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International Journal of Environmental... Jan 2023This comparative pre-post intervention study investigated the feasibility and benefits of Kegel exercises amongst incontinent women, prior to commencing resistance...
This comparative pre-post intervention study investigated the feasibility and benefits of Kegel exercises amongst incontinent women, prior to commencing resistance training (RT), to reduce the risk of stress urinary incontinence (SUI) compared to a group of women without prior Kegel exercises (KE). Incontinence severity index (ISI) score, pelvic floor muscle strength (PFMS), and body composition (such as body mass index (BMI), fat, and muscle mass), were obtained pre and post intervention. Results demonstrated that RT reduced SUI to a significantly greater extent only if preceded by KE as was observed in the Kegel exercise plus RT group (KE + RT) over time. The improvements in total ISI in both the KE + RT and RT groups were large (d = 1.50 and d = 1.17 respectively). A two-way ANOVA indicated a statistically significant improvement in average PFMS within the KE + RT group over time and between the two groups. A positive correlation was found between the average strength of pelvic floor muscles and SUI. Participants in KE + RT group demonstrated a significant increase in muscle mass ( ≤ 0.001) and concomitant reduction in fat mass ( = 0.018). This study determined a dedicated program of KE preceding a RT program improved average pelvic floor muscle strength and was effective in reducing SUI among incontinent women.
Topics: Female; Humans; Urinary Incontinence, Stress; Resistance Training; Pelvic Floor; Exercise Therapy; Urinary Incontinence; Treatment Outcome
PubMed: 36674234
DOI: 10.3390/ijerph20021481 -
Acta Obstetricia Et Gynecologica... Jun 2018Levator trauma is a risk factor for the development of pelvic organ prolapse. We aimed to identify antenatal predictors for significant damage to the levator ani muscle...
INTRODUCTION
Levator trauma is a risk factor for the development of pelvic organ prolapse. We aimed to identify antenatal predictors for significant damage to the levator ani muscle during a first vaginal delivery.
MATERIAL AND METHODS
A retrospective observational study utilizing data from two studies with identical inclusion criteria and assessment protocols between 2005 and 2014. A total of 1148 primiparae with an uncomplicated singleton pregnancy were recruited and assessed with translabial ultrasound at 36 weeks antepartum and 871 (76%) returned for reassessment 3-6 months postpartum. The ultrasound data of vaginally parous women were analyzed for levator avulsion and microtrauma. The former was diagnosed if the muscle insertion at the inferior pubic ramus in the plane of minimal hiatal dimensions and within 5 mm above were abnormal on tomographic ultrasound imaging. Microtrauma was diagnosed in women with an intact levator and if there was a postpartum increase in hiatal area on Valsalva by >20% with the resultant area ≥25 cm .
RESULTS
The complete datasets of 844 women were analyzed. Among them, 609 delivered vaginally: by normal vaginal delivery in 452 (54%), a vacuum birth in 102 (12%) and a forceps delivery in 55 (6%). Levator avulsion was diagnosed in 98 and microtrauma in 97. On multivariate analysis, increasing maternal age, lower body mass index and lower bladder neck descent were associated with avulsion. Increased bladder neck descent and a family history of cesarean section (CS) were associcated with microtrauma.
CONCLUSIONS
Maternal age, body mass index, bladder neck descent and family history of CS are antenatal predictors for levator trauma.
Topics: Adolescent; Adult; Australia; Body Mass Index; Delivery, Obstetric; Female; Humans; Maternal Age; Middle Aged; Obstetric Labor Complications; Pelvic Floor; Predictive Value of Tests; Pregnancy; Retrospective Studies; Risk Factors; Ultrasonography; Ultrasonography, Prenatal
PubMed: 29393505
DOI: 10.1111/aogs.13315 -
American Journal of Human Biology : the... Aug 2022Imaging methods to measure the human pelvis in vivo provide opportunities to better understand pelvic variation and adaptation. Magnetic resonance imaging (MRI) provides...
