Pelvic Floor Muscle Exercise

Background Pelvic floor muscle exercise has gained recognition as a valuable adjunct for promoting maternal well-being and optimizing childbirth outcomes. This study aimed to evaluate the effectiveness of pelvic floor muscle exercise in enhancing the likelihood of improving quality of life pregnant mothers in Bangladesh. Methods/Design This was a randomized controlled trial in which 66 pregnant womenwere divided into control and intervention groups. The control group received conventional treatment, while the intervention group received the Pelvic Floor Muscles Exercise program with a posture explaining booklet. Both groups received supervised 30-min sessions five days a week for six weeks. The WHOQOL-BREF questionnaire measured pregnancy health and quality of life. Both descriptive (median and inter quartile range, IQR) and inferential statistics (Mann-whitney U test and Wilcoxon signedranked test) used to analyse the data by SPSS 25.0 software with 95% Confidence interval. Results The intervention group mothers averaged gestional age was 32.4 (31.7 to 35.2) weeks, while the control group averaged 32.7 (32.3 to 36.2) weeks. According to the intergroup analysis, both groups had significantly improved healthrelated quality of life (p < 0.05). According to the intragroup analysis, participants who received pelvic floor muscle exercise with postural advice had better outcomes than did those who received only usual care with postural advice (p < 0.05). Conclusion Pelvic floor muscle exercise may improve quality of life and the risk of vaginal birth. Healthcare professionals should include pelvic floor muscle exercises in standard prenatal care to help expectant mothers achieve positive childbirth and reduce postnatal problems. Trial registration: Clinical Trial Registry of India: (CTRI/2023/10/059091) (Date: 25/10/2023).

As the US population continues to age, the impact of pelvic floor trauma and the sequelae of these injuries will continue to be a common place for the practicing gynecologist. In this review, the authors will highlight pertinent pelvic floor muscular anatomy, explain basic pelvic floor biomechanics, identify mechanisms of pelvic floor birth injury, discuss pelvic floor muscle recovery and birth injury sequelae, review methods of birth injury prevention, and specify future directions of birth related pelvic floor injury research.

The aim of our study was to assess the performance of levator ani muscle deficiency (LAD) evaluated by 3D endovaginal ultrasound (EVUS) to detect pelvic floor muscle function as assessed by digital examination. This cross-sectional study was conducted among 77 patients referred to our urogynecology clinic for pelvic floor dysfunction symptoms. Patients underwent physical examinations including digital pelvic muscle strength assessment using the Modified Oxford scale (MOS). EVUS volumes were evaluated and levator ani muscles were scored according to a validated LAD scoring system. MOS scores were categorized as nonfunctional (scores 0-1) and functional (scores 2-5). Mean age of participants was 56 (SD ± 12.5) and 71% were menopausal. Overall, 32.5% had nonfunctional muscle strength and 44.2% were classified as having significant LAD. LAD identified by ultrasound had a sensitivity of 60% (95% CI 41 -79%) for detecting nonfunctional muscle and a specificity of 63% (95% CI 50 -77%) for ...

IntroductionThe present study aims to describe: 1. How the side effects of radiotherapy (RT) could impact sexual health in women; 2. The effectiveness of physical rehabilitation including pelvic floor muscle training (PFMT) in the management of sexual dysfunction after RT.Materials and MethodsSearch keys on PubMed, Web of Science, Scopus, PEDro, and Cochrane were used to identify studies on women treated with radical or adjuvant RT and/or brachytherapy for gynecological cancers with an emphasis on vulvo-vaginal toxicities and PFMT studies on sexual dysfunction for this group of women.ResultsRegarding the first key question, we analyzed 19 studies including a total of 2,739 women who reported vaginal dryness, stenosis, and pain as the most common side effects. Reports of dosimetric risk factors and dose-effect data for vaginal and vulvar post-RT toxicities are scant. Only five studies, including three randomized controlled trials (RCTs), were found to report the effect of PFMT alone ...

Hypothesis / aims of study Pelvic floor muscle training (PFMT) has been shown to be effective in the treatment of stress and mixed urinary incontinence (UI) in women. In clinical practice, PFMT is often also advised as part of a preand/or post-operative pelvic surgery physiotherapy intervention, as it is considered beneficial to the surgical outcome in the short term [1], however little is known regarding the effectiveness of this intervention in the long term. Several studies have shown that a large proportion of women with pelvic organ prolapse (POP) have PFM defects and muscle avulsions [2, 3]. Hence, this group of women may not respond as well to PFMT as do women with UI. This randomised controlled trial (RCT) aimed to investigate the effect of a pelvic floor physiotherapy exercise program on the pelvic function of women undergoing vaginal gynaecological surgery at 3, 6 and 12 months post-operative.

Hypothesis / aims of study Of the tools available to measure pelvic floor muscle (PFM) activation, ultrasound alone measures the ‘lift’ component of PFM action. There is a paucity of published work reporting real-time ultrasound (RTUS) as a measurement tool in a clinical trial. The aims of this study were to establish the concurrent and predictive validity and responsiveness of transabdominal RTUS imaging of the PFM in an elderly female sample.

