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Medicina (Kaunas, Lithuania) Dec 2023Pelvic floor muscle training (PFMT) represent the first-line approach to pelvic floor dysfunctions (PFDs). Recently, studies have shown a synergy between the pelvic...
Pelvic floor muscle training (PFMT) represent the first-line approach to pelvic floor dysfunctions (PFDs). Recently, studies have shown a synergy between the pelvic floor and abdominal muscles, hypothesizing that the anatomical and functional integrity of the abdominal wall plays a role in the prevention of pelvic floor disorders. Some studies have shown a significant correlation between diastasis recti abdominis (DRA) and stress urinary incontinence (SUI). Nevertheless, the evidence reported in the literature is controversial and based on low-quality data. The aim of the study is to clarify whether DRA-specific abdominal rehabilitation is needed in women with SUI after childbirth. All consecutive women who had at least one delivery and complained of symptoms of pure SUI that were urodynamically proven were considered for the study. The group of symptomatic patients was compared with a series of consecutive women, identified during the same study period, without any symptoms of SUI. In both groups, we measured the inter-rectal distance (IRD) with an ultrasound scanner above and below the navel. A total of 102 women eligible for the study group and 100 women who did not report any symptoms of SUI were enrolled. The inter-rectal distance above the umbilicus showed no significant difference between the two groups (2.12 ± 0.98 vs. 2.1 ± 0.77; = 0.94). In contrast, the data from the sub-umbilical measurements showed a significant difference. Surprisingly, the asymptomatic group showed significantly greater (0.98 ± 0.9 vs. 1.33 ± 0.87 -value: 0.009) IRD compared to the symptomatic group. The study shows that DRA is not a risk factor for SUI in women after childbirth. Therefore, specific abdominal wall rehabilitation after childbirth does not seem to be indicated.
Topics: Pregnancy; Humans; Female; Urinary Incontinence, Stress; Rectus Abdominis; Case-Control Studies; Pelvic Floor; Exercise Therapy
PubMed: 38138285
DOI: 10.3390/medicina59122182 -
BMC Women's Health Jan 2024Pelvic floor dysfunction (PFD) is an extremely widespread urogynecologic disorder, the prevalence of which increases with aging. PFD has severely affected women's...
BACKGROUND
Pelvic floor dysfunction (PFD) is an extremely widespread urogynecologic disorder, the prevalence of which increases with aging. PFD has severely affected women's quality of life and has been called a social cancer. While previous studies have identified risk factors such as vaginal delivery and obesity for PFD, other reproductive factors, including age at menarche (AAMA), have been largely overlooked. Therefore, we used a Mendelian randomization (MR) study for the first time to investigate the potential causal relationship between reproductive factors and PFD.
METHODS
We obtained summary statistics from genome-wide association studies (GWAS) for female genital prolapse (FGP), stress urinary incontinence (SUI), and five reproductive factors. Two-sample Mendelian randomization analysis (TSMR) was performed to explore the causal associations between these factors. The causal effects of reproductive factors on FGP and SUI were primarily estimated using the standard inverse variance weighting (IVW) method, with additional complementary and sensitivity analyses conducted using multiple approaches. A multivariate Mendelian randomization (MVMR) study was also conducted to adjust for pleiotropic effects and possible sources of selection bias and to identify independent exposure factors.
RESULTS
Our findings revealed that advanced age at first sexual intercourse (AFS) and age at first birth (AFB) exhibited negative causal effects on both FGP and SUI. AAMA showed negative causal effects solely on FGP, while age at last live birth (ALB) and age at menopause (AAMO) did not demonstrate any causal effect on either FGP or SUI. And the MVMR results showed that AFB and AFS had independent negative causal effects on FGP and SUI, respectively.
CONCLUSIONS
This study, for the first time, investigates the causal relationship between reproductive factors and PFD. The results suggested a causal relationship between some reproductive factors, such as AFB and AFS, and PFD, but there were significant differences between FGPand SUI. Therefore, future studies should explore the underlying mechanisms and develop preventive measures for reproductive factors to reduce the disease burden of PFD.