OBJECTIVES
Imaging methods to measure the human pelvis in vivo provide opportunities to better understand pelvic variation and adaptation. Magnetic resonance imaging (MRI) provides high-resolution images, but is more expensive than dual-energy X-ray absorptiometry (DXA). We sought to compare pelvic breadth measurements collected from the same individuals using both methods, to investigate if there are systematic differences in pelvic measurement between these imaging methods.
METHODS
Three pelvic breadth dimensions (bi-iliac breadth, bi-acetabular breadth, medio-lateral inlet breadth) were collected from MRI and DXA scans of a cross-sectional sample of healthy, nulliparous adult women of South Asian ancestry (n = 63). Measurements of MRI and DXA pelvic dimensions were collected four times in total, with one baseline data collection session and three replications. Data collected from these sessions were averaged, used to calculate technical error of measurement and entered into a Bland-Altman analysis. Linear regression models were fitted with a given MRI pelvic measurement regressed on the same measurement collected from DXA scans, as well as MRI mean bias regressed on DXA mean bias.
RESULTS
Technical error of measurement was higher in DXA measurements of bi-iliac breadth and medio-lateral pelvic inlet breadth and higher for MRI measurements of bi-acetabular breadth. Bland Altman analyses showed no statistically significant relationship between the mean bias of MRI and DXA, and the differences between MRI and DXA pelvic measurements.
CONCLUSIONS
DXA measurements of pelvic breadth are comparable to MRI measurements of pelvic breadth. DXA is a less costly imaging technique than MRI and can be used to collect measurements of skeletal elements in living people.
Topics: Absorptiometry, Photon; Adult; Body Mass Index; Cross-Sectional Studies; Female; Humans; Magnetic Resonance Imaging; Pelvis
PubMed: 35460113
DOI: 10.1002/ajhb.23753 -
Women's Health (London, England) 2022Pelvic floor dysfunction has a high prevalence among women worldwide. However, in the Kingdom of Saudi Arabia, it is underreported. Thus, we aimed to estimate the...
OBJECTIVE
Pelvic floor dysfunction has a high prevalence among women worldwide. However, in the Kingdom of Saudi Arabia, it is underreported. Thus, we aimed to estimate the prevalence and risk factors of pelvic floor dysfunction in women in the Kingdom of Saudi Arabia.
METHODS
We conducted a cross-sectional study on literate non-pregnant women aged ⩾18 years who agreed to participate in our survey. We used the validated and translated Australian pelvic floor questionnaire and conducted a multivariate logistic regression analysis to assess the risk factors of pelvic floor dysfunction.
RESULTS
A total of 824 participants completed the questionnaire. While 60.2% of the participants had pelvic floor dysfunction, 67.7% reported signs of bowel dysfunction. Urinary dysfunction, prolapse, and sexual dysfunction were present in 44.1%, 67.7%, and 55.4% of the participants, respectively. Age, high body mass index, chronic medical illness, heavy weight lifting, and multiparity were found as the risk factors of bladder function problems. Meanwhile, chronic medical illness, heavy weight lifting, and multiparity were found as the risk factors of bowel dysfunction and prolapse. Age group and marital status were the independent factors associated with sexual dysfunction.
CONCLUSION
We noted a high rate of pelvic floor dysfunction in the Kingdom of Saudi Arabia, which calls for the need to provide holistic approaches for the prevention and management of pelvic floor dysfunction among women.
Topics: Adolescent; Australia; Cross-Sectional Studies; Fecal Incontinence; Female; Humans; Pelvic Floor; Pelvic Floor Disorders; Prevalence; Saudi Arabia; Surveys and Questionnaires; Urinary Incontinence
PubMed: 35100887
DOI: 10.1177/17455065211072252 -
The Journal of Maternal-fetal &... Dec 2023While a basic understanding of pelvic size and typology is still important for obstetricians, pelvic measurement data for Japanese women are very scarce. To our best... (Observational Study)
Observational Study
OBJECTIVE
While a basic understanding of pelvic size and typology is still important for obstetricians, pelvic measurement data for Japanese women are very scarce. To our best knowledge, no large-scale pelvimetry studies of Japanese women have been made for the past 50 years. This study aimed to investigate the accurate size, particularly the obstetric conjugate (OC) and transverse diameter of the pelvic inlet (TD), of modern Japanese women, using three-dimensional (3D) computed tomography (CT), and to obtain their reference values.
