed that parity, pelvic floor muscle training at home, and the pelvic organ prolapse quantitation stage before treatment were independent prognostic factors. The decision tree model showed that the pelvic organ prolapse quantitation stage before treatment was the main prognostic factor, followed by parity. There was no significant difference in the area under the receiver operating characteristic curve between the two models. CONCLUSION Parity, pelvic floor muscle training at home, and the pelvic organ prolapse quantitation stage before treatment were important prognostic factors of electric stimulation and biofeedback therapy on postpartum pelvic organ prolapse.
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Affiliation(s)
- Hongjin Wu
- Chengdu Medical College, School of Nursing, Chengdu, Sichuan, China
- University of Electronic Science and Technology of China, School of Medicine, Mianyang Central Hospital, Obstetrics and Gynecology Department, Mianyang, Sichuan, China
| | - Xiaoying Zhong
- University of Electronic Science and Technology of China, School of Medicine, Mianyang Central Hospital, Obstetrics and Gynecology Department, Mianyang, Sichuan, China
| | - Linqian He
- Chengdu Medical College, School of Nursing, Chengdu, Sichuan, China
| | - Xixi Li
- Chengdu Medical College, School of Nursing, Chengdu, Sichuan, China
- University of Electronic Science and Technology of China, School of Medicine, Department of Nursing, Mianyang Central Hospital, Mianyang, Sichuan, China
| | - Yan Zeng
- University of Electronic Science and Technology of China, School of Medicine, Mianyang Central Hospital, Obstetrics and Gynecology Department, Mianyang, Sichuan, China
| | - Yuanli Jia
- University of Electronic Science and Technology of China, School of Medicine, Mianyang Central Hospital, Obstetrics and Gynecology Department, Mianyang, Sichuan, China
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Schmidt EM, Ward L, Gregory WT, Cichowski SB. Geographic Access to Urogynecology Care in the United States. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024:02273501-990000000-00253. [PMID: 39018388 DOI: 10.1097/spv.0000000000001547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/19/2024]
Abstract
IMPORTANCE Although access to urogynecologic care is known to influence patient outcomes, less is known regarding geographic access to care and how it may vary by population characteristics. OBJECTIVE The primary objective of this study was to estimate geographic accessibility of urogynecologic services in terms of drive time and by population demographics. STUDY DESIGN We performed a descriptive study using practice location data by zip code for all board-certified urogynecologists who are American Urogynecologic Society members (n = 497) and pelvic floor physical therapists (n = 985). Drive times from each zip code to the nearest health care professional zip code were calculated. These data were then overlaid onto a map of the continental United States. Race/ethnicity, age, education, poverty status, disability status, health insurance coverage, and rurality were compared across travel times. RESULTS Of the 31,754 zip codes of the continental United States, 389 (1.23%) had at least 1 urogynecologist, and 785 (2.47%) had at least 1 pelvic floor physical therapist; 92.29 million women older than 35 years were represented in the demographic analyses. Seventy-nine percent of the studied population live within 1 hour of a urogynecologist, and 85% live within 1 hour of a pelvic floor physical therapist. Seven percent and 3% live >2 hours from urogynecologic services, respectively. Values for drive times to all health care professionals indicate that American Indian/Alaska Native individuals have a much greater travel burden than other racial/ethnic groups. CONCLUSIONS There are population groups with limited geographic access to urogynecologic services. Pelvic floor physical therapists are more geographically accessible to the population studied than urogynecologists.
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Affiliation(s)
- Eleanor M Schmidt
- From the Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR
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7
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Pessoa P, Carvalho A, Mota P. Prevalence of levator ani muscle injuries in primiparous women after delivery and their influence on pelvic floor disorders-systematic review. Neurourol Urodyn 2024. [PMID: 38948963 DOI: 10.1002/nau.25529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/23/2024] [Accepted: 06/11/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND Studies show a significant association between the first vaginal delivery and injuries of the levator ani muscle (LAM), which can cause pelvic floor disorders (PFDs). OBJECTIVES This study aims to identify the prevalence of short and long-term LAM injuries after vaginal delivery in primiparous women and its influence on PFDs. METHOD A systematic review was conducted according to the PRISMA methodology. The databases used were Pubmed, Cochrane, and PEDro. The quality assessment of the evidence was carried out using the Critical Appraisal Skills Programme (CASP). Both the selection of studies and their evaluation were done by two researchers and a third reviewer in cases of disagreement. RESULTS From the search, 57 articles were gathered, and 19 were included to match the eligibility criteria. The prevalence of avulsion of the LAM was found in association with vaginal delivery between 13% and 28% ≤ 1 year after delivery and between 16% and 29% > 1 year after delivery. Ballooning was detected between 20% and 37% ≤ 1 year, and 33% of women > 1 year after delivery, appearing to be more common when compared to avulsion. Pelvic organ prolapse (POP) was considered the most common disorder associated with injuries of the LAM, and there seems to be some connection with sexual dysfunction. CONCLUSION Avulsion of the LAM and ballooning of the hiatal area have a high prevalence in primiparous women after vaginal delivery and have a strong direct relation to the development of POP.
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Affiliation(s)
- Patrícia Pessoa
- ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Andreia Carvalho
- ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
- Universidade de Lisboa, Faculdade de Motricidade Humana, CIPER, LBMF, Lisbon, Portugal
| | - Patrícia Mota
- ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
- Universidade de Lisboa, Faculdade de Motricidade Humana, CIPER, LBMF, Lisbon, Portugal
- H&TRC- Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
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8
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Salvo CJ, Crewe A, Estes D, Kroboth J, Yost C. Screening for Incidence and Effect of Pelvic Floor Dysfunction in College-Aged Athletes. Int J Sports Phys Ther 2024; 19:868-876. [PMID: 38966828 PMCID: PMC11221335 DOI: 10.26603/001c.120211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 06/10/2024] [Indexed: 07/06/2024] Open
Abstract
Background Pelvic floor dysfunction (PFD) occurs when muscles of the pelvic floor become weakened, impaired, or experience tension leading to a variety of complications. Due to the reactive nature and high demands of many sports, athletes are at increased susceptibility and of particular interest concerning PFD. Hypothesis/Purpose The purpose of this study was to explore the prevalence of PFD among college-aged athletes, assess how PFD impacted athletic performance, and identify contributing factors for increased likelihood of PFD in athletes. Study Design Cross-Sectional Study. Methods All fully active LVC NCAA Division 3 athletes were recruited for screening for PFD using the Cozean Pelvic Dysfunction Screening Protocol and were surveyed on their self-knowledge of PFD. Athletes who scored ≥ 3 on this tool completed an additional survey, created by the investigators, to identify the impact PFD had on their athletic performance and personal life and were then randomly assigned to one of three investigators to undergo a noninvasive coccygeal assessment to determine underactive, overactive, or normal pelvic floor muscle (PFM) activity. Results Fifty-three Division III male and female athletes between the ages of 18-25 years old participated in the study. Statistically significant differences were found between Cozean scores and demographic factors of age (p \<0.001), gender (p \<0.05), self-knowledge of PFD (p \<0.001), and sport (p \<0.001) among all participants that contributed to the increased likelihood of PFD. Thirteen athletes scored ≥ 3 on the Cozean with the 92.3% experiencing under/over active PFM activity and the majority indicating that PFD significantly impacted their athletic performance and quality of life. Conclusion The results indicate that older female NCAA Division III college athletes who participate in swimming and who possess self-knowledge of PFD are more likely to experience PFD. Additionally, these athletes are likely to encounter a significant impact on their athletic performance and quality of life. These results provide preliminary evidence on the need of PFD awareness and assessment among college athletes. Level of Evidence Level 3b.
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Wang XQ, Guan LS. Effect of percutaneous electrical stimulation at the Baliao point on preventing postpartum urinary retention after labor analgesia. World J Clin Cases 2024; 12:2758-2764. [PMID: 38899285 PMCID: PMC11185340 DOI: 10.12998/wjcc.v12.i16.2758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/11/2024] [Accepted: 04/19/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Anesthetic drugs used in labor analgesia also paralyze the bladder muscle by blocking the sacral plexus, thereby affecting maternal postpartum spontaneous urination and increasing the risk of postpartum urinary retention (PUR). AIM To analyze the effect of percutaneous electrical stimulation at the Baliao point combined with biofeedback therapy for PUR prevention. METHODS We selected 182 pregnant women who received labor analgesia in obstetrics between June 2022 and December 2023. They were divided into the combined therapy group (transcutaneous electrical stimulation of the Baliao point combined with biofeedback therapy) and the control group (biofeedback therapy alone). The first spontaneous urination time, first postpartum urine volume, bladder residual urine volume, postpartum hemorrhage volume, pre-urination waiting time, PUR incidence, adverse reactions, and the intervention's clinical efficacy were compared between the two groups. RESULTS The first spontaneous urination time after delivery was more delayed (2.92 ± 1.04 h vs 3.61 ± 1.13 h, P < 0.001), with fewer initial postpartum urine (163.54 ± 24.67 mL vs 143.72 ± 23.95 mL, P < 0.001), more residual bladder urine (54.81 ± 10.78 mL vs 65.25 ± 13.52 mL, P < 0.001), more postpartum bleeding (323.15 ± 46.95 mL vs 348.12 ± 45.03 mL, P = 0.001), and longer waiting time for urination (0.94 ± 0.31 min vs 1.29 ± 0.42 min, P < 0.001), in the control group than in the combined therapy group. The control group also had higher PUR incidence (4.65% vs 15.85%, P = 0.016). Both groups had no adverse reactions, but the clinical total efficacy rate of the intervention was significantly higher in the combined therapy group than in the control group (95.35% vs 84.15%, P = 0.016). CONCLUSION Percutaneous electrical stimulation of the Baliao point combined with biofeedback can significantly promote postpartum micturition of parturients with labor analgesia, thereby effectively preventing PUR occurrence.
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Affiliation(s)
- Xiao-Qing Wang
- Department of Obstetrics and Gynecology, Suzhou Ninth Affiliated Hospital of Suzhou University, Suzhou 215200, Jiangsu Province, China
| | - Li-Sha Guan
- Department of Obstetrics and Gynecology, Suzhou Ninth Affiliated Hospital of Suzhou University, Suzhou 215200, Jiangsu Province, China
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Zhou C, Wu Y, Wan S, Lou L, Gu S, Peng J, Zhao S, Hua X. Exosomes isolated from TNF-α-treated bone marrow mesenchymal stem cells ameliorate pelvic floor dysfunction in rats. J Cell Mol Med 2024; 28:e18451. [PMID: 38898783 PMCID: PMC11187403 DOI: 10.1111/jcmm.18451] [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: 03/31/2024] [Revised: 05/07/2024] [Accepted: 05/13/2024] [Indexed: 06/21/2024] Open
Abstract
Exosomes derived from bone marrow-derived mesenchymal stem cells (BMSCs) can alleviate the symptoms of pelvic floor dysfunction (PFD) in rats. However, the potential therapeutical effects of exosomes derived from BMSCs treated with tumour necrosis factor (TNF)-α on the symptoms of PFD in rats are unknown. Exosomes extracted from BMSCs treated with or without TNF-α were applied to treat PFD rats. Our findings revealed a significant elevation in interleukin (IL)-6 and TNF-α, and matrix metalloproteinase-2 (MMP2) levels in the vaginal wall tissues of patients with pelvic organ prolapse (POP) compared with the control group. Daily administration of exosomes derived from BMSCs, treated either with or without TNF-α (referred to as Exo and TNF-Exo), resulted in increased void volume and bladder void pressure, along with reduced peak bladder pressure and leak point pressure in PFD rats. Notably, TNF-Exo treatment demonstrated superior efficacy in restoring void volume, bladder void pressure and the mentioned parameters compared with Exo treatment. Importantly, TNF-Exo exhibited greater potency than Exo in restoring the levels of multiple proteins (Elastin, Collagen I, Collagen III, IL-6, TNF-α and MMP2) in the anterior vaginal walls of PFD rats. The application of exosomes derived from TNF-α-treated BMSCs holds promise as a novel therapeutic approach for treating PFD.
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Affiliation(s)
- Chenchen Zhou
- Department of Obstetrics, Shanghai First Maternity and Infant Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Yuelin Wu
- Department of Obstetrics, Shanghai First Maternity and Infant Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Sheng Wan
- Department of Obstetrics, Shanghai First Maternity and Infant Hospital, School of MedicineTongji UniversityShanghaiChina
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Liqun Lou
- Department of Obstetrics, Shanghai First Maternity and Infant Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Shengyi Gu
- Department of Obstetrics, Shanghai First Maternity and Infant Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Jing Peng
- Department of Obstetrics, Shanghai First Maternity and Infant Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Shifeng Zhao
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Xiaolin Hua
- Department of Obstetrics, Shanghai First Maternity and Infant Hospital, School of MedicineTongji UniversityShanghaiChina
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of MedicineTongji UniversityShanghaiChina
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Cosgriff L, Ramanathan A, Iglesia CB. Pelvic Floor Disorders and Sexual Function: A Review. Obstet Gynecol Clin North Am 2024; 51:241-257. [PMID: 38777481 DOI: 10.1016/j.ogc.2024.02.001] [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] [Indexed: 05/25/2024]
Abstract
Pelvic floor disorders can result in laxity, hypertonicity or spasm, all of which can impact sexual function. It is important for clinicians to understand this impact in order to appropriately counsel and treat their patients.
