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Ali-Ross, Nadia S. "Pelvic floor symptoms and signs in women with and without pelvic floor dysfunction." Thesis, University of Manchester, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.489533.
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The pelvic floor supports the pelvic viscera and plays a role in normal urinary, gastrointestinal and reproductive function including parturition. Weakness of the pelvic floor can result in prolapse of the pelvic viscera and symptoms related to the anatomical and physiological changes. To date, prolapse and its treatment have focussed on restoration of the anatomy although symptom resolution may be more important to the patient. The symptoms attributable to prolapse have not been well defined, which makes the evaluation of treatments impossible. Neither have the factors that may influence symptoms and anatomical signs of pelvic organ prolapse been explored.
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Caudwell-Hall, Jessica. "Pelvic Floor Trauma in Childbirth." Thesis, The University of Sydney, 2019. http://hdl.handle.net/2123/20873.
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Between 4 and 40% of women will suffer permanent pelvic floor trauma in childbirth. Irreversible damage to the pelvic floor at the time of vaginal birth may take the form of trauma to the levator ani complex or obstetric anal sphincter injury (OASI). Long-term sequelae include pelvic organ prolapse, its recurrence after surgical repair, urinary and fecal incontinence, sexual dysfunction and chronic pelvic pain. Detection rates are poor, especially for levator ani trauma, which is often clinically undetectable at the time of vaginal birth. Translabial ultrasound is an objective method for the diagnosis of irreversible pelvic floor trauma and was used in observational studies for this thesis. Original studies undertaken for this thesis showed antenatal risk factors for levator avulsion include increasing maternal age (OR 1.05, p=0.019), lower body mass index (BMI; OR 0.94, p=0.018), and increasing bladder neck descent (BND; OR 0.97, p=0.026). Intrapartum risk factors identified include longer second stage (OR 1.02, p=0.01), OASI (OR 3.2, p= 0.002), and the use of forceps (OR 2.9, p=0.001). The latter is by far the strongest modifiable risk factor and should be avoided. Predictors of atraumatic normal vaginal delivery were younger maternal age (OR 0.93, p<0.001) and earlier gestation at delivery (OR 0.78, p=0.001), which is relevant to family planning. Overall, rates of atraumatic normal vaginal delivery in our population were much lower than generally assumed at 33-40%. An in vitro study showed that the predicted effect of forceps on avulsion risk is not explained by an increase in space requirement alone. It is likely that the main factor determining the traumatic potential of forceps is increased force over time, i.e., the characteristics of the pull exerted by the operator. Finally, it was found that conversion of a primary vacuum to a forceps delivery would result in an overall increase in major pelvic floor trauma from 31% to 39% of primiparas (p=0.018). Current trends towards the use of forceps to reduce Caesarean section rates are likely to result in an inadvertent increase in rates of levator avulsion and OASI. As current methods of anal sphincter repair and surgery for pelvic organ prolapse have high rates of failure, good obstetric care should emphasize the prevention of pelvic floor trauma at the time of a woman’s first birth.
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Mkhombe, Welile. "Pelvic floor dysfunction in female triathletes." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/27827.
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Background: In the past few decades, an increasing number of women have been participating in high-impact sports which involves jumping, landing and/ or running activities. Recent data have shown, however, that this kind of activity might be associated with adverse effects, including pelvic floor disorders. Nevertheless, there is very little in the literature about pelvic floor effects associated with endurance sports where high-impact exercise is performed at submaximal intensity for prolonged periods of time. Objective: The primary objective of the present paper is to describe the prevalence of pelvic floor dysfunction (PFD) in a female triathlete population. Methods: An anonymous on-line survey was administered from September 2015 to March 2016 to women who self-identified as triathletes. We used two validated questionnaires: the Pelvic Floor Distress Inventory Questionnaire short form (PFDI) and the Pelvic Floor Impact Questionnaire short form (PFIQ). In addition, respondents were asked for demographics (age, height, weight, occupation), general health status (medical history, pelvic/abdominal surgical history, pregnancy and birth history) as well as sport practice characteristics (duration of training, level of competition, number of hours spent per week swimming, cycling, and running), so as to characterise these female triathletes. The survey remained active online for seven months, during which time the majority of responses were obtained from having our survey on the IRONMAN December 2015 newsletter. The balance of responses came from various triathlon clubs which we had approached within Western Cape Province. Results: Sixty-seven female triathletes responded to the online survey which we designed on SurveyMonkey. The respondents were between the ages of 22 and 56 years, the mean being 37 years. They had a mean BMI of 22.6 kg/m2. None of them had any medical conditions known to increase the risk of PFD. Of the known surgical history risk factors, 74.6% had had no previous pelvic or abdominal surgery. In the cohort, 69.2% were nulliparous and 30.8% parous. Most of the respondents competed in the recreational age group (70.4%), compared with 29.6% who described themselves as being in the competitive age group. Over 94.4% of the participants had been involved in triathlon training for a period of more than 6 months. At the peak of their training, athletes described their weekly training regime as comprising a mean of 5.4 hours running, 3.9 hours swimming and 9.1 hours cycling. Of those who performed any form of 'core exercises', 29.6% performed pelvic floor exercises, 16.7% yoga, and 25.9% Pilates as part of their routine training. Eighty-two per cent of the triathletes had competed in the half IRONMAN and 37.8% in at least one full IRONMAN competition. The PFDI revealed a number of commonly occurring pelvic floor symptoms. The most reported urinary symptoms were urinary frequency, stress urinary incontinence (SUI) and urge urinary incontinence (UUI) (45.8%, 33.3% and 37.5%, respectively). The most reported colorectal symptoms were incomplete bowel emptying (41.7%), faecal urgency (43.8%), and flatal incontinence (41.7%). Pelvic organ prolapse symptoms were least reported, but those who had symptoms mostly experienced heaviness or dullness in the pelvic area (33.3%), pressure in the lower abdomen (31.3%) and a need for vaginal/rectal digitation in order to have or complete a bowel movement (25%). It was noteworthy to find that the nulliparous triathletes had more pelvic floor symptoms than the parous group. A higher prevalence of colorectal/rectal symptoms were reported by those who had had forceps deliveries. Colorectal symptoms were found to be slightly more prevalent in those who performed any pelvic floor exercises (PFE), yoga or Pilates than amongst those who did not. Even with the myriad symptoms reported, these women were not significantly bothered by their symptoms. Conclusion: It is apparent that PFDs are prevalent in the population reviewed, although the majority of individuals did not seem to be bothered by the symptoms that also did not appear to interrupt training or quality of life. For those who are concerned or troubled by the symptoms, it would be beneficial for them to be identified early so that management options can be offered to relieve the symptoms.
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Kamisan, Atan Ixora. "Pelvic floor trauma following vaginal childbirth." Thesis, The University of Sydney, 2018. http://hdl.handle.net/2123/18813.
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Maternal birth trauma in particular pelvic floor trauma (PFT) is of increasing concern in recent years, mainly due to its association with long term morbidities affecting women’s quality of life. Prediction is difficult and likely to raise ethical, moral and health economic questions, and attempts at primary and interval reconstruction have had only limited success. This work was designed to explore multiple aspects of PFT with a particular focus on prevention and its effect on pelvic organ support through one prospective multicentre randomised controlled trial, two cross-sectional and four retrospective studies, involving 3D/4D Translabial Ultrasound as the principal study tool. The incidence and prevalence of levator ani muscle (LAM) avulsion, microtrauma and sonographic external anal sphincter defects was found to be 13.1%-24%, 13.8%-62% and 12.4% respectively, showing that somatic maternal birth trauma is very common. In a randomised controlled trial, antepartum use of Epi-No® birth trainer was found to be unlikely of clinical benefit in the prevention of pelvic floor trauma. Two observational studies showed that there was no difference in the prevalence of levator avulsion and sonographic EAS defects between women who were vaginally primiparous or multiparous, and that the effect of vaginal birth on hiatal dimensions was largely limited to the first birth. These two observational studies suggest that it is the first vaginal birth that is by far the most traumatic. Another observational study showed that LAM avulsion can be diagnosed clinically by digital palpation, but may require a longer learning curve than imaging. Confirmation by imaging is necessary in high risk cases as part of surgical planning. LAM avulsion was also shown to be associated with increased levator urethra gap (LUG) on ultrasound. LUG and LAM avulsion are associated with signs and symptoms of female pelvic organ prolapse. Variations in obstetric practice such as tolerance of longer second stages and increased Forceps rates are likely to lead to higher rates of pelvic floor trauma. In conclusion, prevention of PFT should focus on the first vaginal birth. Antepartum use of the Epi-No® device is unlikely to be beneficial. LAM avulsion can be diagnosed clinically but involves a longer learning curve, making confirmation by imaging essential. LAM trauma is associated with POP in both symptomatic and asymptomatic cohorts.
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Uustal, Fornell Eva. "Pelvic floor dysfunction : a clinical and epidemiological study /." Linköping : Univ, 2003. http://www.bibl.liu.se/liupubl/disp/disp2003/med822s.pdf.
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Tegerstedt, Gunilla. "Clinical and epidemiological aspects of pelvic floor dysfunction /." Stockholm, 2004. http://diss.kib.ki.se/2004/91-7140-065-6/.
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Laycock, Josephine. "Assessment and treatment of pelvic floor dysfunction : physiotherapy in the management of pelvic floor dysfunction in relation to female urinary incontinence." Thesis, University of Bradford, 1992. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.316501.
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Dolan, Lucia Margaret. "The prevalence and obstetric antecedents of pelvic floor dysfunction." Thesis, University of Newcastle upon Tyne, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.485799.
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It has long been considered that aspects of pregnancy and child birth play a role in the aetiology of pelvic floor dysfunction (PFD). Most women have their first pregnancy in their 20's, yet the peak time for presentation with symptoms is 2 or 3 decades later. The studies embodied in this thesis are designed to examine the prevalence and antecedent risk factors ofPFD in women 20 years after their first delivery. Unique aspects ofthe studies described here are: identification of a consecutive group of women having their first pregnancies over a short time period in a single hospital; the est~blishmentofcurrent contact information for these women 20 years later using the NHS Strategic Tracing System (NSTS); the use ofa robust obstetric database, the Standard Maternity Information System (SMIS) effective at the time of the index pregnancies; and the use of the validated Sheffield Pelvic Floor Assessment Questionnaire (Sheffield-PAQ© v3) to determine current symptoms and their impact on quality of life. Mothers of index cases were also contacted to assess familial risk. PFD was confirmed to be extremely common, with symptoms affecting half of women 20 years after their first pregnancy; 4:10 women reported urinary incontinence (UI), 2:10 had anal incontinence (AI), and 1:8 had prolapse. Symptoms were troublesome in over 50% (prolapse) and over 70% CUI & AI). Logistic regression analyses indicated that caesarean section was protective against UI, faecal incontinence (FI) and mild prolapse. Instrumental delivery was a risk factor for flatal and FI; obesity was a risk factor for all three symptoms. A familial risk for UI and AI was identified. Vaginal birth is a significant risk factor for long term symptoms ofPFD. However, some women may have a predisposition, possibly genetic, to develop symptoms which is independent of obstetric history.
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Abdool, Zeelha. "Evaluation of pelvic floor morphology in South African females." Diss., University of Pretoria, 2017. http://hdl.handle.net/2263/63877.
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Pelvic floor dysfunction in the form of pelvic organ prolapse (POP) is a common gynaecological condition, especially in the elderly. Although the aetiology is poorly understood, several risk factors such as vaginal childbirth, chronically raised intra-abdominal pressure (such as asthma and chronic constipation), ageing, previous hysterectomy and connective tissue disorders are thought to play a role in the pathophysiology of POP. Studies have shown that vaginal childbirth can result in both gross and micro-architectural distortion/alteration of the pelvic floor musculature and is thus considered to play a major role in the development of POP. Although ethnicity has been proposed as a risk factor, there are limited studies on this subject.
Recently, transperineal ultrasound (TPUS) has been used to study the structural integrity and the dynamic interaction between the pelvic organs and pelvic floor musculature. Using a specified methodology we intended to determine and compare pelvic floor morphology, namely pelvic organ descent and levator hiatal distensibility in a multi-ethnic South African population (Asian, Caucasian and Black) in both asymptomatic nulliparous and symptomatic multiparous women. Secondly we also intended to study the association between prolapse symptoms and functional anatomy of the pelvic floor, and finally to determine the impact of vaginal childbirth on the pelvic floor morphology 3-6 month postpartum. For all the studies women were recruited from the local nursing school, general gynaecology and tertiary urogynaecology clinic. Pregnant women were recruited from the district antenatal clinic. This cohort included only Black pregnant women.
After informed consent all ultrasound volumes were acquired at rest, maximal pelvic floor contraction and Valsalva maneuver. Volumes were deindentified and analysed 6-8 weeks later using GE Kretz 4D View (GE Kretztechnik Gmbh, Zipf, Austria).
In the nulliparous cohort, we found that Black South African women had greater pelvic organ descent on ultrasound and clinically and greater distensibility compared to South Asian and Caucasian women. Multivariate modelling revealed that Black
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ethnicity remained a significant factor for pelvic organ mobility on clinical examination, (P=0.024).
In women with symptomatic POP, there was significant variation in clinical prolapse stage, levator distensibility and pelvic organ descent in this racially diverse population presenting with pelvic organ prolapse, with South Asians having a lower avulsion rate than the other two ethnic groups (P= 0.014).
As regards the association between prolapse symptoms and functional anatomy of the pelvic floor we found a significant association between awareness, visualization and/or feeling of a vaginal lump and abnormal pelvic floor functional anatomy, that is, hiatal ballooning and levator avulsion (all P< 0.05).
The fourth part of the study included eighty four women who returned at a mean of 4.8 months postpartum. We found significant alteration in pelvic organ support and levator hiatal distensibility after vaginal delivery i.e. a significant increase in mean values from ante to postpartum measurements, more so for the vaginal delivery group. 15% of Black primiparous women sustained levator trauma after their first vaginal delivery.
In conclusion, to the author‘s knowledge this is the first study on pelvic floor morphology in South African women. Contrary to previous publications inferring that Black women rarely develop PFD, we have shown that this particular ethnic group had significantly different pelvic floor dynamics than Caucasian and South Asian women for both nulliparous and multiparous symptomatic women. Levator trauma occurs in 15% of Black women after vaginal childbirth.Thesis (PhD)--University of Pretoria, 2017.