METHODS
This retrospective, single-center observational study enrolled Japanese non-pregnant women aged between 20 and 40 years, who underwent pelvic CT examination from 2016 to 2021. CT was performed for various reasons, including acute abdomen, search for cancer metastases, and follow-up of existing disease. However, no cases were taken for pelvic measurements. Pelvimetry was performed retrospectively using a 3D workstation. The OC was measured on a strict lateral view and the TD was measured on an axial-oblique view. Other clinical data, such as age, height, and weight, were also extracted from the medical charts and analyzed.
RESULTS
A total of 1,263 patients were enrolled, with the mean age of 32.7 years (standard deviation [SD] 6.2). The mean height, weight, and body mass index were 158.8 cm (SD 5.8), 54.8 kg (SD 11.7), and 21.7 kg/m (SD 4.4), respectively. The mean OC length was 127.0 mm (SD 9.5, 95% confidence interval [CI] 126.5-127.5), while the mean TD length was 126.8 mm (SD 7.5, 95% CI 126.4-127.2). Both values were normally distributed. Height was significantly associated with OC (regression coefficient = 0.75 [95% CI 0.66-0.84], < .001) and TD (regression coefficient = 0.63 [95% CI 0.56-0.70], < .001). Age showed a weak but statistically significant positive association with TD (regression coefficient = 0.14 [95% CI 0.07-0.20], < .001) and OC (regression coefficient = -0.10 [95% CI -0.18 to -0.01], = .026).
CONCLUSION
The 3D CT pelvimetry in 1,263 non-pregnant Japanese women of childbearing age revealed the mean OC and TD of 127.0 mm, and 126.8 mm, which were 11.8 mm and 4.3 mm larger, respectively, than those in the survey in 1972. Our data will be referred to in clinical practice as the standard pelvic measurement values for the Japanese population.
Topics: Pregnancy; Humans; Female; Young Adult; Adult; Pelvimetry; Retrospective Studies; East Asian People; Pelvis; Tomography, X-Ray Computed
PubMed: 36927362
DOI: 10.1080/14767058.2023.2190444 -
Arthroplasty Today Dec 2023Intraoperative pelvic motion during total hip arthroplasty (THA) in the supine position affects acetabular cup placement and occurs at each step of THA; however, there...
BACKGROUND
Intraoperative pelvic motion during total hip arthroplasty (THA) in the supine position affects acetabular cup placement and occurs at each step of THA; however, there are no reports of pelvic motion changes during each stage of THA via the direct anterior approach (DAA). This study aimed to evaluate pelvic motion at each step of THA through the DAA.
METHODS
From March to October 2022, 71 hips were prospectively measured for intraoperative pelvic tilt and axial rotation during THA through the DAA at a single center. These parameters were measured during each surgical step using the augmented reality-hip navigation system.
RESULTS
Both pelvic tilt and axial rotation were maximal during acetabular cup placement. The mean intraoperative pelvic tilt and axial rotation during cup placement were 4.8 ± 2.6° (95% confidence interval, 4.19-5.41°) and 4.2 ± 3.3° (95% confidence interval, 3.42-4.98°), respectively. The effects of the acetabular retractor and cup impactor on pelvic tilt and axial rotation were comparable. Spearman's correlation tests showed significant correlation between axial rotation and body mass index (r = -0.444, = .00011).
CONCLUSIONS
The pelvis tilts forward and rotates toward the surgical side during THA through the DAA. The effects of the acetabular retractor and cup impactor on pelvic motion are comparable. Cup implantation must take into account pelvic movement, and it must be recognized that the pelvis is moving at that time, even with only the acetabular retractor inserted, compared to before the skin incision.
PubMed: 38023653
DOI: 10.1016/j.artd.2023.101251 -
The Journal of Orthopaedic and Sports... Aug 2018Background Femoroacetabular impingement (FAI) syndrome may affect gait kinematics differently between males and females. Objectives To investigate whether individuals...