Objective: The purpose of the present study was to assess whether attempts of a maximal voluntary pelvic floor muscle contraction can reduce vaginal resting pressure (VRP), and surface EMG activity in women with and without provoked vestibulodynia (PVD). Study Design: An assessor blinded comparison study included 35 women with and 35 women without PVD. VRP and PFM strength were measured with a high precision pressure transducer connected to a vaginal balloon (Camtech AS, Sandvika Norway). Pelvic floor muscle activity was measured before and after three MVCs with surface EMG (NeuroTrac ETS™ , Verity Medical Ltd, UK). Paired sample T-test was used to analyze difference within groups and independent sample T-test to analyze differences between groups. P-value was set to <0.05 Results: Mean age of the participants was 24.3 years (SD 4.7) and mean BMI was 22.0 kg/m 2 (SD 2.6). There were no significant differences between the groups in any background variables. PFM contraction lead to a statistically significant reduction of VRP in both the PVD (p=0.001) and the control group (p=0.027). Surface EMG activity was significantly reduced in the PVD group only (p=0.001). Conclusion: Young, nulliparous women with PVD had significantly lower vaginal resting pressure and sEMG activity after three maximum contractions of the PFM. The results indicate that attempts of voluntary maximal contractions may be investigated as a method to reduce PFM hypertonicity.

Objectives To study effects of physiotherapist-guided pelvic floor muscle training on pelvic organ prolapse (POP) early postpartum period. Design Assessor-blinded, randomized controlled trial. Setting Physiotherapy Clinic, Reykjavik. Sample Eighty-four primiparous women with a singleton delivery. Methods Participants were screened for eligibility 6-13 weeks postpartum. Women randomized to the training group conducted 12 weekly individual sessions with a physiotherapist, starting on average 9 weeks after childbirth. Outcomes were assessed after the last session (short-term) and at 12 months postpartum (long-term). The control group received no instructions after the initial assessment. Main outcome measures Self-evaluated POP symptoms by the Australian Pelvic Floor Questionnaire. Results Forty-one and 43 women were randomized to the training and control groups, respectively. At recruitment, 17 (42.5%) of the training and 15 (37%) of the control group reported prolapse symptoms (p=0.6...

A first-line treatment for stress urinary incontinence (SUI) is pelvic floor muscle training (PFMT) for at least three months. The key problem is that patients do not understand the importance of these exercises and their effectiveness. Mobile health apps offer new possibilities to increase treatment adherence. This study compared a reduction in SUI, exercise adherence, and quality of life in PFMT with animation vs. standard instruction. A prospective, single-blind, randomized control trial was collected. SUI patients were randomized into the application or control groups confirmed using a one-hour pad test. In the intervention group, the PFMT application was applied via mobile phone (PFMT with animations, recording system, and reminder system). The standard exercise protocol was similar in both groups. Additional follow-up was conducted at 4, 8, and 12 weeks. A total of 51 participants were randomized to the application (n = 26) and control groups (n = 25), respectively. At the 12-...

Objectives To study effects of physiotherapist-guided pelvic floor muscle training on pelvic organ prolapse (POP) early postpartum period. Design Assessor-blinded, randomized controlled trial. Setting Physiotherapy Clinic, Reykjavik. Sample Eighty-four primiparous women with a singleton delivery. Methods Participants were screened for eligibility 6-13 weeks postpartum. Women randomized to the training group conducted 12 weekly individual sessions with a physiotherapist, starting on average 9 weeks after childbirth. Outcomes were assessed after the last session (short-term) and at 12 months postpartum (long-term). The control group received no instructions after the initial assessment. Main outcome measures Self-evaluated POP symptoms by the Australian Pelvic Floor Questionnaire. Results Forty-one and 43 women were randomized to the training and control groups, respectively. At recruitment, 17 (42.5%) of the training and 15 (37%) of the control group reported prolapse symptoms (p=0.6). Five (13%) from the training and 9 (21%) controls were bothered by the symptoms (p=0.3). There was a gradual decrease in the number of women with symptoms and no significant short-term (p=0.08 at 6 months) or long-term (p=0.6 at 12 months) differences between the groups regarding rates of women with POP sympoms. No difference was between groups regarding bother in the short (p=0.3) or longer term (p=0.4). Repeated measure analyses using Proc Genmod in SAS did not indicate a significant effect of the intervention over time, p>0.05. Conclusions There was an overall decrease in postpartum symptoms of POP and bother during the first year. Physiotherapist-lead pelvic floor muscle training did not change the outcomes.

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The region anterior to the anal canal in women is composed of intertwined smooth and skeletal muscles. The present study aimed to clarify skeletal muscle morphology in the anterior region of the anal canal. The pelvic floor muscles of 28 pelvic halves from 16 female cadavers (mean age 79.75 years) were dissected from the inferior aspect to examine the perineal muscles, followed by midline transection and dissection from the inner surface to examine the pelvic outlet muscles. The bulbospongiosus muscle was found to be attached to the lateral surface of the external anal sphincter. The superficial transverse perineal muscle crossed superiorly to the bulbospongiosus and coursed medially toward its contralateral muscle bundle deep to the anterior portion of the external anal sphincter. The superficial transverse perineal muscle formed the middle sling. From the medial aspect, the anterior part of the levator ani was divided into anterior and posterior bundles to form the anterior and posterior slings, respectively. This study proposes that three muscular slings could be important in supporting the pelvic floor in women. In addition, this study shows that the anterior skeletal muscular wall of the anal canal is composed of the anterior muscle bundle of the levator ani, superficial transverse perineal, and proper external anal sphincter muscles.