Obstetrics and Gynaecology
PhD
Unrestricted
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Onal, Sinan. "Automated Localization and Segmentation of Pelvic Floor Structures on MRI to Predict Pelvic Organ Prolapse." Scholar Commons, 2014. https://scholarcommons.usf.edu/etd/5288.
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Pelvic organ prolapse (POP) is a major health problem that affects women. POP is a herniation of the female pelvic floor organs (bladder, uterus, small bowel, and rectum) into the vagina. This condition can cause significant problems such as urinary and fecal incontinence, bothersome vaginal bulge, incomplete bowel and bladder emptying, and pain/discomfort. POP is normally diagnosed through clinical examination since there are few associated symptoms. However, clinical examination has been found to be inadequate and in disagreement with surgical findings. This makes POP a common but poorly understood condition. Dynamic magnetic resonance imaging (MRI) of the pelvic floor has become an increasingly popular tool to assess POP cases that may not be evident on clinical examination. Anatomical landmarks are manually identified on MRI along the midsagittal plane to determine reference lines and measurements for grading POP. However, the manual identification of these points, lines and measurements on MRI is a time-consuming and subjective procedure. This has restricted the correlation analysis of MRI measurements with clinical outcomes to improve the diagnosis of POP and predict the risk of development of this disorder.
The main goal of this research is to improve the diagnosis of pelvic organ prolapse through a model that automatically extracts image-based features from patient specific MRI and fuses them with clinical outcomes. To extract image-based features, anatomical landmarks need to be identified on MRI through the localization and segmentation of pelvic bone structures. This is the main challenge of current algorithms, which tend to fail during bone localization and segmentation on MRI. The proposed research consists of three major objectives: (1) to automatically identify pelvic floor structures on MRI using a multivariate linear regression model with global information, (2) to identify image-based features using a hybrid technique based on texture-based block classification and K-means clustering analysis to improve the segmentation of bone structures on images with low contrast and image in homogeneity, (3) to design, test and validate a prediction model using support vector machines with correlation analysis based feature selection to improve disease diagnosis.
The proposed model will enable faster and more consistent automated extraction of features from images with low contrast and high inhomogeneity. This is expected to allow studies on large databases to improve the correlation analysis between MRI features and clinical outcomes. The proposed research focuses on the pelvic region but the techniques are applicable to other anatomical regions that require automated localization and segmentation of multiple structures from images with high inhomogeneity, low contrast, and noise. This research can also be applicable to the automated extraction and analysis of image-based features for the diagnosis of other diseases where clinical examination is not adequate. The proposed model will set the foundation towards a computer-aided decision support system that will enable the fusion of image, clinical, and patient data to improve the diagnosis of POP through personalized assessment. Automating the process of pelvic floor measurements on radiologic studies will allow the use of imaging to predict the development of POP in predisposed patients, and possibly lead to preventive strategies.
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Caagbay, Delena. "Pelvic organ prolapse in Nepal: developing and evaluating an enhanced communication tool of conservative treatment strategies for women living in rural and remote communities." Thesis, The University of Sydney, 2019. https://hdl.handle.net/2123/22295.
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Pelvic organ prolapse (POP) is a common condition for women in which increased soft tissue mobility allows one or more of the pelvic organs to descend into the vagina causing a variety of distressing symptoms. While POP is a global problem, there are additional challenges and considerations for women living in low- and middle-income countries (LMICs) for the assessment and treatment of this condition. This is especially true in Nepal, where women may have difficulties accessing appropriate health services because of the distance to the nearest facilities, financial constraints, social stigma, having low awareness and educational status and the inability to take time away from home and work duties. These barriers often result in Nepali women suffering with POP symptoms for years before seeking and receiving appropriate treatment. Conservative treatment strategies for POP include pelvic floor muscle training (PFMT), lifestyle advice and the application of a pessary (1-5). The 2016 systematic review on PFMT for POP included 13 randomised controlled trials and found that women who received PFMT showed greater improvement in POP symptoms and severity than the controls (1). The protocols described in these studies required participants to have multiple one-on-one sessions with a physiotherapist throughout the research period, which may not be feasible in LMICs because there is a dearth of skilled health professionals, especially in rural and remote communities. To our knowledge, no studies have investigated the impact of a single intervention including PFMT and lifestyle advice delivered by a paraprofessional health worker for women with a POP living in a low resource setting. This thesis sought to explore the most efficacious way to provide education on PFMT and lifestyle advice for women with a POP living in rural and remote communities of Nepal. In order to do 2 this, specific ethnic and cultural considerations were explored to ensure the education was tailored and contextualised for this specific group of women. This thesis is composed of two main projects: 1. A cross-sectional observational study using 3D/4D translabial ultrasound to assess pelvic floor muscle functional anatomy in Nepali women attending an outpatient gynaecology clinic in Kathmandu, and 2. Developing and evaluating the impact of a training workshop for local health workers and printed informational tools for conservative treatment strategies for pelvic organ prolapse. The aetiology of POP is complex and multifactorial and the pelvic floor muscles (PFMs) play an important role in this condition. Variations in organ mobility and PFM function have been found between ethnic groups and these differences are important to consider when determining the most appropriate treatment options. In Chapter One of this thesis, a cross-sectional study explored PFM anatomy and any associations with POP for Nepali women (n=129) attending an outpatient gynaecology clinic. A pelvic examination evaluated the degree of pelvic organ prolapse using the Pelvic Organ Prolapse Quantification (POP-Q) system and PFM strength using the Modified Oxford Scale (MOS) and translabial real-time ultrasound was used to assess puborectalis muscle thickness and hiatal area. This study found no association between PFM strength or thickness and POP-Q stages. There was a weak positive correlation found between hiatal area at and POP stage (r=0.339, P<0.001) and a weak negative correlation between PFM strength and hiatal area on contraction (r=-0.356, P<0.001). The results of this research helped to develop the focus for the study presented in Chapter IV where the impact of an informational flipchart on conservative lifestyle advice for POP was assessed. 3 There are a variety of factors to consider when developing pelvic health information resources to suit a specific cultural and ethnic group. Some of these factors include understanding the women’s educational background, awareness of the health condition, birthing practices, diet and exercise, heavy lifting, gender discrimination and social stigma around reproductive health (6, 7). In Chapter two of this thesis, a mixed methods study sought to determine the most efficacious way to illustrate and describe the PFMs and POP. Nepali women (n=15) attending an outpatient gynaecology clinic were interviewed and shown illustrations of pelvic anatomy and the risk factors and treatment options for POP. Following the interview, transabdominal realtime ultrasound was performed to ascertain the most effective verbal instructions to describe how to contract the PFMs correctly. The results of this study highlighted the low knowledge about the PFMs and the difficulties in verbally describing how to contract the muscles correctly. The delivery of health information in rural and remote regions of Nepal is predominantly the responsibility of local health workers (8). A review of the training provided for the local health workers and the currently available informational tools on POP found both to be inadequate, therefore highlighting the need for the development of up to date resources (9). In Chapter Three of this thesis, the impact of a training workshop on POP and PFMT for local health workers (n=88) was assessed with a pre- and post-workshop knowledge quiz. The translation of knowledge was determined by assessing three local health worker’s ability to teach a PFM contraction to community women and was observed using transabdominal ultrasound. The results of this research showed that a training workshop on PFMT and POP significantly increased knowledge (mean change in quiz score of 18.5%, 95% Confidence Interval: 15.5-21.6%, p<0.001) for local health workers, but additional one-on-one supervision is essential for ensuring the translation of knowledge into practice. 4 The results of the formative research described in Chapters I-III were paramount in the development of an informational flipchart on PFMT and lifestyle advice for POP in Nepal. The flipchart was designed as a resource for local health workers to use in providing education to women living in rural and remote communities. In Chapter IV, the impact of the informational flipchart was evaluated with a randomised controlled trial. Nepali women (n=140) with a symptomatic POP stage I-III were assessed with the POP-Q, MOS and the Prolapse Quality of Life Questionnaire (P-QoL) at baseline and 6 months. The control group received brief verbal instruction on PFMT and the intervention group were provided with in-depth education on lifestyle advice and PFMT using the flipchart. The results of this study showed that a one-time educational intervention on PFMT and lifestyle advice delivered by a paraprofessional health worker significantly improved POP symptoms and quality of life for Nepali women when compared to the control group. The findings in this thesis demonstrate that the development of a culturally appropriate informational flipchart is beneficial for Nepali women with a symptomatic POP. This informational tool may be used as a one-time educational intervention by paraprofessional health workers, providing them with a realistic and sustainable option to help support women living in rural and remote regions of Nepal with a POP. Future research should explore this approach for other pelvic floor disorders as a strategy to enhance the wellbeing of women living in similar rural and remote communities globally.
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López, Annika. "The pelvic floor and genital prolapse : a clinical, physiological and radiological study /." Stockholm, 2000. http://diss.kib.ki.se/2000/91-628-4083-5/.
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Spiteri, Margaret. "The role of connective tissue in the female pelvic floor." Thesis, University College London (University of London), 2005. http://discovery.ucl.ac.uk/1446564/.
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Biomechanical studies were performed on biopsies of the rectus sheath, round and uterosacral ligaments as well as anterior and posterior vaginal walls of women with or without genital prolapse. In the second study, 96 healthy women in their fifth decade, were compared with 94 similar women with genital prolapse surgery Their clinical connective tissue markers were assessed by standardised methods and their first childbirth data were collected from hospital notes. The progress of the first labour was analysed by multiple logistic regression in the 2 groups of women. In the third study, 665 primiparous women who had their first baby during the previous 7 to 12 months, had their clinical connective tissue markers assessed as in the second study. Data from their first labour were then collected from the hospital notes and compared to the connective tissue markers by standard multiple regression analysis. Results: In-vitro biomechanical data showed that the round ligament properties were different in women with and without genital prolapse. They were also different amongst women under and over 40 years of age without genital prolapse. In women without genital prolapse, the elasticity of the rectus sheath and the round ligament differed from each other. In women with genital prolapse, the anterior vaginal wall and the uterosacral ligament were different from each other. In the second study, women with uterocervical prolapse had a shorter active first stage of labour than women without prolapse. When women with any type of genital prolapse were compared to women without prolapse, there was no difference in the duration of labour. The study is likely not to have had adequate power to detect a difference in the second stage of labour. More women in the prolapse group had knee hyperextension but there was no difference in the mobility of the upper limb joints. In the third study, primiparous women with increased joint mobility had a shorter second stage of labour. Connective tissue properties play an important role in pelvic floor function.
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Waterfield, Ann Elisabeth. "A community study of pelvic floor muscle function in women." Thesis, Exeter and Plymouth Peninsula Medical School, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.553764.
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Previous studies have indicated that pelvic floor muscle training supervised by a trained health care professional is beneficial, both as treatment and prevention of stress urinary incontinence. Currently there are few reports available in the literature that address pelvic floor muscle condition in the general population of women, and none which have investigated this group irrespective of continence status. However, it is known that verbal and written information are often insufficient for women to learn to contract their pelvic floor muscles correctly. The overall aims of this thesis were to ascertain by objective measurement what proportion of community dwelling women know how to and are able to voluntarily contract their pelvic floor muscles (PFM), and whether a nurse who had undertaken a short course training programme could effectively instruct women to increase strength, endurance and muscular co-ordination of the PFM. This might help to reduce one of the modifiable risk factors for incontinence and pelvic organ prolapse, namely pelvic floor muscle weakness. The first objective was to estimate the prevalence of pelvic floor muscle weakness in a community dwelling sample of women in both urban and rural areas of south west Devon and north east Cornwall, UK, who were attending their General Practice for routine health checks. The subjects were recruited from a general population and were not necessarily symptomatic of any incontinence or pelvic organ prolapse. The second objective was to investigate the relative importance of a number of specific factors (such as age, parity, body mass index etc.) that might be associated with pelvic floor muscle weakness in the sample of women. The key objective outcome measure was perineometry (vaginal squeeze pressure), focussing on pelvic floor muscle strength and endurance of contraction. In order to first assess a correct contraction, digital palpation (Modified Oxford Score) was used. Subjects with weak muscles, (scoring 2 or less) could be assigned to the second study. The final objective was to evaluate the effectiveness of an educational programme of PFMT delivered by Primary Care Nurses compared to a pelvic floor specialist nurse, or a control group with no training, over 3 months. The first study was a survey of pelvic floor muscle condition which investigated objectives 1 and 2. The second study, a randomised controlled trial of PFMT, addressed the final objective. In the survey, 762 women from a range of urban and rural General Practices, aged 19- 76 (mean age 46) were assessed. Forty four percent were found to have weak pelvic floor muscles (PFM). This declines further with age, increasing parity, body mass index, and obstetric factors such as having had a forceps delivery and/or episiotomy. The association of a weak pelvic floor with incontinence has also been confirmed. Although the majority of women knew of pelvic floor exercises (87%), few were practicing them at the time of the study .The greatest adverse effect on pelvic floor muscle strength was the transition from nulliparity to first childbirth. Generalized linear modelling was used to investigate the combined effects of multiple explanatory variables. Some women had strong muscles despite advancing age, obesity or grand multiparity. Those who were physically and sexually active had a significantly increased likelihood of strong PFM. Of the 337 women with weak PFM, 97 declined to take part in the second study. Two hundred and forty subjects were randomised to one of three groups (75 Control, 84 Practice nurse, 8\ Specialist nurse) for the RCT. Both treatment groups showed a significant increase in pelvic floor strength after 3 months' training, compared with Controls (p
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Whitford, Heather M. "Pelvic floor exercises, incontinence and pregnancy : knowledge, motivation and behaviour." Thesis, University of Dundee, 2002. https://discovery.dundee.ac.uk/en/studentTheses/bcba3718-ce12-4ae8-bf57-b22261357f85.