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Affiliation(s)
- Lauren Cosgriff
- Department of Obgyn, National Center for Advanced Pelvic Surgery, Medstar Washington Hospital Center, Georgetown University School of Medicine, 110 Irving Street Northwest, Washington, DC 20010, USA
| | - Aparna Ramanathan
- Department of Obgyn, National Center for Advanced Pelvic Surgery, Medstar Washington Hospital Center, Georgetown University School of Medicine, 110 Irving Street Northwest, Washington, DC 20010, USA
| | - Cheryl B Iglesia
- Department of Obgyn, National Center for Advanced Pelvic Surgery, Medstar Washington Hospital Center, Georgetown University School of Medicine, 110 Irving Street Northwest, Washington, DC 20010, USA.
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Okui N, Okui MA. Efficacy and Safety of Combination Therapy With Vaginal and Urethral Erbium-Doped Yttrium-Aluminum-Garnet (Er:YAG) Laser for Overactive Bladder With Urinary Incontinence. Cureus 2024; 16:e62363. [PMID: 39006699 PMCID: PMC11246590 DOI: 10.7759/cureus.62363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2024] [Indexed: 07/16/2024] Open
Abstract
OBJECTIVE This retrospective cohort study with propensity score (PS) matching aimed to evaluate the efficacy and safety of a combination therapy with vaginal and urethral erbium:yttrium aluminum garnet laser (VEL+UEL) (SP Dynamis; Fotona d.o.o., Ljubljana, Slovenia) in the treatment of overactive bladder with urinary incontinence (OAB-wet). METHODS The study included female OAB-wet patients aged 65 and above who were already taking OAB medication. Data obtained from electronic medical records were subjected to propensity score matching. All patients received instructions on pelvic floor exercises and were prescribed an appropriate dose of OAB medication. The VEL+UEL group (n=30) underwent three monthly laser sessions, while the control group (n=30) did not receive the treatment. Clinical outcomes were evaluated using the Overactive Bladder Symptom Score (OABSS), International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), three-day urination diary, and Vaginal Health Index Score (VHIS). Medication usage and adverse events were also assessed. Statistical analysis and R code were performed using the AI chatbot GPT-4.0. RESULTS The VEL+UEL group showed significant improvements in OABSS score, ICIQ-SF score, voided volume, daytime frequency, nocturia, and VHIS after 12 months of treatment (p<0.001). Notably, 13.3% of patients transitioned from OAB-wet to OAB-dry. In contrast, the control group did not exhibit significant changes. Medication use was significantly reduced in the VEL+UEL group compared to the control group (p<0.001). No long-term side effects were reported. CONCLUSION Combination therapy with VEL+UEL demonstrated efficacy and safety in the treatment of OAB-wet. Improvements in OAB symptoms, voided volume, frequency, nocturia, and vaginal health were observed, with a subset of patients transitioning to OAB-dry. VEL+UEL therapy offers a potential treatment option for OAB-wet, reducing medication use and improving patient outcomes. Further research is warranted to investigate the mechanism, long-term effects, safety, and cost-effectiveness of VEL+UEL therapy.
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Affiliation(s)
- Nobuo Okui
- Urogynecology, Yokosuka Urogynecology and Urology Clinic, Kanagawa, JPN
| | - Machiko A Okui
- Urology, Yokosuka Urogynecology and Urology Clinic, Kanagawa, JPN
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Saraluck A, Aimjirakul K, Jiet NJ, Chinthakanan O, Mangmeesri P, Manonai J. Defecatory dysfunction and anal incontinence symptoms among women with pelvic organ prolapse: 5-year retrospective study in a tertiary center. Arch Gynecol Obstet 2024; 309:2237-2245. [PMID: 38441602 DOI: 10.1007/s00404-024-07426-0] [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: 12/05/2023] [Accepted: 02/10/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE To investigate the prevalence of DD and AI with POP symptoms in females attending a urogynecology clinic, and to identify factors associated with DD and AI in POP symptoms patients. METHODS Computer-based medical records of women with POP symptoms attending a urogynecology clinic in a referral tertiary center between January 2016 and December 2020 were reviewed. Demographic data were collected. Selected defecatory dysfunction (DD) and anal incontinence (AI) were recorded. The associations between patient characteristics, site and severity of prolapse, and DD and AI symptoms in POP patients were investigated for identified associated factors. RESULTS The mean age of the 754 participants was 65.77 ± 9.44 years. Seven hundred and fifteen (94.83%) were menopause. The prevalence of DD and AI in patients with POP symptoms was 44.03% (332/754) and 42.04% (317/754) according to the PFBQ and medical history records, respectively. Advanced posterior wall prolapse (OR 1.59, 95% CI 1.10-2.30) and wider GH (OR1.23, 95% CI 1.05-1.43) were identified as risk factors for DD by multivariate analysis. Additionally, single-compartment prolapse (OR 0.4, 95% CI 0.21-0.76) and a stronger pelvic floor muscle assessed with brink score (OR 0.94, 95% CI 0.88-0.98) are protective factors for AI. CONCLUSION DD and AI are prevalent among women with POP symptoms who visit a urogynecology clinic. DD should be evaluated in women with POP symptoms especially in women with increased genital hiatus and point Ap beyond the hymen. To prevent AI, women with POP should be encouraged to perform pelvic floor muscle training in order to increase pelvic floor muscle strength.
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Affiliation(s)
- Apisith Saraluck
- Department of Obstetrics & Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand.
| | - Komkrit Aimjirakul
- Department of Obstetrics & Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Ng Jun Jiet
- Department of Obstetrics & Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
- Department of Obstetrics and Gynaecology, Kuala Lumpur Hospital, Jalan Pahang, 50586, Kuala Lumpur, Malaysia
| | - Orawee Chinthakanan
- Department of Obstetrics & Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Peeranuch Mangmeesri
- Department of Obstetrics & Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Jittima Manonai
- Department of Obstetrics & Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand.
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Hao J, Yao Z, Remis A, Huang B, Li Y, Yu X. Pelvic floor muscle training in telerehabilitation: a systematic review and meta-analysis. Arch Gynecol Obstet 2024; 309:1753-1764. [PMID: 38340157 DOI: 10.1007/s00404-024-07380-x] [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: 11/20/2023] [Accepted: 01/07/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE This systematic review aims to identify, critically appraise, and summarize current evidence regarding the feasibility and efficacy of pelvic floor muscle training in telerehabilitation. METHODS Three bibliographic databases, PubMed, Embase, and Scopus were searched from inception to October 1, 2023. Clinical trials assessing the feasibility and efficacy of pelvic floor muscle training in telerehabilitation were eligible for inclusion. The Physiotherapy Evidence Database scale and National Institutes of Health Study Quality Assessment Tool were used for methodological quality assessment. Study selection, data extraction, and quality assessment were completed by two independent reviewers. Meta-analyses were performed to determine the effects of pelvic floor muscle training in telerehabilitation. RESULTS Five randomized controlled trials and three single cohort clinical trials were included in this review. Four studies were evaluated as good quality, and four as fair. Pelvic floor telerehabilitation was well tolerated and demonstrated good patient compliance and satisfaction. Pooled analysis indicated significant effects of pelvic floor telerehabilitation on the severity of urinary incontinence with a large effect size, pelvic floor muscle strength with a large effect size, and quality of life with a medium effect size. CONCLUSION This systematic review demonstrates that pelvic floor muscle training in telerehabilitation is a feasible and effective approach and highlights its efficacy in patients with urinary incontinence. This review supports the application of pelvic floor muscle training in telerehabilitation and informs further clinical and research endeavors to incorporate digital health technologies in managing pelvic floor dysfunction.
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Affiliation(s)
- Jie Hao
- Department of Health & Rehabilitation Sciences, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, 68198, USA.
| | - Zixuan Yao
- Department of Rehabilitation Medicine, Institution of Geriatric Medicine, Beijing Hospital, National Center of Gerontology, Chinese Academy of Medical Science, Beijing, 100051, People's Republic of China.
| | - Andréas Remis
- Health Research Association of Keck Medicine, University of Southern California, Los Angeles, CA, 90033, USA
| | - Biying Huang
- Department of Health & Rehabilitation Sciences, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Yanfei Li
- Department of Health & Rehabilitation Sciences, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Xin Yu
- Department of Rehabilitation Medicine, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, People's Republic of China
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15
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Bean C, Lesser I. Increasing Health Equity for Postpartum Women Through Physical Activity. J Phys Act Health 2024; 21:417-419. [PMID: 38479381 DOI: 10.1123/jpah.2024-0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 02/06/2024] [Indexed: 05/01/2024]
Affiliation(s)
- Corliss Bean
- Department of Recreation & Leisure Studies, Brock University, St. Catharines, ON, Canada
| | - Iris Lesser
- School of Kinesiology, University of the Fraser Valley, Chilliwack, BC, Canada
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16
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Christopher SM, Donnelly G, Brockwell E, Bo K, Davenport MH, De Vivo M, Dufour S, Forner L, Mills H, Moore IS, Olson A, Deering RE. Clinical and exercise professional opinion of return-to-running readiness after childbirth: an international Delphi study and consensus statement. Br J Sports Med 2024; 58:299-312. [PMID: 38148108 DOI: 10.1136/bjsports-2023-107489] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 12/28/2023]
Abstract
Female athletes have identified a lack of guidance as a barrier to successfully returning to running postpartum, and existing guidelines are vague. Our aim was to define the current practice of determining postpartum run-readiness through a consensus survey of international clinicians and exercise professionals in postpartum exercise to assist clinicians and inform sport policy changes.A three-round Delphi approach was used to gain international consensus from clinicians and exercise professionals on run-readiness postpartum. Professionals who work with postpartum runners participated in an online survey to answer open-ended questions about the following postpartum return-to-running topics: definitions (runner and postpartum), key biopsychosocial milestones that runners need to meet, recommended screening, timeline to initiate running, support items, education topics and factors that contribute to advising against running. Consensus was defined as ≥75% participant agreement.One hundred and eighteen professionals participated in round I, 107 participated in round II (response rate 90.6%) and 95 participated in round III (response rate 80.5%). Responses indicated that, following a minimum 3-week period of rest and recovery, an individualised timeline and gradual return to running progression can be considered. Screening for medical and psychological concerns, current physical capacity, and prior training history is recommended prior to a return to running.This study proposes recommendations for the initial guidance on return-to-running postpartum, framed in the context of current research and consensus from professionals. Future research is needed to strengthen and validate specific recommendations and develop guidelines for best practice when returning-to-running after childbirth.
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Affiliation(s)
- Shefali Mathur Christopher
- Department of Rehabilitation Sciences, Doctor of Physical Therapy, Tufts University, Seattle, Washington, USA
- Elon University, Elon, North Carolina, USA
| | - Gráinne Donnelly
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | | | - Kari Bo
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
- Department of Obstetrics and Gynecology, Akershus University Hospital, Lorenskog, Norway
| | - Margie H Davenport
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Marlize De Vivo
- Perinatal Physical Activity Research Group, School of Psychology and Life Sciences, Section of Sport, Exercise and Rehabilitation Science, Canterbury Christ Church University, Canterbury, UK
- Active Pregnancy Foundation, None, UK
| | - Sinead Dufour
- The World of my Baby (WOMB), Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada
| | - Lori Forner
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Hayley Mills
- Perinatal Physical Activity Research Group, School of Psychology and Life Sciences, Section of Sport, Exercise and Rehabilitation Science, Canterbury Christ Church University, Canterbury, UK
| | - Isabel S Moore
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | | | - Rita E Deering
- Department of Physical Therapy, Carroll University, Waukesha, Wisconsin, USA
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA
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17
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Gaddam NG, Kingsberg SA, Iglesia CB. Sexual Dysfunction and Dyspareunia in the Setting of the Genitourinary Syndrome of Menopause. Clin Obstet Gynecol 2024; 67:43-57. [PMID: 38281169 DOI: 10.1097/grf.0000000000000846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Sexual dysfunction is a common consequence of the genitourinary syndrome of menopause (GSM). In this book chapter, we discuss the pathophysiology, prevalence, evaluation, and evidence-based management of sexual dysfunction in patients affected by GSM. Additionally, we present an algorithm to guide clinicians in the management and treatment of sexual dysfunction in this setting based on available evidence and best practices.