Topics: Female; Humans; Pelvic Floor Disorders; Quality of Life; Pelvic Floor; Genome-Wide Association Study; Mendelian Randomization Analysis; Urinary Incontinence, Stress
PubMed: 38281950
DOI: 10.1186/s12905-024-02914-6 -
Cureus Nov 2023Secretion retention, atelectasis, and reduced lung compliance occur when endotracheal or tracheostomised patients cough ineffectively. There is a possibility of... (Review)
Review
Secretion retention, atelectasis, and reduced lung compliance occur when endotracheal or tracheostomised patients cough ineffectively. There is a possibility of infection if the collapsed regions of the lungs are not reinflated. Therefore, to improve clinical outcomes, such as diaphragm mobility and thickness, lung volume, and thickness of the abdominal muscles, and decrease the length of hospitalizations, mechanical and manual techniques, such as balloon blowing exercises and incentive spirometer, are required. PubMed, Google Scholar, Pedro, Clinical Keys, Helinet, ProQuest, and Science Direct databases were used for the literature search considering the inclusion and exclusion criteria. The several manual and mechanical methods that were employed for lung expansion treatment for the potential populations are highlighted in this overview of the literature. Ten studies were considered in this review: five on balloon-blowing exercises, four on tracheostomy with incentive spirometry exercises, and one on incentive spirometry with balloon-blowing exercises. The effects were examined on individual outcomes that included rate of perceived exertion (RPE), diaphragm mobility, pulmonary function, volume of breath, length of hospitalization, and postoperative day complications. The structured protocols proved to be effective in improving lung expansion and pulmonary function for the potential population that involved healthy adults, noncritical COVID-19 adults, smokers, thoracotomy patients, and tracheostomised patients. The road to recovery is yet unexplored and underachieved because of the lack of evidence.
PubMed: 38511105
DOI: 10.7759/cureus.49283 -
JMIR MHealth and UHealth Jul 2023Women with urinary incontinence (UI) may consider using digital technologies (DTs) to guide pelvic floor muscle training (PFMT) to help manage their symptoms. DTs that... (Review)
Review
BACKGROUND
Women with urinary incontinence (UI) may consider using digital technologies (DTs) to guide pelvic floor muscle training (PFMT) to help manage their symptoms. DTs that deliver PFMT programs are readily available, yet uncertainty exists regarding whether they are scientifically valid, appropriate, and culturally relevant and meet the needs of women at specific life stages.
OBJECTIVE
This scoping review aims to provide a narrative synthesis of DTs used for PFMT to manage UI in women across their life course.
METHODS
This scoping review was conducted in accordance with the Joanna Briggs Institute methodological framework. A systematic search of 7 electronic databases was conducted, and primary quantitative and qualitative research and gray literature publications were considered. Studies were eligible if they focused on women with or without UI who had engaged with DTs for PFMT, reported on outcomes related to the use of PFMT DTs for managing UI, or explored users' experiences of DTs for PFMT. The identified studies were screened for eligibility. Data on the evidence base for and features of PFMT DTs using the Consensus on Exercise Reporting Template for PFMT, PFMT DT outcomes (eg, UI symptoms, quality of life, adherence, and satisfaction), life stage and culture, and the experiences of women and health care providers (facilitators and barriers) were extracted and synthesized by ≥2 independent reviewers.
RESULTS
In total, 89 papers were included (n=45, 51% primary and n=44, 49% supplementary) involving studies from 14 countries. A total of 28 types of DTs were used in 41 primary studies, including mobile apps with or without a portable vaginal biofeedback or accelerometer-based device, a smartphone messaging system, internet-based programs, and videoconferencing. Approximately half (22/41, 54%) of the studies provided evidence for or testing of the DTs, and a similar proportion of PFMT programs were drawn from or adapted from a known evidence base. Although PFMT parameters and program compliance varied, most studies that reported on UI symptoms showed improved outcomes, and women were generally satisfied with this treatment approach. With respect to life stage, pregnancy and the postpartum period were the most common focus, with more evidence needed for women of various age ranges (eg, adolescent and older women), including their cultural context, which is a factor that is rarely considered. Women's perceptions and experiences are often considered in the development of DTs, with qualitative data highlighting factors that are usually both facilitators and barriers.
CONCLUSIONS
DTs are a growing mechanism for delivering PFMT, as evidenced by the recent increase in publications. This review highlighted the heterogeneity in types of DTs, PFMT protocols, the lack of cultural adaptations of most of the DTs reviewed, and a paucity in the consideration of the changing needs of women across their life course.