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Childbirth and obstetric factors have been linked to the subsequent development of urinary incontinence. It has been suggested that the practice of pelvic floor exercises during pregnancy may reduce the prevalence of postpartum incontinence. However little is known about current information provision about pelvic floor exercises to pregnant women and rates of practice of the exercises. Motivation of pregnant women to practise the exercises has not been examined. This study was designed to address these deficiencies and to find out if the Revised Theory of Planned Behaviour (RTPB) was applicable to the practice of pelvic floor exercises during pregnancy. A cohort of women (n = 289) attending antenatal clinics in Dundee were interviewed in the third trimester of pregnancy regarding information and practice, as well as beliefs and attitudes about pelvic floor exercises using the RTPB as a framework. A follow-up postal questionnaire was sent between 6 – 12 months after delivery (63.4% response rate). 77.9% of women reported receiving information in the current pregnancy: younger women, first-time mothers and those from more deprived backgrounds were less likely to report receiving information. Just over half the women (54.0%) reported the practice of pelvic floor exercises during pregnancy, and 83.2% of responders to the follow-up reported practising the exercises in the first month after delivery. Non-practice of the exercises in pregnancy was associated with younger age, more deprived area of residence and lower educational level, but not parity. The RTPB variables (‘attitude to the new behaviour’, ‘subjective norm’ and ‘self-efficacy’) explained 53.1% of variance in intention to practise pelvic floor exercises during pregnancy. Perceived vulnerability to incontinence (‘attitude to current behaviour’) had no relationship with intention, but this relationship may have been moderated by current behaviour. Generally women did not think postnatal incontinence was likely. Measures of past behaviour significantly improved the percentage of explained variance in intention. Confidence in ability to correctly perform the exercises (‘self-efficacy’) was significant in predicting subsequent practice. These findings will help to inform future interventions in order to encourage more women to practise pelvic floor exercises.
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Faulkner, Gemma. "The relationship between connective tissue abnormality and pelvic floor dysfunction." Thesis, University of Manchester, 2013. https://www.research.manchester.ac.uk/portal/en/theses/the-relationship-between-connective-tissue-abnormality-and-pelvic-floor-dysfunction(d79df4c1-60b8-4546-ac07-b715ea017f56).html.
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Perineal descent (PD) is a sign of connective tissue weakness of the pelvic floor, it can be measured mechanically or radiologically. Joint hypermobility can be a sign of a generalised connective tissue abnormality, there is an increased incidence of pelvic organ prolapse and faecal incontinence amongst patients with heritable connective tissues diseases. To explore the relevance of PD and the relationship between connective tissue abnormality and pelvic floor dysfunction five studies were performed.A new mechanical device for the measurement of PD, the laser commode, and the established mechanical device, the perineometer were compared to the current gold standard method of measurement, defaecating proctography in 68 subjects. The laser commode provided a mean overall PD measurement closer to that of proctography than the perineometer but the repeatability and reproducibility of the measurements were not accurate enough for the laser commode to be used either in the subsequent parts of this research project or in a clinical setting.Perineal descent was measured using proctography and joint hypermobility was measured using the Beighton score in 70 females with pelvic floor dysfunction. No correlation was found between PD and joint mobility.A review of 323 proctograms of females with pelvic floor dysfunction found an association between PD and rectal prolapse but no association between either PD and rectocele formation or PD and rectal intussusception. The Pelvic Floor Distress Inventory questionnaires of 133 females were correlated with their proctography findings. There was no association between PD and any of the clinical symptoms. Biopsies from the rectus sheath and pelvic floor fascia of 19 females with rectal prolapse were compared to those of 8 normal controls. There was no difference in collagen or elastin content between the groups but participant numbers were small. The pelvic floor fascia of the rectal prolapse group showed a higher percentage of well organised elastin than that of the control group but this did not reach statistical significance. Perineal descent does not appear to be a consistent indicator of severe pelvic floor connective tissue abnormality or injury. This study has furthered our understanding of perineal descent and the relationships between this finding and other pelvic floor disorders caused by connective tissue weakness. Future work will focus on further histological analysis of tissue from patients with rectal prolapse in combination with the use of more sensitive methods to establish the presence of an underlying connective tissue abnormality.
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Tan, Emile John Kwong-Wei. "Operative and diagnostic strategies in pelvic floor disease and incontinence." Thesis, Imperial College London, 2012. http://hdl.handle.net/10044/1/9773.
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Introduction: Pelvic floor disease affects many patients, with age, female gender and multiparity being significant associations. This can present clinically as pelvic organ prolapse, internal and external rectal mucosal intussuception, obstructed defecation syndrome, rectocele, cystocele and urinary/faecal incontinence. Diagnostic and treatment strategies for the management of such disorders is significantly varied, and evidence for current surgical management is poor. This thesis explores diagnostic and operative strategies currently regarded as state of the art and examines a novel method of pelvic floor assessment using MRI-based statistical shaped modelling. Methods: Meta-analysis in accordance with Cochrane collaboration guidelines was performed to assess laparoscopic versus open techniques for urinary incontinence, as well as endoanal ultrasound (EUS) scanning versus MRI in the assessment of faecal incontinence. The efficacy of sacral nerve stimulation (SNS) was reviewed. In addition, decision analysis was performed to assess the cost-effectiveness of delayed versus immediate anal sphincter repairs, and current operative treatments for end-stage faecal incontinence, and operative strategies for end-stage incontinence. MRI-based statistical shaped biomechanical modelling was performed to assess normal pelvic floors in comparison with patients with obstructed defecation syndrome. 15 asymptomatic volunteers aged 18 to 60 years were scanned and compared against 7 with obstructed defecation (ODS). Finally, 7 patients who were treated surgically for ODS were reassessed 6 months post-operation. Results: There were significant benefits to laparoscopic colposuspension for urinary incontinence. EUS was superior to MRI at detecting internal sphincter lesions, but not for external sphincter lesions. Immediate sphincter repairs were more cost-effective than delayed repairs. The artificial bowel sphincter and end stoma were more acceptable to both patient and institution than dynamic graciloplasty. Patients with obstructed defecation had significantly more irregular levator muscles with wider levator hiatus. Pressure during straining was concentrated in the posterior aspect of the hiatus, potentially contributing to the rectal neuropathy noted in obstructed defecation. Conclusions: Sacral nerve stimulation is an effective treatment for faecal incontinence. The artificial bowel sphincter and end stoma were cost-effective long-term strategies for end-stage faecal incontinence. A new technique for dynamic imaging and functionally assessing pelvic floor musculature has been developed and is showing promise as an adjunct to conventional assessment. Conventional defecating proctography does not provide the dynamic and functional assessment provided by this technique, and may translate well into a means of functional radiological assessment in the future.
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Brown, Cindy Christine. "Reliability of electromyography detection systems for the pelvic floor muscles." Thesis, Kingston, Ont. : [s.n.], 2007. http://hdl.handle.net/1974/948.
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Roman, Regueros Sabiniano. "Development of an engineered tissue designed for pelvic floor repair." Thesis, University of Sheffield, 2014. http://etheses.whiterose.ac.uk/6651/.
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Stress urinary incontinence (SUI) and pelvic organ prolapse (POP) are diseases related to weakness of supportive tissues of the pelvic floor due to altered collagen production in middle-aged women and traumatic processes in younger women such as pregnancy and vaginal delivery. Currently there is no recommended material for use in the surgical management of these disorders. Synthetic non-absorbable materials, such as polypropylene mesh produce a vigorous inflammatory response followed by dense fibrosis and have been associated with serious complications such as exposure. By contrast acellular biological materials have a tendency toward rapid absorption with questionable long-term mechanical integrity and concerns regarding early failure. Our approach aims to develop a tissue engineered repair material (TERM) to provide the long-term durability of synthetic non-absorbable materials whilst avoiding complications such as exposures and pain. The TERM is composed of a scaffold designed to degrade slowly whilst the inclusion of autologous cells is anticipated to produce a new extracellular matrix (ECM) to remodel fascial tissue for long-term restoration of the mechanical properties. Biodegradable poly-(L)-lactic acid (PLA) scaffolds were identified as the candidate material being more cell compatible in vitro than materials currently used to treat SUI and POP, and with mechanical properties close to the range of native tissues of the pelvic floor. A comparison of oral fibroblasts and adipose-derived stem cells (ADSCs) showed similar results when these cells were cultured on PLA scaffolds to develop a TERM in terms of metabolic activity, ECM production and mechanical properties. Of the two, ADSCs were chosen for further experiments since these cells have been shown in the literature to have regenerative potential and also to be immunosuppressive and to stimulate angiogenesis. The number of cells seeded on the scaffolds, the period of culture and culture conditions were optimized for the production of the best TERM candidate. On the other hand, no significant effects were found when exploring chemical and mechanical stimulation with the aim of increasing ECM production. The host response against the PLA scaffolds implanted cell-free and with ADSCs was studied in rats. The acute host response showed that after an inflammatory response, new collagen ingrowth and blood vessels were developed in all samples. Work was then focussed on the modification of the electrospinning rig to develop a variety of PLA scaffolds with different mechanical properties due to different fibre configuration. Finally, the potential of ADSCs to develop the TERM was assessed using cells from different donors, as well as examining whether this potential was preserved when these cells were rapidly isolated from fat using an enclosed system. In summary, we identified a suitable candidate material, cell candidate and culture conditions to develop a TERM designed for pelvic floor repair. Then, an initial animal study suggested a host response against our TERM leading to constructive remodelling for integration into the native tissues. Finally, a range of PLA scaffolds were produced with improved mechanical properties and preliminary data showed the potential to rapidly isolate ADSCs which were used to develop a TERM in vitro.
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Cerney, Angela D. "Experiences of Postpartum Women Living with a Pelvic Floor Disorder." OpenSIUC, 2014. https://opensiuc.lib.siu.edu/theses/1398.
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Many women with pelvic floor disorders (PFDs) suffer in silence; unaware there is a medical explanation for their symptoms. Limited research on their perspectives living with these conditions was the underlying reason for this phenomenological study. Semi-structured, in-depth interviews were conducted with at least one vaginal delivery and a PFD diagnosis by a medical professional required for all participants. Subjects' ages ranged from 29 to 57, with the mean age of 41.3 years. The four major themes that emerged were (a) pregnancy-related issues, (b) interaction with family and friends, (c) relationships with significant others, and (d) interactions with healthcare professionals. All of the women visited multiple health care specialists, with the average period being 12 years from their first symptoms to diagnosis. Participants shared they did not discuss their symptoms with friends and/or partners hoping the problems would resolve on their own. Further studies on the personal experiences of women living with PFD are essential not only for the quality of prenatal care, but to encourage more women to seek help and improve their overall quality of life.
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Jameson, John Stuart. "Pelvic floor and colonic function in multiple sclerosis and faecal incontinence." Thesis, Imperial College London, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.297173.
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Becker, Winston Reynolds. "Biaxial Mechanical Behavior of Swine Pelvic Floor Ligaments: Experiments and Modeling." Thesis, Virginia Tech, 2014. http://hdl.handle.net/10919/64252.
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Although mechanical alterations to pelvic floor ligaments, such as the cardinal and uterosacral ligaments, are one contributing factor to the development and progression of pelvic floor disorders, very little research has examined their mechanical properties. In this study, the first biaxial elastic and viscoelastic tests were performed on uterosacral and cardinal ligament complexes harvested from adult female swine. Biaxial elastic testing revealed that the ligaments undergo large strains and are anisotropic. The direction normal to the upper vagina was typically stiffer than the transverse direction. Stress relaxation tests showed that the relaxation was the same in both directions, and that more relaxation occurred when the tissue was stretched to lower initial strains. In order to describe the experimental findings, a three-dimensional constitutive model based on the Pipkin-Rogers integral series was formulated and the parameters of such model were determined by fitting the model to the experimental data. In formulating the model, it was assumed that the tissues consist of a ground substance with two embedded families of fibers oriented in two directions and that the ligaments are incompressible. The model accounts for finite strains, anisotropy, and strain-dependent stress relaxation behavior. This study provides information about the mechanical behavior of female pelvic floor ligaments, which should be considered in the development of new treatment methods for pelvic floor disorders.Master of Science
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Lindberg, Erik. "Touch yourself with Bäcka! : Exploring the stigma of the pelvic floor." Thesis, KTH, Skolan för elektroteknik och datavetenskap (EECS), 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-289523.
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This paper explores the pelvic floor and the social stigmas around it, which risks hindering knowledge about intimate health in our society. Working from an autobiographical soma design process, expanded by using both a male and a female participant, relevant experiential qualities were identified and built upon in order create a speculative design prototype. This resulted in Bäcka, an interactive experience that aids self-exploration of the pelvic floor through intimate touch, mediated by an interactive garment and interconnected soundscape. By doing this it aims to prompt discussion about the pelvic floor between participants, playing with the boundaries of normative dichotomies that reinforces a rigidity around this stigma. Thus highlighting these boundaries and subsequently providing an opportunity for participants to question them. With this speculative method, the creation of Bäcka touches on questions for which there are no clear answers, but which tells a story of how we can work to question such social stigmas in intimate health.Denna rapport utforskar bäckenbotten och de sociala stigman som omger den, vilka riskerar att hindra kunskap om intim hälsa i vårt samhälle. Genom att arbeta från en självbiografisk Soma Design-process, utvidgad genom att använda både en manlig och kvinnlig deltagare, kunde relevanta upplevda erfarenheter identifieras och användas som underlag för att skapa en spekulativ designprototyp. Detta resulterade i Bäcka, en interaktiv upplevelse som stödjer utforskande av ens bäckenbotten genom intim beröring, hjälpt av en interaktiv klädsel och ett sammankopplat ljudlandskap. I och med detta syftar det att väcka diskussion om bäckenbotten mellan deltagare, genom att leka med gränsdragningen av de normativa dikotomier som förstärker en rigiditet runt dessa stigman. Följaktligen kan detta framhäva dessa gränslinjer och således förse deltagare med en möjlighet att ifrågasätta dem. Genom denna spekulativa metod så bidrar skapandet av Bäcka med att beröra frågor som det inte finns helt klara svar till, men som ger en berättelse om hur vi kan arbeta för att ifrågasätta sådana sociala stigman i intim hälsa.
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Rouch, Elisenda Laborda. "Collagen Composition in different ethnic groups and changes in pelvic floor dysfunction." Thesis, University of Southampton, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.494384.