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Affiliation(s)
- Neha G Gaddam
- Section of Female Pelvic Medicine and Reconstructive Surgery, MedStar Washington Hospital Center/Georgetown University, Washington, DC
| | - Sheryl A Kingsberg
- Department of OBGYN, University Hospitals Cleveland Medical Center
- Departments of Reproductive Biology, Psychiatry and Urology, Case Western Reserve University School of Medicine
| | - Cheryl B Iglesia
- Section of Female Pelvic Medicine and Reconstructive Surgery, MedStar Washington Hospital Center
- Department of OB/GYN and Urology, Georgetown University School of Medicine, Cleveland, Ohio
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18
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Shah S, Eggers E, Hunter K, Lipetskaia L. Quality of Pelvic Floor Therapy Videos on YouTube: Does Popularity Predict Reliability? UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:233-238. [PMID: 38484236 DOI: 10.1097/spv.0000000000001456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
ABSTRACT This study reviewed instructional videos on YouTube regarding pelvic floor physical therapy and assessed the association between the videos' popularity and the reliability of the videos' content. YouTube was searched using the terms relevant to pelvic floor muscle training. The first 100 videos for each search term were screened, and relevant metrics were collected for those meeting the inclusion criteria. Videos were assessed by 2 independent, trained health care professionals for reliability using the Medical Quality Video Evaluation (MQ-VET) tool, the modified DISCERN tool, the Journal of American Medical Association benchmark criteria, and the Global Quality Score. Popularity was assessed using the Video Power Index (VPI). Higher values for all scoring systems correlated with greater reliability and greater popularity, respectively. Five hundred videos were screened. Two hundred thirty-four videos were duplicates, and 99 did not meet the inclusion criteria. A total of 167 videos were reviewed. The median VPI and MQ-VET score was 201,114.76 (interquartile range, 7,194,020.29) and 48.00 (interquartile range, 12.75), respectively. Spearman's R value was 0.292 (P < 0.001), demonstrating a weak positive correlation between MQ-VET scores and VPI. The interrater reliability of the MQ-VET was good, with an intraclass correlation coefficient of 0.86 (95% confidence interval, 0.71-0.92). In summary, we identified a statistically significant but weak positive correlation between the reliability and popularity of YouTube videos about pelvic floor physical therapy.
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Affiliation(s)
- Shanaya Shah
- From the Cooper Medical School of Rowan University
| | - Erica Eggers
- Department of Obstetrics and Gynecology, Cooper University Healthcare, Camden, NJ
| | - Krystal Hunter
- Cooper Research Institute-Biostatistics Group, Camden, NJ
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19
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Ye AL, Johnston E, Hwang S. Pelvic Floor Therapy and Initial Interventions for Pelvic Floor Dysfunction in Gynecologic Malignancies. Curr Oncol Rep 2024; 26:212-220. [PMID: 38294706 DOI: 10.1007/s11912-024-01498-6] [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] [Accepted: 01/02/2024] [Indexed: 02/01/2024]
Abstract
PURPOSE OF REVIEW This review provides evidence-based updates for the first-line management approaches for pelvic floor disorders in patients with gynecologic malignancies, as well as important provider considerations when referring for pelvic floor physical therapy. RECENT FINDINGS Currently, there is strong evidence to recommend pelvic floor muscle training as initial treatment for urinary incontinence and for pelvic organ prolapse; some evidence to recommend a more targeted pelvic floor muscle training program for fecal incontinence; and mostly expertise-based evidence to recommend vaginal gels or estrogen to aid with dyspareunia causing sexual dysfunction. More research is greatly needed to understand the role of overactive pelvic floor muscles in survivors with chronic pelvic pain and the treatment of post-radiation pelvic complications such as vaginal stenosis and cystitis. While pelvic floor disorders are common concerns in gynecologic cancer survivors, there are evidence-based initial noninvasive treatment approaches that can provide relief for many individuals.
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Affiliation(s)
- Alice L Ye
- Department of Pain Medicine, FC13.3017, The University of Texas MD Anderson Texas Cancer Center, 1400 Holcombe Blvd., Houston, TX, 77030, USA.
| | - Eleanor Johnston
- Creighton School of Medicine, Creighton University, Phoenix, AZ, USA
| | - Sarah Hwang
- Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine & Rehabilitation, Northwestern Feinberg School of Medicine, Chicago, IL, USA
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20
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Deering RE, Donnelly GM, Brockwell E, Bo K, Davenport MH, De Vivo M, Dufour S, Forner L, Mills H, Moore IS, Olson A, Christopher SM. Clinical and exercise professional opinion on designing a postpartum return-to-running training programme: an international Delphi study and consensus statement. Br J Sports Med 2024; 58:183-195. [PMID: 38191239 DOI: 10.1136/bjsports-2023-107490] [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] [Accepted: 12/12/2023] [Indexed: 01/10/2024]
Abstract
Returning to running postpartum presents challenges such as musculoskeletal pain and pelvic floor dysfunction for some females, but there is little guidance on developing and progressing postpartum training programmes. This study aims to establish expert consensus recommendations on designing and modifying a postpartum return-to-running training programme, highlight costs and access to qualified professionals as potential barriers and discuss clinical, research and sports policy implications.A three-round Delphi survey of clinical and exercise professionals working with postpartum runners was conducted. Round I consisted of open-ended questions related to designing the training plan, modifications based on biopsychosocial factors, key muscle groups to train and referral and payment sources. Rounds II and III involved Likert-scale voting to identify consensus (≥75% agreement).118 participants completed Round I, 107 completed Round II (response rate 90.6%) and 95 completed Round III (response rate 80.5%). Consensus was reached in 42/47 (89%) statements, including recommendations for a period of relative rest, gradual increases in duration and intensity, starting with a walk-run protocol and incorporating strength training. Training should be modified based on musculoskeletal or pelvic symptoms, sleep, mental health, lactation or energy availability concerns. Cost and access to experienced postpartum running professionals were identified as potential barriers for runners to receive care.Consensus recommendations for a postpartum return-to-running programme include an individualised exercise prescription, gradual increases in physical activity, walk-run protocols and targeted muscle strengthening. Further research and improved access to clinical and exercise professionals are needed to inform and facilitate best practices.
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Affiliation(s)
- Rita E Deering
- Department of Physical Therapy, Carroll University, Waukesha, Wisconsin, USA
- Department of Orthopedics and Rehabilitation, School of Medicine & Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Gráinne M Donnelly
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | | | - Kari Bo
- Department of Sport Medicine, Norwegian School of Sports Sciences, Oslo, Norway
- Department of Obstetrics and Gynaecology, Akershus University Hospital, Lorenskog, Norway
| | - Margie H Davenport
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Marlize De Vivo
- The Active Pregnancy Foundation, England, UK
- Sheffield Hallam University, Sheffield, UK
- Perinatal Physical Activity Research Group, School of Psychology and Life Sciences, Section of Sport, Exercise and Rehabilitation Science, Canterbury Christ Church University, Canterbury, Kent, UK
| | - Sinead Dufour
- McMaster University Faculty of Health Sciences, Hamilton, southeastern Ontario, Canada
| | - Lori Forner
- University of Queensland, Brisbane, Queensland, Australia
| | - Hayley Mills
- Perinatal Physical Activity Research Group, School of Psychology and Life Sciences, Section of Sport, Exercise and Rehabilitation Science, Canterbury Christ Church University, Canterbury, Kent, UK
| | - Isabel S Moore
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | | | - Shefali Mathur Christopher
- Doctor of Physical Therapy Program, Tufts University, Seattle, Washington, USA
- Elon University, Elon, North Carolina, USA
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Sassani JC, Giugale LE, Lavelle ES, Shepherd JP. Cost-Utility Analysis of Midurethral Sling Timing Among Women Undergoing Prolapse Surgery. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:65-72. [PMID: 37493280 DOI: 10.1097/spv.0000000000001384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
IMPORTANCE There are no guidelines regarding the ideal timing of midurethral sling (MUS) placement following prolapse repair. OBJECTIVE The objective of this study was to estimate the cost-utility of concomitant MUS versus staged MUS among women undergoing apical suspension surgery for pelvic organ prolapse. STUDY DESIGN Cost-utility modeling using a decision analysis tree compared concomitant MUS with staged MUS over a 1-year time horizon. The primary outcome was the incremental cost-effectiveness ratio (ICER). Six scenarios were modeled to estimate cost-utilities for women with preoperative overt, occult, or no stress urinary incontinence (SUI) who underwent either minimally invasive sacrocolpopexy or vaginal native tissue apical suspension. Possible complications of de novo overactive bladder, urinary retention requiring sling lysis, mesh exposure, and persistent SUI were included. Costs from a third-party payer perspective were derived from Medicare 2022 reimbursements. One-way sensitivity analyses were performed. RESULTS Among women without preoperative SUI, staged MUS was the dominant strategy for both surgical routes with higher utility and lower costs. For women with either occult or overt SUI undergoing sacrocolpopexy or vaginal repair, concomitant MUS was cost-effective (ICER = $21,114-$96,536 per quality-adjusted life-year). Therefore, concomitant MUS is preferred for patients with preoperative SUI as higher costs were offset by higher effectiveness. One-way sensitivity analyses demonstrated that ICERs were most affected by probability of cure following MUS. CONCLUSIONS A staged MUS procedure is the dominant strategy for women undergoing apical prolapse repair without preoperative SUI. In women with either overt or occult SUI, the ICER was below the willingness-to-pay threshold of $100,000 per quality-adjusted life-year, suggesting that concomitant MUS surgery is cost-effective.
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Affiliation(s)
| | - Lauren E Giugale
- Division of Urogynecology, Magee-Women's Hospital, University of Pittsburgh, Pittsburgh, PA
| | | | - Jonathan P Shepherd
- Division of Urogynecology, University of Connecticut Health Center, Farmington, CT
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Sandler MD, Ledesma B, Thomas J, Ben-Ezra L, Lokeshwar SD, Paz LA, White J, Ramasamy R, Masterson TA. Biopsychosocial approach to male chronic pelvic pain syndrome: recent treatments and trials. Sex Med Rev 2023; 12:59-66. [PMID: 37717957 DOI: 10.1093/sxmrev/qead038] [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: 05/05/2023] [Accepted: 08/04/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION Chronic pelvic pain syndrome (CPPS) is a common urologic condition that can cause significant disability in affected individuals. Physiologic explanations of chronic pain are often incomplete; appropriate management of CPPS includes recognition of biological, psychological, and social elements, known as the biopsychosocial model. OBJECTIVE The aim of this narrative review is to investigate treatments for men with CPPS, with a special focus on those utilizing the biopsychosocial model of care. METHODS A comprehensive literature search was conducted on the electronic databases PubMed, Embase, and Cochrane Library, using relevant Medical Subject Heading terms and keywords related to CPPS treatments. The search was limited to studies published in English from inception to January 2023. Additionally, reference lists of selected studies were manually reviewed to find studies not identified by the initial search. Studies were included if they investigated pharmacologic or nonpharmacologic treatments for men with CPPS. RESULTS A total of 30 studies met the inclusion criteria. Antibiotics, α-blockers, nonsteroidal anti-inflammatory drugs, gabapentinoids, antidepressants, and phosphodiesterase type 5 inhibitors were among the pharmacologic agents included in trials attempting to reduce symptoms of male CPPS. Studies that focused on treating CPPS without medication included interventions such as shockwave therapy, acupuncture, physical therapy, botulinum toxin, cryotherapy, electrotherapy, exercise, and cognitive behavioral therapy. CONCLUSION α-Blockers and nonsteroidal anti-inflammatory drugs have shown promising results in treating CPPS in men, while the effectiveness of antibiotics remains controversial. Antidepressants and phosphodiesterase type 5 inhibitors may also be useful in decreasing symptoms in patients with CPPS. Treatments such as pelvic floor muscle therapy, acupuncture, shockwave therapy, and cognitive behavioral therapy must be considered effective complements to medical management in men with CPPS. While these interventions demonstrate benefits as monotherapies, the individualization and combination of treatment modalities are likely to result in reduced pain and improved quality of life.