Topics: Pregnancy; Female; Humans; Aged; Adolescent; Pelvic Floor; Quality of Life; Digital Technology; Exercise Therapy; Urinary Incontinence
PubMed: 37405818
DOI: 10.2196/44929 -
Journal of Biomechanics Dec 2023Pain in the lower part of the back is one of the most common chronic illnesses globally. This work aimed to determine the impact of the reinforcement of particular...
Pain in the lower part of the back is one of the most common chronic illnesses globally. This work aimed to determine the impact of the reinforcement of particular groups of abdominal and dorsal muscles on the loads exerted on the lumbar section of the spine in 30 mothers of children with motor disabilities. An optical Ariel Performance Analysis System recorded and processed the kinematics data of everyday activities. Tests investigating the effects of the strengthening or weakening of abdominal and dorsal muscles on loading in the lumbar section of the spine utilized the AnyBody Modelling System. Input data for the simulations included mean values of body positions, while the effects of strengthening or weakening of muscles were simulated in the muscle forces model by introducing different values for muscle physiological cross-sectional area (PCSA). Simulations used decreasing or increasing PCSA values of abdominal muscles and the erector spinae. The analysis involved component and resultant force values on the lumbosacral joint (L5-S1) of the spine and intra-abdominal pressure values. The highest reduction of the resultant reaction value in L5-S1 was observed in the simulations that increased the PCSA of the transverse abdominal (TrA). Indeed, a double increase in the TrA cross-section caused a reduction of the resultant reaction in L5-S1 by 30% and the anterior-posterior and proximal-distal forces by approximately 20-30%. Increased PCSA of the erector spinae exerted higher loads on the spine. These results indicate that strengthening weakened abdominal muscles, particularly TrA, in parents of children with motor disabilities reduces lower spinal loads during daily activities.
Topics: Child; Humans; Lumbar Vertebrae; Disabled Children; Spine; Abdominal Muscles; Abdomen; Parents; Biomechanical Phenomena
PubMed: 37976939
DOI: 10.1016/j.jbiomech.2023.111864 -
Cureus Apr 2024Introduction Lower cross syndrome, also known as pelvic crossed syndrome, occurs if there is inadequate muscle strength, leading to an imbalance in the lower...
Introduction Lower cross syndrome, also known as pelvic crossed syndrome, occurs if there is inadequate muscle strength, leading to an imbalance in the lower extremities. This condition is characterized by the weakening and tightening of muscle groups on the anterior and posterior aspects of the body. Mostly, there is weakness in the abdominal muscles, gluteus maximus, and gluteus medius, while there is tightness in the hip flexor muscle groups. There are various studies investigating musculoskeletal disorders across different professions, but there is no research on the prevalence of lower cross syndrome among housemaids. Housemaids frequently report complaints of joint pain and exhibit specific postural changes such as anterior pelvic tilt, increased lumbar lordosis, and lower back pain. Therefore, this research aims to fill this gap by determining the prevalence of lower cross syndrome within the housemaid profession. The study aims to find out the prevalence of lower cross syndrome among housemaids. Methodology A total of 75 housemaids between the ages of 35 and 50 years complaining of pain in the lower back were included in the study, and the housemaids with recent surgical histories and cognitive impairments were excluded. The evaluation was done by measuring the strength and range of motion (ROM) of the affected muscles. Outcome measures include the length of the iliopsoas muscle, measurement of the spinal extensor muscle, and strength of the gluteus maximus muscle to identify which structures are tight or weak. Result Statistical changes were observed in the housemaids' population to check tight and weak structures using all outcome measures. According to the visual analogue scale (VAS), the pain was found to have a standard deviation of 5.39 ± 1.26 (3-8). The length of the iliopsoas muscle on the right and left sides had a t-value of 1.51 (p = 0.13), and the length of lumbar extensors had a standard deviation of 5.39 ± 1.26 (3-8). Conclusion In our study, the conclusion was found that housemaids who are working continuously for long periods without maintaining good ergonomics are prone to lower cross syndrome. It indicates a strong need for further research on the management of symptoms in such a population (housemaids) to prevent chronic musculoskeletal illness.
