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Objetivo: descrever o processo de desenvolvimento e validação de um curso on-line sobre incontinência urinária gestacional no Brasil. Materiais e método: trata-se de um estudo metodológico que contemplou as etapas de levantamento bibliográfico, elaboração e validação de um curso on-line. A validação teve a participação de 22 especialistas e foi empregado o índice de validade de conteúdo (IVC). Também participaram 51 estudantes de graduação em Fisioterapia (público-alvo), considerando o Suitability Assessment of Materials. Resultados: a síntese adquirida na revisão integrativa subsidiou o conteúdo teórico do curso, considerado adequado pelos especialistas quanto ao conteúdo, à linguagem, à apresentação, à estimulação/motivação e à adequação cultural (IVC = 0,99), bem como à aparência/interface (IVC = 0,95). O público-alvo considerou o curso organizado, de fácil entendimento, atrativo e motivador, com índice de concordância em repostas positivas a variar de 84,3 % a 100 %. Conclusões: informa-se que a versão brasileira do curso on-line desenvolvido foi considerada suficientemente adequada em termos de conteúdo e qualidade da interface, tanto pelos especialistas quanto pelo público-alvo., Objective: To describe the development and validation process of an online course on urinary incontinence during pregnancy in Bra-zil. Materials and methods: This methodological study followed an online course’s literature search, development, and validation steps. A total of 22 specialists participated in the validation step, and the content validity index (CVI) was used. Fifty-one Physical Therapy students (target audience) also participated in the Suitability Assessment of Materials. Results: The synthesis reached in the integrative review provided the basis for the course’s theoretical content, which was regarded as suitable by the specialists regarding its con-tent, language, presentation, stimulation/motivation, and cultural adequacy (CVI = 0.99). The target audience considered the course organized, easily understandable, engaging, and motivational, with a positive response index ranging from 84.3 % to 100 %. Conclu-sions: The Brazilian version of the online course was considered sufficiently adequate in content and interface quality by both specialists and the target audience.

Pelvic floor disorders (PFDs) and obstetric fistula (OF) are common across the globe. PFDs include stress and urge urinary incontinence, overactive bladder, pelvic organ prolapse, fecal incontinence, sexual dysfunction, and pelvic pain. Although PFD and OF are common in low- and middle-income countries (LMIC) there is a lack of awareness and constraints in health care resources. This article focuses on epidemiology, risk factors, assessment, and treatment of PFD and OF in resource-poor settings. Adherence to basic medical ethics principles has to be maintained at all times, coupled with knowledge of and respect for local cultures, traditions, and perceptions of health norms.

Many women experience pelvic floor disorders which may require medical intervention such as transvaginal mesh implant surgeries (TVM; the abdominal or vaginal insertion of woven netting to support pelvic tissue). We examined women's perceptions of communication with their health professionals concerning TVM.We analysed 153 women's written submissions to an Australian Government Inquiry regarding their experiences of transvaginal mesh surgery to explore their perceptions of TVM-related doctor-patient communication. Data were analysed using deductive and inductive reflexive thematic analysis.Women expressed several challenges in their communication with their health professionals. Three themes regarding communication were generated: Insufficient information was abundant; Normalisation and minimisation of the procedure and risks; and, Desired communication interactions.According to women's accounts, doctor-patient communication was poor. Health professionals must be knowledgeable about medical procedures and their potential complications and provide their patients with adequate, accurate information to make informed choices about their health. Health professionals should also document informed consent.Health professionals should be well-informed about TVM, including best-practice treatments for pelvic floor disorders, indications for TVM, the risks, outcomes and potential complications from various forms of TVM, and ways to adequately communicate sufficient information to women.

A weakened pelvic floor is less efficient counteracting the increased intra-abdominal pressure during exercise. While intra-abdominal pressure is higher in Sit-up than in Curl-up, Sit-up continues to be practiced in fitness classes. This raises the question of whether it has advantages over the Curl-up for instance in reducing the interrecti distance (IRD), a goal searched by many parous women. IRD has been shown to be acutely reduced during Curl-up.To determine if the IRD is more reduced during Sit-up than during Curl-up.Parous women with an IRD greater than 15mm were included in the study. IRD was measured at 20mm above umbilicus with a caliper in Head-lift, Curl-up, Sit-up and Drawing-in+Curl-up. IRD was compared across the four conditions using a one-way Anova test with repeated measures and Bonferroni correction between pairwise comparisons.Nineteen parous women aged between 28 and 54 participated in this study. Compared to Head-lift (20.3±3.9mm), the IRD was significantly decreased during the Curl-up (12.2±3.0mm) and the Sit-up (12.1±3.6mm), but not during the Drawing-in+Curl-up (18.4±4.9mm). There was no significant difference in IRD between Curl-up and Sit-up.IRD was similarly acutely reduced during Curl-up and Sit-up. The long-term effect of Curl-up on the IRD and on the pelvic floor muscles needs to be studied.To reduce IRD in parous women Curl-up rather than Sit-up should be practiced. Fitness coaches should consider this information especially with classes attended by parous women, many of whom complain about pelvic floor disorders.EL05.

Background: flat magnetic stimulation is based on a stimulation produced by electromagnetic fields with a homogenous profile. Patients with stress urinary incontinence (SUI) can take advantage of this treatment. We aimed to evaluate medium-term subjective, objective, and quality-of-life outcomes in patients with stress urinary incontinence to evaluate possible maintenance schedules. Methods: a prospective evaluation through the administration of the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), the Incontinence Impact Questionnaire (IIQ7), and the Female Sexual Function Index (FSFI) was performed at three different time points: at the baseline (T0), at the end of treatment (T1), and at 3-month follow-up (T2). The stress test and the Patient Global Impression of Improvement questionnaire (PGI-I) defined objective and subjective outcomes, respectively. Results: 25 consecutive patients were enrolled. A statistically significant reduction in the IIQ7 and ICIQ-SF scores was noticed at T1 returned to levels comparable to the baseline at T2. However, objective improvement remained significant even at a 3-month follow-up. Moreover, the PGI-I scores at T1 and T2 were comparable, demonstrating stable subjective satisfaction. Conclusion: despite a certain persistence of the objective and subjective continence improvement, the urinary-related quality of life decreases and returns to baseline values three months after the end of flat magnetic stimulation. These findings indicate that a further cycle of treatment is probably indicated after 3 months since benefits are only partially maintained after this timespan.

To summarize some of the most recent evidence on disparities in the prevalence, treatment and outcomes of pelvic floor disorders (PFDs), and to address potential interventions to dismantle these inequities.There is a paucity of data on the prevalence and treatment of PFDs in racial minority women. The existing studies are limited and poor quality. These studies suggest that racial and ethnic minorities may be at a higher risk of PFDs, however the epidemiologic data regarding prevalence varies by disorder and at times are conflicting. Nevertheless, the data on treatment and complications is clear. Racial and ethnic minorities are less likely to receive gold-standard treatment and are more likely to experience treatment related complications.We discuss the lack of racially inclusive research that perpetuates ongoing health inequities.

To evaluate prevalence of pelvic floor disorders, association of endocrine therapy with pelvic floor disorders, and rates of pelvic floor surgery among breast cancer survivors compared to matched controls without history of cancer.This is a retrospective, cohort study using electronic medical record data from a ten-hospital regional healthcare system. A total of 19,483 women diagnosed with breast cancer between January 2008 and April 2020 were propensity score matched to 19,483 women without a history of cancer. Medical charts were abstracted for ICD-9 and ICD-10 codes for pelvic floor disorders, use of endocrine therapy, and CPT codes for pelvic floor surgeries and procedures.Overall, the prevalence of pelvic floor disorders was lower among breast cancer survivors (8.8% vs. 22.6%, p0.001), and mean time to development of pelvic floor disorders among breast cancer survivors was 3 years. Selective estrogen receptor modulators and aromatase inhibitors were associated with pelvic organ prolapse and stress urinary incontinence, while estrogen antagonists were associated with urge urinary incontinence and lower urinary tract symptoms. Women with breast cancer had similar or higher rates of pelvic floor surgery compared to matched controls.Rates of pelvic floor disorders were lower among breast cancer survivors compared to controls but rates of surgical intervention did not differ and were higher for some conditions among breast cancer survivors.Screening for these disorders should be considered as part of routine survivorship care.

Introduction and hypothesis The German “Pelvic Floor Questionnaire for pregnant and postpartum women” is a self-administered questionnaire customized for pregnancy and the postpartum period that assesses four domains of pelvic floor function regarding perceived symptoms, suffering, and impact on quality of life: bladder, bowel, prolapse, and sexual function. No similar questionnaire is available in Swedish, despite a high prevalence of pregnancy and postpartum pelvic floor dysfunction. Thus, we aimed to translate the validated German questionnaire into Swedish and test its validity and reliability in a Swedish population. Methods Translation and cultural adaptation were performed according to guidelines. Of the 248 women who answered the Swedish questionnaire, 57 filled out the questionnaire twice to evaluate test-retest reliability. We also assessed internal consistency and discriminant validity. Results The Swedish version of the questionnaire showed good face and content validity. Cronbach’s alpha was in the acceptable to excellent range (bladder 0.82, bowel 0.78, prolapse 0.91, and sexual 0.83), showing adequate internal consistency. A comparison of means (≥ 1 point) showed that the questionnaire significantly (p < 0.05) distinguished between women who reported suffering and those who did not. Cohen's kappa for all individual items showed fair to almost perfect agreement (0.24–0.87) between test and retest scores. The intraclass correlation coefficients for domain scores (0.92–0.97) were all in an optimal range. Conclusions The Swedish version of the questionnaire is a reliable and valid instrument for assessing pelvic floor disorders, symptom severity, and impact on quality of life during pregnancy and the postpartum period.

