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.

archives@tulane.edu / Pelvic organ prolapse (POP) is characterized by the descent of the pelvic organs due to the loss of pelvic support. The underlying mechanism leading to POP is unknown. However, age is a known risk factor for POP, and location and microstructural composition are both associated with prolapse. How the passive biaxial mechanical properties of the vagina change with age as well as between the anterior and posterior vaginal wall are not well-established. Additionally, the extent to which elastic fiber content disruption contributes to prolapse is unknown. The objective of this study was to elucidate the mechanical properties of the murine vagina as a function of age, location, and elastic fiber composition. A planar biaxial mechanical testing protocol evaluated mechanical properties of vaginal tissue from three age groups and the anterior and posterior vaginal walls. Additionally, histological analysis and opening angle measurements were performed on normal and elastase-treated tissues to determine the effect of elastic fiber disruption on mechanical function. Evaluation of mechanical changes within individual age groups showed that material stiffness was higher in the axial direction compared to the circumferential direction within the youngest age group but not in the older age groups. This may suggest that microstructural remodeling occurred that resulted in a comparable stiffness in both directions, thus, reducing the physiologic anisotropy of the tissue. As anisotropy is important for vaginal mechanohomeostasis, a disruption of this homeostasis may contribute to the increased prevalence of prolapse with age. Further, the posterior vaginal wall demonstrated a greater material stiffness compared to the anterior wall. However, prior worked suggests that increased stiffness is associated with prolapse and that anterior prolapse is more prevalent than posterior prolapse. Regional microstructural differences may be responsible for this disparity in material stiffness and may explain the increased susceptibility of the anterior vaginal wall to prolapse. Finally, elastin area fraction and mechanical function displayed a positive correlation suggesting that elastic fiber disruption directly affects mechanical properties. The data presented may improve clinical efficacy in POP treatment by elucidating relationships between POP risk factors and mechanical properties of the vagina. / 1 / Rachel Russell

Feci quod potui: Fa ciant meliora potentes ( I did what I could, allow others to do better) Inscriptions on graduation dissertations in old Russia.This work began with a search for the pubo-recto-analis muscle at the instigation of Professor J.H. Louw. Requests followed from surgeons and urologists for information about, and demonstration of, structure related to the pelvic floor in infants and adults, these encouraged me to go more and more deeply into the anatomy of this region in Man. I found that welding of viscera to their fascial,muscular and bony environs is not described in current textbooks. The absence of clear-cut boundaries between some of the muscles, in areas where they are contiguous,is likewise never emphasised. The beautiful drawings in atlases and textbooks have a comforting way of reassuring us that all has been revealed about the pelvic floor and its viscera. However, when the time-consuming expedient of removing the superior fascia of the levator had already yielded dividends,in that failure to do this, had led generations of anatomists to misrepresent the commonest form of the origin of the pubo-coccygeus, it seemed worthwhile to pursue the fascia,muscles and terminal viscera and their nerves, in order to fully understand their complex interwoven relationships. The unusual electrical activity of the musculature was especially intriguing and demanded an explanation. My findings,many of which fully corroborate the findings of others, led me to a consideration of the factors which combine to produce the remarkably efficient functioning of intestinal and genito-urinary outlet mechanisms. It then appeared essential to adopt a correlative approach. Accordingly I have aimed to present a selective account of the soft tissues of the pelvis and perineum which is comprehensive and I hope useful. From it certain aspects,which appear of primary importance,should emerge clearly.