Introduction: Pelvic organ prolapse (POP) is a significant health concern for young Nepali women, with potential risk factors including pelvic floor trauma from vaginal delivery and heavy lifting. The prevalence of symptomatic POP (SPOP) among nulliparous women in Nepal is 6%, while the general population of Nepali women aged 15-49 years reports a prevalence of 7%. Surprisingly, the average age of SPOP onset in Nepal is 27 years, challenging the assumption that postmenopausal age and vaginal delivery are the sole risk factors. This study aims to investigate the influence of increased intra-abdominal pressure (IAP) during lifting tasks on pelvic organ descent in Nepali women across different menstrual cycle stages. The study included 22 asymptomatic Nepali women aged 18-30 years who regularly engage in heavy lifting. Intra-abdominal pressure was measured intra-vaginally during typical and simulated lifting tasks, which encompassed various scenarios such as ballistic lifting, ramped lifting, and pre-contraction of pelvic floor muscles, as well as coughing, Valsalva maneuver, and pelvic floor contractions. Pelvic floor displacement was recorded using transperineal ultrasound during menstruation, ovulation, and the mid-luteal phase. Results: Results indicated that pelvic floor displacement was greater during menstruation than ovulation when performing a simulated ballistic lifting task (6.0 ± 1.6 mm vs. 5.1 ± 1.5 mm, p = 0.03, d = 0.6). However, there was no significant difference in pelvic floor displacement during lifting when the pelvic muscles were pre-contracted. These findings suggest that lifting heavy loads during menstruation may increase the risk of stretching and injuring pelvic floor supportive tissues, potentially contributing to SPOP in young Nepali women. Pre-contracting pelvic floor muscles during lifting tasks may offer a protective effect. Understanding these factors could aid in developing targeted preventive measures and raising awareness about the impact of heavy lifting on pelvic floor health among Nepali women.

Your article is well designed and working with this group of patients is appreciated. Please consider some points to achieve better results. 1-Revise the exclusion criteria. The cases that lead to exit from the investigation should be considered. 2-The position of Kegel exercises; Is supine the most effective position? 3-It would be great to chose some photos of participants for exercise protocol.

Pelvic floor musculature assessment methods are generally invasive, subjective, and technologically expensive. Therefore, there is a need to identify other methods that can predict changes in the function of these muscles. This study aimed to verify whether the levels of strength and myoelectric activity of pelvic floor muscles (PFM) can be related to handgrip strength (HGS), to ensure faster and earlier identification of possible dysfunctions of this musculature. Furthermore, we verified whether these variables vary across different age groups. This was a cross-sectional observational study involving 44 healthy women. The women were divided into two groups: the young (18–35 years) and middle-aged (36–55 years) adult groups. Social, anthropometric, and clinical data were collected from the participants, and a functional assessment of their PFM was performed by bidigital palpation, electromyographic biofeedback (sEMG), and HGS (using a dynamometer). The levels of physical and sexual ...

The number of people suffering from urinary incontinence increases every year. Along with it, the knowledge of the society increases that there are various methods of eliminating this ailment.. Both patients and researchers are constantly looking for new treatments for urinary incontinence. One of the new solutions is sonofeedback of the pelvic oor muscles, which may help to strengthen them and thus reduce the problem. The aim of this study was to evaluate the effectiveness of sonofeedback and transvaginal electrostimulation in increasing the bioelectrical activity of pelvic oor muscles in postmenopausal women with stress urinary incontinence. Sixty women with stress urinary incontinence were enrolled in the study. The patients were divided into two groups: A -where sonofeedback was used and B -where electrostimulation of the pelvic oor muscles was performed with biofeedback training. In patients, the resting bioelectrical activity of the pelvic oor muscles was assessed using an electromyograph. The assessment of the resting bioelectrical activity of the pelvic oor muscles was performed before the therapy, after the 5th training and after the therapy. It was observed that after the end of the therapy, the average bioeltrical potential increased by 1.1 µV compared with baseline in group A. It can be suggested that the sonofeedback method is comparatively effective in reducing symptoms that are associated with urinary incontinence as a electrostimulation method with biofeedback training.

Aims: Assess the intrarater and interrater reliabilities and diagnostic accuracy of a new vaginal dynamometer to measure pelvic floor muscle (PFM) strength in incontinent and continent women. Methods: A test-retest reliability study including 152 female patients. Exclusion criteria: history of urge urinary incontinence, prolapse of pelvic organ, pregnancy, previous urogynecological surgery, severe vaginal atrophy, or neurological conditions. The examination comprised digital assessment using the modified Oxford scale (MOS) and dynamometry measurements with a new prototype hand-held dynamometer. The MOS score ranges from 0 to 5: 0, no contraction; 1, flicker; 2, weak; 3, moderate; 4, good; 5, strong. Examinations were performed by a physiatrist, a physiotherapist and a mid-wife. The rest period between each rater measurement was 5 minutes. Assessment of intrarater and interrater reliability was calculated with the intraclass correlation coefficient. Results: One hundred twenty-two incontinent women and 30 continent women were included. Scores between 0 and 2 in MOS were recorded in 72% of incontinent women versus 20% in continent patients (P < 0.001). Intrarater reliability of the dynamometer was 0.942 (95% confidence interval [CI], 0.920-0.958) and the interrater reliability was 0.937 (95% CI, 0.913-0.954). The analysis of variance analysis showed significant differences in PFM strength across digital assessment categories. The post-hoc analysis showed statistical differences between adjacent categories of MOS 1-2 and 2-3. The diagnostic accuracy showed an area under the curve of 0.82 (95% C,: 0.75-0.89), 0.87 (95% CI, 0.81-0.92), and 0.83 (95% CI, 0.77-0.90) for the physiatrist, midwife, and physiotherapist, respectively. Conclusions: The results obtained show a good reliability and validity of this new vaginal dynamometer to quantify PFM strength.