Striae gravidarum are linear atrophic scars appearing on the abdomen of pregnant women reported to be related to pregnancy-induced changes in the connective tissue. Pelvic floor distress symptoms are also known to be linked to connective tissue weakness. Given that common pathophysiological pathways may play a role in both striae gravidarum and pelvic floor dysfunction symptoms, we sought to examine whether there is a correlation between them during pregnancy.A prospective observational study among third-trimester pregnant women who visited a tertiary medical center for routine pregnancy follow-up was conducted by using the Pelvic Floor Distress Inventory (PFDI-20) questionnaire to evaluate pelvic floor distress symptoms and the Davey method for evaluating striae gravidarum severity. Obstetrical characteristics as well as pelvic floor distress symptoms were compared between two groups according to the severity of striae gravidarum. Univariate analysis was carried out using appropriate tests; PFDI scores were compared between the groups using the Mann-Whitney test.Women with striae gravidarum were significantly older (31.06 vs. 28.83 years, p0.01), had a lower body mass index (27.5 vs. 30.98, p0.01), and gave birth to smaller neonates (3155 vs. 3389 g, p0.01). In addition, the overall and median PFDI-20 scores differed between the groups (with severe SG having the highest median score of 20 and those with milder SG having a score of 16 compared to 14 in those without SG). A distinct association between the PFDI-20 score and SG severity was not demonstrated (p = 0.63).In our population, an association was demonstrated between pelvic floor distress symptoms and the presence of striae gravidarum. However, following a linear regression model, no statistically significant association between SG severity and total PFD-20 score was seen. Our findings strengthen the hypothesis of common connective tissue involvement in the pathophysiology of both conditions.

This study compared the pelvic floor dysfunction (PFD) symptoms and knowledge levels in obese and non-obese women. The study included 40 obese and 41 non-obese women. The presence of PFD and the severity of its symptoms were questioned with the Pelvic Floor Distress Inventory-20 (PFDI-20) (its sub-scales: Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6), Colorectal-Anal Distress Inventory-8 (CRADI-8), Urinary Distress Inventory-6 (UDI-6)). Participants' PFD knowledge levels were evaluated with the Prolapse and Incontinence Knowledge Questionnaire (PIKQ) and the Anal Incontinence Knowledge Questionnaire (AIKQ). The rates of urinary incontinence (UI) and pelvic organ prolapse (POP) symptoms were higher in the obese group compared to the control group (p = .001). The POPDI-6, CRADI-8, UDI-6, and PFDI-20 scores were higher in the obese group compared to the control group (p .001). Moreover, the knowledge level related to treatment methods for PFD was lower in the obese women compared to the non-obese women (p .05). PFD symptom incidence and severity were higher and knowledge levels related to PFD were lower in the obese women compared to the non-obese women. Informative teaching programs on this issue would be beneficial as part of preventive health services.

Objectives To examine the association between pelvic floor disorders (pelvic organ prolapse, urinary incontinence and anal incontinence) and bone mineral density (BMD). Study design: A cross-sectional study of 6809 women who participated in the third survey of the population-based Norwegian HUNT study was undertaken. BMD was measured by dual-energy X-ray absorptiometry. Information on BMD and self-reported pelvic floor disorders from the HUNT study was linked with hospital-derived data on diagnosis and surgical treatment of pelvic floor disorders. BMD was categorized according to the World Health Organization criteria (normal, osteopenia and osteoporosis). Multi-variate logistic regression models were used to estimate odds ratios (OR) with 95% confidence intervals (CI) for the association between pelvic floor disorders and BMD. Results Women with a hospital diagnosis of stress urinary incontinence (SUI) were less likely to have osteopenia (OR 0.66, 95% CI 0.50–0.87) or osteoporosis (OR 0.66, 95% CI 0.34–1.30) compared with women without a diagnosis of SUI. In women with self-reported information on pelvic floor disorders, women with a history of SUI had lower odds for osteopenia (OR 0.88, 95% CI 0.75–1.02) or osteoporosis (OR 0.69, 95% CI 0.46–1.01), while no association was found between anal incontinence, self-reported surgery for pelvic organ prolapse, and osteopenia or osteoporosis. Conclusion Pelvic organ prolapse was not associated with BMD. The reasons underlying the observed association between SUI and BMD require further investigation.

Introduction Hypertonicity of the pelvic floor (PFH) is a disabling condition with urological, gynecological and gastrointestinal symptoms, sexual problems and chronic pelvic pain, impacting quality of life. Pelvic floor physical therapy (PFPT) is a first-line intervention, yet no systematic review on the efficacy of PFPT for the treatment of PFH has been conducted. Objectives To systematically appraise the current literature on efficacy of PFPT modalities related to PFH. Methods PubMed, Embase, Emcare, Web of Science, and Cochrane databases were searched from inception until February 2020. A manual search from reference lists of included articles was performed. Ongoing trials were reviewed using clinicaltrial.gov. Randomized controlled trials (RCTs), prospective - and retrospective cohorts and case-study analyses were included. Outcome measures were pelvic floor muscle tone and function, pain reports, sexual function, pelvic floor symptom scores, quality of life and patients’ perceived effect. Results The literature search resulted in 10 eligible studies including 4 RCTs, 5 prospective studies, and 1 case study published between 2000 and 2019. Most studies had a high risk of bias associated with the lack of a comparison group, insufficient sample sizes and non-standardized interventions. Six studies were of low and 4 of medium quality. All studies were narratively reviewed. Three of 4 RCTs found positive effects of PFPT compared to controls on five out of 6 outcome measures. The prospective studies found significant improvements in all outcome measures that were assessed. PFPT seems to be efficacious in patients with chronic prostatitis, chronic pelvic pain syndrome, vulvodynia, and dyspareunia. Smallest effects were seen in patients with interstitial cystitis and painful bladder syndrome. Conclusion The findings of this systematic review suggest that PFPT can be beneficial in patients with PFH. Further high-quality RCTs should be performed to confirm the effectiveness of PFPT in the treatment of PFH. van Reijn-Baggen DA, Han-Geurts IJM, Voorham-van der Zalm PJ, et al. Pelvic Floor Physical Therapy for Pelvic Floor Hypertonicity: A Systematic Review of Treatment Efficacy. Sex Med Rev 2021;XX:1–22.

Introduction and hypothesis The objective was to explore the impact of levator ani muscle (LAM) trauma and pelvic floor contraction on symptoms and anatomy after pelvic organ prolapse (POP) surgery. Methods Prospective study including 200 women with symptomatic POP ≥ grade 2 examined 3 months prior to and 6 months after surgery. Prolapse in each compartment was graded using the Pelvic Organ Prolapse Quantification (POP-Q) system, and women answered yes/no to a question about bulge sensation. Pelvic floor muscle contraction was assessed with transperineal ultrasound measuring proportional change in levator hiatal anteroposterior diameter from rest to contraction. LAM trauma was diagnosed using tomographic ultrasound imaging. Statistical analysis was performed using multivariate logistic regression analysis. Results A total of 183 women (92%) completed the study. Anatomical recurrence (POP ≥ grade 2) was found in 76 women (42%), and a bulge sensation was reported by 35 (19%). Ninety-two women (50%) had LAM trauma, and this was associated with increased risk of anatomical recurrence (OR 2.1 (95% CI 1.1–4.1), p = 0.022), but not bulge sensation (OR 1.1 (95% CI 0.5–2.4), p = 0.809). We found a reduced risk of bulge sensation for women with absent to weak contraction compared with normal to strong contraction (OR 0.4 (95% CI 0.1–0.9), p = 0.031), but no difference in risk for POP ≥ 2 after surgery (OR 1.5 (95% CI 0.8–2.9), p = 0.223). Conclusions Levator ani muscle trauma was associated with increased risk of anatomical failure 6 months after POP surgery. Absent to weak pelvic floor muscle contraction was associated with reduced risk of bulge sensation after surgery.

Introduction and hypothesis Patient-reported outcome measures (PROMs) are helpful instruments when measuring and reporting changes in patient health status (Al Sayah et al. J Patient Rep Outcomes 5 (Suppl 2):99, 2021) such as the health-related quality of life (HrQoL) of women with pelvic organ prolapse (POP) and stress urinary incontinence (SUI). The Australasian Pelvic Floor Procedure Registry (APFPR) aims to increase capacity for women to report surgical outcomes through the collection of HrQoL data (Ruseckaite et al. Qual Life Res. 2021) but currently lacks a pain-specific PROM for women with pelvic floor disorders (PFDs), particularly POP and SUI. This review aims to systematically review the existing literature and identify instruments that measure pain in women with POP and SUI for inclusion within the APFPR, which reports on complications from these conditions. Methods We conducted a literature search on OVID MEDLINE, Embase, CINAHL, PsycINFO and EMCARE databases in addition to Google Scholar and grey literature to identify studies from inception to April 2021. Full-text studies were included if they used PROMs to measure pain in women with POP and SUI. Two authors independently screened articles, extracted data and assessed methodological quality. Results From 2001 studies, 23 publications describing 19 different PROMs were included for analysis. Eight of these instruments were specific to the pelvic floor; four were only specific to pain and used across multiple disorders; three were generic quality of life instruments and four were other non-validated instruments such as focus group interviews. These instruments were not specific to pain in women with POP or SUI, as they did not identify all relevant domains such as the sensation, region and duration of pain, or incidents where onset of pain occurs. Conclusions The findings of this review suggest there are no current PROMs that are suitable pain-specific instruments for women with POP or SUI. This knowledge may inform and assist in the development of a new PROM to be implemented into the APFPR.