Background Femoroacetabular impingement (FAI) syndrome may affect gait kinematics differently between males and females. Objectives To investigate whether individuals with FAI syndrome have different hip and pelvic motion during gait, at their preferred speed and a prescribed speed, compared to individuals of the same sex without pain. Methods Twenty-one participants (11 males and 10 females) with FAI syndrome and 41 participants (19 males and 22 females) without hip pain were included in this case-control laboratory study. There were no differences between the 2 groups in age, body mass index, and activity score. Kinematic data for all participants were collected while walking at a preferred speed and at 1.25 m/s. For sex and walking speed, linear regression analyses were used to examine the effect of group and the interaction of group by limb. Results At both speeds, males with FAI syndrome walked with more than 6° less peak hip extension (P≤.018), 5° greater anterior pelvic tilt (P≤.020), and 5° less posterior pelvic tilt (P≤.018) compared to males without hip pain. Females with FAI syndrome walked with 2° less hip extension (P≤.012) and at least 3° more hip adduction (P<.001) in the more painful hip than in the less painful hip at both speeds. Conclusion Males and females with FAI syndrome have different gait alterations when compared to a same-sex comparison group. In males, differences were between groups. In females with FAI syndrome, differences were between the more painful and the less painful limb. J Orthop Sports Phys Ther 2018;48(8):649-658. Epub 22 May 2018. doi:10.2519/jospt.2018.7913.
Topics: Adult; Biomechanical Phenomena; Case-Control Studies; Female; Femoracetabular Impingement; Gait; Hip; Humans; Male; Pelvis; Self Report; Sex Factors; Thigh; Young Adult
PubMed: 29787694
DOI: 10.2519/jospt.2018.7913 -
Fertility and Sterility Jun 2022To identify metabolites in presurgical blood associated with risk of persistent postsurgical pelvic pain 1 year after endometriosis surgery in adolescent and young adult... (Observational Study)
Observational Study
OBJECTIVE
To identify metabolites in presurgical blood associated with risk of persistent postsurgical pelvic pain 1 year after endometriosis surgery in adolescent and young adult patients.
DESIGN
Prospective observational study within the Women's Health Study: From Adolescence to Adulthood, a US-based longitudinal cohort of adolescents and women enrolled from 2012-2018.
SETTING
Two tertiary care hospitals.
PATIENT(S)
Laparoscopically confirmed endometriosis patients (n = 180) with blood collected before their endometriosis surgery. Of these, 77 patients additionally provided blood samples 5 weeks to 6 months after their surgery. We measured plasma metabolites using liquid chromatography tandem mass spectrometry, and a total of 390 known metabolites were included in our analysis.
INTERVENTION(S)
None.
MAIN OUTCOME MEASURE(S)
Persistent postsurgical pelvic pain, defined as severe, life-impacting pelvic pain 1 year after endometriosis surgery.
RESULT(S)
Most patients (>95%) were at stage I/II of the revised American Society for Reproductive Medicine classification. Their average age at diagnosis was 18.7 years, with 36% reporting persistent postsurgical pelvic pain. Of the 21 metabolites in presurgical blood that were associated with risk of persistent postsurgical pelvic pain, 19 metabolites, which were mainly lipid metabolites, were associated with increased risk. Only 2 metabolites-pregnenolone sulfate (odds ratio = 0.64, 95% confidence interval = 0.44-0.92) and fucose (odds ratio = 0.69, 95% confidence interval = 0.47-0.97)-were associated with decreased risk. Metabolite set enrichment analysis revealed that higher levels of lysophosphatidylethanolamines (false discovery rate = 0.01) and lysophosphatidylcholines (false discovery rate = 0.01) in presurgical blood were associated with increased risk of persistent postsurgical pelvic pain.
CONCLUSION(S)
Our results suggest that dysregulation of multiple groups of lipid metabolites may play a role in the persistence of pelvic pain postsurgery among young endometriosis patients.