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Osman, Nadir I. "Developing a tissue engineered autologous fascial graft for pelvic floor reconstructive surgery." Thesis, University of Sheffield, 2014. http://etheses.whiterose.ac.uk/9673/.
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Stress urinary incontinence (SUI) and pelvic organ prolapse (POP) are common problems that affect many women. Approximately 1 in 10 women will require surgery to treat one or both conditions during their lifetime. Recently, surgical repair has utilized non-degradable synthetic mesh which has led to an incidence of serious complications such as exposure in up to 15% of patients. The main aim of this thesis was to produce a pelvic floor repair material (PFRM), composed of an electrospun synthetic polymeric scaffold seeded with autologous fibroblasts, that is robust enough for surgical handling and has adequate mechanical properties to enforce/or reinforce repair techniques used for SUI and POP at the point of implantation and beyond. We produced and evaluated 5 polymeric scaffolds and identified that 2, random fibre electrospun scaffolds composed of PLA and PU, most closely resembled native vaginal tissue in mechanical properties whilst having the best handling characteristics. The response of fibroblasts on scaffolds to mechanical conditioning was then evaluated using three simple models. Dynamic uniaxial tension (stretch) using near physiological strains led to organization of the extracellular matrix and was the most promising conditioning technique. Future work will further assess responses of scaffolds and cell/scaffold combinations to repetitive stretch. The response of fibroblasts on scaffolds to a variety of bioactive factors added to the culture media was also assessed. Dexamethasone and Ascorbic acid supplementation led to significant increases in the production of ECM proteins and mechanical properties of cell-seeded polymeric scaffolds. In future, it may be useful to integrate these factors into polymeric scaffolds so that they are released into the wound bed with the aim of providing an ongoing stimulus for ECM production and the maintenance of the mechanical integrity of healing tissues.
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Ng, Sau-loi, and 吳秀來. "A randomised controlled trial study of the efficacy of intensive pre-operative pelvic floor muscle training to decrease post-prostatectomy urinary incontinence." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/198846.
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Background: Radical prostatectomy is the gold-standard treatment for clinically organ-confined cancer of the prostate. However, urinary incontinence and erectile dysfunction are major clinical problems, despite advances in surgical techniques. Pelvic floor muscle training is still the first-line treatment used to restore pelvic floor or bladder function after radical prostatectomy although its role is still inconclusive.
Objectives: To determine the benefit of starting pelvic floor muscle training three weeks before radical prostatectomy in order to find by the end of three months after surgery: (1) any degree of continence regained in the intervention group, measured by 24-hour and one-hour pad tests; (2) any positive improvement in the quality of life in that group.
Methods: Sixty-six eligible participants were randomised into either the intervention or the control group before radical prostatectomy. The former received three weeks’ pre-operative pelvic floor muscle training from an advanced practice nurse, while the latter received only standard care. Urine loss by 24-hour pad test was compared in the two groups as the primary outcome, and the questionnaires on incontinence impact, functional assessment on prostate cancer and potency satisfaction at one, two, three and six months after surgery were compared as secondary outcomes.
Results: The intervention group regained continence significantly (p=0.002) earlier than the control group at the end of three months after surgery, as measured by the 24-hour pad test. The intervention group also reported a significantly better quality of life in the questionnaire on ‘incontinence impact’ than the control group. Interestingly, the Functional Assessment of Cancer Therapy-Prostate questionnaire showed no statistical significant difference between the groups, despite significantly less urine loss in the intervention group, which also had a higher potency satisfaction score on the International Index of Erectile Function (p=0.005) by the end of three months after surgery.
Discussion: The present study found that three weeks’ pre-operative pelvic floor muscle training decreased the duration and severity of incontinence after radical prostatectomy, as measured by the 24-hour pad test of urine loss (in grams). Some other studies counted the number of pads used as the comparative data between the groups; however, there might be divergent findings in different studies. In one previous study of pelvic floor muscle training initiated two to four weeks before surgery but showing no benefit, it was found that patients received only one training session before surgery without further monitoring. A limitation of present study is that participants were followed-up for six months after surgery. It is possible that a longer period, perhaps one or two years, of post-prostatectomy follow-up might provide further important information.
Conclusions: This is the first comprehensive study in Hong Kong to examine the efficacy of three weeks’ pre-operative pelvic floor muscle training in reducing post-prostatectomy urinary incontinence, and to evaluate the continence-related quality of life and potency satisfaction of intervention and control groups. The results demonstrated that such training not only significantly hastens the recovery of urinary continence after surgery but also leads to a better continence-related quality of life and potency satisfaction in the intervention group.published_or_final_version
Nursing Studies
Doctoral
Doctor of Nursing
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Cavalcanti, Marianna Carvalho e. Souza Leão 1984. "Adaptação cultural da brochura "Your pelvic floor" para a língua portuguesa do Brasil." [s.n.], 2014. http://repositorio.unicamp.br/jspui/handle/REPOSIP/283879.
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Orientador: Maria Helena Baena de Moraes LopesTexto em português e inglês
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Enfermagem
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Resumo: Objetivos: Traduzir e adaptar culturalmente para a língua portuguesa do Brasil o material educativo "Your Pelvic Floor", criado na língua inglesa, para divulgar entre as adolescentes informações sobre o assoalho pélvico e comparar o conhecimento de um grupo de adolescentes sobre essa temática, antes e após a leitura deste material já traduzido e adaptado. Métodos: A pesquisa foi dividida em três momentos. No primeiro momento, foi realizada a adaptação cultural do material educativo "Your Pelvic Floor" para a língua portuguesa do Brasil. No segundo momento, as pesquisadoras criaram um questionário com cinco questões de múltipla escolha baseadas nos tópicos abordados no material educativo e validado por um comitê de especialistas. No terceiro momento da pesquisa, foram realizadas sessões educativas compostas por três etapas: pré-teste, leitura do material traduzido e pós-teste. No pré-teste, as adolescentes responderam o questionário, cujo objetivo era avaliar as informações prévias delas sobre o assoalho pélvico. Após essa etapa, foi realizada a leitura em grupo do material "Seu Assoalho Pélvico". Ao final de cada sessão, realizava-se o pós-teste, momento em que se aplicava novamente o questionário usado no pré-teste com o objetivo de avaliar mudanças do conhecimento das alunas sobre o assunto. Resultados: O processo de adaptação cultural foi composto de cinco etapas, de acordo com as recomendações metodológicas da literatura internacional: tradução, síntese das traduções, retrotradução, avaliação pelo Comitê de Especialistas e pré-teste. As três primeiras etapas foram realizadas a contento. Os membros do comitê de especialistas fizeram algumas modificações para assegurar as equivalências entre as versões original e traduzida. No pré-teste, o material traduzido foi lido por 32 adolescentes, com idade entre 10 e 18 anos, que compuseram quatro grupos focais divididos de acordo com a faixa etária. Elas sugeriram mudanças de alguns termos e palavras para melhorar sua compreensão, sendo estas aceitas e aprovadas pelo comitê, ficando a versão final intitulada "Seu Assoalho Pélvico". Com base na versão final do material educativo, desenvolveu-se sessão educativa com 16 adolescentes, com idade entre 11 e 18 anos, que responderam o questionário sobre o tema antes e após a leitura em grupo da brochura "Seu assoalho Pélvico". Após a leitura do material, o número de questões corretas foi significativamente (p<0,05) maior que antes da leitura. Conclusão: A adaptação do material educativo "Your Pelvic Floor" para a cultura brasileira foi realizada satisfatoriamente, com uma linguagem acessível e compreensível para as adolescentes brasileiras. O material traduzido mostrou ser adequado para que as adolescentes tenham maior conhecimento sobre o assoalho pélvico, suas funções e disfunções. Frente a estas considerações, julgamos ser essencial sua divulgação e utilização por profissionais da saúde e educadores
Abstract: Objectives: To translate and culturally adapt to Brazilian Portuguese the educational material "Your Pelvic Floor", created in English, to disseminate the knowledge amongst adolescents about the pelvic floor and compare the knowledge of a group of teenagers on this topic before and after reading this material already translated and adapted. Methods: The research was divided into three moments. First it was performed the cultural adaptation of educational material "Your Pelvic Floor" into Brazilian Portuguese. Secondly, the researchers created a questionnaire with five multiple choice questions based on the topics discussed in the educational material, subsequently validated by an expert committee. At last, educational sessions were performed in three steps: pretest, reading material translated and posttest. At the pretest, adolescents answered the questionnaire, to register their previous knowledge about pelvic floor. After this stage, the material "Your Pelvic Floor" was read in group. At the end of each session, the posttest was answered, its content was the same as the one used in the pretest. Results: The process of cultural adaptation was developed in five steps, according to the methodological recommendations of international literature: translation, translation's synthesis, back-translation, review by the expert committee and pretesting. The first three steps were performed satisfactorily. The members of the expert committee made some changes to ensure the equivalence between the original and translated versions. In the pretest, translated material was read by 32 teenagers between 10 and 18 years old. They were divided in four focal groups according to the age. Some changes were suggested to improve their understanding, which were accepted and approved by the committee. The final version was entitled "Seu Assoalho Pélvico". Based on the final version of the educational material, educational sessions were developed with 16 adolescents, aged between 11 and 18, who answered the questionnaire about the topic before and after reading in group the brochure "Seu Assoalho Pélvico". After reading the material, the number of correct answers was significantly (p < 0.05) greater than before reading. Conclusion: Adaptation of educational material "Your Pelvic Floor" for Brazilian culture was performed satisfactorily, with an accessible and understandable language for Brazilian adolescents. The translated material was shown to be suitable for teens to learn about the pelvic floor, its functions and dysfunctions. In conclusion, we believe to be essential their dissemination and use by health professionals and educators
Mestrado
Enfermagem e Trabalho
Mestra em Enfermagem
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Van, der Walt Ina. "An investigation of pelvic floor muscle strength and vaginal resting pressure in nulliparous women of different race groups." Thesis, Stellenbosch : University of Stellenbosch, 2010. http://hdl.handle.net/10019.1/4196.
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Thesis (MScPhysio (Interdisciplinary Health Sciences. Physiotherapy))--University of Stellenbosch, 2010.ENGLISH ABSTRACT: The pelvic floor muscles (PFM) contribute to urinary continence and overactive PFM seem to be associated with pelvic pain syndrome (PPS). The literature indicates that ethnic differences regarding symptoms of urinary incontinence may exist. Research is needed to establish relationships between PFM function and symptoms reported by women of different ethnic groups. Objectives: To compare the PFM strength and endurance in black, white and coloured women. To investigate relationships between PFM strength, vaginal resting pressures, risk factors and symptoms associated with PFM dysfunction and PPS. Method: A cross-sectional study assessed the PFM strength and vaginal resting pressures of 122 nulliparous black (n=44), white (n=44) and coloured (n=34) university students. A self-developed questionnaire determined inclusion, demographic variables, factors affecting/factors associated with PFM strength and symptoms related to PPS. Maximum voluntary contraction pressure (cmH2O) and vaginal resting pressure (cmH2O) were measured with the Peritron TM 9300 (Cardio Design, Australia) used with the Camtech AS vaginal balloon sensor (Sandvika, Norway). Two sets of 3 maximum voluntary contractions of the PFM were recorded. Results: The mean age of the group was 22 ± 3.54 years and mean BMI of 23± 4.16 kg/m2. Black women (25 cmH2O ± 13.5) had significantly stronger PFM than white (p=0.02) or coloured (p<0.01) women, but no significant difference (p=0.78) in PFM strength existed between white (18.4 cmH2O ± 9.8) and coloured (15.6 cmH2O ± 8) women. In black women, PFM strength decreased significantly (p=0.02) between the sets, whereas no significant difference between sets was noted in the other ethnic groups. Increased PFM strength was associated with SUI (p=0.03) and amenorrhoea (p=0.01) and decreased PFM strength was associated with decreased frequency of bowel motion (p=0.01). In this sample, increased vaginal resting pressure was associated with menorrhagia (p=0.04). Conclusion: Black nulliparous women had stronger PFM than white and coloured women. There was no difference in PFM strength between white and coloured women. Endurance, as measured in this study, indicates that black women have decreased endurance of the PFM compared to white and coloured women. These findings inform the current research on ethnic differences in the prevalence of urinary incontinence. Preliminary data suggest that there was no relationship between vaginal resting pressures and symptoms of PPS and risk factors for PFM dysfunction, except for menorrhagia.
AFRIKAANSE OPSOMMING: Die bekkenvloer spiere (BVS) dra by tot urinêre kontinensie en ooraktiewe BVS kan moontlik geassosieer wees met pelviese pyn sindroom (PPS). Uit die literatuur blyk dit of daar etniese verskille bestaan in die simptome van urinere inkontinensie gerapporteer deur vroue. Navorsing is nodig om die verwantskap tussen BVS funksie en simptome wat deur pasiënte van verskillende etniese groepe gerapporteer word vas te stel. Doel: Om „n vergelyking te tref tussen BVS sterkte in swart, wit en kleurling vroue. Om vas te stel of daar assosiasies bestaan tussen BVS sterkte, rustende vaginale druklesings en risiko faktore en simptome geassosieer met bekkenvloer disfunksie en PPS. Metodologie: „n Dwarssnit studie het die BVS sterkte en rustende vaginale drukke van 122 nullipareuse swart (n=44), wit (n=44) en kleurling (n=34) universiteit studente geëvalueer. Insluiting, uitsluiting, demografiese veranderlikes, faktore wat kan affekteer/faktore geassosieer met BVS sterkte en simptome geassosier met PPS is deur „n self ontwikkelde vraelys geëvalueer. Maksimale willekeurige spiersametrekking drukke (cmH2O) en rustende vaginale drukke (cmH2O) was gemeet met „n Peritron™9300 perineometer (Cardio Design, Australië) wat saam „n vaginale ballon sensor (Camtech AS, Sandvika, Noorweë) gebruik is. Twee stelle van 3 maksimale willekeurige sametrekkings van die BVS was gemeet. Resultate: Die groep se gemiddelde ouderdom was 22±3.54 jaar en die gemiddelde liggaamsgewig indeks was 23±4.16kg/m2. Swart vroue (25 cmH2O ±13.5) het beduidend sterker BVS gehad as wit (p=0.02) en kleurling (p<0.01) vroue, maar daar was geen beduidende verskil (p=0.78) in BVS sterkte tussen wit (18.4 cmH2O ± 9.8) en kleurling (15.6 cmH2O ± 8) vroue nie. Die BVS sterkte in swart vroue het beduidend (p=0.02) verminder tussen die stelle, maar geen beduidende verskille was waargeneem in die ander etniese groepe tussen stelle. Verhoogde BVS sterkte was geassosieer met druklek (p=0.03), amenorrhoea (p=0.01) en verminderde BVS sterkte was geassosieer met verminderde frekwensie van opelyf (p=0.01). Verhoogde rustende vaginale drukke was geassosieer met menoragie in hierdie steekproef. Gevolgtrekking: Swart nullipareuse vroue het sterker BVS gehad as wit en kleurling vroue, Daar was geen verskil in BVS sterkte tussen wit en kleurling vroue nie. Uithouvermoë soos in hierdie studie getoets toon dat swart vroue verminderde uithouvermoë het i.v.m. wit en kleurling vroue. Hierdie bevindings dra by tot die huidige navorsing oor etniese verskille in die prevalensie van urinêre inkontinensie. Daar was geen verwantskap tussen vaginale rustende drukke en simptome van PPS en risiko faktore vir die ontwikkeling van bekkenvloer disfunksie, behalwe vir menoragie.