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Affiliation(s)
- Max D Sandler
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, FL 33136, United States
| | - Braian Ledesma
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, FL 33136, United States
| | - Jamie Thomas
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, FL 33136, United States
| | - Logan Ben-Ezra
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Soum D Lokeshwar
- Department of Urology, School of Medicine, Yale University, New Haven, CT 06520, United States
| | - Lisa A Paz
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, FL 33136, United States
| | - Joshua White
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, FL 33136, United States
| | - Ranjith Ramasamy
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, FL 33136, United States
| | - Thomas A Masterson
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, FL 33136, United States
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Wadhwani S, Ratnaparkhi C, Dhok A. Comparison of Dynamic Magnetic Resonance Defecography With Clinical Examination in Diagnosing Pelvic Floor Dysfunction: An Observational Study. Cureus 2023; 15:e51378. [PMID: 38292993 PMCID: PMC10825726 DOI: 10.7759/cureus.51378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Pelvic floor dysfunction (PFD) is frequently reported in both sexes. Dynamic magnetic resonance defecography (DMRD) is the preferred modality, mainly due to its superiority and complementary role in clinical examination. However, studies from the perspective of Indian patients are scarce and mostly restricted to females. Thus, we assessed the diagnostic performance of DMRD in patients with PFD and correlated the findings with those on clinical examination. MATERIALS AND METHODS This prospective, observational study involved 57 adult patients of either sex, presenting with pelvic floor symptoms (PFS) and diagnosed with PFD. Initially, the patients underwent clinical examination, and diagnosis was recorded. Subsequently, the patients were subjected to DMRD. The findings were correlated with the Pearson "r" correlation coefficient. RESULTS A significantly greater proportion of patients had involvement of multiple compartments (36 vs. 12, p<0.001), cystocele (23 vs. 8, p=0.002), and rectal prolapse (25 vs. 14, p=0.030) on DMRD than clinical examination, while there was no significant difference regarding uterine prolapse (p=0.789). Grading of cystocele and rectal prolapse as well as diagnosis of enterocele/peritoneocele, rectocele, and intussusception could be done only with DMRD. DMRD had a strong and significant correlation with clinical examination regarding cystocele (r=0.943, p=0.003), uterine prolapse (r=0.972, p=0.001), and rectal prolapse (r=0.951, p=0.001). CONCLUSIONS DMRD demonstrated significantly better performance in the diagnosis of multiple compartment involvement, cystocele, and rectal prolapse. DMRD and clinical examination were significantly correlated regarding the diagnosis of cystocele, uterine prolapse, and rectal prolapse. Thus, DMRD provides information, in addition to the clinical examination, and should be used in symptomatic patients.
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Affiliation(s)
- Sanajana Wadhwani
- Department of Radiodiagnosis and Imaging, National Cancer Institute, Nagpur, IND
| | - Chetana Ratnaparkhi
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Nagpur, IND
| | - Avinash Dhok
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Nagpur, IND
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Smith D, Gugerty L, Schug S, Lipetskaia L. Triangulation of a Needs Assessment on High-Tone Pelvic Floor Dysfunction. UROGYNECOLOGY (PHILADELPHIA, PA.) 2023:02273501-990000000-00155. [PMID: 38031275 DOI: 10.1097/spv.0000000000001435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
IMPORTANCE High-tone pelvic floor dysfunction is a complex condition that is challenging to manage effectively. Pelvic floor physical therapy (PFPT) is often used in the treatment and relies on a coordinated effort between the physician, patient, and physical therapist. Collaboration is crucial for therapy success, but there is limited research that includes personal perspectives from these individuals. OBJECTIVE The objective of this qualitative study was to gain further insight from these groups to identify areas for improvement in patient counseling and understanding of the diagnosis of high-tone pelvic floor dysfunction and the role of physical therapy. STUDY DESIGN The following participants were recruited: urogynecologists, pelvic floor physical therapists, and patients. Semistructured interviews were conducted exploring participant experiences with therapy and management of the condition and surrounding phenomena. RESULTS Participants interviewed included 5 urogynecologists, 5 pelvic floor physical therapists, and 15 patients. Similarities in key themes were identified: (1) the usefulness of pelvic models and illustrations in counseling, (2) appropriate descriptions of therapy, (3) motivating factors for patients, and (4) patient barriers to completing therapy. Several emergent themes revealed a misalignment in perspectives, including (1) patients reporting an unclear understanding of PFPT, (2) patient unawareness of the intimacy of therapy, and (3) reports of unsupportive and unempathetic physician providers. CONCLUSIONS There are both similarities and discrepancies in the perspectives among physicians, pelvic floor physical therapists, and patients regarding high-tone pelvic floor dysfunction and PFPT. Acknowledging these comparisons and adapting practices could facilitate patient-centered care and improve patient understanding of their diagnosis.
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Affiliation(s)
- Devon Smith
- From the Division of Female Pelvic Medicine & Reconstructive Surgery, Department of OBGYN, Cooper University Hospital, Camden, NJ
| | | | - Seran Schug
- Department Sociology and Anthropology, Rowan University, Glasboro, NJ
| | - Lioudmila Lipetskaia
- From the Division of Female Pelvic Medicine & Reconstructive Surgery, Department of OBGYN, Cooper University Hospital, Camden, NJ
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25
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de Aquino ACQ, Sarmento ACA, Simões ACZ, de Oliveira R, Monteiro MN, Gonçalves AK. Nonpharmacological treatment of postpartum sexual dysfunction: a systematic review and meta-analysis. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20230808. [PMID: 37971132 PMCID: PMC10645184 DOI: 10.1590/1806-9282.20230808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 08/22/2023] [Indexed: 11/19/2023]
Affiliation(s)
| | | | - Ana Carolina Zimmermann Simões
- Universidade Federal do Rio Grande do Norte, Sciences Applied to Women’s Health Postgraduate Program – Natal (RN), Brazil
| | | | - Michelly Nóbrega Monteiro
- Universidade Federal do Rio Grande do Norte, Department of Obstetrics and Gynecology – Natal (RN), Brazil
| | - Ana Katherine Gonçalves
- Universidade Federal do Rio Grande do Norte, Health Sciences Postgraduate Program – Natal (RN), Brazil
- Universidade Federal do Rio Grande do Norte, Sciences Applied to Women’s Health Postgraduate Program – Natal (RN), Brazil
- Universidade Federal do Rio Grande do Norte, Department of Obstetrics and Gynecology – Natal (RN), Brazil
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26
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Prillaman G, Zillioux J, Beller H, Yeaman C, Rapp D. Predictors of pelvic pain in a general urology clinic population. BJUI COMPASS 2023; 4:668-672. [PMID: 37818032 PMCID: PMC10560618 DOI: 10.1002/bco2.262] [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: 01/06/2023] [Revised: 04/14/2023] [Accepted: 05/21/2023] [Indexed: 10/12/2023] Open
Abstract
Objectives To assess the prevalence and predictors of chronic pelvic pain in a general urology population presenting for evaluation of unrelated non-painful complaints.Generalized pelvic pain is estimated to afflict between 6% and 26% of women and is often multifactorial in aetiology. A paucity of prospective research exists to characterize chronic pelvic pain patterns and to understand related predictors. Materials and Methods This is a prospective, cross-sectional survey-based study of female patients presenting to a general urology clinic over a 10-month period (7/2018-5/2019). Patients completed a 32-item survey with questions pertaining to demographics, comorbidities and chronic pelvic pain characteristics. Comparison tests (chi-squared, Fisher's exact) and stepwise multivariable logistic modelling were performed to assess for predictors of chronic pelvic pain. Results A total of 181 women completed the survey, with a mean age of 56 years. Overall, 75 (41%) women reported chronic pelvic pain. Those with chronic pelvic pain were younger compared to those without (52 vs 59 years, p = 0.001). Univariable logistic regression analysis identified BMI, depression, fibromyalgia, overactive bladder and any bowel symptoms as possible positive predictors of chronic pelvic pain. Final best-fit multivariable model found overactive bladder, fibromyalgia and presence of bowel symptoms as independent positive predictors of chronic pelvic pain. Conclusions Our study is one of the few studies that has prospectively analysed chronic pelvic pain and its predictors. The present study identified significant associations with overactive bladder, fibromyalgia and bowel symptoms. Further research is needed to better understand the aetiologies of chronic pelvic pain and the possible relationship with identified clinical predictors.
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Affiliation(s)
- Grace Prillaman
- University of Virginia School of MedicineCharlottesvilleVirginiaUSA
| | | | - Haerin Beller
- Department UrologyUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - Clinton Yeaman
- Department UrologyUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - David Rapp
- Department UrologyUniversity of VirginiaCharlottesvilleVirginiaUSA
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27
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Li J, Li T, Zhao X, Li J, Yu L, Tang W, Liu Y, Huang X, Chen L, Cai W. Development and validation of a Decision-Making Ability Scale for postpartum urinary incontinence women engaging in pelvic floor physical therapy. Neurourol Urodyn 2023; 42:1756-1768. [PMID: 37723922 DOI: 10.1002/nau.25282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/26/2023] [Accepted: 08/31/2023] [Indexed: 09/20/2023]
Abstract
OBJECTIVE This study aimed to develop and validate a Decision-Making Ability Scale (DMA-S) for postpartum urinary incontinence (PPUI) women engaging in pelvic floor physical therapy (PFPT). METHODS Items were created in line with a review of the literature and exploratory qualitative study with 22 women. The items were submitted for expert opinion and a pilot implementation was made with 58 women with PPUI. Furthermore, the construct validity of the scale was tested with exploratory factor analysis (EFA) (n = 220) and confirmatory factor analysis (CFA) (n = 240). Internal consistency for the Chronbach's α and test-retest reliability for the intraclass correlation coefficient (ICC) were also investigated for the DMA-S in the study. RESULTS The results of the EFA indicated a Kaiser-Meyer-Olkin value of 0.85 and Bartlett's test of sphericity showed a χ2 value of 8352.101, p < 0.001. After removing one item with factor loading values below 0.50, the resulting factor structure accounted for 83.38% of the total variance. The fit indices of the scale model tested in the CFA were determined as χ2 /df = 1.08 < 3, root mean square error of approximation = 0.018 < 0.08, comparative fit index = 0.996 > 0.90, Tucker-Lewis index = 0.995 > 0.90, goodness-of-fit index (GFI) = 0.933 > 0.90, adjusted GFI = 0.916 > 0.90, and incremental fit index = 0.996 > 0.90. The Cronbach's α values were 0.95-0.97 for the subdimensions of the scale and 0.93 for the total scale. Data also showed a good test-retest stability (ICC = 0.984). CONCLUSION The DMA-S is a reliable and valid tool for assessing the decision-making ability for PPUI women engaging in PFPT.
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Affiliation(s)
- Jie Li
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, China
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Tiantian Li
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Xiaoling Zhao
- Department of Reproductive Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Juanhua Li
- Obstetrics Department, Zengcheng Branch of Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Lanlan Yu
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Wenjun Tang
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, China
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Yuanwen Liu
- Obstetrics Department, Bao'an District Maternal and Child Health Care Hospital, Shenzhen, China
| | - Xiaoli Huang
- Department of Reproductive Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ling Chen
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, China
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Wenzhi Cai
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, China
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
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Mollà-Casanova S, Muñoz-Gómez E, Sempere-Rubio N, Inglés M, Aguilar-Rodríguez M, Moreno-Cervera N, Serra-Añó P. Fibromyalgia syndrome is associated with sexual dysfunction regardless of physical activity status: a cross-sectional study. J Sex Med 2023; 20:1285-1291. [PMID: 37740987 DOI: 10.1093/jsxmed/qdad121] [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: 02/20/2023] [Revised: 08/17/2023] [Accepted: 08/26/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND Fibromyalgia syndrome (FMS) is a rheumatic disorder that has been observed to affect self-perception of sexuality. AIM The study aims to assess sexual dysfunction (SD), establish possible associations with SD levels, and evaluate the impact of physical activity (PA) levels on SD in Spanish women with FMS as compared with healthy control women. METHODS The study was cross-sectional. A total of 170 women voluntarily agreed to participate between September 2019 and February 2020: 88 in the FMS group and 82 in the control group. OUTCOMES The main outcome measures were SD, as assessed through the Female Sexual Function Index (FSFI), and PA levels, as assessed with a structured interview. RESULTS There were significant differences in every domain and total SD score between the FMS and control groups (P < .05). In addition, we obtained a moderate significant direct association (χ2[1] = 37.071, P < .05, phi = 0.467) when exploring the associations between FMS and risk of SD. Results showed statistically significant differences between the FMS group and the control group when PA levels were not reached in the desire, pain, and total scores of the FSFI (P < .05). When the PA levels were reached, between-group differences were found in all domains, as well as in the total score of the FSFI (P < .05). CLINICAL IMPLICATIONS Sexual function should be evaluated in women with FMS, while future treatments should address this clinical area with the aim of managing SD in this population. STRENGTHS AND LIMITATIONS The main limitation is that the outcome measures were self-reported. CONCLUSION We found a high prevalence of SD in Spanish women with FMS, with an impact on aspects such as desire, arousal, lubrication, orgasm, satisfaction, and pain during sexual intercourse. In addition, there is a moderate direct association between FMS and SD. Ultimately, the results showed that, irrespective of PA, women with FMS reported increased SD.