PubMed: 38699138
DOI: 10.7759/cureus.57425 -
Annals of Anatomy = Anatomischer... Aug 2023The pectoralis major muscle is located in the anterior chest wall. In most cases, it is divided into clavicular, sternal (sternocostal) and abdominal heads. The aim of...
BACKGROUND
The pectoralis major muscle is located in the anterior chest wall. In most cases, it is divided into clavicular, sternal (sternocostal) and abdominal heads. The aim of this study is to demonstrate and classify the morphological variability of the pectoralis major muscles in human fetuses.
MATERIAL AND METHODS
Classical anatomical dissection was performed on 35 human fetuses aged 18-38 weeks of gestation at death were examined. (17 female, and 18 male, 70 sides; fixed in 10% formalin solution). The fetuses were obtained from spontaneous abortion after informed consent of both parents and through deliberate donation to the Medical University anatomy program. Upon dissection, the following morphological features were assessed: the morphology of the pectoralis major, the possible occurrence of accessory heads, the possible absence of some head, and morphometric measurements of each head of the pectoralis major muscle.
RESULTS
Five types of morphology (based on number of bellies) were observed in the fetuses. Type I was characterized by a single claviculosternal belly (10% of all samples). Type II comprised the clavicular and sternal heads (37.1%). Type III comprised three clavicular, sternal and abdominal heads (31.4%). Type IV (17.2%) was characterized by four muscle bellies and was divided into four subtypes. Type V (4.3%), was represented by five parts, and was divided into two subtypes.
CONCLUSIONS
Due to its embryological development, the PM demonstrates great variability in the numbers of its parts. The most common type was the PM with two bellies, in line with previous studies which also distinguished only clavicular and sternal heads.
Topics: Humans; Male; Female; Pectoralis Muscles; Clavicle; Dissection; Cadaver
PubMed: 37211259
DOI: 10.1016/j.aanat.2023.152108 -
World Journal of Gastrointestinal... Dec 2023Transversus abdominis plane block (TAPB) is a block of the abdominal afferent nerve fibers between the internal oblique muscle and the transverse abdominal muscle...
BACKGROUND
Transversus abdominis plane block (TAPB) is a block of the abdominal afferent nerve fibers between the internal oblique muscle and the transverse abdominal muscle achieved with local anesthetics. It can effectively block the conduction of the anterior nerve of the abdominal wall and exert a good analgesic effect. However, the effect of combining the block with remimazolam on anesthesia in patients undergoing gastrointestinal tumor surgery is still unclear.
AIM
To examine the effects of combining TAPB with remimazolam on the stress response and postoperative recovery of gastrointestinal tumor surgery patients.
METHODS
A retrospective analysis was conducted on the clinical data of 102 individuals diagnosed with gastrointestinal malignancies who underwent laparoscopic surgery under general anesthesia between April 2020 and June 2023. The patients were categorized into a control group ( = 51), receiving remimazolam for general anesthesia, and an observation group ( = 51), receiving TAPB combined with remimazolam for general anesthesia. A comparison was made between both groups in terms of hemodynamic parameters, stress markers, pain levels, recovery quality, analgesic effects, and adverse reactions during the perioperative period.
RESULTS
The observation group had significantly higher heart rates at time points 1 min after induction and upon leaving the operating room than the control group ( < 0.05). The mean arterial pressure at time point T1 in the observation group was significantly higher than that in the control group ( < 0.05). Five minutes after extubation, the levels of the hormones adrenaline and noradrenaline in the observation group were considerably lower than those in the control group ( < 0.05). At 12 h, 24 h, and 48 h following surgery, the visual analog scale scores of the observation group were considerably lower than those of the control group ( < 0.05). The observation group had shorter awakening and extubation times and lower Riker sedation-agitation scale scores than the control group ( < 0.05). The observation group exhibited considerably fewer effective pump presses, lower fentanyl dosages, and lower incidences of rescue analgesia within 24 h following surgery than the control group ( < 0.05).
CONCLUSION
The application effect of TAPB combined with remimazolam general anesthesia in anesthesia of patients undergoing gastrointestinal tumor surgery is good, which is helpful to promote faster recovery after operation.
PubMed: 38173426
DOI: 10.4251/wjgo.v15.i12.2101