Hypothesis / aims of study Though several studies of pelvic floor muscle assessment have been performed, there is still no general consensus on the most appropriate diagnostic method. Vaginal digital palpation using the Oxford Grading Scale is the most common method for evaluating pelvic floor muscle (PFM) strength. The technique is simple but it lacks reliability and validity. Measuring intravaginal pressure using a manometer also has limitations because it does not selectively record PFM strength. As a result, both methods estimate PFM strength only indirectly [1-3]. The aim of this study was to test the diagnostic reliability and validity of a new vaginal dynamometer for measuring PFM strength.

Aims Assess the intrarater and interrater reliabilities and diagnostic accuracy of a new vaginal dynamometer to measure pelvic floor muscle (PFM) strength in incontinent and continent women. Methods A test-retest reliability study including 152 female patients. Exclusion criteria: history of urge urinary incontinence, prolapse of pelvic organ, pregnancy, previous urogynecological surgery, severe vaginal atrophy, or neurological conditions. The examination comprised digital assessment using the modified Oxford scale (MOS) and dynamometry measurements with a new prototype hand-held dynamometer. The MOS score ranges from 0 to 5: 0, no contraction; 1, flicker; 2, weak; 3, moderate; 4, good; 5, strong. Examinations were performed by a physiatrist, a physiotherapist and a midwife. The rest period between each rater measurement was 5 minutes. Assessment of intrarater and interrater reliability was calculated with the intraclass correlation coefficient. Results One hundred twenty-two incont...

The first choice treatment in urinary incontinence (UI) is rehabilitation of the pelvic floor in order to improve muscle strength. However, no entirely reliable instruments for quantifying pelvic floor muscle (PFM) strength are currently available. Our aim was to test the intra-rater reliability and diagnostic accuracy of a new vaginal dynamometer for measuring PFM strength. Methods: Test-retest reliability study. One hundred and four women with stress urinary incontinence (SUI) were recruited. Patients were excluded if they had a history consistent with urge urinary incontinence or pelvic organ prolapse, pregnancy, previous urogynecological surgery, severe vaginal atrophy, or neurological conditions. The examination comprised digital palpation quantified by the modified Oxford scale and by two consecutive dynamometry measurements obtained using a new prototype dynamometer. This instrument comprises a speculum in which an inductive displacement sensor (LVDTSM210.10.2.KTmodel, Schreiber) is attached to a spring of known stiffness constant (k). The intraclass correlation coefficient (ICC) was calculated to assess intra-rater reliability. Diagnostic accuracy was assessed using Receiver Operating Characteristics (ROC) curves analysis. Results: Of the 104 subjects included, 59.6% presented scores between 0-2 on the Oxford scale. Intra-rater reliability was 0.98 (95%CI: 0.97-0.99). In the Bland & Altman plot, the distribution of disagreements was similar in the lowest and the highest strength values. The diagnostic accuracy of the dynamometer with regard to digital palpation showed an area under the curve of 0.85 (95%CI: 0.77-0.93). Conclusions: Our results suggest that this new vaginal dynamometer is a reliable and valid instrument for quantifying PFM strength. Neurourol. Urodynam.

Objective: This integrative review identified studies that reported the prevalence of physiotherapeutic interventions for urinary incontinence among postpartum women. Methods: This is an integrative literature review study. We used the integrative literature review framework proposed by Whittemore and Knafl to search for relevant literature. The search strategy for electronic databases was developed from the research question and definitions of key concepts, assisted by the librarian. Databases that were searched include Google Scholar, Medline (PubMed), CINAHL, and the Joanna Briggs Institute databases. Both qualitative and quantitative studies that met the inclusion criteria were included. We used the CASP tool to assess the quality of selected papers. The included articles were thematically analyzed. Thirty-six papers met the inclusion criteria for the review. Six themes emerged from the analysis: prevalence of postpartum UI; risk factors for postpartum UI; antenatal pelvic floor muscle training; conservative treatment and quality of life; experiences of postpartum women with UI; and possible coping strategies adopted by women. Most of the articles were quantitative studies (80.5%); 16.6% were qualitative and 2.7% adopted mixed methods. Conclusions: Urinary incontinence is common in postpartum women. Antenatal pelvic floor muscle training is protective against postpartum UI and should be the firstline treatment option.

The aim of this study was to assess the effect of a single session of EMG biofeedback in a group of postmenopausal women on improving technique in pelvic floor muscle (PFM) contractions (exercises). Methods: Sixty-two women aged 60 to 85 years (69 ± 4; mean ± SD) participated in the study. We assessed the technique of PFM exercises via surface electromyography (EMG) using a vaginal probe. A single assessment sequence consisted of 11 exercises involving the conscious contraction of the PFM, during which the order of activation for selected muscles was determined. We then awarded scores for exercise technique on a scale from 0 to 4, where 4 represented the best technique and 0 represented no activation of PFMs. In the second assessment, we used a biofeedback method to teach PFM exercise technique. Results: In total, 32% (n = 20) of the participants were unable to correctly perform the first PFM contraction, scoring 0.9 ± 0.79. After a single EMG biofeedback session, these women received 1.7 ± 1.08 scores (p = 0.003). In the tenth exercise, there was also a statistically significant improvement between the first (baseline) and second assessment (1.7 ± 1.34 and 2.15 ± 1.09, respectively; p = 0.037). For the remaining exercises, the results were not statistically significant, but we observed a positive trend of change. Conclusions: The use of a single EMG biofeedback session is an effective method of improving technique in PFM exercises in a group of women who initially performed them incorrectly.