Aim To assess the knowledge of adolescent girls and young women on pelvic-perineal disorders (PPD). Method We searched on PubMed, Cochrane Library, Kinedoc and Semantic Scholar databases using the MeSH keywords: "knowledge" "awareness" "surveys" "young women" "pelvic floor" "adolescent" "teenager" "athletic injury" "urinary incontinence". The articles had to have been published within the last 15 years, written in French or English, and deal with the state of knowledge of adolescents and young women concerning the perineal sphere using questionnaires. Results A total of 8 studies were included in the review, 5 cross-sectional studies and 3 intervention studies. The knowledge of adolescent girls and young women interviewed about the anatomy of the pelvic floor, its function, and risk factors for PPD was low. The majority of the participants wanted more information about the pelvic floor. Two studies that conducted an educational intervention showed a significant improvement in knowledge. Conclusion Knowledge of pelvic-perineal disorders and pelvic floor function is poor in adolescent girls and young women. To better assess them, it would be necessary to validate a questionnaire containing all the items about knowledge.

Obesity may be a modifiable risk factor for pelvic floor disorders.The objective of this study is to determine associations between weight, weight changes, and cumulative exposure to excess body mass index (BMI) from prepregnancy to 1 year postpartum on pelvic floor support and symptoms 1 year after first vaginal birth.In 645 primiparous women who gave birth vaginally, we assessed anatomic pelvic floor support, pelvic floor symptoms and BMI at the third trimester, 5 - 10 weeks, and 1 year postpartum; we also assessed BMI prepregnancy and predelivery. Using multivariable models, we determined associations between pelvic floor outcomes 1 year postpartum and BMI quartiles at different timepoints, gestational weight gain, and postpartum weight retention. We evaluated associations between stress urinary incontinence (SUI) and moderate/severe urinary incontinence (UI) 1 year postpartum and cumulative excess BMI from prepregnancy to 1-year postpartum (BMI1year).Body mass index was not associated with anatomic support, composite symptom burden, overactive bladder, anal incontinence, or constipation at any timepoint. Gestational weight gain and postpartum weight retention were not associated with any 1-year outcome. Body mass index at every timepoint was positively associated with SUI and moderate/severe UI; BMI1year was most predictive. Cumulative excess BMI was positively associated with SUI and moderate/severe UI but only slightly more predictive of these outcomes than BMI1year alone.Body mass index over the pregnancy trajectory was not associated with outcomes other than UI. The small advantage of cumulative exposure to excess BMI over BMI1year in predicting SUI and moderate/severe UI suggests that BMI1year adequately captures risk of these 1-year outcomes.

Introdução:O prolapso de órgãos pélvicos é uma desordem de caráter anatômico e funcional que acomete mulheres. Além disso, possui elevado impacto sobre a qualidade de vida das pessoas acometidas, trazendo sintomas como desconforto e sensação de peso em região pélvica, além de distúrbios sexuais e urinários.Objetivo:Descrever o perfil de mulheres hospitalizadas no Brasil por prolapso de órgãos pélvicos entre janeiro de 2014 e julho de 2022.Métodos:Trata-se de um estudo descritivo quantitativo.A pesquisa foi realizada utilizando dados fornecidos pela base DATA/SUS; foi analisado o número de hospitalizações por prolapso genital feminino, categorizado por ano, região brasileira, faixa etária, gastos públicos, número de óbitos, dias de permanência hospitalar e caráter de atendimento.Resultados:O maior número de internações ocorreu na região Nordeste. Com relação à mortalidade, o Sudeste foi a região com maior mortalidade, representando 44% do total do país. A região Nordeste foi responsável pelo maior gasto hospitalar médio apresentando uma média de R$ 320,00 por internação. Quanto ao perfil das internações observa-se que 79% destas tiveram caráter eletivo, com 21% urgente. A faixa etária de 60-69 anos foi a mais acometida. A região Norte apresentou a maior média de permanência (aproximadamente 3 dias).Conclusão:De 2014 a 2022 houveram 192.462 internações e os gastos hospitalares por região foram proporcionais ao total de internações. Nota-se um número constante de internações ao longo dos anos, comprovando que a patologia estudada tem ocorrência constante nos hospitais brasileiros, necessitando de uma atenção adequada a nível de saúde pública. &nbsp

(1) Background: Women experience pelvic floor dysfunction symptoms during pregnancy. This study is the first to investigate and compare variances in the prevalence and severity of pelvic floor symptoms between trimesters using a valid pregnancy-targeted questionnaire. (2) Methods: A retrospective cohort study was conducted between August 2020 to January 2021 at two university-affiliated tertiary medical centers. Pregnant women (n = 306) anonymously completed the Pelvic Floor Questionnaire for Pregnancy and Postpartum with its four domains (bladder, bowel, prolapse, and sexual). (3) Results: Thirty-six women (11.7%) were in the 1st trimester, eighty-three (27.1%) were in the 2nd trimester, and one hundred and eighty-seven (61.1%) were in the 3rd trimester. The groups were similar in age, pregestational weight, and smoking habits. A total of 104 (34%) had bladder dysfunction, 112 (36.3%) had bowel dysfunction, and 132 (40.4%) reported sexual inactivity and/or sexual dysfunction. Least prevalent (33/306; 10.8%) were prolapse symptoms. Increased awareness of prolapse and significantly higher rates of nocturia and the need to use pads due to incontinence were recorded in the 3rd trimester. Sexual dysfunction or abstinence were equally distributed in all three trimesters. (4) Conclusions: Bladder and prolapse symptoms, equally frequent throughout pregnancy, significantly intensified in the 3rd trimester. Bowel and sexual symptoms, equally frequent throughout pregnancy, did not intensify in the third trimester.

It is known that pregnancy and childbirth bring biological, psychological and social changes in a woman's life. Studies regarding the pelvic floor function focus on the year after delivery, but unfortunately, long-term studies are rare. Furthermore, an association between postpartum pain and birth pain management on the pelvic floor function has rarely been examined. The aim of this study is the evaluation of the pelvic floor function years after delivery in order to detect possible risk factors.This is a retrospective cohort study. All women who delivered in our hospital between 2015 and 2016 were contacted by mail between 2018 and 2019 and asked to participate. The letters included study information, declaration of consent, the "Pelvic floor questionnaire for pregnant women and women after childbirth" (PFQ), contact information and pre-paid envelopes. Questions about pain after childbirth and the management of birth related fear and pain were particularly of interest in the surveys. The interested participants were asked to return the completed declaration of consent and the questionnaire. Overall, 308 women were included in the analysis. Due to the large number of participants, different subgroups were defined in order to compare influencing factors adequately.No significant association between the mode of delivery and the total score of the PFQ was found after 3-4 years in primiparous women (p = 0.688). Our study also showed that recorded pain after childbirth and insufficient pain and fear management after childbirth had a negative impact on the pelvic floor function (total scores: pain after childbirth p = 0.00; no pain management p = 0.04; no fear management p = 0.021).No association was found between delivery mode and pelvic floor function in primiparous women three to four years after childbirth. On the other hand, a negative impact of birth related pain and fears on the pelvic floor function years after delivery was significant. Therefore, these revealing findings should certainly be considered in postpartum management.

Pregnancy and delivery have a major effect on pelvic floor disorders. Assessing knowledge regarding pelvic floor disorders in childbearing age women and appropriate interventions will enable women to seek appropriate medical advice once pelvic floor disorders have developed. The purpose of this study was to validate the prolapse and incontinence knowledge questionnaire in the Hebrew language.Translation of the prolapse and incontinence knowledge questionnaire to the Hebrew language according to international recommended guidelines. A study was conducted to validate the questionnaire. The study took place between June to September 2020 in a tertiary medical center in Israel. A total of 240 third trimester pregnant women completed the Hebrew version of the prolapse and incontinence knowledge questionnaire. Construct validity, criterion validity and reliability tests were performed.Factor analysis of the Hebrew version of the prolapse and incontinence knowledge questionnaire demonstrated 12 strong positive factor loadings to one principal factor in the prolapse and incontinence knowledge questionnaire-pelvic organ prolapse domain (FL 0.3) and 10/12 in the prolapse and incontinence knowledge questionnaire-urinary incontinence domain. The Hebrew prolapse and incontinence knowledge questionnaire was found to have internal consistency, with Cronbach alpha coefficient of 0.745 for the urinary incontinence domain and 0.796 for the pelvic organ prolapse domain.The Hebrew version of the prolapse and incontinence knowledge questionnaire is a new, reliable, consistent, and valid instrument to examine the level of knowledge regarding pelvic floor disorders in Hebrew-speaking pregnant women.