OBJECTIVES: This study aims to explore the relationship between central pain amplification and persistent pelvic pain. No previous studies have utilized bimanual pelvic examination findings, in addition to pressure-pain analysis, in an effort to investigate the mechanisms contributing to Chronic Pelvic Pain (CPP) in women with endometriosis. METHODS: Participants included 144 women aged 18-50 years old, diagnosed with CPP and/or surgically-confirmed endometriosis compared to healthy controls. Participants were categorized into four groups, including pain-free endometriosis (Endo Ø Pain), painful endometriosis (Endo + Pain), Chronic Pelvic Pain without endometriosis (CPP Ø Endo), and healthy controls. Pressure-pain Quantitative Sensory Testing (QST) was conducted on all participants to determine levels of pain thresholds. External systemic tenderpoints were assessed utilizing standardized fibromyalgia tenderpoint criteria. A pelvic examination was performed on participants in the gynecological sample in order to assess internal tenderness. One-way ANOVA, chi-square analyses were conducted to assess descriptive variables. Correlation calculations were performed to assess the relationship between pressure-pain thresholds and tenderpoints. Generalized Linear Models (GLM) were conducted to analyze the differences on pressure-pain thresholds and pelvic exam tenderpoints between groups, while controlling for age and number of comorbid chronic pain syndromes (CPS). RESULTS: Endo Ø Pain had a significantly higher stage of endometriosis and were significantly older than the Endo + Pain group. Healthy controls had less external systemic tenderpoints than all patient subgroups. CPP Ø Endo and Endo + Pain had more CPS than healthy controls and Endo Ø Pain. Pelvic exam tenderpoints (r= -0.31, p < 0.01) and systemic external tenderpoints (r = -0.35, p <0.01) were negatively correlated with low pressure-pain threshold. Systemic external tenderpoints were negatively correlated with the high pressure staircase (r= -0.41, p < 0.01), but pelvic exam tenderpoints were not. The GLMs conducted revealed that Endo Ø Pain had significantly higher low pressure-pain threshold compared to both Endo + Pain (difference = 0.57, p < 0.01, CI= 0.12, 1.02) and healthy controls (difference = 0.55, p < 0.05, CI= 0.08, 1.02). The CPP Ø Endo group had significantly lower high pressure-pain threshold scores compared to healthy controls (difference = 0.38, p < 0.05, CI= 0.05, 0.71). The Endo + Pain group also had significantly lower high-pain thresholds as compared to healthy controls (difference= 0.31, p < 0.05, CI= 0.04, 0.58). CPP Ø Endo group had significantly more pelvic tenderpoints compared to Endo Ø Pain (difference = 2.81, p < 0.001, CI = 1.36, 4.27); Endo + Pain group also had significantly more pelvic exam tenderpoints than the Endo Ø Pain (difference= 2.10, p < 0.001, CI = 0.96, 3.24). CONCLUSIONS: The findings of this study suggest that pain thresholds, as measured by QST pressure-pain testing, are associated with persistent pelvic pain. CPP Ø Endo and Endo + Pain experienced more systemic tenderness, and more CPS than the Endo Ø Pain group and healthy controls. This indicates that chronic pain, not endometrial lesions, are likely responsible for the development of centralized pain amplification. Although the etiology of endometriosis and CPP is poorly understood, the findings of this study contribute to the idea that central sensitization is associated with the shared underlying pain mechanism in chronic pain syndromes. / 2020-07-03T00:00:00Z

Indiana University-Purdue University Indianapolis (IUPUI) / Women describe pelvic organ prolapse (POP) surgery as difficult to recover from. Expectancy is related to recovery in other surgeries but has not been examined in POP. There is no established measure of surgery expectancy or utility in women with POP. This research had four aims: 1) to establish the factor structure of a new measure of POP surgery expectancy; 2) to establish predictive validity of the expectancy measure by examining its ability to predict self-rated recovery over time; 3) to establish concurrent validity of the expectancy measure; and 4) to examine the ability of utility to predict additional variance in recovery. Exploratory factor analysis revealed a three-factor solution. Factors are conceptualized as: 1) Bladder/Bowel Function; 2) Sexual Function; and 3) Physical Function. Bladder/Bowel Function correlated with optimism and self-efficacy (r = .17, p = .03 and r = .27, p = .00, respectively). Physical Function was predictive of recovery at 42 days (standardized coefficient = .25; p < .05). However, these factors were generally poor and inconsistent predictors of recovery. Utility did not predict additional variance in recovery. Potential explanations for the poor predictive ability of the measure are discussed. The development of a measure that amends these limitations may still be beneficial. Further, exploring and establishing the relationship between surgery expectancy, utility, and recovery may guide physician-patient discussions and lead to improved surgical outcomes.

No / This paper presents the main findings of a systematic literature review that was undertaken to investigate whether physiotherapist-guided exercise is effective in reducing the severity of pregnancy-related pelvic girdle pain (PPGP). Seven electronic databases were systematically searched. Studies that met the inclusion criteria were assessed for methodological quality and internal validity. Five primary randomized controlled trials (RCTs) and one post-partum follow-up study were included in the review. The authors of all six studies incorporated advice and physiotherapist-guided exercise, either in a group setting or as part of an individualized exercise programme, into at least one of their intervention groups, with or without the addition of a pelvic support belt, acupuncture or other physiotherapy treatment modality. Two of the primary RCTs found that exercise and advice effectively reduced pre-partum PPGP. One study concluded that exercise had no additional value beyond simply supplying a pelvic support belt and advice. The results of another trial supported the use of physiotherapist-guided stabilization exercises for the treatment of post-partum PPGP. Yet another study did not find any differences between the intervention groups involved. The works included in this review all reported that PPGP reduced over time, regardless of the intervention used to treat it, suggesting that the greatest factor influencing the resolution of PPGP is time rather than exercise. The findings do not support the routine use of physiotherapist-guided exercise in the treatment of all women with PPGP. Advice, information and a non-elastic pelvic support belt should be offered to women with pre-partum PPGP, whereas patients with persistent symptoms of post-partum PPGP should receive individualized physiotherapist-guided exercise aimed at stabilizing the pelvic area as part of a wider package of physiotherapy treatment.

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.

published_or_final_version / Medicine / Master / Doctor of Medicine

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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