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Pereira, Larissa Carvalho 1983. "Impacto da gestação e do parto na sinergia entre os musculos transverso do abdome/obliquo interno e o assoalho pelvico = avaliação eletromiografica." [s.n.], 2010. http://repositorio.unicamp.br/jspui/handle/REPOSIP/312345.
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Orientadores: Cassio Luiz Zanettini Riccetto, Simone Botelho PereiraDissertação (mestrado) - Universidade Estadual de Campinas. Faculdade de Ciencias Medicas
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Resumo: Introdução e objetivos: Os exercícios dos músculos do assoalho pélvico e do abdome devem ser minuciosamente avaliados e orientados para que, através da sinergia, haja aperfeiçoamento na qualidade dos exercícios e se conheça as reações desencadeadas durante a realização dos mesmos. É de grande importância entender a sinergia do recinto abdomino pélvico em diferentes fases da vida feminina, como na gestação e puerpério, pois, nestas fases surgem grandes alterações na musculatura abdominal e do assoalho pélvico, necessitando de maior atenção para que os exercícios sejam realmente eficazes. Sendo assim, este estudo observacional, teve como objetivo a avaliação eletromiográfica simultânea dos músculos transverso do abdome e do assoalho pélvico, durante exercícios comumente realizados por mulheres em fase gestacional e/ou puerperal. Métodos: Este estudo, clínico, prospectivo, observacional e controlado foi constituído de 81 mulheres, com idade média de 23,56 anos (DP=4,82), as quais foram divididas em quatro grupos: Grupo (A): 20 nulíparas; Grupo (B): 25 primigestas, com idade gestacional maior ou igual à 24 semanas; Grupo (C): 19 puérperas em fase remota (40 a 60 dias), pós parto vaginal; Grupo (D): 17 puérperas em fase remota (40 a 60 dias), pós parto cesariana. Inicialmente foi realizado a avaliação funcional do assoalho pélvico (AFA) e posteriormente o probe endovaginal foi posicionado. A atividade elétrica dos músculos abdominais e do assoalho pélvico foi registrada simultaneamente por eletromiografia de superfície. As contrações solicitadas do assoalho pélvico e do abdome foram máximas, voluntárias e repetidas três vezes, sendo as contrações do abdome do tipo isométrico e isotônico. Os resultados obtidos foram submetidos à análise de variância (ANOVA) com aplicação de Teste Contrastes Ortogonais através do programa estatístico "R", da R Development Core Team (2008). Os contrastes realizados foram: Contraste 1- Nulíparas versus demais grupos; Contraste 2- Gestantes versus Puérperas e Contraste 3- Puérperas pós parto vaginal versus Puérperas pós parto cesariana. O nível de significância adotado foi abaixo de 1%. Resultados: Durante os exercícios para o assoalho pélvico, foi mostrada significância da sinergia abdominal das mulheres nulíparas (p=0,0007) quando comparadas aos outros grupos. Os demais contrastes realizados para verificação da sinergia durante exercício do assoalho pélvico não apresentou significância (p=0,4509 e p=0,2786). Ao realizar o exercício abdominal do tipo isométrico, as nulíparas mostraram valores significativos ao serem comparadas aos demais grupos estudados (p=0,00001). Entretanto, quando os outros grupos foram comparados entre si, não houve significância (p=0,7949 e 0,9633). Quando solicitado o exercício abdominal isotônico, as nulíparas se mostraram sinérgicas quando comparadas às demais mulheres em fases específicas (p=0,00002) o que não ocorreu nas demais comparações (p=0,8355 e p=0,4662). Conclusão: Há sinergia entre os músculos transverso do abdome/oblíquo interno e o assoalho pélvico em mulheres, jovens, nulíparas e saudáveis. Mulheres em fase gestacional e puerperal remota não apresentam co-ativação dos músculos transverso do abdome/oblíquo interno e do assoalho pélvico, independente do tipo de parto e exercício solicitado
Abstract: Introduction and objectives: Pelvic floor and abdominal muscles exercises must be carefully evaluated and coached so that throughout synergy there can be improvement of the quality of the exercises as well as a greater knowledge of the reactions produced during their execution. It is of great importance to understand the synergy of the abdominal-pelvic area during the different stages of the women such as gestation and puerperium, since in those phases there are many and great alterations of the abdominal and pelvic floor muscles that require more attention during exercises executions resulting in real efficacy. This observational study had as objective to evaluate through simultaneous electromyography the transversus abdominis, obliquous internus and pelvic floor muscles during commonly used exercises performed by women in gestational and/or puerperal phases. Methods: This is a clinical, observational, prospective and controlled study which was composed of 81 women with a mean age of 23. 56 years old (SD=4,82) who were divided into 4 groups: Group (A): 20 nulliparous; Group (B): 25 primiparous with gestational age superior or equal to 24 weeks; Group(C): 19 in late puerperal phase (40-60 days) after vaginal delivery; Group (D): 17 in late puerperal phase (40- 60 days) after cesarean delivery. The Functional Pelvic Floor Evaluation (AFA) was made prior to the endovaginal probe positioning. The electric activity of the abdominal and pelvic floor muscles was simultaneously recorded through surface electromyography. The requested contractions of those muscles were maximum, voluntary and performed for three times, being both isometric and isotonic. The results were analyzed by ANOVA (analysis of variance) with Orthogonal Contrast Test using the statistic program "R" from R Development Core Team (2008). The used contrasts were: Contrast 1: Nulliparous versus other groups; Contrast 2-Pregnant versus Puerperals and 3-After Vaginal Delivery Puerperals versus After Cesarean Delivery Puerperals. The significance level was below 1%. Results: During exercises of the pelvic floor muscles, there was a synergic response of the abdominal muscles in the nulliparous group (p=0,0007) when compared to the other groups. There was no significance for the other contrasts regarding pelvic floor muscles exercises (p=0,4509 and p=0,2786). There were significant values for the nulliparous women during isometric abdominal exercise when compared to the other groups (p=0,00001). However when the other groups were compared among each other, there were no significant values (p=0,7949 and 0,9633). During isotonic abdominal exercise, the nulliparous women showed synergy when compared to the other women who were in specific stages (p=0,00002). It did no happen with other comparisons (p=0,8355 and p=0,4662). Conclusão: There is synergy among transversus abdominis, obliquous internus and pelvic floor muscles in young, nulliparous and healthy women. Pregnant and late puerperal women do not present co-activation of the transversus abdominis, obliquous internus and pelvic floor muscles, independently of the delivery mode
Mestrado
Pesquisa Experimental
Mestre em Cirurgia
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Varma, Jagmohan Singh. "Observations on some motility disturbances of the human distal bowel and pelvic floor." Thesis, University of Edinburgh, 1987. http://hdl.handle.net/1842/27019.
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Stephen, Catriona. "Adherence to pelvic floor muscle exercises and the role of smart phone apps." Thesis, University of the Highlands and Islands, 2015. https://pure.uhi.ac.uk/portal/en/studentthesis/adherence-to-pelvic-floor-muscle-exercises-and-the-role-of-smart-phone-apps(4337fb88-fbed-4fe5-991a-3d8309eed192).html.
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Urinary incontinence (UI) is a condition commonly experienced by women worldwide. Many women suffer in silence as they refrain from or delay seeking help. Pelvic Floor Muscle Exercises (PFME) have proven to be effective and are recommended as the first line of treatment. Regular exercise of the pelvic floor muscles can prevent symptoms developing. However, there is evidence of lack of motivation and poor adherence to exercises. The use of mobile phone applications have been suggested as an effective resource for health behaviour interventions, especially for sensitive or embarrassing conditions. A mixed methodology was used to gather evidence about the experience of community dwelling women in the North of Scotland over a three month period. Of the twenty three participants who completed a three month explanatory randomised controlled trial, fifteen participants exercised at least daily on average by the end of the trial. Of the fifteen who exercised at least daily, five continued average exercise of at least daily at the twelve month follow-up. Taking part in the study helped women to focus on the exercises and this had a positive impact on their adherence. Eleven out of the fifteen participants with incontinence experienced an improvement in their symptoms after twelve weeks. This had a positive impact on their quality of life. Of those who experienced UI, the women who had the biggest increase in level of exercise also had the biggest improvement in symptoms. Participants in the intervention group of the trial were provided with apps for PFME. Six out of the ten of intervention group participants who completed the trial reported that the apps were not useful and of the four who found them useful, their level of use was varied. The data from this study suggests that simply being provided with apps or equipment to use the apps cannot be linked to improved levels of participation in the study. This suggests that the provision of technology is insufficient in itself to engage with individuals in health behaviour change and has important implications for future service provision in continence promotion and mHealth.
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Hillary, Christopher. "Improving tissue engineered repair materials used in the treatment of pelvic floor diseases." Thesis, University of Sheffield, 2017. http://etheses.whiterose.ac.uk/19513/.
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Li, Xiaolong. "Semi-Automatic Segmentation of Normal Female Pelvic Floor Structures from Magnetic Resonance Images." Cleveland State University / OhioLINK, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=csu1265412807.
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Crisp, Catrina C. M. D. "Intra-vaginal Diazepam for High Tone Pelvic Floor Dysfunction: A Randomized Placebo-Controlled Trial." University of Cincinnati / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1367926075.
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Prudencio, Caroline Baldini. "Evolução dos achados eletromiográficos dos músculos do assoalho pélvico de gestantes com diabete melito gestacional." Botucatu, 2017. http://hdl.handle.net/11449/150230.
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Orientador: Marilza Vieira Cunha RudgeResumo: Foi realizado estudo de coorte prospectiva para analisar a evolução dos achados eletromiográficos dos músculos do assoalho pélvico de gestantes com diabete melito gestacional entre 24-30 e 36-40 semanas gestacionais. O estudo foi conduzido no Centro de Investigação Clínica e Experimental do Diabete na Gestação da Faculdade de Medicina de Botucatu /UNESP com 52 gestantes divididas em dois grupos: (DMG) 26 gestantes com diabete melito gestacional e (NG) 26 gestantes normoglicêmicas. Foi realizado eletromiografia dos músculos do assoalho pélvico de nulíparas ou primíparas com cesariana prévia diagnosticadas com diabete melito gestacional da American Diabetes Association. Os critérios de não elegibilidade foram diabete clínico, mais de duas gestações, prolapso genitais ou cirurgia uroginecológicas, doenças neurológicas, exercício físico e tabagismo. Previamente a eletromiografia foi realizado instrução sobre a anatomia e funcionalidade do assoalho pélvico. Partes do protocolo de Glazer foram aplicadas entre 24-30 semanas gestacionais e reaplicadas entre 36-40 semanas gestacionais para analisar a evolução no recrutamento em repouso, nas contrações fásicas e tônica. O recrutamento foi analisado pelo cálculo do root mean square normalizado pelo pico das contrações fásicas entre 24-30 semanas gestacionais que foi considerado como parâmetro inicial de contração dos músculos do assoalho pélvico. Os dados demográficos e obstétricos demonstraram-se homogêneos entre os grupos. Em relação ... (Resumo completo, clicar acesso eletrônico abaixo)
Mestre
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Porrett, Theresa. "Coping and help seeking behaviour in women with Pelvic Floor Dysfunction : the emic perspective." Thesis, City University London, 2010. http://openaccess.city.ac.uk/8612/.
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Pelvic Floor Dysfunction: (PFD) encompasses symptoms that rarely occur in isolation and include urinary and faecal incontinence, rectal evacuatory dysfunction and pelvic organ prolapse. It impacts on the quality of life of at least one third of adult women, with recent reviews suggesting that pelvic floor prolapse may occur in up to 50% of parous women. PFD is associated with a delay in seeking help. Why women with PFD seek or do not seek help for their symptoms has been unclear but is recognised as being multi-factorial. Aim: to learn from women with PFD, to understand the coping mechanisms they develop to live with PFD, and the triggers which prompt their seeking help. Methodology: this study, grounded in the naturalist paradigm, was a micro-ethnographic study focusing on the emic perspective of a defined group, women diagnosed with PFD, who presented to an East London Hospital for treatment. Leininger?s Culture Care theory and ethno-nursing methods were used to facilitate knowledge generation. The study took place in three consecutive phases, each informing the next phase. Phase 1 - One Life Health Care History. This was an instrumental case study which obtained a personalised and longitudinal account of the woman?s health, care and illness experiences from a lifetime perspective. Phase 2 - Eight semi structured interviews; these focussed on the themes generated from a review of the literature pertaining to coping and help seeking behaviour, and themes generated from Phase 1, which were continued until saturation was achieved. Phase 3 - Focus groups from three cultures (Turkish, Orthodox Jewish and African) which represent the ethnic mix of the local population. These explored universality and diversity amongst different cultural groups with respect to coping and help seeking behaviour. Results: this study has identified universality and diversity in coping and help seeking behaviour in women with PFD. Personality and culture have a significant impact on coping and help seeking behaviour, and lack of knowledge is a barrier to help seeking. Social taboo and the role of women in society influenced the coping behaviours of women. Women developed masking and containment strategies, and avoided aspects of social interaction to ensure their PFD problems remained secret. The fear of disgrace (opprobrium) and the delay in seeking help is linked to the woman?s position in her society, and the degree to which women appropriate opprobrium is dependent on their personality and their cultural feelings of self-worth as women in their own communities. Recommendations: if women are to be encouraged and supported to seek help for their PFD, it will be imperative to raise public knowledge and awareness of PFD. Public Health Departments, in conjunction with GP practises, will be key in promoting awareness and advertising integrated PFD services, ensuring posters and information leaflets are translated and displayed in facilities frequently used by women. Facilitating ease of access to PFD services will require the development of integrated PFD services, with community based self referral clinics or drop-in clinics being made available. Health care providers need education and support to ensure they empower women to seek help by giving them permission to discuss any PFD concerns they may have. Conclusions: the contribution to knowledge from this study include the lay care practices that women with PFD employ in order to cope with the problem, and an appreciation of the laycare practices utilised by women. Understanding of care influencers has facilitated recommendations for service and practice development. Areas for further research have been identified. The increasing prevalence of PFD is well known, with studies suggesting that over the next 30 years the number of women seeking help for PFD symptoms will increase at twice the population growth rate. Knowledge and understanding of women?s coping and help seeking behaviour is essential if services are to be developed to meet this growing need. Knowledge generated from this research in relation to opprobrium appropriation makes a unique contribution to the discipline of nursing.