Made available in DSpace on 2022-04-29T08:38:39Z (GMT). No. of bitstreams: 0 Previous issue date: 2022-01-01 Introduction: To investigate the influence of a training of mobility, gait speed and postural balance of pelvic floor muscles (PFM). Methods: A single-arm clinical trial study was approved and registered at the Brazilian Clinical Trials Registry (RBR-4rxhd4). Eighteen women over the age of 60 with pelvic floor dysfunction complaints were subjected to 10 sessions of functional electrical stimulation and digital palpation of PFM. Mobility and gait speed were evaluated by the Timed up and Go and the 10-m walk tests respectively. Standing balance was evaluated using a force plate. Results: No significant differences were found in mobility, gait speed, and standing balance. PFM contraction worsened mobility, gait speed, and standing balance performance. Conclusions: The training protocol enhanced PFM strength and endurance, but the improved ability to recruit PFM did not positively affect balance, mobility, and gait speed. Human Development and Technologies Program Institute of Biosciences São Paulo State University (UNESP) Department of Tocogynecology Botucatu Medical School (FMB) São Paulo State University (UNESP) Department of Physiotherapy and Occupational Therapy Faculty of Philosophy and Sciences São Paulo State University (UNESP) Human Development and Technologies Program Institute of Biosciences São Paulo State University (UNESP) Department of Tocogynecology Botucatu Medical School (FMB) São Paulo State University (UNESP) Department of Physiotherapy and Occupational Therapy Faculty of Philosophy and Sciences São Paulo State University (UNESP)

Increasing evidence has suggested that pelvic floor exercises and manual physical therapy may improve premature ejaculation (PE) and erectile dysfunction (ED) in males.To examine the effects of pelvic floor physical therapy treatment in men suffering from PE and ED.We searched Google Scholar, PubMed, Medline, PEDro databases from inception till January 2020 applying the following keywords: pelvic floor, erectile dysfunction, impotence, physiotherapy, exercises, rehabilitation, and pelvic floor muscle exercises.The review included 37 papers reporting on PE and ED, of which 5 were randomized controlled trials, 2 meta-analyses, and 4 observational studies. Pelvic floor physical therapy treatment included education and rehabilitation. The rehabilitation part encompassed manual therapy techniques that contribute to the normalization of muscle tone and improvement of muscle relaxation. Moreover, exercises, according to the patients' clinical assessment were presented. Most of the studies reported that by strengthening the pelvic floor muscles (PFMs), ED and PE can be improved if manual physical therapy treatments are combined with PFM training.A multifaceted approach should be chosen by physical therapists when evaluating and treating ED and PE and contending with both musculoskeletal dysfunction and behavioral contributions. It is recommended that exercises be monitored and situations involving, that is, hyperactivity/increased tone of the PFMs should be avoided. PFM training is simple, safe, and noninvasive; therefore, it should be a preferred approach in the management of ED and PE. This paper presents narrative reviews with a potential bias that systematic reviews or meta-analyses do not have, however, we strove to be all-encompassing and unbiased. There is a demand for high-quality scientific reviews examining the effectiveness of PFM training, manual therapy, and the rationale of pelvic floor physical therapy, in general, in treating individuals with PE and ED. Yaacov D, Nelinger G, Kalichman L. The Effect of Pelvic Floor Rehabilitation on Males with Sexual Dysfunction: A Narrative Review. Sex Med Rev 2022;10:162-167.

OBJECTIVES: Researchers and clinicians tend to focus on one pelvic floor symptom (PFS) at the time. However, the pelvic floor acts as one functional unit, increasing the likelihood of concurrent PFS in patients with pelvic floor dysfunction. There is also a paucity of literature on the prevalence of concomitant PFS, especially in males. Therefore, we explored the occurrence of concomitant PFS in community-dwelling males and females.MATERIALS AND METHODS: This prospective observational population-based cohort study included males and females aged ≥16 years from a single Dutch municipality. Participants completed validated questionnaires on lower urinary tract symptoms (LUTS), defecation problems, sexual dysfunction, pelvic pain, and pelvic organ prolapse. Medical general practitioner records were examined. Furthermore, a randomly selected group of non-responders aged RESULTS: We invited 11 724 people, among which 839 females and 566 males completed the questionnaires. Of the female participants, 286 (34.1%) reported no PFS, and 251 (29.9%) reported two or more PFS. The most prevalent PFS clusters in females were sexual dysfunction and pelvic pain, sexual dysfunction and defecation problems, LUTS and defecation problems, and LUTS, defecation problems, and pelvic pain. Of the male participants, 212 (37.5%) reported no PFS, and 191 (33.7%) reported two or more PFS. The most prevalent clusters in males were sexual dysfunction and LUTS, defecation problems and LUTS, and sexual dysfunction, LUTS, and defecation problems.CONCLUSION: A considerable overlap existed between PFS, with differences in PFS clusters between females and males. Of note, females reported pelvic pain more than males. We conclude that healthcare providers should address all PFS in males and females.

Background Spasm or increased tonus of the pelvic floor muscles (PFM) can cause myofascial pain (MP), which may result in painful intercourse and sexual dysfunction. Aim The effect of vaginal stretching (VS) with photobiomodulation therapy (PBMT) is compared to VS with sham PBMT in overall sexual function, rate and severity of painful intercourse at baseline and after treatment in women with pelvic floor MP. Methods A double-blind randomized clinical trial of 103 women with MP: 1 group received 10 sessions of VS with PBMT (4 Joules of near-infrared light-808 nm at 3 points), and the other group received VS with sham PBMT. Outcomes Impact of treatment was measured by the number of women experiencing painful intercourse, Pain severity was measured by Visual Analog Scale and sexual function was assessed by the FSFI questionnaire. Variables were assessed at baseline and after ten sessions in the intervention groups. Results After treatment, the number of women experiencing painful intercourse was significantly lower in both the VS with PBMT group (90.2–55%, P = .001), and VS with sham PBMT group (86.6–46.2%, P < .001). There was a significant reduction in pain measure by Visual Analog Scale (P < .001, [VS with PBMT group: P = .002; VS with sham PBMT group: P < .001]). There was a significant decrease in the number of participants with sexual dysfunction (FSFI score ≤26.55) after the treatment in the VS with PBMT group (92.2–74.5%, P = .003) and in the VS with sham PBMT group (90.4–76.9%, P = .035). Both groups showed improvement in the FSFI pain domain after treatment (P < .001, [VS with PBMT group: P = .038; VS with sham PBMT group: P = .005]). Only the VS with sham PBMT group had a significant increase in FSFI desire and total score (P < .001) after treatment. Clinical Implications We found that VS associated or not with PBMT may be effective in reducing complaints of painful intercourse, alleviating pain severity, and reducing the number of women with pelvic floor MP suffering from sexual dysfunction. Strengths & Limitations Strengths of this study are the randomized design and use of validated questionnaires. Limitation of the study is the lack of a long follow-up period and the lack of a usual care comparison group hampers generalizability of the results. Conclusion VS only and VS with PBMT have short-term efficacy in reducing painful intercourse and reducing a number of women with sexual dysfunction.

BACKGROUND Laparoscopic ventral mesh rectopexy (LVMR) continues to be a popular treatment option for rectal prolapse, obstructive defecation/faecal incontinence and rectoceles. In recent years there have been concerns regarding the safety of mesh placements in the pelvis. AIM To assess the safety of the mesh and the outcome of the procedure. METHODS Eighty-six patients underwent LVMR with Permacol (Biological) mesh from 2012 to 2018 at University Hospital Wishaw. Forty were treated for obstructive defecation secondary to prolapse, rectocele or internal rectal intussusception, 38 for mixed symptoms obstructive defecation and incontinence, 5 for pain and bleeding secondary to full thickness prolapse and 3 with symptoms of incontinence. Questionnaires for the calculation of Wexner scores for constipation and incontinence were completed by the patients who were followed up in the clinic 12 wk after surgery and again in 6-12 mo. The average review of their notes was 18.3 ± 4.2 mo. RESULTS The median Wexner scores for constipation pre-operatively and post-operatively were 14.5 [Interquartile range (IQR): 10.5-18.5] and 3 (IQR: 1-6), respectively, while the median Wexner score for faecal incontinence was 11 (IQR: 7-15) and 2 (IQR: 0-5), respectively (P < 0.01). There were 4 (4.6%) recurrences, 2 cases that presented with erosion of a suture through the rectum and one with diskitis. No mesh complications or mortalities were recorded. CONCLUSION LVMR using a Permacol mesh is a safe and effective procedure for the treatment of obstructive defecation/faecal incontinence, rectal prolapse, rectoceles and internal rectal prolapse/intussusception.