Topics: Adolescent; Adult; Endometriosis; Female; Humans; Laparoscopy; Lipids; Pain, Postoperative; Pelvic Pain; Pelvis; Young Adult
PubMed: 35367064
DOI: 10.1016/j.fertnstert.2022.02.012 -
International Urogynecology Journal May 2017Pelvic floor muscle rehabilitation is a widely utilized, but often challenging therapy for pelvic floor disorders, which are prevalent in older women. Regimens involving...
INTRODUCTION AND HYPOTHESIS
Pelvic floor muscle rehabilitation is a widely utilized, but often challenging therapy for pelvic floor disorders, which are prevalent in older women. Regimens involving the use of appendicular muscles, such as the obturator internus (OI), have been developed for strengthening of the levator ani muscle (LAM). However, changes that lead to potential dysfunction of these alternative targets in older women are not well known. We hypothesized that aging negatively impacts OI architecture, the main determinant of muscle function, and intramuscular extracellular matrix (ECM), paralleling age-related alterations in LAM.
METHODS
OI and LAM were procured from three groups of female cadaveric donors (five per group): younger (20 - 40 years), middle-aged (41 - 60 years), and older (≥60 years). Architectural predictors of the excursional (fiber length, L ), force-generating (physiological cross-sectional area, PCSA) and sarcomere length (L ) capacity of the muscles, and ECM collagen content (measure of fibrosis) were determined using validated methods. The data were analyzed using one-way ANOVA and Tukey's post-hoc test with a significance level of 0.05, and linear regression.
RESULTS
The mean ages of the donors in the three groups were 31.2 ± 2.3 years, 47.6 ± 1.2 years, and 74.6 ± 4.2 years (P < 0.005). The groups did not differ with respect to parity or body mass index (P > 0.5). OI L and L were not affected by aging. Age >60 years was associated with a substantial decrease in OI PCSA and increased collagen content (P < 0.05). Reductions in OI and LAM force-generating capacities with age were highly correlated (r = 0.9).
CONCLUSIONS
Our findings of age-related decreases in predicted OI force production and fibrosis suggest that these alterations should be taken into consideration, when designing pelvic floor fitness programs for older women.
Topics: Adult; Age Factors; Aged; Aging; Analysis of Variance; Cadaver; Collagen; Female; Humans; Middle Aged; Muscle, Skeletal; Pelvic Floor; Pelvic Floor Disorders
PubMed: 27704154
DOI: 10.1007/s00192-016-3167-5 -
JPMA. the Journal of the Pakistan... Apr 2023To determine the efficacy of whole-body vibration in the treatment of postnatal constipation. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
To determine the efficacy of whole-body vibration in the treatment of postnatal constipation.
METHODS
The prospective, randomised, single-blind, pre-post, controlled trial was conducted from December 2020 to May 2021 at the outpatient clinic of the Obstetrics and Gynaecology Department, Kafrelsheikh University Hospital, Egypt, and comprised women with complaint of postnatal constipation. They were randomised into two groups. Group A was subjected to whole-body vibration in addition to diet instructions, pelvic floor exercises and static abdominal exercisesforsix weeks. Group B wassubjected to pelvic floor exercises,static abdominal exercises and diet instructions. Constipation symptom questionnaire and patient assessment of constipation quality of life questionnaire were used at baseline and post-intervention. Data was analysed using SPSS 25.
RESULTS
Of the 40 women, 20(50%) were in each of the 2 groups. Group A mean age was 24.88±2.22 years, while it was 24±2.25 years in Group B. Age, height and body mass index were not significantly different between the groups (p>0.05). There was significant improvement in Group A quality of life and constipation severity (p<0.05).
CONCLUSIONS
Whole-body vibration had positive impact on postpartum women's constipation symptoms and quality of life.
RCT REGISTRATION
NCT05286476, Link: https://clinicaltrials.gov/ct2/show/NCT05286476.
Topics: Pregnancy; Humans; Female; Young Adult; Adult; Quality of Life; Vibration; Single-Blind Method; Prospective Studies; Pelvic Floor; Constipation; Exercise Therapy
PubMed: 37482821
DOI: 10.47391/JPMA.EGY-S4-3