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Mäkelä-Kaikkonen, J. (Johanna). "Robotic-assisted and laparoscopic ventral rectopexy in the treatment of posterior pelvic floor procidentia." Doctoral thesis, Oulun yliopisto, 2019. http://urn.fi/urn:isbn:9789526221977.
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Abstract Rectal prolapse and internal rectal prolapse with symptoms of obstructed defecation and/or faecal incontinence are debilitating conditions. Often, symptoms coexist from other pelvic compartments, reducing quality of life. Robot-assisted surgery with its advanced features may offer better conditions in narrow pelvic space to correct rectal prolapses with rectopexy operation. In this thesis, we compared robot-assisted and laparoscopic techniques during the early learning curve in a ‘matched-pairs’ feasibility study (n = 30, follow-up three months) and in a prospective randomized series (n = 33, follow-up 24 months). The long-term functional results were assessed in a retrospective multicenter study with cross-sectional questionnaire assessment (n = 508, median follow-up 44 months). In the randomised series, as demonstrated with MR defecography, ventral rectopexy corrects the posterior compartment defects, external and internal rectal prolapses and recto-enteroceles. The operation restores the posterior and middle compartment anatomy and reduces pelvic organ mobility with a minor impact on the anterior compartment. Pelvic floor dysfunction and symptom-specific quality of life is improved after rectopexy; specifically, the colorectal-anal and the pelvic organ prolapse subscales in the questionnaires showed improvement. We found equality between robot-assisted rectopexy and laparoscopic rectopexy in most relevant outcome measures, which does not justify the added cost of the routine use of robots in rectopexy operations. The health-related quality of life and cost-utility analysis in our cohort indicated, however, that in long-term the technique may be cost-effective. The functional results are retained in the long term. The rate of recurrences (7.1%) and complications (10%) are acceptable and mesh-related complications (1.4%) are rare. Denovo symptoms, such as the urge to defecate or urinary incontinence, may arise, while urinary symptoms may be alleviated. In the long-run, patients with external rectal prolapse benefit more than patients with internal rectal prolapse. In part, the results of this thesis support using a multidisciplinary approach in examining patients with posterior pelvic floor dysfunction. Furthermore, the indications for robotic use in rectopexy operations need to be explored in larger patient samplesTiivistelmä Rektumprolapsi ja peräsuolen sisäinen tuppeuma eli interni prolapsi aiheuttavat hankalia oireita, kuten ulostusvaikeuksia, ulosteinkontinenssia ja lantion kipua. Elämänlaatua heikentäviä oireita esiintyy usein samanaikaisesti myös muissa lantion osissa. Robottiavusteinen kirurgia tarjoaa paremmat leikkausolosuhteet lantion ahtaassa tilassa tehtävään rektopeksialeikkaukseen ja mahdollisesti edut voivat näkyä leikkaustuloksessa. Tässä väitöskirjassa vertailimme robottiavusteista ja laparoskooppista leikkaustekniikkaa oppimiskäyrän alkuvaiheessa käyttökelpoisuustutkimuksessa kaltaistetussa parivertailuasetelmassa (n = 40, seuranta-aika 3 kk) sekä prospektiivisessa randomoidussa tutkimussarjassa (n = 33, seuranta-aika 24 kk). Monikeskustutkimuksessa (n = 508, seuranta-ajan mediaani 44 kk) selvitimme laajassa aineistossa laparoskooppisen ventraalisen rektopeksian pitkäaikaistuloksia liittämällä aineiston analyysiin poikkileikkauskyselytutkimuksen tulokset. Randomoidussa sarjassa MR-defekografialla todennettiin, että rektopeksialeikkauksen jälkeen peräsuolen sisäinen tuppeuma, rektoseele ja enteroseele korjaantuvat. Rektopeksialeikkaus palauttaa lantion taka- ja keskiosan anatomian, vähentää elinten dynaamista liikkuvuutta ja parantaa lantionpohjan toimintaa sekä oireisiin liittyvää elämänlaatua, erityisesti suolioireiden ja gynekologisten laskeumaoireiden osalta. Robottiavusteinen ja laparoskooppinen tekniikka olivat samanvertaisia perioperatiivisten parametrien, komplikaatioiden, anatomisten ja toiminnallisten tulosten suhteen. Vaikka kustannusvertailussa kalliimpi robottikirurgia voi osoittautua kustannustehokkaaksi pitkäaikaisseurannassa, yhdenvertaiset tulokset eivät oikeuta menetelmää rutiinikäyttöön. Retrospektiivisen tutkimuksen poikkileikkauskyselyn mukaan toiminnalliset tulokset säilyvät pitkäaikaisseurannassa, residiivien (7,1 %) ja komplikaatioiden (10 %) määrä on hyväksyttävä ja verkkoon liittyviä komplikaatioita esiintyy vähän (1,4 %). Leikkauksen jälkeen ilmenee myös uusia oireita, kuten ulostuspakkoa tai virtsankarkailua. Toisaalta virtsankarkailuoire voi korjaantuakin. Pitkäaikaisseurannassa totaalin rektumprolapsin vuoksi leikatut potilaat hyötyvät leikkauksesta enemmän kuin oireisen internin prolapsin vuoksi leikatut. Osa väitöskirjatyön tuloksista tukee moniammatillisen lähestymistavan käyttöä potilaiden arvioinnissa. Jatkossa robottikirurgian käytön indikaatioita rektopeksialeikkauksissa tulisi arvioida isommissa potilasaineistoissa
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Wong, Vivien Lai Peng. "Surgery for pelvic organ prolapse: the quest to reduce failure rates." Thesis, The University of Sydney, 2018. http://hdl.handle.net/2123/20444.
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Female pelvic organ prolapse (FPOP) is a debilitating condition. In Australia, 19% of women require prolapse surgery in their lifetime and recurrence rates range as high as 40 – 60% in the anterior compartment. Given the high surgical failure rate, this thesis aimed to identify the use of mesh to improve surgical outcomes utilising translabial ultrasound as the principal study method. In a retrospective analysis of mesh use in vaginal repair, anterior mesh proved to have a lower recurrence rate compared to native tissue repair, and anterior anchored mesh such as the PerigeeTM was of maximum benefit only in women who had a levator avulsion, a risk factor for prolapse recurrence. Apical anchoring supports were also evaluated in this thesis. Vaginally, the anterior ElevateTM was found to be inferior compared to the PerigeeTM, highlighting the possible poorer load-bearing capability of the self-fixating anterior ElevateTM anchors, whilst abdominally, there was still a very high rate of cystocele recurrence (>80%) despite excellent apical support in those that had laparoscopic sacrocolpopexy. Regardless of anchoring methods, mesh repair did not seem to completely compensate for the effect of levator avulsion and it did not confer additional benefit in women with an enlarged levator hiatal area, another risk factor for prolapse recurrence. The Puborectalis sling was designed to prevent excessive levator hiatal enlargement and proof of concept was achieved in a phase II observational pilot study of 110 women. There was a mean reduction of the levator hiatal area by 12cm2 sustained for over two years. During the course of this work, the rise in reported mesh related complications had also led to heated debates over its use in urogynaecology. Prolapse repair with mesh shifted from being readily embraced to complete withdrawal of use in many countries. This work hopes to contribute to the evolving mesh literature and to outline an alternative operative approach in women at high risk of prolapse recurrence.
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Krause, Hannah. "Pelvic Floor Dysfunction and Social and Mental Health Sequelae Following Childbirth Injuries in Women in Eastern and Central Africa." Thesis, Griffith University, 2019. http://hdl.handle.net/10072/387401.
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Female pelvic organ dysfunction occurring in eastern and central Africa results in significant morbidity and adverse social and mental health sequelae.Lack of adequate resources available for health care compounds the suffering faced by these women. Obstetric fistula (OF), chronic 4th degree obstetric tears and severe pelvic organ prolapse(POP) are all common gynaecological morbidities seen in Uganda, D.R. Congo and Ethiopia. Despite successful closure of OF, bladder dysfunction and incontinece may persist due to detrusor overactivity, stress urinary incontinence and voiding dysfunction. Chronic 4th degree obstetric tears require effective surgical repair. Women suffering with severe POP need to be given surgical and non‐surgical options of treatment. Non‐surgical options include the availability and use of support pessaries. This research has focused on evaluation of post‐OF bladder dysfunction assessment and treatment options. In particular, urodynamic bladder function studies were utilized and a bulking agent used as an option for post-‐OF repair continence surgery. A surgical repair technique for chronic 4th degree obstetric tears has been described with post‐operative follow‐up of women giving encouraging results. Support pessaries have been introduced and evaluated for women experiencing severe POP.
In order to be able to improve treatment and management options available for women affected with such pelvic floor dysfunction, additional information and understanding regarding risk factors and anatomical defects are needed.
The relevance of height and age as risk factors for OF have been evaluated here. Pelvic floor anatomy as measured with 4D pelvic floor ultrasound includes levator hiatal dimensions and identification of levator muscle trauma. Assessment of nulliparous Ugandan women has documented differences in levator hiatal dimensions compared to non‐Ugandan women, and Ugandan women with OF,chronic 4th degree obstetric tears and severe POP have also been scanned and levator hiatal areas and incidence of levator muscle trauma compared. Significantly, the levator hiatal area in women with OF is smaller than in women with chronic 4th degree obstetric tears and severe POP. Possible reasons for these findings are discussed. The incidence of levator muscle 3 defects in women with pelvic floor dysfunction is compared with all 3 groups experiencing a similar high rate of complete levator muscle trauma. The social and mental health of women with pelvic floor dysfunction including risk of domestic violence has been assessed. High levels of loss of social cohesion and mental health dysfunction have been identified in women with OF, chronic 4th degree obstetric tears and severe POP.
The social and mental health of women with pelvic floor dysfunction including risk of domestic violence has been assessed. High levels of loss of social cohesion and mental health dysfunction have been identified in women with OF, chronic 4th degree obstetric tears and severe POP.
Through identifying and highlighting the health sequelae faced by women with pelvic floor dysfunction including OF, chronic 4th degree obstetric tears and severe POP, effective treatment and management options can be evaluated and promoted. Further research is required to consolidate the perioperative outcomes of the surgical techniques described here with functional longterm outcomes necessary to guide future recommendations. Understanding risk factors associated with the development of pelvic floor dysfunction may guide strategies for prevention. Social and mental health dysfunction needs to be identified and addressed within this group of women with the availability of adequate support networks and treatment. In addition, there must be communitywide awareness of the prevalence of domestic violence with effective solutions promoted.Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Medicine
Griffith Health
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DATI, STEFANO. "Mesh sintetica vs biosintetica: studio comparativo nel trattamento dei prolassi genitali severi." Doctoral thesis, Università degli Studi di Roma "Tor Vergata", 2009. http://hdl.handle.net/2108/931.
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L’autore, dopo una breve esposizione sulle strutture anatomiche di supporto del pavimento pelvico e sulla fisiopatologia ed eziopatogenesi del prolasso genitale, enfatizza l’utilizzo di materiali protesici nel loro trattamento chirugico. Evidenzia le indicazioni nella terapia sostitutiva fasciale e l’evoluzione dei diversi materiali utilizzati, elencandone caratteristiche e limiti. Esamina dettagliatamente le complicanze mesh-related, la loro prevenzione e gestione. Nello studio comparativo condotto su 158 pazienti, affette da prolassi severi, verifica i risultati confrontando materiali dalle diverse proprietà fisico-chimiche attraverso 2 procedure chirurgiche con accesso transvaginale. Le pazienti selezionate e divise in 2 gruppi sono state sottoposte a scrupoloso work-up uroginecologico preoperatorio e follow-up a 3-6-12-24 mesi.
Conclude riportando gli esiti anatomici e funzionali delle 2 procedure e gli effetti sulla qualità di vita deducendone alcune considerazioni, legate all’utilizzo dei materiali protesici nella correzione dei difetti del pavimento pelvico.After providing a brief outline of both the anatomical support structures of the pelvic floor and the pathophysiology and etiopathogenesis of genital prolapse, the Author emphasises the use of prosthetic materials in prolapse surgery. The indications for fascial replacement are described and the evolution of the different materials used is discussed, including their characteristics and constraints. Mesh-related complications, as well as their prevention and management, are examined in detail. In the comparative study of 158 female patients with severe prolapse, the results are verified by comparing two transvaginal procedures using materials with different physical-chemical properties. The patients selected were divided into 2 groups and underwent a thorough preoperative urogynecological work-up as well as a follow-up at 3, 6, 12, and 24 months. In conclusion, the anatomical and functional outcomes of both procedures and the effects on the quality of life are reported. Some considerations are drawn concerning the use of prosthetic materials in the repair of pelvic floor defects.