Introduction and hypothesis Evidence-based care pathways improve care standardization and patient outcomes. We created pelvic organ prolapse (POP) and stress urinary incontinence (SUI) care pathways as decision aids for our multidisciplinary team to use when counseling patients. Methods Using a modified Delphi process, an expert team reviewed existing guidelines and literature to reach consensus on pathway definitions and components. Results Entry to the care pathways occurs via an advanced practice provider visit. Symptom and quality-of-life questionnaires as well as open-ended patient goals are used to guide patient–provider shared decision making. All treatment choices, including surgical and nonsurgical management, are presented to patients by advanced practice providers. Patients electing nonsurgical management follow-up by telehealth (preferred) or in-person visits as determined by the care pathway. Surgeon consultations are scheduled for patients desiring surgery. Surgical patients undergo urodynamics, simple cystometrics or deferred bladder testing according to the urodynamics clinical pathway. Postoperative follow-up includes telehealth visits and minimizes in-person visits for women with uncomplicated postoperative courses. Patients with resolution of symptoms are graduated from clinic and return to their referring physician. The pathways are revised following publication of new compelling evidence. Conclusions We developed POP and SUI care pathways to standardize care across a diverse provider group. Advanced practice providers use care pathways with patients as shared decision-making tools for initial evaluation of patients with prolapse and incontinence. These pathways serve as components of value-based care and encourage team members to function independently while utilizing the full scope of their training.

Objectives To establish the impact of pelvic floor (PF) symptoms (urinary incontinence [UI], anal incontinence [AI] and pelvic organ prolapse [POP]) on exercise participation in women. Design Observational, cross-sectional survey. Methods Australian, 18- to 65-year-old women with self-identified PF symptoms during exercise (current, past or fear of) were included. This survey included validated questionnaires: Questionnaire for female Urinary Incontinence Diagnosis, Incontinence Severity Index, Pelvic Floor Bother Questionnaire, International Physical Activity Questionnaire and purpose-designed questions on the impact of PF symptoms on sport/exercise participation. Analysis utilised descriptive statistics. Chi-square tests for independence and t-tests were used to explore differences between groups. Results Of 4556 women, 46% stopped exercise they had previously participated in due to their PF symptoms. Urinary incontinence had the largest impact; 41% with UI, followed by 37% with POP and 26% with AI stopped at least one form of exercise. Forty-two percent of women who experienced symptoms in high-impact sports stopped participation (versus low-impact: 21%). Sports commonly ceased included volleyball (63%), racquet-sports (57%) and basketball (54%). Exercise cessation was reported amongst younger (18–25 years: 35%) and nulliparous women (31%). Common exercise modifications included lowering the intensity (58%) or frequency (34%) of participation or changing to a low-impact form of sport/exercise (45%). Conclusions Pelvic floor symptoms stop women of all ages and levels of participation from exercising. High-impact sports were most affected but low-impact sports were also ceased. Symptomatic women also modify exercise to less vigorous/frequent participation, which may place them at risk of physical inactivity, and chronic illness.

Objective: To describe the development and validation process of an online course on urinary incontinence during pregnancy in Bra-zil. Materials and methods: This methodological study followed an online course’s literature search, development, and validation steps. A total of 22 specialists participated in the validation step, and the content validity index (CVI) was used. Fifty-one Physical Therapy students (target audience) also participated in the Suitability Assessment of Materials. Results: The synthesis reached in the integrative review provided the basis for the course’s theoretical content, which was regarded as suitable by the specialists regarding its con-tent, language, presentation, stimulation/motivation, and cultural adequacy (CVI = 0.99). The target audience considered the course organized, easily understandable, engaging, and motivational, with a positive response index ranging from 84.3 % to 100 %. Conclu-sions: The Brazilian version of the online course was considered sufficiently adequate in content and interface quality by both specialists and the target audience., Objetivo: descrever o processo de desenvolvimento e validação de um curso on-line sobre incontinência urinária gestacional no Brasil. Materiais e método: trata-se de um estudo metodológico que contemplou as etapas de levantamento bibliográfico, elaboração e validação de um curso on-line. A validação teve a participação de 22 especialistas e foi empregado o índice de validade de conteúdo (IVC). Também participaram 51 estudantes de graduação em Fisioterapia (público-alvo), considerando o Suitability Assessment of Materials. Resultados: a síntese adquirida na revisão integrativa subsidiou o conteúdo teórico do curso, considerado adequado pelos especialistas quanto ao conteúdo, à linguagem, à apresentação, à estimulação/motivação e à adequação cultural (IVC = 0,99), bem como à aparência/interface (IVC = 0,95). O público-alvo considerou o curso organizado, de fácil entendimento, atrativo e motivador, com índice de concordância em repostas positivas a variar de 84,3 % a 100 %. Conclusões: informa-se que a versão brasileira do curso on-line desenvolvido foi considerada suficientemente adequada em termos de conteúdo e qualidade da interface, tanto pelos especialistas quanto pelo público-alvo., Objetivo: describir el proceso de desarrollo y validación de un curso en línea sobre incontinencia urinaria durante el embarazo en Brasil. Materiales y método: se trata de un estudio metodológico que contempló las etapas de recolección bibliográfica, elaboración y validación de un curso en línea. La validación contó con la participación de 22 expertos y se empleó el índice de validación de contenido (IVC). Además, participaron 51 estudiantes del pregrado en Fisioterapia (público objetivo) en la Evaluación de Idoneidad de los Materiales. Resultados: la síntesis adquirida en la revisión integrativa fundamentó el contenido teórico del curso, considerado adecuado por los expertos en cuanto al contenido, el lenguaje, la presentación, la estimulación/motivación y la adecuación cultural (IVC = 0,99), así como la apariencia/interfaz (IVC = 0,95). El público objetivo consideró el curso organizado, de fácil entendimiento, atractivo y motivador, con un índice de concordancia en respuestas positivas entre 84,3 % y 100 %. Conclusiones: la versión brasileña del curso en línea desarrollado se consideró lo suficientemente adecuada en términos de contenido y calidad de la interfaz, tanto por parte de los expertos como del público objetivo.

Objectives Pelvic floor disorders (PFDs), which include urinary incontinence, pelvic organ prolapse, sexual dysfunction and gastrointestinal disorders, affect over 20% of the adult population. Prevalence may also be underestimated, since a certain portion of patients may be reluctant to talk to physicians about PFDs due to embarassment. Consequently, there is a need for self-assessed diagnostic tools with the capability to screen population and collect clinical information. Symptom and quality of life (QoL) questionnaires - also identified as patient-reported outcomes (PROs) - have been developed with this purpose. Despite the large number of questionnaires available for the assessment of PFDs and QoL-related issues in the English language, few of them have been validated for the Italian language. The objective of this article is to update the list of Italian-validated PROs for PFDs along with practical information concerning literature references and suggestions on how to obtain every single questionnaire. Methods PubMed/MEDLINE databases and websites were used to update the list of available Italian-validated questionnaires about PFDs. Once identified, the possibility to get a copy of the questionnaire was verified and steps to obtain it are reported in the tables. Results eight additional questionnaires validated into the Italian language, for diagnosis and overall management of common urinary, vaginal, sexual and bowel conditions, were retrieved. The complete list of PFDs PROS is reported in a modular format for consultation. Conclusions This format is intended to serve as a tool to promote appropriateness in PROs adoption while investigating PFDs in Italian patients.

Background: Up to 80% of women are affected by a perineal laceration after their first vaginal birth. An estimated 40–50% of lacerations involve the perineal muscles, and up to 7% are obstetric anal sphincter injuries (OASI). There is a lack of knowledge about the extent of short-term complications such as pelvic floor dysfunction (PFD) following spontaneous or iatrogenic pelvic floor trauma. Women’s experiences of daily life after childbirth complicated by OASI is poorly understood. Three-dimensional endoanal ultrasonography (3D-EAUS) is a welldocumented method for evaluating damage to the anal sphincter in other contexts. Adding ultrasonography to standard clinical examination has revealed injuries previously missed, and research evaluating diagnostic methods for the routine screening of OASI has been called for. Aim: This thesis aims to evaluate the diagnostics of OASI, determine if the degree of perineal injury or anal sphincter defects after childbirth are associated with pelvic dysfunction, and explore women’s experiences of OASI.Methods Studies I and IV were prospective cohort-studies to evaluate any association between perineal tear or sphincter defect to PFD. Study II was an interview study addressing women’s experiences of OASI by qualitative content analysis. Study III was a cross-sectional study designed to examine the utility of endoanal ultrasound to detect OASI. Participants were clinically examined after birth and 3D-EAUS was performed immediately after giving birth and 3 months postpartum. PFD was evaluated using a web-based questionnaire one year after delivery. Results: A total of 511 women completed the one-year questionnaire (Study I) and a purposive sample of 11 women were invited to take part in Study II. In Study III, 680 women underwent a clinical examination and 3D-EAUS recording immediately after birth. In Study IV, 239 women who attended all follow-ups were included. PFD was experienced by women with a perineal laceration of any grade, but also those with an intact perineum. Dyspareunia and urinary incontinence were the most common problems. Women with OASI had a higher risk for developing vi symptoms of prolapse, urinary urge incontinence, dyspareunia, and pain as well as experiencing a negative impact on their daily life. Elements that negatively influenced women’s experiences of OASI were pain and symptoms of PFD, normalisation of symptoms by healthcare providers, and unrealistic expectations about this period in life. 3D-EAUS immediately after delivery had poor sensitivity and specificity in detecting clinically diagnosed OASI. Postpartum anal sphincter defects were associated with genital pain and dyspareunia. Conclusions: OASI is an evident risk factor for pelvic floor dysfunction after childbirth, but symptoms of pelvic floor disorder were found to be common, even in women with mild to moderate perineal laceration. OASI has a negative impact on how a woman experiences relationships, social contact, and sexuality. Using 3D-EAUS in a maternity ward to diagnose OASI is demanding. Staff generally have little experience in 3D-EAUS. There are also difficulties in obtaining good image quality, due to local oedema, bleeding, positioning of the woman, and unintentional movements. These factors all complicate the interpretation of images.