Background: Mobile health apps, for example, the Tät, have been shown to be potentially effective in improving pelvic floor muscle training (PFMT) among women, but they have not yet been studied among pregnant women. Adherence to daily PFMT will improve pelvic floor muscle strength leading to urinary incontinence (UI) improvement during the pregnancy. Objective: This study aims to document the validation process in developing the Kegel Exercise Pregnancy Training app, which was designed to improve the PFMT adherence among pregnant women. We utilized an intervention mapping approach incorporated within the mobile health development and evaluation framework. The framework involved the following steps: (1) conceptualization, (2) formative research, (3) pretesting, (4) pilot testing, (5) randomized controlled trial, and (6) qualitative research. The user-centered design-11 checklist was used to evaluate the user-centeredness properties of the app. A cross-sectional study was conducted to better understand PFMT and UI among 440 pregnant women. The study reported a UI prevalence of 40.9% (180/440), with less than half having good PFMT practice despite their good knowledge. Five focus group discussions were conducted to understand the app design preferred by pregnant women. They agreed a more straightforward design should be used for better app usability. From these findings, a prototype was designed and developed accordingly, and the process conformed to the user-centered design-11 (UCD-11) checklist. A PFMT app was developed based on the mHealth development and evaluation framework model, emphasizing higher user involvement in the application design and development. The application was expected to improve its usability, acceptability, and ease of use. The Kegel Exercise Pregnancy Training app was validated using a thorough design and development process to ensure its effectiveness in evaluating the usability of the final prototype in our future randomized control trial study.

Background: Mobile health apps, for example, the Tät, have been shown to be potentially effective in improving pelvic floor muscle training (PFMT) among women, but they have not yet been studied among pregnant women. Adherence to daily PFMT will improve pelvic floor muscle strength leading to urinary incontinence (UI) improvement during the pregnancy. Objective: This study aims to document the validation process in developing the Kegel Exercise Pregnancy Training app, which was designed to improve the PFMT adherence among pregnant women. We utilized an intervention mapping approach incorporated within the mobile health development and evaluation framework. The framework involved the following steps: (1) conceptualization, (2) formative research, (3) pretesting, (4) pilot testing, (5) randomized controlled trial, and (6) qualitative research. The user-centered design-11 checklist was used to evaluate the user-centeredness properties of the app. A cross-sectional study was conducted to better understand PFMT and UI among 440 pregnant women. The study reported a UI prevalence of 40.9% (180/440), with less than half having good PFMT practice despite their good knowledge. Five focus group discussions were conducted to understand the app design preferred by pregnant women. They agreed a more straightforward design should be used for better app usability. From these findings, a prototype was designed and developed accordingly, and the process conformed to the user-centered design-11 (UCD-11) checklist. A PFMT app was developed based on the mHealth development and evaluation framework model, emphasizing higher user involvement in the application design and development. The application was expected to improve its usability, acceptability, and ease of use. The Kegel Exercise Pregnancy Training app was validated using a thorough design and development process to ensure its effectiveness in evaluating the usability of the final prototype in our future randomized control trial study.

Pelvic muscle strength and stress urinary incontinence were studied in 20 nulliparous women at 32 to 36 antepartum weeks and 6 postpartum weeks. Measures used included a digital muscle strength score, observed incontinence, and urine flow interruption. Pelvic muscle strength declined from the antepartum to postpartum periods in women with vaginal births; however, women with greater antepartal pelvic muscle strength tended to preserve a higher level of strength during the postpartum period. In general, less pelvic muscle strength was found in women who demonstrated stress urinary incontinence.

The purpose of this study was to examine the longterm effi cacy of an exercise regimen based on circular muscle strengthening (Paula method) as opposed to pelvic fl oor muscle training (PFMT) on stress urinary incontinence symptoms at 6 months postintervention. Of 240 women who had initially participated in a randomized clinical trial, 143 women suffering from stress urinary incontinence participated in this follow-up study. METHODS: Subjects participated in a randomized controlled clinical trial comparing 2 exercise programs (12 private Paula lessons vs 6 group PFMT lessons) over a 12-week period. Of these, 143 women took part in the follow-up study: 64 from the Paula group and 79 from the PFMT group. Six-month follow-up data were gathered via telephone interviews. No signifi cant deterioration in stress urinary incontinence symptoms occurred 6 months after completion of the interventions in either group. We found a statistically significant difference between the groups with regard to reported frequency of urinary leakage; 25 of subjects (39.7%) allocated to the Paula method reported a low frequency rate of incontinence episodes upon completion of the study as compared to 18 (22.8%) in the PFMT group ( P ϭ .03). Forty-nine of the 64 women in the Paula group (76.6%) and 62 of the 79 women in the PFMT group (78.5%) reported that they continued exercising 6 months after completion of the trial ( P ϭ .8). CONCLUSIONS: Both intervention methods reduced frequency of urinary incontinence over a 6-month period. Long-term adherence was similar in both groups. Pelvic fl oor muscle training was associated with fewer sessions and decreased cost and fewer lessons needed as compared with the Paula method. Nevertheless, results also suggest that the Paula method achieves a lower frequency of urinary leakage than PFMT.