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MORETTI, Eduarda Correia. "Desenvolvimento de um jogo virtual destinado a aparelhos com sistema operacional ANDROID para conscientização e fortalecimento da musculatura do assoalho pélvico." Universidade Federal de Pernambuco, 2016. https://repositorio.ufpe.br/handle/123456789/18733.
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Contextualização: a realidade virtual é uma possibilidade de modalidade terapêutica utilizada nos distúrbios do assoalho pélvico. Objetivo: determinar o local anatômico do assoalho pélvico com melhor nível de atividade eletromiográfica a fim de servir como referência para o local do sensor de um jogo. Pretende-se, também desenvolver um jogo virtual para conscientização e fortalecimento da musculatura do assoalho pélvico a ser inserido em um aplicativo móvel Android, testar sua usabilidade e avaliar a satisfação. Métodos: 30 mulheres participaram da pesquisa do local anatômico do assoalho pélvico com maior nível de atividade eletromiográfica, dado por média e pico de RMS normalizados. Para eletromiografia, utilizou-se um eletromiógrafo da Miotec® (Miotool 400) e o software Miotec Suite. Cada participante compareceu a três dias de coleta, onde eram solicitadas três contrações voluntárias máximas da musculatura perineal. O sinal eletromiográfico era captado através de uma sonda intravaginal e de dois pares de eletrodos de superfície, sendo um posicionado imediatamente abaixo dos grandes lábios e outro nas horas três e nove do relógio perianal. Para elaboração do jogo, foram considerados protocolos de exercícios perineais com evidência na literatura. Posteriormente, o jogo foi inserido em um aplicativo móvel. A satisfação do sistema foi avaliada através de uma escala visual analógica, e o nível de usabilidade do aplicativo, através do MATCH (Checklist para Avaliação da Usabilidade de Aplicativos para Celular Touchscreen). O teste de Kruskal-Wallis e o post hoc de Mann-Whitney foram utilizados para comparação entre as médias e identificação das diferenças das variáveis eletromiográficas. Foi adotado um nível de significância de α ≤ 0,05 e utilizado o SPSS versão 20. Para os dados de usabilidade, as distribuições de frequência das variáveis categóricas foram obtidas através do SPSS. Medidas de tendência central e de dispersão das variáveis numéricas também foram calculadas. Resultados: os eletrodos perianais apresentaram uma média de RMS normalizada de 37,81(13,78 DP) e um pico de RMS normalizado de 47,14(16,9 DP), enquanto os eletrodos posicionados imediatamente abaixo dos grandes lábios apresentaram uma média de 20,32(10,15 DP) e pico de 25,86(12,38 DP). Os valores para média e pico de RMS captados pela sonda intravaginal foram de 33,47(20,82 DP) e 43,81(27,81 DP), respectivamente. Não foi encontrada diferença entre os valores de média e pico de RMS da sonda e dos eletrodos perianais (p=0,225; p=0,315), entretanto ambos foram maiores que os captados pelos eletrodos localizados imediatamente abaixo dos grandes lábios (média e pico em relação à sonda: p = 0,016; p=0,02. Em relação aos eletrodos perianais: p<0,001). O aplicativo de jogo desenvolvido foi denominado MyoPelvic e possui um modo de jogo para fibras musculares rápidas e outro para fibras musculares lentas. Ambos os modos envolvem o controle de uma ciclista em um percurso de subidas e decidas por montanhas através de contrações perineais. A satisfação em relação ao sistema apresentou uma mediana de 9 e a média do nível de usabilidade do aplicativo foi 62,42(5,03 DP). Conclusão: a sonda intravaginal e eletrodos de superfície posicionados nas horas três e nove do relógio perianal são equivalentes para avaliação da função do assoalho pélvico. A escolha do tipo de eletrodo deve respeitar os valores e preferências dos pacientes. O MyoPelvic apresentou alto grau de satisfação e nível de usabilidade muito alto.
Context: virtual reality is a possibility of therapeutic modality used in pelvic floor disorders. Objective: To determine the anatomical location of the pelvic floor with better level of electromyographic activity in order to serve as a reference for the location of a game’s sensor. The main aim is to develop a virtual game that raises awareness and strengthen the pelvic floor muscles. It is also intended to insert the game into a mobile application Android, test its usability and evaluate its satisfaction. Methods: 30 women participated in the study of the anatomical location of the pelvic floor with the highest level of electromyographic activity, given by the mean and the peak of normalized RMS. For electromyography, a surface electromyograph Miotec® (Miotool 400) and a Miotec Suite software were used. Each participant attended three collection days, in which three maximal voluntary contractions of the perineal muscles were requested. The electromyographic signal was picked up by an intravaginal probe and two pairs of surface electrodes, one positioned immediately below the labia majora and the other at three and nine hours of the perianal clock. Perineal exercise protocols with evidence in the literature were considered to create the game. Then, the game was inserted in a mobile application. The satisfaction with the system developed was evaluated by a visual analog scale, and the application's usability level was also evaluated by MATCH (Checklist for Usability Evaluation of Applications Touchscreen Phones). The Kruskal-Wallis test and the Mann-Whitney’s post hoc were used to compare averages and differences identification in the electromyographic variables. A significance level of α ≤ 0.05 was adopted and it was used the SPSS version 20. For the usability data, frequency distributions of categorical variables were obtained using SPSS. Measures of central tendency and dispersion of numerical variables were also calculated. Results: The perianal electrodes showed a mean of normalized RMS of 37.81 (13.78 SD) and a peak of normalized RMS of 47.14 (SD 16.9), while the electrodes positioned immediately below the labia majora had a mean of 20.32 (10.15 SD) and a peak of 25.86 (12.38 SD). The values for mean and peak RMS obtained by intravaginal probe were 33.47 (20.82 SD) and 43.81 (27.81 SD), respectively. No difference was found between the mean and the peak RMS values obtained by the probe and the perianal electrodes (p = 0.225; p = 0.315), though both were higher than those captured by the electrodes placed just below the labia majora (mean and peak according to the probe: p = 0.016; p = 0.02. According to the perianal electrodes: p <0.001). The developed game app was named MyoPelvic and has a game mode for the fast muscle fibers and another for slow muscle fibers. Both methods involve the control by perineal contractions of a cyclist on a road that goes up and down in mountains. The satisfaction with the system showed a median of 9 and the application usability level average was 62.42 (5.03 SD). Conclusion: The intravaginal probe and the surface electrodes placed at three and nine hours of perianal clock are equivalent to evaluate the pelvic floor function. The choice of the electrode type must respect the values and preferences of the patients. The MyoPelvic showed high levels of satisfaction and usability.
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Polpeta, Nádia Cristina 1981. "Avaliação funcional da musculatura do assoalho pélvico e da sexualidade de mulheres com candidíase vulvovaginal recorrente e vulvodínia." [s.n.], 2011. http://repositorio.unicamp.br/jspui/handle/REPOSIP/311583.
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Orientadores: Paulo César Giraldo, Cássia Raquel Teatin JuliatoDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: Introdução: Candidíase vulvovaginal recorrente (CVVR) e vulvodínia (VVD) cursam com dor e desconforto vulvoperineal, o que afeta a vida da mulher nas esferas: sexual, afetiva, social, e psíquica. Objetivo: Avaliar a função da musculatura do assoalho pélvico (MAP) e da sexualidade de mulheres com CVVR ou VVD. Desenho do estudo: Estudo de corte transversal com 61 mulheres entre 18 e 50 anos e sexualmente ativas, sendo 19 mulheres com VVD, 12 mulheres com CVVR e 30 assintomáticas (controles). A função da MAP foi avaliada através de eletromiografia de superfície (sEMG) e de registro da pressão vaginal (PV), utilizando-se o aparelho "Miotool Uro" e o "software Biotrainer" (Miotec LTDA). A função sexual foi avaliada através do questionário "Female Sexual Function Index" (FSFI) que consta de 19 questões, agrupadas em 6 domínios (desejo sexual, excitação, lubrificação vaginal, orgasmo, satisfação sexual e dor). Resultados: As mulheres com CVVR e VVD apresentaram potenciais elétricos da MAP, evidenciados pela sEMG, significativamente menores que os controles, porém não foram encontradas diferenças significativas entre as mulheres portadoras de CVVR, VVD e controles para os valores eletromiograficos do tônus basal e pressão vaginal no repouso ou nas contrações da MAP. Da mesma forma mulheres com CVVR e VVD apresentaram um tempo máximo de contração sustentada significativamente menor que os controles. Mulheres com VVD apresentaram um pior desempenho sexual (excitação, lubrificação, orgasmo, satisfação sexual e dor). Apenas o desejo sexual não foi pior que das mulheres controles. Nas mulheres com CVVR estas diferenças não foram tão evidentes, havendo comprometimento apenas dos domínios orgasmo e satisfação. O escore total de pontuação do grupo CVVR foi 25 (±5), do VVD 21 (±5) e dos controles de 29 (±4) (p<0,05). Conclusão: Mulheres com VVD e CVVR apresentam disfunção da MAP e qualidade de vida sexual inferior aos controles
Abstract: Introduction: Recurrent vulvovaginal candidiasis (RVVC) and vulvodynia (VVD) are characterized by pain and vulvoperineal discomfort, which may affect a woman's life in the sexual, affective, social and psychological spheres. Objective: To evaluate pelvic floor muscle (PFM) function and sexuality in women with RVVC or VVD. Study design: A cross-sectional study conducted with 61 sexually active women (age range: 18 to 50 years). Of the total women, 19 had VVD, 12 had RVVC caused by Candida and 30 were asymptomatic (controls). PFM function was evaluated by surface electromyography (sEMG) and vaginal pressure (PV) recording. A "Miotool Uro" device and Biotrainer" software (Miotec Ltd) were used for this purpose. Sexual function was assessed by the "Female Sexual Function Index" (FSFI) questionnaire including 19 questions, grouped into 6 domains (sexual desire, arousal, vaginal lubrication, orgasm, sexual satisfaction and pain). Results: The electrical potential of the PFM in women with RVVC and VVD as evidenced by sEMG was significantly lower than in the controls. However, no significant differences were found among women with RVVC, those with VVD and controls for electromyography values at basal tone and vaginal pressure at rest or PFM contractions. Similarly, the maximum time of sustained contraction in women with RVVC and VVD was significantly lower than in women in the control group. Women with VVD had a worse sexual performance (arousal, lubrication, orgasm, sexual satisfaction and pain). Only sexual desire was not worse in these women compared to the control group. In women with RVVC, these differences were not sufficiently evident and only the domains of orgasm and satisfaction were compromised. The total score was 25 (±5) for the RVVC group, 21 (±5) for the VVD group and 29 (±4) for the control group (p<0.05). Conclusion: Women with VVD and RVVC had PFM dysfunction and a lower sexual quality of life than women in the control group
Mestrado
Fisiopatologia Ginecológica
Mestre em Ciências da Saúde
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Alves, Fabiola Kenia 1987. "O efeito de um programa de treinamento dos músculos do assoalho pélvico realizado em grupo para mulheres na pós-menopausa = The effect of a pelvic floor muscle training performed in group to postmenopausal women." [s.n.], 2013. http://repositorio.unicamp.br/jspui/handle/REPOSIP/313088.
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Orientadores: Simone Botelho Pereira, Cássio Luís Zanettini RiccettoDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: O processo de envelhecimento é um dos principais fatores de disfunções uroginecológicas. O treinamento dos músculos do assoalho pélvico (TMAP) é o método de primeira escolha para o tratamento de incontinência urinária e também recomendado para a prevenção e tratamento de prolapsos dos órgãos pélvicos. O objetivo deste estudo foi avaliar o efeito de um programa de TMAP em grupo sobre a contratilidade muscular em mulheres na pós-menopausa, assim como sobre a presença de sintomas urinários e prolapsos de órgãos genitais. Métodos. Foi realizado um ensaio clínico, randomizado, controlado e cego com 30 mulheres na pós-menopausa (idade média de 65.93 ±8.76 anos), divididas em dois grupos: Resumo: Grupo Tratado (n=18) e Grupo Controle (n=12). A avaliação foi realizada antes e após o tratamento em ambos os grupos e consistiu de palpação vaginal (Escala Modificada de Oxford), eletromiografia de superfície dos músculos do assoalho pélvico, avaliação da presença de prolapsos dos órgãos pélvicos e avaliação de sintomas miccionais e vaginais por meio da aplicação dos questionários validados: International Consultation on Incontinence Questionnaire - Short Form (ICIQ-UI SF); International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB) e International Consultation Questionnaire on Vaginal Symptoms (ICIQ-VS). O protocolo de tratamento consistiu de 12 sessões em grupo de 8-10 participantes, duas vezes na semana, por 30 minutos, totalizando seis semanas. Foram utilizados para análise estatística os Testes ANOVA, Teste de Comparação múltipla de Tukey, Teste de Wilcoxon e Teste Perfil de Contrastes. Resultados. A contratilidade dos músculos do assoalho pélvico aumentou significativamente depois do programa de treinamento tanto na eletromiografia (p=0.003) quanto na palpação digital (p=0.001). Houve decréscimo do escore do questionário ICIQ-OAB apenas no grupo tratado (p<0.001) com diferença significativa entre os grupos através do tempo (p=0.002). Houve decréscimo do escore do questionário ICIQ-UI SF com diferença significativa entre o grupo controle e o grupo tratado depois do tratamento (p=0.03). O grau do prolapso anterior também diminuiu apenas no grupo tratado (p=0.03). Não foram encontradas diferenças significativas no grau do prolapso posterior e no questionário ICIQ-VS. Conclusão. O programa de TMAP em grupo foi eficaz para o aumento da contratilidade muscular, diminuição da gravidade do prolapso de parede anterior e dos sintomas urinários em mulheres na pós-menopausa.
Abstract: Introduction. The aging process is one of the major reasons for urogynecological dysfunctions. Pelvic floor muscle training (PFMT) is the method chosen in the first place for the treatment of urinary incontinence, also indicated for the prevention and treatment of the pelvic organs' prolapses. The aim of this study was to evaluate the effects of a group pelvic floor muscle training program on post-menopausal women's pelvic floor muscle contractility , as well as on the presence of urinary symptoms and genital organ prolapses. Methods. A clinical, randomized, controlled and assessor-blinded study was conducted with 30 post-menopausal women (mean age 65.93 ±8.76 years), divided into two groups: Treatment Group (n=18) and Control Group (n=12). The evaluation was carried out using digital palpation (Modified Oxford Grading Scale), pelvic floor surface electromyography (sEMG), the Pop-Q System to evaluate the presence of pelvic organ prolapse using validated questionnaires: International Consultation on Incontinence Questionnaire - Short Form (ICIQ-UI SF); International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB) and International Consultation Questionnaire on Vaginal Symptoms (ICIQ-VS). The treatment protocol consisted of 12 group sessions, with 8-10 participants, carried out by a physiotherapist (main investigator), twice a week, with 30 minutes of duration each, totaling six weeks. The statistical analysis was performed using ANOVA, Tukey¿s Multiple Comparison Test, McNemar¿s Test and the Contrast Profile Test. Results. The pelvic floor muscle contractility increased after the training program, assessed by sEMG (p=0.003) and by vaginal palpation (p=0.001). There was a decrease in the ICIQ-OAB scores only in the treated group's final evaluation (p<0.001) with a significant difference between the groups along the time (p=0.002). There was a decrease in the ICIQ-UI SF scores (p=0.03) between the treated and control groups after the treatment. There was a significant decrease in the anterior pelvic organ prolapse (p=0.03) in the treated group. No significant differences were found in the posterior pelvic organ prolapse and the ICIQ-VS scores. Conclusion. Group pelvic floor muscle training program is an effective way to increase the pelvic floor muscle contractility and to decrease the anterior pelvic organ prolapse as well as urinary symptoms in post-menopausal women.
Mestrado
Fisiopatologia Cirúrgica
Mestra em Ciências
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Brooks, Kaylee. "Characteristics Predictive of Successful Pelvic Floor Muscle Training Outcomes Among Women with Stress Urinary Incontinence." Thesis, Université d'Ottawa / University of Ottawa, 2017. http://hdl.handle.net/10393/36667.
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Physiotherapist-supervised pelvic floor muscle (PFM) training is the recommended first-line treatment for women with stress urinary incontinence (SUI); however, only up to 50% of women are cured with this treatment. The primary objective of this study was to develop a predictive model of successful physiotherapy intervention outcomes among women with SUI using predictors that are accessible to clinicians. The secondary objective of this study was to run a preliminary investigation of morphologic differences between women with SUI who were cured with a physiotherapy intervention and those who were not cured, using a subset of ultrasound
imaging data. Seventy-nine women with SUI were assessed at baseline on measures of demographic data (i.e. age, body mass index, etc.), 3-day bladder diary, 30-minute standardized pad test, clinical assessments of PFM strength and tone, and transperineal ultrasound assessments of PFM morphology. Women then attended a 12-week physiotherapy intervention and returned for a follow-up assessment. The multivariate logistic regression model was significant (p < .001) with two predictors: baseline ICIQ-FLUTS UI subscale (SUI severity; p = .01) and parity (p = .06). A significant ROC curve for the ICIQ-FLUTS UI subscale (p ˂ .01) predicts physiotherapy intervention outcomes with 55.6% sensitivity and 80.8% specificity at a cut-off score of 7.50. Women most likely to be cured with a physiotherapy intervention were those with lower scores on the ICIQ-FLUTS UI subscale and those who have given birth to fewer children. Significant differences were found in a subset of data between women with SUI who are cured with the physiotherapy intervention and women who are not cured on morphologic measures in standing of bladder neck height at peak cough (p = .03), descent of the bladder neck during maximal Valsalva maneuver (MVM; p = .04), levator hiatus circumference at rest (p = .03) and at maximal voluntary contraction in both standing and supine (MVC; p = .01; p = .03). Variables that were trending towards significance included bladder neck height in standing at rest, levator plate length (LPL) at maximal excursion during a cough and MVM in standing, and mid-urethral wall cross-sectional area. These significant differences indicate potential value in using ultrasound imaging outcomes as predictors of a cure with physiotherapy intervention in future models, and a combination of demographic, clinical, and morphologic variables may build a
more robust predictive model.
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Dorey, Grace Francis. "Evaluation of pelvic floor muscle exercises and manometric biofeedback in the management of erectile dysfunction." Thesis, University of the West of England, Bristol, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.271042.
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Davis, Kathryn Julie. "Pelvic floor dysfunction and the role of combined therapies in the management of faecal incontinence." Thesis, St George's, University of London, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.414396.
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Hallam, S. M. "Enhancing self-efficacy and pelvic floor muscle exercise adherence through sEMG biofeedback : a randomised study." Thesis, University of Salford, 2012. http://usir.salford.ac.uk/33239/.
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Background Pelvic floor muscle exercises are a recommended first-line treatment for stress urinary incontinence (SUI) in women (NICE, 2006). Poor adherence to pelvic floor muscle exercises (PFME) is a recognised problem which has the potential to compromise successful treatment (Bø, 1995; Alewijnse et al., 2001). Biofeedback is thought to help motivate PFME practice but so far this has not been evaluated in a randomised study. Aim This study tests the hypothesis that use of clinic-based sEMG biofeedback improves women’s motivation to exercise (PFME adherence) by increasing pelvic floor muscle exercise self-efficacy, an important construct in pelvic floor muscle exercise adherence behaviour. Method After ensuring that they are able to make an informed decision to participate, a sample of sixty women referred for physiotherapy treatment of SUI between December 2008 and February 2010, gave consent to participate in the study. They were randomised into one of two groups. Thirty one women received clinic-based sEMG biofeedback in addition to the usual care, twenty nine received the usual care. Each participant attended clinic twice in a three month treatment period. Women were also asked to adhere to a daily home exercise programme (HEP). The primary outcome was pelvic floor muscle exercise self-efficacy. PFME self-efficacy and HEP adherence, were assessed by means of self-completed questionnaires. Results Ten women dropped out of the study before completion. Both groups improved on all outcomes, but no significant difference was found between the groups in terms of self-efficacy levels or exercise adherence rates. PFME recall was more accurate in the intervention group receiving clinic-based sEMG biofeedback. A positive and significant relationship was confirmed between PFME self-efficacy and PFME adherence. These findings are discussed in respect to the concept of self-efficacy and behavioural change. xi xii Conclusion In the short term, clinic-based sEMG biofeedback does not increase PFME self-efficacy or HEP practice beyond that achieved through instruction using vaginal palpation. These findings refute the belief that monitoring with sEMG biofeedback improves self-efficacy or women’s motivation to adhere to a HEP, but does suggest that biofeedback may be a useful adjunct to teaching PFME.
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Lovegrove, Jones Ruth Cerian. "Dynamic evaluation of female pelvic floor muscle function using 2D ultrasound and image processing methods." Thesis, University of Southampton, 2010. https://eprints.soton.ac.uk/157609/.
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The aim of this study was to define new quantitative parameters of dynamic Pelvic Floor Muscle (PFM) function using 2D transperineal (TP) ultrasound imaging combined with image processing methods (IPM). Ultrasound and digital vaginal data were obtained from a volunteer convenience sample of 23 continent and 9 Stress Urinary Incontinent (SUI) women recruited from the San Francisco Bay Area community, California, U.S.A. Two methods of IPM were used; speckle tracking for measuring displacement of the ano-rectal angle (ARA) and symphysis pubis (SP); and segmentation IPM for measuring displacement of the urethra. Good to excellent inter and intra observer reliability was established for processing the ultrasound images on stored audio-visual imaging files (AVI). Intraclass correlation coefficient (ICC) values: 0.61 to 0.99; 95% confidence intervals (CI) 0.08→0.84 to 0.97→0.99; standard error of measurement (SEM) 0.01to 0.25 cm. There was good agreement between measures on Bland and Altman analysis: mean difference 0.06 to -0.21 cm; 95% CI 0.02→0.45cm to -0.01→0.20cm. Validity of the IPM was confirmed with digital palpation, and furthermore indicated good sensitivity and specificity. Technical and methodological limitations of the IPM, and suggestions for future studies were discussed. Several research questions were addressed using TP ultrasound combined with IPM that enabled the dynamic evaluation of pelvic floor (PF) displacement throughout an entire manoeuvre, rather than limiting the quantification from static images at rest to the end of the manoeuvre. In this way, IPM determined unique quantitative data regarding the automatic displacement, velocity and acceleration of the ARA and urethra during a cough, Valsalva, voluntary PFM contraction, The Knack and a Transversus Abdominis contraction. During automatic events that raised intra-abdominal pressure (IAP), normal PFM function produced timely compression of the PF and additional external support to the urethra, reducing the displacement, velocity, and acceleration. In women with SUI, who have weaker urethral attachments, this shortening contraction did not occur; consequently, the urethra of women with SUI moved further and faster for a longer duration. Caution regarding the generalisability of this study is warranted due to the small number of women in the SUI group and the significant difference in parity between groups. However this non-invasive physiological measurement tool demonstrated a new way of assessing the PFM. It is envisaged that this study will provide the foundation for future studies with larger parity matched populations and eventually improve the rehabilitation of women with SUI and other PF disorders.
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Wallin, Hanna, and Jennifer Wiklund. "Träningsråd efter graviditet & förlossning." Thesis, Umeå universitet, Idrottsmedicin, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-121799.
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Regular physical activity is a recognised factor in the promotion of lifelong health. Exercise during pregnancy has been more accepted lately, and research shows that exercise during pregnancy is safe and beneficial, as opposed to the general view a few years ago when exercise during pregnancy was considered dangerous for both mother and fetus. It is likely that exercise plays a crucial role for women's health in postpartum as at any other time during her life. However, exercise after pregnancy is not a wellstudied field and there are uncertainties about how exercise postpartum should be performed. This fact contributes to that an estimated 75% of women in postpartum reports that they want more information about lifestyle related factors such as diet, physical activity and exercise. The aim of the present study was to investigate how well exerciseadvise given to women postpartum match with current research. To investigate this, a survey was made. Seven midwifes responded to how they advise and supervise women when it comes to exercise postpartum. The results shows that a majority of midwifes are unsure of how exercise should be performed, and the advise given does not always match with current research. The present study indicates that more research and education concerning exercise postpartum is needed.
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Noronha, Alessandra Ferreira de. "Avaliação das repercussões do tratamento para câncer invasor do colo uterino no assoalho pélvico /." Botucatu : [s.n.], 2007. http://hdl.handle.net/11449/93101.
Full textAbstract:
Resumo: Avaliar a prevalência de disfunções do assoalho pélvico após o tratamento de carcinoma invasor de colo uterino. Uma amostra de sessenta mulheres submetidas á histerectomia radical (n=20), radioterapia exclusiva (n=20) ou quimiorradiação (n=20) foram incluídas para análise. As funções de assoalho pélvico foram avaliadas por meio de questionários e avaliação física após, pelo menos, 6 meses do final do tratamento. A análise estatística realizada foram os testes de Mann-Whitney, kruskal-Wallis, Wilcoxon, Qui-quadrado quando apropriados. O p<0,05 foi considerado significativo. A idade variou de 28 a 75 anos (52,5 l 9,3 anos). O estádio clínico do tumor (FIGO) foi I em 25 casos (41,67%), II em 12 (20%), III em 22 (36,67%) and IV em 1 caso (1,67%). Os grupos foram semelhantes em relação a idade, paridade, menopausa e IMC. O comprimento vaginal foi menor em pacientes submetidas à radioterapia ou quimiorradiação quando comparadas com o grupo de histerectomia radical (5,5l1,9, 5,3l1,5 versus 7,4l1,1 cm, respectivamente; p<0,001). Não houve diferença em relação à incontinência urinária de esforço (p=0,56), urgência (p=0,44), urgeincontinência (p=0,54) e noctúria (p=0,53). Vida sexual ativa foi mais freqüente nas mulheres submetidas à cirurgia (90%) quando comparadas com o grupo da radioterapia (50%) e quimiorradiação (50%) (p=0,01). A dispareunia foi maior no grupo da radioterapia exclusiva, seguida da quimiorradiação e da histerectomia radical (p=0.021). O grupo da quimiorradiação apresentou maior freqüência evacuatória/dia (p<0.001) e a presença de diarréia foi menor no grupo da histerectomia radical (p=0.025), nos outros dois grupos foi semelhante. As disfunções do assoalho pélvico são comuns após o tratamento para carcinoma invasor de colo uterino. A radioterapia e a quimiorradiação são mais associadas às limitações... (Resumo completo, clicar acesso eletrônico abaixo)Abstract: This study was undertaken to evaluate the prevalence of pelvic floor dysfunction following treatment for invasive carcinoma of the cervix. Sixty patients submitted to radical hysterectomy (n=20), radiotherapy (n=20) or chemoradiation (n=20) were included for analysis. Pelvic floor function was assessed by questionnaires and physical examination at least 6 months after the treatment has finished. Main outcome measures were urinary, intestinal and sexual functions and vaginal length. Data of patients were collected prospectively. Statistical analysis was performed using oe2 , Mann- Whitney, Kruskal-Wallis and Wilcoxon as appropriate. P-value< 0.05 was significantly. The age of patients ranged from 28 to 75 years old (52.5 l 9.3 years). Tumor staging (FIGO) was I in 25 cases (41.67%), II in 12 (20%), III in 22 (36.67%) and IV in 1 case (1.67%). Vaginal length was shorter in the patients submitted to radiotherapy or chemoradiation compared to radical hysterectomy group (5.5l1.9, 5.3l1.5 versus 7.4l1.1 cm; p<0.001). There were no differences regarding stress incontinence (p=0.56), urgency (p=0.44), urgeincontinence(p=0.54) and nocturia (p=0.53). Active sexual life was significantly higher in women submitted to surgical treatment (p=0.01), and dyspareunia was higher in the group of radiotherapy (p=0.021). The bowel frequency was higher in group of patients submitted to chemoradiation (p=0.025). Pelvic floor dysfunctions are common after treatment for invasive cervical carcinoma. Radiotherapy and chemoradiaiton are more associated to a limitation in sexual activity and bowel dysfunction than surgery.
Orientador: Agnaldo Lopes da Silva-Filho
Coorientador: Paulo Traiman
Banca: Jorge Nahás Neto
Banca: Sérgio Augusto Triginelli
Mestre