Introduction Functional gastrointestinal disorders (FGID) including impaired rectal evacuation are common in patients with Hypermobility Spectrum Disorder (HSD) or Hypermobile Ehlers-Danlos Syndrome (hEDS). The effect of connective tissue pathologies on pelvic floor function in HSD/hEDS remains unclear. We aimed to compare clinical characteristics and anorectal pressure profile in patients with HSD/hEDS to those of age and sex matched controls. Methods We conducted a retrospective review of all FGID patients who underwent high resolution anorectal manometry (HR-ARM) and balloon expulsion test (BET) for evaluation of impaired rectal evacuation. Patients with HSD/hEDS were age and sex matched to a randomly selected cohort of control patients without HSD/hEDS. An abnormal BET was defined as the inability to expel a rectal balloon within 2 minutes. Wilcoxon rank sum test and Fisher’s exact test were used to make comparisons and logistic regression model for predictive factors for abnormal evacuation. Results A total of 144 patients (72 with HSD/hEDS and 72 controls) were analyzed. HSD/hEDS patients were more likely to be Caucasian (p p p Conclusions These results suggest anorectal pressure profile is not compromised by connective tissue pathologies in HSD patients. Whether concurrent psychosomatic disorders or musculoskeletal involvement impact the pelvic floor function in these patients needs further investigation.

Overactive bladder (OAB) is prevalent in older adults in whom management is complicated by comorbidities and greater vulnerability to the cognitive effects of antimuscarinic medications.The aim of this study is to provide a comprehensive evidence-based summary of the 2021 State-of-the-Science (SOS) conference and a multidisciplinary expert literature review on OAB and cognitive impairment.The American Urogynecologic Society and the Pelvic Floor Disorders Research Foundation convened a 3-day collaborative conference. Experts from multidisciplinary fields examined cognitive function, higher neural control of the OAB patient, risk factors for cognitive impairment in older patients, cognitive effects of antimuscarinic medications for OAB treatment, OAB phenotyping, conservative and advanced OAB therapies, and the need for a multidisciplinary approach to person-centered treatment. Translational topics included the blood-brain barrier, purine metabolome, mechanotransduction, and gene therapy for OAB targets.Research surrounding OAB treatment efficacy in cognitively impaired individuals is limited. Short- and long-term outcomes regarding antimuscarinic effects on cognition are mixed; however, greater anticholinergic burden and duration of use influence risk. Oxybutynin is most consistently associated with negative cognitive effects in short-term, prospective studies. Although data are limited, beta-adrenergic agonists do not appear to confer the same cognitive risk.The 2021 SOS summary report provides a comprehensive review of the fundamental, translational, and clinical research on OAB with emphasis on cognitive impairment risks to antimuscarinic medications. Duration of use and antimuscarinic type, specifically oxybutynin when examining OAB treatments, appears to have the most cognitive impact; however, conclusions are limited by the primarily cognitively intact population studied. Given current evidence, it appears prudent to minimize anticholinergic burden by emphasizing nonantimuscarinic therapeutic regimens in the older population and/or those with cognitive impairment.

Relat?rio de Est?gio de Natureza Profissional no ?mbito do Mestrado em Enfermagem de Reabilita??o apresentada na Escola Superior de Sa?de do Instituto Polit?cnico de Viana do Castelo Resultante da evolu??o sociodemogr?fica das popula??es, a import?ncia atribu?da ? sa?de e ? qualidade de vida conduz a um conjunto de necessidades de cuidados identificados e de respostas diferenciadas em cuidados de sa?de. A mulher, durante o seu ciclo vital, tem oportunidade de viver o processo de gerar uma nova vida. Desta fase, incorrem altera??es importantes em todos os seus sistemas, que carecem do devido acompanhamento de forma a reprogramar as estruturas envolvidas e maximizar fun??es e qualidade de vida. O Enfermeiro Especialista em Enfermagem de Reabilita??o (EEER) tem como foco da sua aten??o a pessoa com necessidades especiais, visa o diagn?stico e a interven??o precoce, a promo??o da qualidade de vida, a maximiza??o da funcionalidade e do autocuidado e a preven??o de complica??es evitando incapacidades ou minimizando as mesmas ao longo de todo o ciclo vital. Desta forma, a Enfermagem de Reabilita??o (ER) tem indubitavelmente um contributo a dar para a reabilita??o da mulher no p?s-parto. Este Est?gio de Natureza Profissional (ENP) visa o desenvolvimento de compet?ncias comuns e especificas do ?mbito da especialidade de Enfermagem de Reabilita??o, com o objetivo, major de desenvolver compet?ncias enquanto EEER em contexto comunit?rio, norteando-se pelo referencial te?rico de Alaf Meleis, a Teoria das Transi??es. Como componente de investiga??o foi desenvolvido um estudo cujos objetivos foram: Identificar os sintomas motores e sensitivos da musculatura abdominal e p?lvica das mulheres no p?s-parto; Implementar um programa de reeduca??o funcional motora e sensitiva na mulher no p?s-parto; Analisar os efeitos do programa de reeduca??o funcional motora e sensitiva na mulher no p?s-parto; Conhecer a perce??o das mulheres sobre os efeitos do programa de reabilita??o motora e sensitiva no p?s-parto. O estudo realizado ? um estudo misto, com abordagem qualitativa e quantitativa, de natureza explorat?ria e descritiva. Os instrumentos de recolha de dados foram o Question?rio de Caracteriza??o da Mulher, o International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) e a Entrevista Semi-Estruturada. A Amostra do estudo foi constitu?da por 7 mulheres no p?s-parto. A interven??o concretizou-se atrav?s da implementa??o de um programa de reabilita??o motora e sensitiva da musculatura abdominal e p?lvica, em grupo, numa sess?o semanal de 60 minutos, durante 8 semanas. Ap?s interven??o verificou-se que o programa de reabilita??o implementado contribuiu para a diminui??o da dor lombar e p?lvica, diminui??o da di?stase dos m?sculos retos abdominais, diminui??o das queixas relativas a incontin?ncia de esf?ncteres, aumento da for?a da musculatura perineal. No final do programa as mulheres demonstraram maior conhecimento e habilidade sobre os exerc?cios de reabilita??o da musculatura abdominal e p?lvica, revelaram perce??o de maior for?a, menos flacidez e menor dor comparativamente ao in?cio do programa, manifestaram sentimentos de surpresa e satisfa??o assim como a import?ncia do apoio profissional. Resulting from the sociodemographic evolution of populations, the importance attributed to health and quality of life leads to a set of identified care needs and differentiated responses in health care. The woman, during her life cycle, has the opportunity to live the process of generating a new life. From this stage, important changes are made in all its systems, which lack proper monitoring in order to reprogram the structures involved and maximize functions and quality of life. The Specialist Nurse in Rehabilitation Nursing (EEER) focuses his attention on the person with special needs, aims at early diagnosis and intervention, promoting quality of life, maximizing functionality and self-care and preventing complications by avoiding disabilities or minimizing them throughout the life cycle. In this way, Rehabilitation Nursing (RE) undoubtedly has a contribution to make to the rehabilitation of women in the postpartum period. This Internship of a Professional Nature (ENP) aims at the development of common and specific competences within the scope of the Rehabilitation Nursing specialty, with the main objective of developing competences as an EEER in a community context, guided by the theoretical framework of Alaf Meleis, the Transition Theory. As an investigation component, a study was developed whose objectives were: To identify the motor and sensory symptoms of the abdominal and pelvic muscles of women in the postpartum period; Implement a motor and sensory functional reeducation program for postpartum women; To analyze the effects of the motor and sensory functional reeducation program on postpartum women; To know the perception of women about the effects of the motor and sensory rehabilitation program in the postpartum period. The study carried out is a mixed study, with a qualitative and quantitative approach, of an exploratory and descriptive nature. The data collection instruments were the Woman Characterization Questionnaire, the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) and the Semi-Structured Interview. The study sample consisted of 7 postpartum women. The intervention took place through the implementation of a program of motor and sensory rehabilitation of the abdominal and pelvic muscles, in a group, in a weekly session of 60 minutes, for 8 weeks. After the intervention, it was found that the rehabilitation program implemented contributed to the reduction of low back and pelvic pain, decreased diastasis of the rectus abdominis muscles, decreased complaints related to sphincter incontinence, increased perineal muscle strength. At the end of the program, the women showed greater knowledge and skill about the abdominal and pelvic muscle rehabilitation exercises, revealed a perception of greater strength, less flaccidity and less pain compared to the beginning of the program, expressed feelings of surprise and satisfaction as well as the importance of professional support.