The aim of this study was to determine the efficacy of the Paula method of circular muscle training in the management of stress incontinence (SI). The theory behind this method states that activity of distant sphincters affects other muscles. In a pilot study, 59 women, mainly hospital employees, were randomly assigned to participate in exercises according to the Paula method or pelvic floor training. Efficacy was measured by reports of incontinence, quality of life (I-QOL), pad test, and pelvic floor muscle strength (assessed by perineometer and digital examination). Both the Paula exercises and pelvic floor training produced significant changes in urinary leakage compared to baseline as measured by the pad test [mean decrease of 5.4 g (p=0.002) and 9.5 g (p=0.003), respectively]. Women randomized to the Paula method reported improvement in I-QOL scores. The Paula method was found to be efficacious for SI in a population of Israeli women. Larger community-based studies will be required to confirm these results and enable evaluation of betweengroup differences.

Introduction and hypothesis Urinary incontinence (UI) is prevalent in antenatal and postnatal women. Pelvic floor muscle training (PFMT) is the first-line treatment for UI. Group-based PFMT provides a way for professionals to deliver this intervention to more women who need to prevent and/or treat UI. This review aims to (1) assess the effectiveness of group-based PFMT in preventing and treating UI in antenatal and postnatal women and (2) explore the characteristics of group-based intervention and factors which had an impact on the success of group-based PFMT. Methods Randomized controlled trials (RCTs) were included in this review. A comprehensive search was conducted in PubMed, Embase, Medline, PsycINFO, Maternity and Infant Care Database, CINAHL, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, VIP Database and Wanfang Database. The overall quality was assessed using Grading of Recommendations, Assessment, Development and Evaluations (GRADE). RCTs which included pregnant and/or postnatal women with or without UI investigating the effectiveness of group-based PFMT were included. Results Five RCTs were included in this review. The overall quality of the results of the included studies was low. Delivering group-based PFMT during pregnancy significantly reduced the prevalence of UI in both the pregnant period [risk ratio (RR) = 0.67, 95% confidence interval (CI) 0.57 to 0.80, P < 0.00001] and the postnatal period [RR = 0.66, 95% CI 0.52 to 0.84, P = 0.0008]. Only one RCT delivered group-based PFMT during the postnatal period. Conclusion Evidence of weak quality supports the effectiveness of undertaking group-based PFMT in pregnancy to prevent UI during pregnancy and the postnatal period. No evidence showed the effectiveness of undertaking group-based PFMT in the postnatal period.

Twelve to 55% of women experience stress urinary incontinence at some time during their lifetime. To compare the effectiveness of pelvic floor muscle training with and without electrical stimulation in treatment of stress urinary incontinence. Participants were 24 women, 27-73 years of age, diagnosed with stress urinary incontinence. Exclusion criteria were pregnancy and urge urinary incontinence. These participants were randomly divided into group 1 and 2. Both groups trained 15 min. twice a day for 9 weeks. Group 2 used simultaneously intermittent electrical stimulation. The pelvic floor muscles were evaluated using the Oxford scale, vaginal palpation, and by electromyogram, (Myomed 930, Enraf Nonius). The quantity and frequency of urinary incontinence episodes was evaluated using a questionnaire and a VAS scale before and after the treatment. The groups were demographically similar, except group 2 was significantly younger. Both groups had significantly increased pelvic floor mus...

Background/aim: To evaluate the effects of pelvic floor muscle training (PFMT) on symptoms of overactive bladder (OAB) as well as uroflowmetry parameters and functional bladder capacity. Materials and methods: Fifty-nine female patients with OAB symptoms were included. Patients were assessed by SEAPI-QMM, uroflowmetry, and abdominal ultrasound. A specially designed PFMT program using a Pilates ball was generated for patients. The training period was 1-h sessions twice a week for 6 weeks and aerobic home exercises to be performed at home 4 or 5 times every other day. Following training, subjects were reevaluated for body mass index, SEAPI questionnaire, and uroflowmetry. Results: Initial mean SEAPI score, mean maximum and average flow rates, and mean voided volume were 9.8 ± 7.2, 29.8 ± 16.4 mL/s, 16.3 ± 8.7 mL/s, and 211.6 ± 173.5 mL, respectively. After completion of the training program, SEAPI scores improved significantly to 3.4 ± 6.4 (P < 0.05). Maximum and average flow rate results did not show significant changes, whereas voided volume seemed to have improved in conjunction with patients' symptom scores (Pearson correlation coefficient: 0.86). Conclusion: According to our results, we think that proper PFMT results in increase of functional bladder capacity as well as improvement in OAB symptoms and can be recommended as first-line therapy or in conjunction with medical therapy in severe cases.

Unconscious discharge of urine in sufficient quantity and frequency and causes health, social, psychological, physical, and sexual problems is called urinary incontinence. Urinary incontinence occurs due to a decrease in pelvic floor muscle strength as a result of the aging process. One of the efforts made to reduce complaints of incontinence in the elderly is Kegel exercises which aims to rebuild the strength of the pelvic floor muscles. The purpose of the study was to determine the effect of Kegel exercises on the frequency of urination in the elderly with urinary incontinence in the Pisang Candi Village, Mulyorejo Sukun Health Center Work Area, Malang City on 02 December 2019-02 January 2020. The research design used a Pre Experimental Design with a One Group Pre-Order design. Posttest. The sampling technique used is purposive sampling. The sample size is 32 elderly. The results showed that there was a significant decrease in the frequency of urination after the Kegel exercise. D...