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Affiliation(s)
- Sara Mollà-Casanova
- UBIC Research Group, Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia 46010, Spain
| | - Elena Muñoz-Gómez
- UBIC Research Group, Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia 46010, Spain
| | - Núria Sempere-Rubio
- UBIC Research Group, Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia 46010, Spain
| | - Marta Inglés
- UBIC Research Group, Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia 46010, Spain
| | - Marta Aguilar-Rodríguez
- UBIC Research Group, Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia 46010, Spain
| | - Noelia Moreno-Cervera
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia 46010, Spain
| | - Pilar Serra-Añó
- UBIC Research Group, Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia 46010, Spain
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29
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Rao SSC, Ahuja NK, Bharucha AE, Brenner DM, Chey WD, Deutsch JK, Kunkel DC, Moshiree B, Neshatian L, Reveille RM, Sayuk GS, Shapiro JM, Shah ED, Staller K, Wexner SD, Baker JR. Optimizing the Utility of Anorectal Manometry for Diagnosis and Therapy: A Roundtable Review and Recommendations. Clin Gastroenterol Hepatol 2023; 21:2727-2739.e1. [PMID: 37302444 PMCID: PMC10542660 DOI: 10.1016/j.cgh.2023.05.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 04/13/2023] [Accepted: 05/25/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND & AIMS Anorectal manometry (ARM) is a comprehensive diagnostic tool for evaluating patients with constipation, fecal incontinence, or anorectal pain; however, it is not widely utilized for reasons that remain unclear. The aim of this roundtable discussion was to critically examine the current clinical practices of ARM and biofeedback therapy by physicians and surgeons in both academic and community settings. METHODS Leaders in medical and surgical gastroenterology and physical therapy with interest in anorectal disorders were surveyed regarding practice patterns and utilization of these technologies. Subsequently, a roundtable was held to discuss survey results, explore current diagnostic and therapeutic challenges with these technologies, review the literature, and generate consensus-based recommendations. RESULTS ARM identifies key pathophysiological abnormalities such as dyssynergic defecation, anal sphincter weakness, or rectal sensory dysfunction, and is a critical component of biofeedback therapy, an evidence-based treatment for patients with dyssynergic defecation and fecal incontinence. Additionally, ARM has the potential to enhance health-related quality of life and reduce healthcare costs. However, it has significant barriers that include a lack of education and training of healthcare providers regarding the utility and availability of ARM and biofeedback procedures, as well as challenges with condition-specific testing protocols and interpretation. Additional barriers include understanding when to perform, where to refer, and how to use these technologies, and confusion over billing practices. CONCLUSIONS Overcoming these challenges with appropriate education, training, collaborative research, and evidence-based guidelines for ARM testing and biofeedback therapy could significantly enhance patient care of anorectal disorders.
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Affiliation(s)
- Satish S C Rao
- Division of Gastroenterology and Hepatology, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia.
| | - Nitin K Ahuja
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Adil E Bharucha
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Darren M Brenner
- Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois
| | - William D Chey
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan
| | - Jill K Deutsch
- Section of Digestive Diseases, Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut
| | - David C Kunkel
- Division of Gastroenterology, University of California San Diego, La Jolla, California
| | - Baharak Moshiree
- Division of Gastroenterology and Hepatology, Atrium Health, Wake Forest Medical University, Charlotte, North Carolina
| | - Leila Neshatian
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Redwood City, California
| | - Robert M Reveille
- Division of Gastroenterology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Gregory S Sayuk
- Division of Gastroenterology, Washington University School of Medicine, Veterans Affairs Medical Center, St. Louis, Missouri
| | | | - Eric D Shah
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan
| | - Kyle Staller
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Steven D Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida
| | - Jason R Baker
- Department of Gastroenterology and Hepatology, Atrium Health, University of North Carolina, Charlotte, North Carolina
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30
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Ugur Tosun B, Yilmaz Gokmen G. Cause of non-specific low back pain in women: pelvic floor muscle weakness. Int Urogynecol J 2023; 34:2317-2323. [PMID: 37466692 DOI: 10.1007/s00192-023-05606-1] [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: 04/18/2023] [Accepted: 06/16/2023] [Indexed: 07/20/2023]
Abstract
INTRODUCTION AND HYPOTHESIS This study aimed to evaluate the relationship between pelvic floor muscle (PFM) strength and low back pain (LBP) in women with and without non-specific low back pain (NSLBP) with similar demographic and physical characteristics. METHODS The study included 40 women (35.73±6.74 years) with NSLBP (with LBP group) and 32 women (34.59±5.93) without LBP (without LBP group). PFM strength with a perineometer, pain intensity with a Visual Analog Scale (VAS), quality of life with the Short Form-36 (SF-36), and perceptions of LBP and related disability with the Rolland Morris Disability Questionnaire (RMDQ) were evaluated. RESULTS There was no difference between the groups in terms of age, BMI, number of births (0, 1, and 2 births) and mode of delivery (vaginal/cesarean section) (p>0.05). There was a statistical difference between the groups in all parameters except SF-36 Emotional Role Limitation subscale (p<0.05). We found PFM strength an independent predictor of the RMDQ score, and RMDQ and VAS scores as independent predictors of SF-36 physical and mental components (p<0.05). CONCLUSIONS Decreased PFM strength in women causes non-specific mechanical low back pain and disability independent of age, BMI, and the number and type of delivery. Decreased PFM strength is a predictor of disability. Disability and pain are also independent predictors of decreased quality of life. PFM measurement should be prioritized when evaluating women with NSLBP. PFM strength may be a determinant of LBP.
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Affiliation(s)
- Burcin Ugur Tosun
- Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation, Eastern Mediterranean University, North Cyprus via Mersin 10, Famagusta, Turkey
| | - Gulhan Yilmaz Gokmen
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Bandırma Onyedi Eylul University, Yeni Mahalle Şehit Astsubay Mustafa Soner Varlık Caddesi No:77 PK:10200, Bandirma, Balıkesir, Turkey.
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31
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Duran P, Sesillo FB, Cook M, Burnett L, Menefee SA, Do E, French S, Zazueta-Damian G, Dzieciatkowska M, Saviola AJ, Shah MM, Sanvictores C, Osborn KG, Hansen KC, Shtrahman M, Christman KL, Alperin M. Proregenerative extracellular matrix hydrogel mitigates pathological alterations of pelvic skeletal muscles after birth injury. Sci Transl Med 2023; 15:eabj3138. [PMID: 37531414 PMCID: PMC10460616 DOI: 10.1126/scitranslmed.abj3138] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/14/2023] [Indexed: 08/04/2023]
Abstract
Pelvic floor disorders, including pelvic organ prolapse and urinary and fecal incontinence, affect millions of women globally and represent a major public health concern. Pelvic floor muscle (PFM) dysfunction has been identified as one of the leading risk factors for the development of these morbid conditions. Childbirth, specifically vaginal delivery, has been recognized as the most important potentially modifiable risk factor for PFM injury; however, the precise mechanisms of PFM dysfunction after parturition remain elusive. In this study, we demonstrated that PFMs exhibit atrophy and fibrosis in parous women with symptomatic pelvic organ prolapse. These pathological alterations were recapitulated in a preclinical rat model of simulated birth injury (SBI). The transcriptional signature of PFMs after injury demonstrated an impairment in muscle anabolism, persistent expression of genes that promote extracellular matrix (ECM) deposition, and a sustained inflammatory response. We also evaluated the administration of acellular injectable skeletal muscle ECM hydrogel for the prevention of these pathological alterations. Treatment of PFMs with the ECM hydrogel either at the time of birth injury or 4 weeks after injury mitigated PFM atrophy and fibrosis. By evaluating gene expression, we demonstrated that these changes are mainly driven by the hydrogel-induced enhancement of endogenous myogenesis, ECM remodeling, and modulation of the immune response. This work furthers our understanding of PFM birth injury and demonstrates proof of concept for future investigations of proregenerative biomaterial approaches for the treatment of injured pelvic soft tissues.
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Affiliation(s)
- Pamela Duran
- Shu Chien-Gene Lay Department of Bioengineering, University of California San Diego, La Jolla, CA 92093, USA
- Sanford Consortium for Regenerative Medicine, University of California San Diego, La Jolla, CA 92037, USA
| | - Francesca Boscolo Sesillo
- Sanford Consortium for Regenerative Medicine, University of California San Diego, La Jolla, CA 92037, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Female Pelvic Medicine and Reconstructive Surgery, University of California San Diego, La Jolla, CA 92093, USA
| | - Mark Cook
- Department of Integrative, Biology and Physiology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Lindsey Burnett
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Female Pelvic Medicine and Reconstructive Surgery, University of California San Diego, La Jolla, CA 92093, USA
| | - Shawn A. Menefee
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Kaiser Permanente, San Diego, CA 92110, USA
| | - Emmy Do
- Department of Biology, University of California San Diego, La Jolla, CA 92093, USA
| | - Saya French
- Department of Biology, University of California San Diego, La Jolla, CA 92093, USA
| | - Gisselle Zazueta-Damian
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Kaiser Permanente, San Diego, CA 92110, USA
| | - Monika Dzieciatkowska
- Department of Biochemistry and Molecular Genetics, School of Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Anthony J. Saviola
- Department of Biochemistry and Molecular Genetics, School of Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Manali M. Shah
- Shu Chien-Gene Lay Department of Bioengineering, University of California San Diego, La Jolla, CA 92093, USA
| | - Clyde Sanvictores
- Department of Physics, University of California San Diego, La Jolla, CA 92093, USA
| | - Kent G. Osborn
- Center for Veterinary Sciences and Comparative Medicine, Division of Comparative Pathology and Medicine, University of California San Diego, La Jolla, CA 92093, USA
| | - Kirk C. Hansen
- Department of Biochemistry and Molecular Genetics, School of Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Matthew Shtrahman
- Sanford Consortium for Regenerative Medicine, University of California San Diego, La Jolla, CA 92037, USA
- Department of Neurosciences, University of California San Diego, La Jolla, CA 92093, USA
| | - Karen L. Christman
- Shu Chien-Gene Lay Department of Bioengineering, University of California San Diego, La Jolla, CA 92093, USA
- Sanford Consortium for Regenerative Medicine, University of California San Diego, La Jolla, CA 92037, USA
| | - Marianna Alperin
- Sanford Consortium for Regenerative Medicine, University of California San Diego, La Jolla, CA 92037, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Female Pelvic Medicine and Reconstructive Surgery, University of California San Diego, La Jolla, CA 92093, USA
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Li J, Li T, Huang S, Chen L, Cai W. Motivations, psychosocial burdens, and decision-making modes of post-partum women with stress urinary incontinence engaging in pelvic floor physical therapy: a qualitative research. Int Urogynecol J 2023; 34:1803-1813. [PMID: 36745133 DOI: 10.1007/s00192-023-05466-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 01/02/2023] [Indexed: 02/07/2023]
Abstract
INTRODUCTION AND HYPOTHESIS This qualitative research explores the motivations, psychosocial burdens, and decision-making modes of post-partum women with stress urinary incontinence (SUI) engaging in pelvic floor physical therapy (PFPT). METHODS This study was conducted face-to-face in a treatment room using qualitative semi-structured interviews with post-partum women who received PFPT for SUI between May and October 2022. Participant interviews were transcribed verbatim and thematically analyzed using NVivo software, which is most commonly used for qualitative data analysis. RESULTS Themes that impacted participants' decisions to receive PFPT included avoiding deterioration of SUI symptoms, believing that the sooner it is treated the better, being unable to adhere to home exercise programs, and dissatisfaction with quality of life. Some participants experienced psychosocial burdens when receiving PFPT, including impact on daily activities, worries about the baby, financial burdens, and uncertainty about the effect. There were two modes of decision making, which brought different experiences. Some participants preferred participant-provider shared decision making and reported effective doctor-patient communication, and striving for autonomous decisions. Other participants preferred their clinicians to decide on PFPT protocols in view of their trust in their midwives, institutional reputation, and lacking knowledge of PFPT. CONCLUSIONS We discovered that participants had both motivations and psychosocial burdens when receiving therapy. Some participants preferred participant-provider shared decision making, whereas others preferred their midwives to make decisions. Further more standardized studies with more robust samples are needed.
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Affiliation(s)
- Jie Li
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Number 1333, Xinhu Road, Baoan District, Shenzhen, 518101, Guangdong, China
- School of Nursing, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Tiantian Li
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Number 1333, Xinhu Road, Baoan District, Shenzhen, 518101, Guangdong, China
| | - Shurong Huang
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Number 1333, Xinhu Road, Baoan District, Shenzhen, 518101, Guangdong, China
| | - Ling Chen
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Number 1333, Xinhu Road, Baoan District, Shenzhen, 518101, Guangdong, China
| | - Wenzhi Cai
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Number 1333, Xinhu Road, Baoan District, Shenzhen, 518101, Guangdong, China.
- School of Nursing, Southern Medical University, Guangzhou, 510515, Guangdong, China.
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Fernández-Pérez P, Leirós-Rodríguez R, Marqués-Sánchez MP, Martínez-Fernández MC, de Carvalho FO, Maciel LYS. Effectiveness of physical therapy interventions in women with dyspareunia: a systematic review and meta-analysis. BMC Womens Health 2023; 23:387. [PMID: 37482613 PMCID: PMC10364425 DOI: 10.1186/s12905-023-02532-8] [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: 11/10/2022] [Accepted: 07/08/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND Dyspareunia is defined as the occurrence of pain during or after sexual intercourse, which directly affects physical, sexual, and mental health. This condition can lead to depression, anxiety, and low self-esteem in women who experience it. OBJECTIVES The aim of this research was to evaluate the effectiveness of physical therapy interventions for the treatment of female dyspareunia. DESIGN A systematic review and meta-analysis was conducted. METHOD Search of publications was conducted in Scopus, Medline, Pubmed, Cinahl and Web of Science. Treatment effects were defined as standardized mean difference and their 95% confidence intervals. Statistical heterogeneity was assessed using Crohan's Q test and quantified using the I2 index. RESULTS Of the 19 articles selected, six applied multimodal physiotherapy treatments; five, electrotherapy; three, Thiele's massage; two, interdisciplinary interventions or pelvic floor muscle training; and one, extracorporeal shockwave therapy. The meta-analysis showed significant results for the variables pain and quality of life with the interventions based on electrotherapy and electrotherapy combined with pelvic floor muscle training. These interventions did not show significant results for the improvement of sexual function. CONCLUSIONS Physiotherapy techniques are effective and procedures have been identified with reliable results in improving pain and quality of life in patients with dyspareunia. One of the most important aspects is the strengthening of the perineal musculature and the application of Transcutaneous Electrical Nerve Stimulation. Furthermore, manual trigger point release therapy and Thiele massage, optimize and guarantee the reduction of pain intensity. PROSPERO REGISTRATION CRD42021236155.
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Affiliation(s)
- Paula Fernández-Pérez
- Nursing and Physical Therapy Department, University of Leon, Astorga Ave, 24401 Ponferrada, Spain
| | - Raquel Leirós-Rodríguez
- SALBIS Research Group, Nursing and Physical Therapy Department, University of Leon, Astorga Ave, 24401 Ponferrada, Spain
| | - Mª Pilar Marqués-Sánchez
- SALBIS Research Group, Nursing and Physical Therapy Department, University of Leon, Astorga Ave, 24401 Ponferrada, Spain
| | | | | | - Leonardo Y. S. Maciel
- Physical Therapy Department of Lagarto, Universidade Federal de Sergipe, Gov. Marcelo Déda Ave, São José, Lagarto 49400-000 Brazil
- Faculty of Sport, Research Centre in Physical Activity, Health and Leisure (CIAFEL), University of Porto, R. Dr. Plácido da Costa 91, 4200-450 Porto, Portugal
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Lua-Mailland LL, Wallace SL, Yao M, Propst K. Sexual Function in Women at 6 and 12 Months After Obstetric Anal Sphincter Injury: Is Pelvic Floor Physical Therapy Associated With Improved Outcomes? UROGYNECOLOGY (PHILADELPHIA, PA.) 2023:02273501-990000000-00092. [PMID: 37093575 DOI: 10.1097/spv.0000000000001356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
IMPORTANCE Women with obstetric anal sphincter injury (OASI) are at increased risk of postpartum sexual dysfunction. Risk persists beyond 3 years after perineal trauma in up to half of patients with OASI. OBJECTIVES The aims of this study were to determine if postpartum pelvic floor physical therapy (PFPT) is associated with improved sexual function after vaginal delivery with OASI and to describe sexual function in patients with OASI at 6 and 12 months postpartum. STUDY DESIGN This is a retrospective cohort study of patients with OASI. Women were grouped according to PFPT attendance. The Postpartum Pelvic Floor and Birth Questionnaire (PPFBQ), which compares current sexual function to baseline prepregnancy sexual function, and the Female Sexual Function Index (FSFI) were administered at 6 and 12 months, respectively, to evaluate postpartum sexual function. RESULTS Two hundred women were included. Sixty-four (32%) women attended PFPT; 136 (68%) did not attend PFPT. Patients reported worse-than-baseline sexual function at 6 months postpartum in the PPFBQ sexual activity domain, but the PFPT group had lower median score than the non-PFPT group (2.3 [2.0, 2.8] vs 2.7 [2.1, 3.1], P = 0.034), with scores <3.0 indicating worse-than-baseline functioning. The FSFI composite scores were similar between groups and showed 80.7% of the patients with OASI meeting the criteria for female sexual dysfunction at 12 months postpartum. Attendance of PFPT was not significantly associated with composite FSFI scores and most domains of PPFBQ. CONCLUSIONS Attendance of PFPT did not significantly impact overall sexual function in OASI patients at 6 and 12 months postpartum. Sexual function is complex and may be more effectively addressed in the postpartum period using a multidimensional approach.
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Affiliation(s)
- Lannah L Lua-Mailland
- From the Center for Urogynecology and Pelvic Reconstructive Surgery, Obstetrics/Gynecology and Women's Health Institute, Cleveland Clinic
| | - Shannon L Wallace
- From the Center for Urogynecology and Pelvic Reconstructive Surgery, Obstetrics/Gynecology and Women's Health Institute, Cleveland Clinic
| | - Meng Yao
- Department of Quantitative Health Sciences, Section of Biostatistics, Cleveland Clinic, Cleveland, OH
| | - Katie Propst
- Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL
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Lewis GK, Chen AH, Craver EC, Crook JE, Carrubba AR. Trigger point injections followed by immediate myofascial release in the treatment of pelvic floor tension myalgia. Arch Gynecol Obstet 2023; 307:1027-1035. [PMID: 36513896 DOI: 10.1007/s00404-022-06880-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 12/03/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Pelvic floor physical therapy (PFPT) is first-line therapy for treatment of pelvic floor tension myalgia (PFTM). Pelvic floor trigger point injections (PFTPI) are added if symptoms are refractive to conservative therapy or if patients experience a flare. The primary objective was to determine if a session of physical therapy with myofascial release immediately following PFTPI provides improved pain relief compared to trigger point injection alone. METHODS This was a retrospective cohort analysis of 87 female patients with PFTM who underwent PFTPI alone or PFTPI immediately followed by PFPT. Visual analog scale (VAS) pain scores were recorded pre-treatment and 2 weeks post-treatment. The primary outcome was the change in VAS between patients who received PFTPI alone and those who received PFTPI followed by myofascial release. RESULTS Of the 87 patients in this study, 22 received PFTPI alone and 65 patients received PFTPI followed by PFPT. The median pre-treatment VAS score was 8 for both groups. The median post-treatment score was 6 for the PFTPI only group and 4 for the PFTPI followed by PFPT group, showing a median change in VAS score of 2 and 4, respectively (p = 0.042). Seventy-seven percent of patients in the PFTPI followed by PFPT group had a VAS score improvement of 3 or more, while 45% of patients in the PFTPI only group had a VAS score improvement greater than 3 (p = 0.008). CONCLUSION PFTPI immediately followed by PFPT offered more improvement in pain for patients with PFTM. This may be due to greater tolerance of myofascial release immediately following injections.
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Affiliation(s)
- Gregory K Lewis
- Department of Medical and Surgical Gynecology, Mayo Clinic, 4500 San Pablo South Road, Jacksonville, FL, 32224, USA.
| | - Anita H Chen
- Department of Medical and Surgical Gynecology, Mayo Clinic, 4500 San Pablo South Road, Jacksonville, FL, 32224, USA
| | - Emily C Craver
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Julia E Crook
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Aakriti R Carrubba
- Department of Medical and Surgical Gynecology, Mayo Clinic, 4500 San Pablo South Road, Jacksonville, FL, 32224, USA
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Zang Y, Bai M, Wang L, Zhang M, Li L. Effects of acupuncture and pelvic floor muscle training on bladder dysfunction after spinal cord injury: A meta-analysis. Medicine (Baltimore) 2023; 102:e33048. [PMID: 36897726 PMCID: PMC9997793 DOI: 10.1097/md.0000000000033048] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 01/31/2023] [Indexed: 03/11/2023] Open
Abstract
OBJECTIVE We aimed to systematically review and quantify the association between acupuncture and pelvic floor muscle exercise and bladder dysfunction rehabilitation in individuals with spinal nerve injury. METHODS A meta-analysis was conducted using an evidence-based nursing analysis method based on clinical evidence. China National Knowledge Infrastructure, PubMed, VIP database, Wan Fang database, Cochrane Library, and other databases were searched by computer from January 1, 2000 to January 1, 2021. The literature was searched for clinical randomized controlled trials on acupuncture stimulation, pelvic floor muscle function training, and bladder function recovery training after spinal cord nerve injury. Two reviewers independently used The Cochrane Collaboration recommended randomized controlled trial risk of bias assessment tool to evaluate the quality of the literature. Then, the meta-analysis was performed using RevMan 5.3 software. RESULTS A total of 20 studies were included, with a total sample size of 1468 cases, including 734 patients in the control group and 734 patients in the experimental group. The results of our meta-analysis showed that acupuncture treatment [OR = 3.98, 95% CI (2.77, 5.72), Z = 7.49, P < .001] and pelvic floor muscle treatment [OR = 7.63, 95% CI (4.47, 13.04), Z = 7.45, P < .001] was statistically significant. CONCLUSION Acupuncture and pelvic floor muscle exercise are effective intervention and treatment methods, which have obvious effects on rehabilitation treatment of bladder dysfunction after spinal nerve injury.
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Affiliation(s)
- Y.T. Zang
- The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - M.J. Bai
- School of Nursing, Inner Mongolia Medical University, Hohhot, China
| | - L. Wang
- School of Nursing, Inner Mongolia Medical University, Hohhot, China
| | - M.X. Zhang
- Ordos Institute of Applied Technology, Ordos, China
| | - L. Li
- The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
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Işık C, Aslan E. The effects of sexual counseling and pelvic floor relaxation on sexual functions in women receiving vaginismus treatment: a randomized controlled study. Int Urogynecol J 2023; 34:683-692. [PMID: 35501569 DOI: 10.1007/s00192-022-05204-7] [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: 11/24/2021] [Accepted: 04/05/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The purpose of this study is to determine the effects of sexual counseling and pelvic floor relaxation on sexual functions in women receiving vaginismus treatment. METHODS A total of 34 women at the vaginismus treatment stage, including 17 in the experiment group and 17 in the control group, were included in the study with a randomized controlled design. In addition to the routine treatment protocol, women in the experiment group were provided with pelvic relaxation and sexual counseling based on the Information, Motivation, Behavior (IMB) model consisting of four sessions. The control group received the routine treatment protocol. The assessments were made at the 3rd week and 2nd month after coitus. The women filled out an Information Form, the validated Female Sexual Function Index (FSFI), and the Vaginal Penetration Cognition Questionnaire (VPCQ). RESULTS The mean age of the women was 27.59±5.32, and their mean duration of marriage/relationship was 33.44±12.11 months. After the treatment statistically significant increases were observed in the total FSFI scores and the desire, arousal, and pain dimension scores of the experiment group in comparison with the control group (p<0.05). In the VPCQ total scores, there was a significant reduction in the experiment group in comparison with the control group and after the treatment in comparison with before the treatment (p<0.01). CONCLUSIONS The sexual counseling based on the IMB model and pelvic relaxation interventions provided to the women who were receiving vaginismus treatment affected their sexual function positively. It may be recommended to conduct comparative studies with a broader sample and different models.
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Affiliation(s)
- Cansu Işık
- Hamidiye Faculty of Health Sciences, Department of Midwifery, University of Health Sciences, İstanbul, Turkey.
| | - Ergül Aslan
- Florence Nightingale Faculty of Nursing, Department of Women's Health and Diseases Nursing, İstanbul University-Cerrahpaşa University, İstanbul, Turkey
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Booker LN, Weigle M, Medina S, Day C. Atypical groin pain in a volleyball player. PM R 2023; 15:402-404. [PMID: 35187837 DOI: 10.1002/pmrj.12791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 02/02/2022] [Accepted: 02/14/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Lyndsey N Booker
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, United States
| | - Meagan Weigle
- Franciscan Health Lafayette, Lafayette, Indiana, United States
| | | | - Carly Day
- Franciscan Physician Network, West Lafayette, Indiana, United States
- Purdue University Department of Health and Kinesiology, West Lafayette, Indiana, United States
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Bertozzi S, Londero AP, Xholli A, Azioni G, Di Vora R, Paudice M, Bucimazza I, Cedolini C, Cagnacci A. Risk-Reducing Breast and Gynecological Surgery for BRCA Mutation Carriers: A Narrative Review. J Clin Med 2023; 12:jcm12041422. [PMID: 36835955 PMCID: PMC9967164 DOI: 10.3390/jcm12041422] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/04/2023] [Accepted: 02/07/2023] [Indexed: 02/16/2023] Open
Abstract
This narrative review aims to clarify the role of breast and gynecological risk-reduction surgery in BRCA mutation carriers. We examine the indications, contraindications, complications, technical aspects, timing, economic impact, ethical issues, and prognostic benefits of the most common prophylactic surgical options from the perspectives of a breast surgeon and a gynecologist. A comprehensive literature review was conducted using the PubMed/Medline, Scopus, and EMBASE databases. The databases were explored from their inceptions to August 2022. Three independent reviewers screened the items and selected those most relevant to this review's scope. BRCA1/2 mutation carriers are significantly more likely to develop breast, ovarian, and serous endometrial cancer. Because of the Angelina effect, there has been a significant increase in bilateral risk-reducing mastectomy (BRRM) since 2013. BRRM and risk-reducing salpingo-oophorectomy (RRSO) significantly reduce the risk of developing breast and ovarian cancer. RRSO has significant side effects, including an impact on fertility and early menopause (i.e., vasomotor symptoms, cardiovascular disease, osteoporosis, cognitive impairment, and sexual dysfunction). Hormonal therapy can help with these symptoms. Because of the lower risk of developing breast cancer in the residual mammary gland tissue after BRRM, estrogen-only treatments have an advantage over an estrogen/progesterone combined treatment. Risk-reducing hysterectomy allows for estrogen-only treatments and lowers the risk of endometrial cancer. Although prophylactic surgery reduces the cancer risk, it has disadvantages associated with early menopause. A multidisciplinary team must carefully inform the woman who chooses this path of the broad spectrum of implications, from cancer risk reduction to hormonal therapies.
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Affiliation(s)
- Serena Bertozzi
- Breast Unit, University Hospital of Udine, 33100 Udine, UD, Italy
- Ennergi Research (Non-Profit Organisation), 33050 Lestizza, UD, Italy
| | - Ambrogio P. Londero
- Ennergi Research (Non-Profit Organisation), 33050 Lestizza, UD, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health, University of Genoa, 16132 Genova, GE, Italy
- Correspondence:
| | - Anjeza Xholli
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale San Martino, 16132 Genoa, GE, Italy
| | - Guglielmo Azioni
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale San Martino, 16132 Genoa, GE, Italy
| | - Roberta Di Vora
- Breast Unit, University Hospital of Udine, 33100 Udine, UD, Italy
| | - Michele Paudice
- Anatomic Pathology Unit, Department of Surgical Sciences, and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, GE, Italy
- Anatomic Pathology Unit, IRCCS Ospedale San Martino, 16132 Genoa, GE, Italy
| | - Ines Bucimazza
- Department of Surgery, Nelson R. Mandela School of Medicine, University of KwaZulu Natal, Durban 4001, South Africa
| | - Carla Cedolini
- Breast Unit, University Hospital of Udine, 33100 Udine, UD, Italy
- Ennergi Research (Non-Profit Organisation), 33050 Lestizza, UD, Italy
| | - Angelo Cagnacci
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health, University of Genoa, 16132 Genova, GE, Italy
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale San Martino, 16132 Genoa, GE, Italy
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The Impact of Pelvic Floor Physical Therapy on Bladder and Bowel Function After Obstetric Anal Sphincter Injury. UROGYNECOLOGY (HAGERSTOWN, MD.) 2023; 29:234-243. [PMID: 36735439 DOI: 10.1097/spv.0000000000001286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
IMPORTANCE Women with obstetric anal sphincter injury (OASI) are at increased risk of pelvic floor disorders. No standard of care exists for management of pelvic floor dysfunction after OASI. OBJECTIVES The aims of this study were to evaluate the impact of pelvic floor physical therapy (PFPT) on bladder and bowel function after OASI and to describe adherence to PFPT. STUDY DESIGN A retrospective cohort study of women with OASI presenting at a postpartum care clinic from 2017 to 2021 was conducted. Women were grouped according to PFPT attendance. Urinary Distress Inventory 6 (UDI-6) and Fecal Incontinence Severity Index (FISI) were administered at baseline and 6 months. RESULTS A total of 430 women with OASI presented to a postpartum care clinic, of which 137 (31.9%) attended PFPT, and 293 (68.1%) did not attend. Baseline and 6-month questionnaires were completed by 169 women: 52 (30.8%) in the PFPT group and 117 (69.2%) in the non-PFPT group. Baseline UDI-6 and FISI scores were higher in the PFPT group. Improvement in UDI-6 was not different between groups (-5.8 ± 14.9 vs -3.7 ± 10.8, P = 0.36). The non-PFPT group had greater worsening of FISI compared with PFPT group (9.8 ± 15.2 vs 1.1 ± 11.5, P < 0.001). Sixty-six percent (n = 136) of women referred to PFFT attended at least 1 session, of which 32.4% (n = 44) completed all sessions. Completely adherent women were referred to PFPT earlier (18.5 vs 28.5 days postpartum, P = 0.027). CONCLUSIONS Women in both the PFPT and non-PFPT groups reported improvement in bladder leakage 6 months after OASI. Women who did not attend PFPT had significant worsening of bowel leakage. Early referral to PFPT in women with pelvic floor dysfunction following OASI should be considered.
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The effect of pelvic floor muscle training in women with functional bladder outlet obstruction. Arch Gynecol Obstet 2023; 307:1489-1494. [PMID: 36695900 PMCID: PMC9875757 DOI: 10.1007/s00404-023-06930-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/10/2023] [Indexed: 01/26/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Female voiding dysfunction is often due to bladder outlet obstruction (BOO). We investigated pelvic floor muscle training (PFMT) effectiveness in women with functional BOO. METHODS This is a prospective study recruiting 63 women functionally obstructed, over 18yo, maximum flow rate (Qmax) less than 12 ml/sec, naïve of voiding treatment. Exclusion criteria were anatomical BOO, neurological condition, pelvic intervention, psychiatric or anticholinergic medication, diabetes mellitus and affected upper urinary tract. At baseline, women underwent uroflow, post void residual (PVR) measurement, cystoscopy, cystogram and urodynamic study (UDS) with pelvic electromyography (EMG). Blaivas-Groutz nomogram has been used to define obstruction. After diagnosis, patients underwent six-month PFMT. Re-evaluation was offered four weeks after end of treatment. Data were analyzed with SPSSv22.0. RESULTS 63 women were recruited and 48 finally included. At baseline, 20 reported 3 urinary tract infections (UTIs) during last year, and 12 had one episode of urine retention. Median Qmax was 7.5 ml/sec and median PVR 110 ml. 40 women were obstructed. 16 (40%) had mild, 16 (40%) moderate and 8 (20%) severe obstruction. All subjects had an overactive pelvic floor on EMG. Obstructed women were re-evaluated. Median Qmax was 8.5 ml/sec, close to baseline (p = 0.16). Median PVR was 65 ml, reduced to baseline (p = 0.02). 33 (82.5%) remained obstructed, 22 (66.67%) with mild, 8 (24.24%) moderate and 3 (9.09%) severe obstruction. 7 (17.5%) were non-obstructed. 4 patients reported one UTI episode with no cases of retention. CONCLUSIONS A 6 month PFMT reduced UTIs and PVR in women with functional BOO. Additionally, most patients had a de-escalation to milder obstruction.
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Torres-Balanzá S, Fuentes-Aparicio L, Mena-Del Horno S, Martínez-Aspas A, Sempere-Rubio N. Sexual Perception in Spanish Female Breast Cancer Survivors. Cross-Sectional Survey. Clin Breast Cancer 2023; 23:15-22. [PMID: 36357269 DOI: 10.1016/j.clbc.2022.10.011] [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: 04/18/2022] [Revised: 09/25/2022] [Accepted: 10/16/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND The aim was to assess sexual perception in female breast cancer survivors and establish if women presenting with sexual dysfunctions symptoms receive pelvic floor physiotherapy or request information on treatment. METHODS Cross-sectional survey carried out between January and March 2021. An online survey designed by the authors was structured in 3 dimensions: demographic and anthropometric data, medical data and sexual perception data. An open format survey with 23 questions available to any website visitor. The survey followed the CHERRIES guidelines. The study included 130 women who fulfilled the inclusion criteria. RESULTS The presence of pain during sexual activity was reported in 56.92% of cases. Specifically, 40.8% reported superficial dyspareunia, which is most commonly expressed by women as a "stinging pain." Surprisingly, only 4.6% of the women had received any type of pelvic floor physiotherapy treatment or had sought information. CONCLUSIONS Women breast cancer survivors have a negative perception of their sexuality. In addition, there is a lack of knowledge about the role of physiotherapy in sexual dysfunction, and only a small percentage of women received pelvic floor treatment or information to address their sexual dysfunction.
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Affiliation(s)
| | - Laura Fuentes-Aparicio
- Department of Physiotherapy, Universitat de València, Valencia, Spain; PTinMOTION. Physiotherapy in Motion, Multispeciality Research Group, Department of Physiotherapy, Universitat de València, Valencia, Spain.
| | | | - Ana Martínez-Aspas
- Obstetrics and Gynecology Service, Hospital Clínico Universitario de Valencia, Valencia, Spain; POG department (pediatrics, obstetrics, and gynecology), Faculty of Medicine, Universitat de València, Valencia, Spain
| | - Núria Sempere-Rubio
- Department of Physiotherapy, Universitat de València, Valencia, Spain; Clinical Biomechanics Research Unit (UBIC), Department of Physiotherapy, Universitat de València, València, Spain
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Zhou Q, Lu M, Li GS, Peng GL, Song YF. Knowledge mapping and visualization analysis of pelvic organ prolapse repair with mesh from 2001 to 2021. Front Bioeng Biotechnol 2023; 11:1104724. [PMID: 37091336 PMCID: PMC10113510 DOI: 10.3389/fbioe.2023.1104724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/22/2023] [Indexed: 04/25/2023] Open
Abstract
Aims: In recent decades, extensive attention has been paid to the application of mesh to repair pelvic floor defects. However, a large body of related literature has not been system summarized. The purpose of this study is to summarize and visualize the literature on pelvic organ prolapse (POP) repair with mesh using bibliometrics. Methods: Medical literature regarding POP repair with mesh were searched and obtained in the Web of Science™ Core (WoSCC) database from 2001 to 2021. Microsoft Excel 2020, CiteSpace and VOSviewer were used to conduct the bibliometric and knowledge-map analysis. Results: In the past 20 years, a total of 2,550 articles and reviews have been published in 35 journals, and the published and cited results show a growing trend. Cosson M and International Urogynecology Journal were the authors and journals with the highest output, respectively. The United States, France and the United Kingdom are among the top three countries/organizations in relevant publications in worldwide. 584 key words in the literature are divided into 8 clusters, which are mainly related to prolapse type, risk factors, surgical methods, imaging, quality of life and bioengineering. Using clinical research and tissue engineering technology to reduce mesh complications is the current hot spot in this field. Conclusion: Reasonable application of mesh and avoiding mesh complications are still the most concerned topics in POP research. Although clinical research, surgical improvement, biological mesh and bioengineering technology have shown promising results, it is still urgent to carry out clinical transformation application research.
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Affiliation(s)
- Quan Zhou
- Department of Gynecology and Obstetrics, The People’s Hospital of China Three Gorges University/The First People’s Hospital of Yichang, Yichang, China
- Department of Gynecology and Obstetrics, The 900th Hospital of Joint Logistic Support Force, Fuzhou, Fujian, China
- *Correspondence: Quan Zhou, ; Yan-Feng Song,
| | - Man Lu
- Department of Gynecology and Obstetrics, The People’s Hospital of China Three Gorges University/The First People’s Hospital of Yichang, Yichang, China
| | - Guo-Sheng Li
- Department of Gynecology and Obstetrics, The People’s Hospital of China Three Gorges University/The First People’s Hospital of Yichang, Yichang, China
| | - Gan-Lu Peng
- Department of Gynecology and Obstetrics, The People’s Hospital of China Three Gorges University/The First People’s Hospital of Yichang, Yichang, China
| | - Yan-Feng Song
- Department of Gynecology and Obstetrics, The 900th Hospital of Joint Logistic Support Force, Fuzhou, Fujian, China
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Baecher-Lind L, Fleming AC, Bhargava R, Cox SM, Everett EN, Forstein DA, Madani Sims S, Morgan HK, Morosky CM, Royce CS, Sonn TS, Sutton JM, Graziano SC. Enhancing interprofessional collaboration and interprofessional education in women's health. MEDICAL EDUCATION ONLINE 2022; 27:2107419. [PMID: 35924355 PMCID: PMC9359162 DOI: 10.1080/10872981.2022.2107419] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 05/05/2022] [Accepted: 07/26/2022] [Indexed: 08/05/2023]
Abstract
This article is from the 'To The Point' series from the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee. The purpose of this review is to provide an understanding of the differing yet complementary nature of interprofessional collaboration and interprofessional education as well as their importance to the specialty of Obstetrics and Gynecology. We provide a historical perspective of how interprofessional collaboration and interprofessional education have become key aspects of clinical and educational programs, enhancing both patient care and learner development. Opportunities to incorporate interprofessional education within women's health educational programs across organizations are suggested. This is a resource for medical educators, learners, and practicing clinicians from any field of medicine or any health-care profession.
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Affiliation(s)
- Laura Baecher-Lind
- Department of Obstetrics and Gynecology, Tufts University School of Medicine, Boston, MA, USA
| | - Angela C. Fleming
- Department of Obstetrics and Gynecology, Beaumont Hospital, Novi, MI, USA
| | - Rashmi Bhargava
- Department of Obstetrics and Gynecology, University of Saskatchewan College of Medicine, Regina, SK, Canada
| | - Susan M. Cox
- Department of Obstetrics and Gynecology, Dell Medical School, Austin, TX, USA
| | - Elise N. Everett
- Department of Obstetrics and Gynecology, Larner College of Medicine at the University of Vermont, Burlington, VT, Canada
| | - David A. Forstein
- Department of Obstetrics and Gynecology, Rocky Vista College of Osteopathic Medicine, Parker, CO, USA
| | - Shireen Madani Sims
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Helen K. Morgan
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Christopher M. Morosky
- Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Celeste S. Royce
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA, USA
| | - Tammy S. Sonn
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - Jill M. Sutton
- Department of Obstetrics and Gynecology, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Scott C. Graziano
- Department of Obstetrics and Gynecology, Loyola University Medical Center, Hines, IL, USA
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Rajasingh CM, Gurland BH. Management of Full Thickness Rectal Prolapse. SEMINARS IN COLON AND RECTAL SURGERY 2022. [DOI: 10.1016/j.scrs.2022.100938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Molina-Torres G, Amiano-López L, Córdoba-Peláez MM, Ibáñez-Vera AJ, Diaz-Mohedo E. Analysis of the Structural Characteristics and Psychometric Properties of the Pelvic Floor Bother Questionnaire (PFBQ): A Systematic Review. J Clin Med 2022; 11:jcm11237075. [PMID: 36498649 PMCID: PMC9735776 DOI: 10.3390/jcm11237075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/22/2022] [Accepted: 11/26/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The Pelvic Floor Bother Questionnaire is a validated and reliable questionnaire that studies the presence and degree of pelvic floor discomfort, providing a global vision of pelvic floor dysfunction. This questionnaire assesses urinary stress incontinence, urinary urgency, urinary frequency, urge urinary incontinence, pelvic organ prolapses, dysuria, dyspareunia, defecatory dysfunction, fecal incontinence, and the disability it causes to the respondent. AIM The aim of the present study was to analyze the structural characteristics and psychometric properties of the different versions of the pelvic floor bother questionnaire, as well as the methodological quality, the quality of evidence, and the criteria used for good measurement properties. METHODS A systematic review was carried out in different databases, such as PubMed, SCOPUS, Web of Science, Dialnet, ScienceDirect, and CINAHL, on studies adapting and validating the pelvic floor bother questionnaire in other languages. The data were analyzed taking into account the guidelines of the preferred reporting item statement for systematic reviews and meta-analyses (PRISMA) and following the COSMIN guidelines, considering articles published up to 28 February 2022, and registered in the PROSPERO database. RESULTS Initially, a total of 443 studies were found, from which a total of four studies were analyzed with regard to structural characteristics and psychometric properties, such as reliability, internal consistency, construct validity, and criterion validity. CONCLUSIONS The different versions of the questionnaires show basic structural characteristics and psychometric properties for the evaluation of patients with pelvic floor dysfunctions. Most of the analyzed versions present criteria for good measurement properties qualified as sufficient, inadequate-adequate methodological quality, and low-moderate quality of evidence.
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Affiliation(s)
- Guadalupe Molina-Torres
- Department of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almeria, 04120 Almeria, Spain
| | | | | | - Alfonso Javier Ibáñez-Vera
- Department of Health Sciences, University of Jaen, Campus las Lagunillas, 23071 Jaen, Spain
- Correspondence: ; Tel.: +34-9-5321-3519
| | - Esther Diaz-Mohedo
- Department of Physiotherapy, Faculty of Health Sciences, University of Malaga, Campus Teatinos, 29071 Malaga, Spain
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Yao H, Zhang X, Sun F, Tang G, Wu J, Zhou Z. The efficacy of intravaginal electrical stimulation (IVES) in treating female with urinary incontinence symptom from meta-analysis of nine randomized controlled trials. Front Neurol 2022; 13:933679. [PMID: 36176556 PMCID: PMC9514856 DOI: 10.3389/fneur.2022.933679] [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: 05/01/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundUrinary incontinence (UI) is a common disease in the middle-aged and elderly women, and physical therapy has gradually become the mainstream treatment of UI. We conducted a meta-analysis to evaluate the efficacy of intravaginal electrical stimulation (IVES) in the treatment of UI.MethodsFrom January 2006 to December 2021, we finally selected nine randomized controlled trials (RCTs) including 657 participants from PubMed, EMBASE, and Cochrane databases to evaluate the efficacy of IVES in the treatment of female UI. Continuous data were represented by mean difference and 95% CI, while dichotomous data were represented by odds ratio and 95% CI. All the data were analyzed by the Review Manager Version 5.4.ResultsCompared with the control group, there were significant improvements in urine pad test (P = 0.01), urinary incontinence frequency (P = 0.04), some indicators in the incontinence quality of life questionnaire and King's health questionnaires, and subjective feeling of cure (P = 0.009) in the IVES group. However, in other indicators reflecting UI, there was no significant difference between the IVES group and the control group. In addition, subgroup analysis showed that IVES and IVES combined with training could significantly reduce the weight of the urine pad, which reflected the improvement of urine leakage.ConclusionThis meta-analysis proved that IVES can partially improve the symptoms of female patients with UI compared with the control group. However, it still needs to be further evaluated through more high-quality research in the future.
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Affiliation(s)
- Huibao Yao
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Xiaofei Zhang
- Department of Neurology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Fengze Sun
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Gonglin Tang
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Jitao Wu
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
- Jitao Wu
| | - Zhongbao Zhou
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
- Department of Urology, Beijing TianTan Hospital, Capital Medical University, Beijing, China
- *Correspondence: Zhongbao Zhou
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Lin M, Lu Y, Chen J. Tissue-engineered repair material for pelvic floor dysfunction. Front Bioeng Biotechnol 2022; 10:968482. [PMID: 36147522 PMCID: PMC9485870 DOI: 10.3389/fbioe.2022.968482] [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: 06/14/2022] [Accepted: 08/09/2022] [Indexed: 11/13/2022] Open
Abstract
Pelvic floor dysfunction (PFD) is a highly prevalent urogynecology disorder affecting many women worldwide, with symptoms including pelvic organ prolapse (POP), stress urinary incontinence (SUI), fecal incontinence, and overactive bladder syndrome (OAB). At present, the clinical treatments of PFD are still conservative and symptom-based, including non-surgical treatment and surgery. Surgical repair is an effective and durable treatment for PFD, and synthetic and biological materials can be used to enforce or reinforce the diseased tissue. However, synthetic materials such as polypropylene patches caused a series of complications such as mesh erosion, exposure, pain, and inflammation. The poor mechanical properties and high degradation speed of the biomaterial meshes resulted in poor anatomical reduction effect and limitation to clinical application. Therefore, the current treatment options are suboptimal. Recently, tissue-engineered repair material (TERM) has been applied to repair PFD and could markedly improve the prognosis of POP and SUI repair surgery in animal models. We review the directions and progression of TERM in POP and SUI repair. Adipose-derived stem cells (ADSCs) and endometrial mesenchymal stem cells (eMSCs) appear to be suitable cell types for scaffold seeding and clinical implantation. The multidisciplinary therapy approach to tissue engineering is a promising direction for tissue repair. More and longer follow-up studies are needed before determining cell types and materials for PFD repair.
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Affiliation(s)
- Meina Lin
- NHC Key Laboratory of Reproductive Health and Medical Genetics (China Medical University) and Liaoning Key Laboratory of Reproductive Health, Liaoning Research Institute of Family Planning (The Affiliated Reproductive Hospital of China Medical University), Shenyang, China
| | - Yongping Lu
- NHC Key Laboratory of Reproductive Health and Medical Genetics (China Medical University) and Liaoning Key Laboratory of Reproductive Health, Liaoning Research Institute of Family Planning (The Affiliated Reproductive Hospital of China Medical University), Shenyang, China
- *Correspondence: Yongping Lu, ; Jing Chen,
| | - Jing Chen
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
- *Correspondence: Yongping Lu, ; Jing Chen,
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Brilhante MMS, Marinho MDFD, Magalhães AG, Correia GN. Impact of the SARS-CoV-2 pandemic on urinary incontinence and quality of life of nulliparous women. Rev Gaucha Enferm 2022; 43:e20200479. [PMID: 36043638 DOI: 10.1590/1983-1447.2022.20200479.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 11/16/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To evaluate the impact of social isolation due to SARS-CoV-2 on the prevalence and severity of urinary incontinence and how this correlates with the quality of life of the nulliparous women evaluated. METHOD Observational, longitudinal study, carried out from August/2019 to September/2020, at the Faculdade de Ciências da Saúde do Trairi/RN, with 37 nulliparous women from 18 to 35 years old, who answered the socio-anthropometric assessment, to the Incontinence Severity Index Questionnaire and King's Health Questionnaire, before and during isolation due to SARS-CoV-2. Statistical analysis: Wilcoxon test, and Spearman's correlation coefficient. Significance level p≤0.05. RESULTS During social isolation, there was an improvement in urge incontinence (p=0.01) and in the frequency of urinary incontinence (p=0.03). The severity of urinary incontinence correlated with: general health perception (p=0.02; r=0.65); physical limitations (p=0.03; r=0.60); social (p=0.001; r=0.82). CONCLUSION The social isolation from SARS-CoV-2 improved urge incontinence and frequency of urinary incontinence. The more severe the urinary incontinence, the worse the general health perception, physical and social limitations during isolation.
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Affiliation(s)
- Magdalena Muryelle Silva Brilhante
- Universidade Federal do Rio Grande do Norte (UFRN), Faculdade de Ciências da Saúde do Trairi, Programa de Pós-Graduação em Ciências da Reabilitação. Santa Cruz, Rio Grande do Norte, Brasil
| | - Maria de Fátima Duarte Marinho
- Universidade Federal do Rio Grande do Norte (UFRN), Faculdade de Ciências da Saúde do Trairi, Programa de Pós-Graduação em Ciências da Reabilitação. Santa Cruz, Rio Grande do Norte, Brasil
| | - Adriana Gomes Magalhães
- Universidade Federal do Rio Grande do Norte (UFRN), Faculdade de Ciências da Saúde do Trairi, Programa de Pós-Graduação em Ciências da Reabilitação. Santa Cruz, Rio Grande do Norte, Brasil
| | - Grasiéla Nascimento Correia
- Universidade Federal do Rio Grande do Norte (UFRN), Faculdade de Ciências da Saúde do Trairi, Programa de Pós-Graduação em Ciências da Reabilitação. Santa Cruz, Rio Grande do Norte, Brasil
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Using the Pelvic Floor Impact Questionnaire to Improve Urinary Incontinence Assessments for Female Veterans. Nurs Womens Health 2022; 26:353-362. [PMID: 35988708 DOI: 10.1016/j.nwh.2022.07.007] [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: 01/19/2022] [Revised: 04/27/2022] [Accepted: 07/22/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate quality of life (QoL) in female veterans by comparing responses of the Pelvic Floor Impact Questionnaire (PFIQ-7) before and after a chosen treatment for urinary incontinence (UI), determine whether a QoL assessment was being completed for each woman seeking care for UI, and review the PFIQ-7 questionnaire scores to ensure the veterans were offered the appropriate levels of treatment. DESIGN Quality improvement project using the plan-do-study-act cycle for evaluating change. SETTING /Local Problem: A Veterans Affairs Medical Center in the midwestern United States. No standardized education or QoL questionnaire was being used for female veterans diagnosed with UI before implementation of the project. PARTICIPANTS Twenty female veterans diagnosed with stress or mixed UI who had completed Kegel exercises or pelvic floor rehabilitation (PFR) and a pre- and posttreatment PFIQ-7. INTERVENTIONS/MEASUREMENTS The Veterans Affairs Medical Center incorporated the PFIQ-7 into routine practice for pre- and posttreatment assessment of UI. Data were collected through a retrospective chart review. RESULTS The mean initial PFIQ-7 score for participants (n = 4) who chose PFR was 71.77 (SD = 82.79). The mean final PFIQ-7 score for participants in the PFR group was 43.99 (SD = 63.34). The mean initial PFIQ-7 score for participants who chose Kegel exercises was 71.72 (SD = 34.92), and the final score was 60.71 (SD = 44.98). When comparing pre- and posttreatment scores, a lower score means there was a positive effect from the treatment and reflects an improved QoL. CONCLUSION The addition of the QoL assessment tool assisted staff in developing an individualized plan of care for female veterans. Regardless of treatment option chosen, participants who did not show an overall improvement in the pre- and posttreatment QoL scores were referred to a more advanced level of care.
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