Pelvic floor disorders (PFDs) include a series of conditions that can be poorly tolerated, negatively affecting the quality of life. Current treatment options show unsatisfactory results and new ones are therefore needed. Stem cell (SC) therapy might be an alternative treatment strategy. This systematic review aims to define the state of art of SC therapy for PFDs in clinical trials, by systematically reviewing the available evidence. A systematic search strategy was conducted up to November 7, 2020, in PubMed, Scopus, Cochrane Library, and ISI Web of Science. Preclinical studies on animal models were not considered. Studies were included when the patients were affected by any PFDs and cells were isolated, cultured, and characterized as SC. The study protocol was registered in PROSPERO (CRD42020216551). A total of 11 prospective clinical studies were included in the final assessment, specifically 7 single-arm studies dealing with SC therapy for stress urinary incontinence and 4 with anal incontinence. Among the latter, there were two prospective, single-arm studies and two randomized controlled trials. No papers concerning the use of SC for prolapse repair were retrieved. Due to the great heterogeneity, data pooling was not possible. Stem cell injection resulted in a safe procedure, with few mild adverse side effects, mostly related to harvesting sites. However, a clear beneficial impact of SC treatment for the treatment of pelvic floor disorders could not be demonstrated. Further larger targeted studies with control arms are needed before any conclusions can be made.

The Pelvic Floor Disorders Consortium (PFDC) is a multidisciplinary organization of colorectal surgeons, urogynecologists, urologists, gynecologists, gastroenterologists, radiologists, physiotherap...

Objectives There does not currently exist a complication scale to evaluate pelvic reconstructive surgery (PRS) that takes in account patient-centered outcomes. The purpose of this study was to characterize and compare patient and surgeon responses to a simplified, patient-centered version of the previously described Pelvic Floor Complication Scale (PFCS). Methods This is a multicenter (4 female pelvic medicine and reconstructive surgery practices) cross-sectional study of patients and surgeons. Using focus groups and telephone surveys, the original PFCS questionnaire was simplified. One hundred and twenty-four patients were recruited 6-12 months after PRS. Fifty-seven surgeons were recruited via electronic questionnaires. Surgeons and patients were asked to rank the severity and bother of each complication on a scale of 0 to 5 (0, none; 1, mild; 3, moderate; 5, major). Results Patients rated bother higher than severity for 36 of 38 complications (all differences ≤0.5 points). For statistical analysis, the highest response to patient bother/severity was chosen to weigh in favor of the patient. Patient bother/severity scores were significantly different (±0.5 points) for 27 of 38 complications compared with surgeon responses. Surgeon scores were higher for 5 complications (0.5-1.9 point differences) related to major injury requiring repair and wound breakdown. Patient scores were higher for 22 complications with the highest differences related to dyspareunia, constipation, or new/persistent urinary incontinence. Conclusions This mixed methods investigation revealed key differences between how patients and surgeons value PRS complications. Surgeons scored major surgical injuries higher than patients, whereas patients rated issues that many surgeons consider quality-of-life outcomes higher due to potential long-term bother. These data will be used to create a simplified, patient-centered PFCS.

PURPOSE OF REVIEW Pelvic floor disorders are common among gynecologic cancer survivors. With improvements in survivorship, quality of life conditions in these women need greater attention and care. This review focuses specifically on vulvovaginal symptoms, which are common and have a negative impact on sexual health and quality of life in women affected by gynecologic cancer. RECENT FINDINGS We review publications on treatment-specific sexual health outcomes, screening and treatment of vulvovaginal symptoms and sexual pain, and surgical management options. Recent evidence regarding the safety of concomitant prolapse repair at the time of surgery for gynecologic malignancies and CO2 laser therapy is discussed and areas needing further research and innovation are highlighted. SUMMARY Pelvic floor disorders, including vaginal and sexual health concerns, are common in women affected by gynecologic cancer due to both common risk factors and as a side effects of cancer treatment. Gynecologists play a critical role in screening, treatment, and collaboration with other specialists to provide comprehensive care for these women throughout their lifetime.

Among the various risk factors of pelvic floor disorders, pregnancy has been reported to affect the pelvic floor structure; however, not all these effects have been understood yet. The aim of this study is to elucidate how pregnancy affects pelvic floor structure via magnetic resonance imaging (MRI).We conducted a retrospective study between January 2010 and December 2019 to extract clinical records of pregnant and non-pregnant women, who underwent MRI for obstetrical diseases and ovarian benign tumors, respectively. The data on age, body mass index (BMI), complications, gravida, parity, gestational age, and obstetrical history were collected, and pubo-coccygeal line (PCL), pubo-rectal line (PRL), and M line (ML) on their MR images were measured. Statistical analyses were performed with Wilcoxon test, chi-square test, and Kruskal-Wallis test with Steel-Dwass post hoc test as appropriate. Statistical significance was set at P 0.05.We analyzed the reports of 56 (pregnancy group) and 106 women (non-pregnancy group). There was no significant difference in age or BMI, while the obstetric history was significantly different between these groups. Median PCL, PRL, and ML in the pregnancy group were significantly longer than those in the non-pregnancy group (114.1 mm vs. 110.0 mm, P = 0.018; 48.6 mm vs. 41.6 mm, P0.0001 and 21.7 mm vs. 10.0 mm, p0.0001. respectively). The subgroup analysis of the effect of pregnancy and vaginal delivery (VD) history on changes in these lines revealed that pregnancy-induced PRL increase tended to recover to the reference level of "non-pregnant without VD," but ML increase did not fully recover.MRI revealed a strong effect of pregnancy on pelvic floor structure.

This article discusses various pelvic floor ultrasonographic modalities and the clinical applications of ultrasonography of the pelvic floor. Ultrasonography provides a detailed anatomic assessment of the muscles and surrounding organs of the pelvic floor. Different anatomic variabilities and pathologic conditions, such as prolapse, fecal incontinence, urinary symptoms, vaginal wall cysts, synthetic implanted material, and pelvic pain, are assessed with pelvic floor ultrasonography. This imaging modality is an important adjunct to the evaluation and diagnosis of pelvic floor disorders.

There is a lack of high-quality long-term follow-up regarding pessary treatment. Most studies are case series or retrospective with a small sample size and short-term follow-up.This study aimed to evaluate differences in women who continue versus discontinue pessary use and the effectiveness, quality of life, and safety associated with pessary management at 1 year.This study analyzed a multicenter national registry following women for 3 years with vaginal prolapse treated with a pessary or surgery. The primary outcome of this analysis was to compare the difference in characteristics among those who continue versus discontinue pessary use at 12 months.Among 1,153 participants enrolled, 376 (32.6%) opted for a pessary, and 296 (78.7%) were successfully fitted. Data were available for 240 participants (81%). At 1 year, 62% (n = 148) were still using pessaries, and 38% (n = 92) had stopped with 25% opting for surgery. Most commonly reported de novo adverse effects were urinary leakage (16%), feeling or seeing a bulge (12%), and vaginal discharge (11%). There was no difference in baseline characteristics among women who continued versus discontinued pessary use. At 12 months, subjective symptoms were similar between groups, with similar change in symptoms from baseline on most validated instruments. Those who continued to use a pessary reported worse urinary symptoms due to de novo urinary leakage ( P = 0.01).At 1 year, most women successfully fitted with a pessary continued pessary use. Although there was a significant improvement in condition-specific quality of life and low rates of complications, approximately 40% of women discontinued pessary use by 12 months. We were unable to identify any baseline characteristics associated with pessary discontinuation.

Patient-reported outcome (PRO) instruments measure the patient's perspective. It is unclear whether commonly used PRO measures were tested in populations that had racial and ethnic distributions comparable with those reported in U.S. census data.The aim of this study was to compare the proportion of non-White race and Hispanic ethnicity participants with their expected proportion based on U.S. census data for PRO instruments with U.S.-based validation studies.This was a retrospective review of PRO measures considered by the Pelvic Floors Disorders Consortium Working Group on Patient-Reported Outcomes in their 2020 consensus publication. Study and participant information were abstracted from PRO validation studies. Racial and ethnic representation in U.S.-based studies were compared with U.S. census data. The primary outcome was the representation quotient of reported races and ethnicities, calculated as the reported percentage of the study population identifying with a race and/or ethnicity divided by the proportion of the U.S. population identifying with that race and/or ethnicity when the study was published.Forty-five studies with 21,080 total participants were included. Race was reported in 17 of 45 studies (37.8%), and ethnicity was reported in 7 of 45 (15.6%). Most studies did not specify how race and ethnicity information was collected. For U.S.-based studies, the representation quotient of White participants from 1995 to 2019 was 1.15. Indigenous American/Native American/American Indian/Alaska Natives had the lowest representation quotient (0.22). Reporting of ethnicity increased over time (P = 0.001), although there was no significant change in the reporting of race or the representation of various races and ethnicities (P0.05).Non-White and Hispanic patients may be underrepresented in U.S.-based validation studies for PRO instruments in pelvic floor disorders.

Background: The terminology of urinary incontinence (UI) and pelvic floor dysfunctions is complex. It affects quality of life and daily activities in personal, social, and professional fields. Managing UI without pharmacologic therapies is effective with a low risk of adverse effects and a large benefit for increasing continence rates. The aim of this preliminary retrospective observational study is to evaluate the effectiveness of the association between manual therapy and focused mechano-acoustic vibrations in women with nonspecific UI. Materials and methods: A group of 15 incontinent women (mean age 59.5 ± 11.4), referred to the Physiotherapy Center, Rehabilitation and Re-education (Ce.Fi.R.R.), located at the University “Gabriele d’Annunzio” of Chieti-Pescara from January 2019 December 2021, were enrolled after medical examination. The women were evaluated at T0 (admission protocol), T1 (after 8 weeks), and T2 (after 12 weeks). All patients received the rehabilitation protocol twice a week for a total of 8 weeks (T1) and were reevaluated after 12 weeks (T2). Outcome measures were: the Pelvic Floor Disability Index, the Pelvic Floor Impact Questionnaire-7, and the MyotonPRO. Results: The analysis of MyotonPRO data showed no significant improvements in all parameters. The PFDI-20 and PFIQ-7 questionnaire results showed a significant reduction in scores between T0 and T2.Results over time of the ANOVA values confirming the significant differences in the PFDI-20 and PFIQ-7 questionnaire results but not in the MyotonPRO variables. Conclusions: Despite limitations and no significant results, this study demonstrated that the integration of manual and focused mechano-acoustic vibrations therapy improved the symptoms of UI and reduced its psychosocial impact. Further experience could be required to establish the place of this integrated approach in achieving long-term improvements in UI.