Urinary incontinence is uncontrolled or undesirable urine loss redardless of the frequency or amount of urine lost, that the patient feels it to be a social or hygienic problem. Surveys conducted in Asian countries found 38% presentation experienced by women and 19% experienced by men. The prevalence of urinary incontinence that occurs in many elderly living in the orphanage. Efforts that can be made to reduce the frequency of urinary incontinence are kegel exercises. This study aims to determine the effect of giving kegel exercises to the frequency of urinary incontinence in elderly women in Panti Wreda Dharma Bakti Surakarta. The method of research used in this study was quasy experiment with non-randomized two group pre-test and post-test design. Sampling technique by purposive sampling is chosen based on certain characteristics that is inclusion and exclusion criteria. The sample in this research is 13 elderly woman. The sample was divided into two group, the treatment group and...

in dorsal lithotomy position, 2D transperineal USI assessments were carried out independently by two trained raters (R1;R2) with different level of experience. R1 (a resident in radiology) performed 2 assessments, each separated by a 30-minute interval, while R2 (a trained research physiotherapist; SB) performed a single assessment on the same day. After complete bladder voiding, 3 images of 5 variables were collected: bladder wall thickness (BWT); levator plate length at rest (LPR), during a maximal voluntary contraction of the PFM (MVC) and during a maximal Valsalva manoeuvre (MVM); and urethral length (UL). Reliability was analysed using intra-class correlation coefficients and 95% confidence intervals (ICC[CI]). Results: Between-raters reliability was very good for LPR

Introduction and hypothesis There is a high prevalence of urinary incontinence among endometrial cancer survivors. They are also known to present with pelvic floor muscle alterations. Evidence on the effects of conservative interventions for the management of UI is scarce. This study aims at verifying the effects of an in-home rehabilitation program, including the use of a mobile technology, to reduce UI severity in endometrial cancer survivors. Methods This study used a single-case experimental design with replications. Primary outcome for UI severity was the pad test, and secondary outcomes were the ICIQ-UI SF questionnaire and 3-day bladder diary. Pelvic floor muscle function was assessed using 2D-transperineal ultrasound and intravaginal dynamometry. Adherence was documented using mobile technology and an exercise log. Visual and non-parametric analyses of longitudinal data were conducted. Results Results show a reduction in UI severity for 87.5% of participants, with a significant relative treatment effect of moderate size (RTE: 0.30). Significant small relative treatment effects were found for the quick contraction and endurance dynamometric tests. Conclusion This study provides new evidence that endometrial cancer survivors can improve the severity of their UI following an in-home rehabilitation program, including the use of a mobile technology. This mode of delivery has the potential to address a gap in access to pelvic floor physiotherapy services for survivors of EC living in rural and remote communities.

Background. Endometrial cancer is the fourth most prevalent cancer in Canadian women. Radiotherapy (RT) is frequently recommended as an adjuvant treatment. There is a high prevalence (>80%) of urinary incontinence (UI) after RT. It is plausible that UI is associated, at least in part, with alterations of the pelvic-floor muscles (PFM). Objective. The aim of this exploratory study was to compare the PFM functional properties of women reporting UI after hysterectomy and RT for endometrial cancer with those of women with a history of hysterectomy but without UI. Design. A descriptive cross-sectional study was conducted. Eleven women were recruited for the affected group, and 18 were recruited for the comparison group. Methods. Urogenital and bowel functions were assessed using International Consultation on Incontinence Questionnaires, and PFM properties were evaluated using a Montreal dynamometer. Nonparametric tests were used for comparison of personal characteristics, functional status, and muscle properties. A correspondence analysis detailed the association between UI severity and PFM properties. Results. Maximal opening of dynamometer branches, maximal vaginal length, PFM maximum force and rate of force development in a strength test, and number of rapid contractions during a speed test were reduced in the affected group. No significant difference was found for the endurance test. The severity of UI was found to correspond to the rate of force development and the number of rapid contractions in a speed test, endurance, age, and vaginal length. Limitations. The results are limited to the population studied. The small sample size limited the strength of the conclusions. Conclusions. Some evidence of alterations in PFM properties were found in women with UI after hysterectomy and RT for endometrial cancer. These alterations appeared to be associated with UI, suggesting a possible role for rehabilitation.

Introduction: Pelvic floor problems are a broad group of diseases and disorders affecting women, men and children. In the treatment and rehabilitation of these problems, health professionals work in cooperation. Objective: The aim of this study is to examine the theses on ‘pelvic floor’ conducted in Turkıye from the perspective of physiotherapists, to present bibliometric analysis, to determine the prominent topics and shortcomings of the related literature. Method: Theses published in YÖKTEZ will be included in the study. Theses will be searched by using the key words ‘pelvic floor’, ‘pelvic floor rehabilitation’, ‘pelvic floor physiotherapy’, including the abstracts of the theses, without limitation of year and field. Theses will be analysed in terms of publication year, institution, language, type and field. Results: As a result of the search, 288 completed theses and 23 ongoing theses were reached. All of the theses were written in Turkish. Of the completed theses, 112 were published in 2021-2024, 57 in 2016-2020, and 59 in 1998-2015. 192 of the theses were conducted in state universities and 36 in foundation universities. Of the theses, 92 were master's theses, 83 were medical speciality theses and 53 were doctoral theses. Physiotherapy and rehabilitation (89), gynaecology and obstetrics and gynaecology (56) and nursing (32) are the fields with the highest number of theses out of a total of 14 speciality fields. Conclusion: It has been observed that the number of dissertations in the field has increased over the years and has reached its highest level in recent years. The fact that the dissertations are spread over many areas of specialisation shows that awareness and interest in the field has increased. Each specialisation adds a different dimension to the subject and multidisciplinary studies deepen it. High quality, multidisciplinary studies will continue to contribute to the field.

