[Pelvic floor disorders: What do adolescents and young women know? A literature review]

AIM

To assess the knowledge of adolescent girls and young women on pelvic-perineal disorders (PPD).

METHOD

We searched on PubMed, Cochrane Library, Kinédoc and Semantic Scholar databases using the MeSH keywords: "knowledge" "awareness" "surveys" "young women" "pelvic floor" "adolescent" "teenager" "athletic injury" "urinary incontinence". The articles had to have been published within the last 15 years, written in French or English, and deal with the state of knowledge of adolescents and young women concerning the perineal sphere using questionnaires.

RESULTS

A total of 8 studies were included in the review, 5 cross-sectional studies and 3 intervention studies. The knowledge of adolescent girls and young women interviewed about the anatomy of the pelvic floor, its function, and risk factors for PPD was low. The majority of the participants wanted more information about the pelvic floor. Two studies that conducted an educational intervention showed a significant improvement in knowledge.

CONCLUSION

Knowledge of pelvic-perineal disorders and pelvic floor function is poor in adolescent girls and young women. To better assess them, it would be necessary to validate a questionnaire containing all the items about knowledge.

[Relationship between perineal characteristics and symptoms and pelvic girdle pain: A literature review]

INTRODUCTION

Pelvic girdle pain (PGP) is characterized by the presence of pain in the posterior pelvic area, distally and laterally to the fifth lumbar vertebra, and/or at the pubic symphysis. PGP is a very common pain condition in women, especially during pregnancy and postpartum. After delivery, pain prevalence decreases to 7 % in the first three months. The current literature describes an association between pelvic girdle pain and different perineal characteristics and symptoms.

OBJECTIVES

A better understanding of perineal structures influence on PGP could assist towards the management of this condition. The aim of this review is to describe the peer-reviewed literature about perineal function in patients with PGP.

METHODS

A bibliographic search on PubMed was conducted. The key words used were: pelvic girdle pain, pregnacy-related low back pain, lumbopelvic pain, posterior pelvic pain, peripartum pelvic pain, pelvic girdle relaxation, pelvic joint instability, peripartum pelvic pain, sacroiliac joint pain, sacroiliac joint dysfunction, sacroiliac-joint related pelvic pain and pelvic floor. Two hundred and twenty-one (221) articles were identified. Out of them, a total of nine articles were selected. The level of evidence was determined using Oxford's scale.

RESULTS

Patients with PGP showed increased activity of the pelvic floor muscles (P=0.05) (LE3), decreased urogenital hiatus area (PGP 12.4 cm²±2.7, control 13.7 cm²±2.8, P=0.015) (LE3), shorter endurance time (PGP 17.8 s; control 54.0 s, P=0.00) (LE3), significantly later onset time during affected side leg elevation (PGP 25ms, control -129ms, P=0.01) (LE3), levator ani and obturator internus tenderness (PGP 25/26; control 5/25, P<0.001) (LE3) and a higher prevalence of vesico-sphincteric disorders compared to asymptomatic subjects (LE3).

CONCLUSION

This review confirms that subjects suffering PGP present particular perineal characteristics regarding morphology and biomechanics. It would be interesting to develop clinical research concerning pelvic floor release effect in PGP.

[Pelvic floor muscle contraction and maximum urethral closure pressure]

OBJECTIVES

The aim of this study was to precise the relationship between the pelvic floor muscle (PFM) contraction and the maximum urethral closure pressure (MUCP) at rest and during a containing effort.

MATERIALS

Longitudinal study, observational, single-center retrospective performed in successively 358 women addressed for urodynamics. MUCP at rest and during a containing effort, gain of MUCP, functional urethral length (FUL), scores USP and ICQ-SF, cervico-urethral mobility (CUM) according to POP-Q classification and leak point pressure were analyzed according to the PFM contraction.

RESULTS

One hundred and seventy-three had genuine stress urinary incontinence, 25 urge urinary incontinence, 148 mixed incontinence and 12 had no urinary incontinence. PFM contraction was not associated with a hysterectomy, age, parity, BMI, CUM, FUL, MUCP at rest, the severity of the incontinence assessed by ICIQ-SF score and leak point pressure. There was a proportional relationship between PFM contraction and the value of MUCP measured during this contraction (P<0.0001) on the one hand, and the gain of MUCP (P<0.0001) on the other. MUCP at rest was independent from the MUCP during the containing effort and the gain of MUCP.

CONCLUSIONS

The strength of contraction of the PFM is not correlated with MUCP at rest but proportional to the augmentation of the MUCP during the containing effort.