The objective was to evaluate the agreement between 2D and 4D translabial ultrasound (TLUS) technique in showing levator ani muscle (LAM) states after vaginal birth.In a prospective observational cohort study between March 2017 and April 2019 we evaluated LAM states (intact, hematoma, partial, complete avulsion) of primiparous women having given birth vaginally with singletons in vertex presentation ≥ 36+0 gestational weeks by using 2D and 4D TLUS within 1-4 days postpartum (assessment A1) and again 6-10 weeks postpartum (assessment A2). Cohen's Kappa analysis was performed for each side separately to evaluate the test agreement between the two ultrasound techniques at every assessment period.A total of 224 women participated at A1 and 213 at A2. The agreement between the two ultrasound techniques was good to very good at A1 (Cohen`s kappa right-sided 0.78, left-sided 0.82) and very good at A2 (Cohen`s kappa both sides 0.88). The agreement was best when assessing an intact LAM or a complete avulsion (Cohen`s kappa between 0.78-0.92 for complete avulsions).The comparison between 2D and 4D TLUS showed a good to very good agreement in LAM trauma immediately after birth as well as 6-10 weeks postpartum. Therefore, 2D ultrasound could also be a valuable method for demonstrating a LAM abnormality and could be used in settings where 3D/4D ultrasound equipment is not available.

Pelvic Floor Dysfunctions (PFDs) are a group of disorders characterized by inter-related symptoms of urology, gynaecology, colorectal or general pelvic pain. These mainly cause voiding or defecation disorders, pelvic organ prolapses, sexual dysfunctions and pelvic pain. PFDs adversely impact various domains of women's life including psychological, physical, social and sexual well-being. Pelvic Floor Rehabilitation (PFR) has been recommended as part of a multidisciplinary approach for evaluation and management of the multiple PFDs. The assessment of PFD has improved with utilization of new measurement tools and specific outcome measures for PFDs. PFR is a first-line treatment approach effective for PFDs. However, robust research is needed to test standardised assessment and physical therapy treatment protocols with long term efficacy. In this review, we discuss a range of PFDs, impairment-based classification, recent updates, and advances in the evaluation of PFDs, physical therapy tools and techniques for the treatment of PFDs.

Introduction Urinary incontinence (UI), fecal inconti-nence (FI), and genito-pelvic pain or penetration disorder (GPPPD) are considered pelvic floor dysfunction (PFD), and are mainly characterized by poor functionality of the pelvic floor muscles. Despite the relevance of these dysfunctions in women's lives, the demand for care is low. Objective To analyze the prevalence of PFD, in university women, and factors associated with PFD. Methods This is a cross-sectional study conducted at São Paulo State University, Marília, SP, Brazil, with undergraduate and/or postgraduate women aged over 18 years. An online questionnaire containing 40 open and multiple-choice questions about PFD was developed by the authors and a Google form was disclosed via social media (Facebook, Instagram) to the participants. The questionnaire was applied between April and July 2020. Results A sample of 707 participants was included. The average age was 22.5 ± 21.0 years old. The most prevalent PFD was GPPPD, reported by 30.7% of women, followed by UI (16.8%) and FI (3.2%). PFD was significant less reported in the Midwest region compared to other regions (p = 0.015) and significantly more prevalent in women who attended public university (p = 0.038), in women with UI, FI, and GPPPD. The association-test showed that attending public university showed association to UI (p < 0.001), FI (p = 0.008) and GPPPD (p = 0.006). In addition, parity showed association with GPPD (p = 0.032) and to attend health courses with UI (p = 0.002). Conclusion PFD is prevalent among university women and GPPPD was the most recurrent, followed by UI and FI. GPPPD was associated with parity and attending a public university. UI was associated with attending public university and health courses. FI was associated with attending a public university. Resumo Introdução A incontinência urinária (IU), a incontinência fecal (IF) e a dor genitopélvica ou distúrbio de penetração (DGDP) são considerados disfunções do assoalho pélvico (DAP) e caracterizam-se principalmente pela má funcionalidade dos músculos do assoalho pélvico. Apesar da relevância dessas disfunções na vida das mulheres, a demanda por atendimento é baixa. Objetivo Analisar a prevalência das DAP em mulheres universitárias e fatores associados à DAP. Métodos Trata-se de um estudo transversal realizado na Universidade Estadual Paulista, Marília, SP, Brasil, com graduandas e/ou pós-graduandas maiores de 18 anos. Um questionário online contendo 40 questões abertas e de múltipla escolha sobre DAP foi desenvolvido pelos autores e um formulário do Google foi divulgado via mídia social (Facebook, Instagram) às participantes. O questionário foi aplicado entre abril e julho de 2020. Resultados Uma amostra de 707 participantes foi incluída. A média de idade foi de 22,5 ± 21 anos. A disfunção mais prevalente foi a DGDP, relatada por 30,7% das mulheres, seguida por IU (16,8%) e IF (3,2%). As características gerais não diferiram entre os grupos, mas no geral as disfunções foram significativamente menos relatadas na região Centro-Oeste em comparação com outras regiões (p = 0,015) e significativamente mais prevalente em mulheres que frequentaram universidade pública (p = 0,038) e em mulheres com IU, IF e DGDP. O teste de associação não demonstrou associação entre as disfunções e etnia, índice de massa corporal ou tipo de assistência à saúde. Além disso, frequentar universidade pública apresentou associação com IU (p < 0,001), IF (p= 0,008) e DGDP (p = 0,006). Além disso, a paridade mostrou-se associada à DGDP (p = 0,032) e frequentar cursos de saúde com IU (p = 0,002). Conclusão A disfunção do assoalho pélvico é prevalente entre as universitárias e a DGDP foi a mais recorrente, seguida de IU e IF. DGDP foi associado à paridade e a frequentar universidade pública. IU foi associada a frequentar universidade pública e a cursos da área da saúde. IF foi associada a frequentar universidade pública.

Introduction: Sexual health is an important area of women's health, comprising aspects that can be affected by stressors, such as in the COVID-19 pandemic scenario. Objective: To investigate genital self-image, sexual function and pelvic floor discomfort in young female university students during the COVID-19 pandemic, comparing these factors with their sexual activity. Methods: This study is a quantitative and cross-sectional survey of young female university students during the COVID-19 pandemic period, carried out through an online form. To assess the variables, the Female Sexual Function Index, Pelvic Floor Distress Inventory, and Female Genital Self-Image Scale were used. Results: 182 women participated in the study, and the general mean age was 22.06 ± 2.75 years. Sexually active women (n = 128) had significantly better genital self-image compared to inactive women (22.87 ± 2.92 vs. 20.85 ± 4.41; p = 0.004). Likewise, better genital self-image was also observed in women without sexual dysfunction (23.36 ± 2.72 vs. 21.11 ± 2.96; p < 0.001) and in those who reported fewer symptoms of pelvic floor discomfort (p = 0.014). Conclusion: A positive genital self-image was associated with fewer sexual dysfunctions, better sexual function, and fewer symptoms of pelvic floor discomfort. Furthermore, sexual activity is associated with a better genital self-image. Resumo Introdução: A saúde sexual é uma área importante da saúde da mulher, compreendendo aspectos que podem ser afetados por estressores, como no cenário de pandemia da COVID-19. Objetivo: Investigar a autoimagem genital, função sexual e desconforto do assoalho pélvico em jovens universitárias durante a pandemia de COVID-19, comparando esses fatores com sua atividade sexual. Métodos: Este estudo é uma pesquisa quantitativa e transversal com jovens universitárias durante o período da pandemia de COVID-19, realizada por meio de formulário online. Para avaliar as variáveis, foram utilizados o Índice de Função Sexual Feminina, Inventário de Desconforto do Assoalho Pélvico e Escala de Autoimagem Genital Feminina. Resultados: Participaram do estudo 182 mulheres, com média de idade de 22,06 ± 2,75 anos. Mulheres sexualmente ativas (n = 128) apresentaram autoimagem genital significativamente melhor em comparação às mulheres inativas (22,87 ± 2,92 vs. 20,85 ± 4,41; p = 0,004). Da mesma forma, melhor autoimagem genital também foi observada em mulheres sem disfunção sexual (23,36 ± 2,72 vs. 21,11 ± 2,96; p < 0,001) e naquelas que relataram menos sintomas de desconforto do assoalho pélvico (p = 0,014). Conclusão: Uma autoimagem genital positiva foi associada a menos disfunções sexuais, melhor função sexual e menos sintomas de desconforto do assoalho pélvico. Além disso, a atividade sexual está associada a uma melhor autoimagem genital.