Introduction: In today's fast-paced world, the generation of new information and updating of scientific knowledge is very fast. For researchers and clinicians, reviewing systematic reviews and meta-analyses is one of the easy and effective ways to update their knowledge and accurate information. Objective: The aim of this study was to review the topic of pelvic floor muscle training using current systematic reviews and meta-analyses and to identify the prominent and missing points in this topic. Method: To identify the systematic reviews and meta-analyses to be studied, a search of the Medline (PubMed) database will be performed using the keywords 'pelvic floor muscle training' and 'pelvic floor muscle rehabilitation', covering articles published in 2024. The articles obtained will be included in the study by examining their topic and scope. The studies are analysed in terms of participant population, pelvic problems, intervention methods and primary endpoints. Results: The search yielded 36 articles, 1 of the articles was excluded because it was not in English, 6 of the articles were excluded because the full text could not be accessed, 7 of the articles were excluded because they dealt with different topics, and 22 articles were included in the study and analysed. The studies covered a wide range of topics, with urinary incontinence (7), post-surgery rehabilitation (3), labour and related conditions (3), female athletes (2), sexual dysfunction (2) and hypopressive exercises (2) being the most commonly studied topics. Conclusion: The increase in the number of review studies in recent years, the fact that pelvic floor muscle training is being used in a wide range of medical conditions, and the variety of methods used for training purposes demonstrate the importance of the subject and the strength of the scientific evidence. It is predicted that pelvic floor muscle training will become more widespread in the future.

Background/aim: To evaluate the effects of pelvic floor muscle training (PFMT) on symptoms of overactive bladder (OAB) as well as uroflowmetry parameters and functional bladder capacity. Materials and methods: Fifty-nine female patients with OAB symptoms were included. Patients were assessed by SEAPI-QMM, uroflowmetry, and abdominal ultrasound. A specially designed PFMT program using a Pilates ball was generated for patients. The training period was 1-h sessions twice a week for 6 weeks and aerobic home exercises to be performed at home 4 or 5 times every other day. Following training, subjects were reevaluated for body mass index, SEAPI questionnaire, and uroflowmetry. Results: Initial mean SEAPI score, mean maximum and average flow rates, and mean voided volume were 9.8 ± 7.2, 29.8 ± 16.4 mL/s, 16.3 ± 8.7 mL/s, and 211.6 ± 173.5 mL, respectively. After completion of the training program, SEAPI scores improved significantly to 3.4 ± 6.4 (P < 0.05). Maximum and average flow rate results did not show significant changes, whereas voided volume seemed to have improved in conjunction with patients' symptom scores (Pearson correlation coefficient: 0.86). Conclusion: According to our results, we think that proper PFMT results in increase of functional bladder capacity as well as improvement in OAB symptoms and can be recommended as first-line therapy or in conjunction with medical therapy in severe cases.

Background A chronic anal fissure is a common, painful condition with great impact on daily life. The exact pathogenesis has not been fully elucidated and treatment varies. A large percentage of patients experience pelvic floor dysfunction (dyssynergia and increased pelvic floor muscle tone). The aim of our study was to investigate the effect of pelvic floor physical therapy in patients with chronic anal fissure. Methods Between December 2018 and July 2021, at the Proctos Clinic in the Netherlands, patients with chronic anal fissure and pelvic floor dysfunction were randomly assigned to an intervention group, receiving 8 weeks of pelvic floor physical therapy including electromyographic biofeedback or assigned to a control group receiving postponed pelvic floor physical therapy. The primary outcome was muscle tone at rest during electromyographic registration of the pelvic floor before and after pelvic floor physical therapy. Secondary outcomes contained healing of the fissure, pain ratings, improvement of pelvic floor function, and complaint reduction measured with a proctology-specific patient-reported outcome measurement. Endpoints were measured at 8-and 20-week follow-up. Results One hundred forty patients were included in the study, 68 men (48.6%) and 72 women (51.4%) with a mean age of 44.5 ± 11.1 (range 19-79) years. Mean resting electromyographic values of the pelvic floor in the intervention group significantly improved from pre-to post-treatment (p < 0.001) and relative to controls (mean estimated difference between groups − 1.88 µV; 95% CI, − 2.49 to − 1.27 (p < 0.001) at first follow-up and remained significant from baseline at 20-week follow-up (p < 0.001). The intervention group performed better compared to the control group on all secondary outcomes, i.e., healing of the fissure (55.7% of the patients vs 21.4% in control, pain ratings (p < 0.001), diminished dyssynergia (p < 0.001), complaint reduction (p < 0.001), and decrease of pelvic floor muscle tone (p < 0.05) at first follow-up. Conclusions The findings of this study provide strong evidence that pelvic floor physical therapy is effective in patients with chronic anal fissure and pelvic floor dysfunction and supports its recommendation as adjuvant treatment besides regular conservative treatment.

Introduction and hypothesis Vaginal delivery may lead to tearing of the levator ani (LA) muscle from its bony insertions (complete LA avulsion) and increased levator hiatus (LH) area, both risk factors for pelvic floor dysfunctions. Early active rehabilitation is standard treatment after musculo-skeletal injury. We hypothesized that pelvic floor muscle training (PFMT) early postpartum would reduce the presence of LA avulsions and reduce LH area. