The physiological basis of pelvic floor exercises in the treatment of stress urinary incontinence

Bidirectional Relationships between Sarcopenia and Pelvic Floor Disorders

Sarcopenia and pelvic floor disorders (PFDs) are prevalent and often cooccurring conditions in the aging population. However, their bidirectional relationship and underlying mechanisms remain underexplored. This narrative review aims to elucidate this relationship by exploring potential causative interplays, shared pathophysiological mechanisms, and common risk factors. A comprehensive literature search was conducted to identify relevant studies focusing on epidemiological associations, interaction mechanisms, and implications for patient care. While epidemiological studies demonstrate associations between sarcopenia and PFDs, our findings reveal a cyclical relationship where sarcopenia may exacerbate PFDs through mechanisms such as decreased muscle strength and mobility. Conversely, the presence of PFDs often leads to reduced physical activity due to discomfort and mobility issues, which in turn exacerbate the muscle atrophy associated with sarcopenia. Additionally, shared risk factors such as physical inactivity, nutritional deficiencies, metabolic syndrome, and menopausal hormonal changes likely contribute to the onset and progression of both conditions. These interactions underscore the importance of concurrently integrated care approaches that address both conditions. Effective management requires comprehensive screening, the recognition of contributing factors, and tailored exercise regimens supported by a multidisciplinary approach. Future research should focus on longitudinal studies tracking disease progression and evaluating the efficacy of multidisciplinary care models in optimizing patient outcomes.

The Most Common Functional Disorders and Factors Affecting Female Pelvic Floor

The pelvic floor (PF) is made of muscles, ligaments, and fascia, which ensure organ statics, maintain muscle tone, and are involved in contractions. This review describes the myofascial relationships of PF with other parts of the body that determine the proper functions of PF, and also provides insight into PF disorders and the factors contributing to them. PF plays an important role in continence, pelvic support, micturition, defecation, sexual function, childbirth, and locomotion, as well as in stabilizing body posture and breathing, and cooperates with the diaphragm and postural muscles. In addition, PF associates with distant parts of the body, such as the feet and neck, through myofascial connections. Due to tissue continuity, functional disorders of muscles, ligaments, and fascia, even in the areas that are distant from PF, will lead to PF disorders, including urinary incontinence, fecal incontinence, prolapse, sexual dysfunction, and pain. Dysfunctions of PF will also affect the rest of the body.

Association of pelvic floor function with postoperative urinary incontinence in cervical cancer patients after the radical hysterectomy

AIMS

To assess the pelvic floor function in cervical cancer patients after radical hysterectomy and its relationship with urinary incontinence (UI).

METHODS

Cervical cancer patients who underwent radical hysterectomy were recruited from 18 hospitals in China from January 2012 to March 2015. Pelvic floor examinations were conducted by measuring the pelvic floor muscle strength, fatigue of pelvic floor muscle fatigue, dynamic pressure of vaginal, nerve injury, A3 feedback, muscle potential, static tension, and dynamic tension. Postoperative urinary incontinence (UI) was identified using the International Consultation on Incontinence Questionnaire. Multivariable logistic regression analysis was used to assess the association of pelvic floor function examination results with postoperative UI.

RESULTS

Totally 169 patients were included in this study. The prevalence of UI was 39.6% (67/169). The proportion of abnormal fatigue of Type I muscle (64% vs. 36%, p = .04) and abnormal A3 feedback (53.9% vs. 46.1%, p = .03) were higher among patients with postoperative UI compared to those without UI. In the multivariable analysis, abnormal fatigue of Type I muscle (odds ratio [OR] = 3.73, 95% confidence interval [CI]: 1.42-9.84), abnormal A3 feedback (OR = 2.40, 95% CI: 1.04-5.51), and length of resected vagina > 3 cm (OR = 3.44, 95% CI: 1.27-9.31) were associated with postoperative UI. Compared to laparoscopy, laparotomy was less likely to cause postoperative UI (OR = 0.12, 95% CI:0.04-0.33).

CONCLUSIONS

The abnormal function of the pelvic floor muscle is related to postoperative UI. Early assessment among these patients is needed to prevent the development of pelvic floor disorder postoperatively.

Pelvic floor muscle training in female stress urinary incontinence: comparison between group training and individual treatment using PERFECT assessment scheme

INTRODUCTION AND HYPOTHESIS

Pelvic floor muscle training (PFMT) is a treatment for stress urinary incontinence (SUI) that can be done individually or in a group. The aim of this study was to compare these two types of treatment.

METHODS

Sixty women 30 to 75 years old with SUI were randomly assigned to participate in the two groups. They were evaluated before and after the treatment with the Oxford grading system, pad test, voiding diary, and the King's Health Questionnaire.

RESULTS

Both groups experienced significant reductions in urinary leakage as measured by the pad test and bladder diary. A negative pad test was observed in about 50% of patients in both groups. There were statistically significant improvements in both muscle strength and quality of life. When the groups were compared, there were no differences in the results between them.

CONCLUSIONS

Individual treatment and group PFMT appear to be equally effective for improving SUI.

Female Pelvic Floor Health

An often neglected but important area of women's health involves the pelvic floor. Pelvic floor health can be reviewed by examining phases of a woman's life. Because pelvic floor health is not readily discussed and few professionals are considered experts in this area, it is often overlooked in women's healthcare. In medicine, care of the pelvic area can become fragmented as it is divided among urologists, gynecologists, and colorectal surgeons. The specialty of urogynecology combines 2 of the areas, and some physical therapists and nurses choose to specialize in female pelvic floor health. The issues of pelvic floor health are often addressed only after symptoms have presented. However, healthy practices can enhance pelvic floor well-being and maintain quality of life as a woman ages. This article is a review of clinical, research, and editorial articles on female pelvic floor issues and a discussion of measures that can contribute to optimal pelvic floor health.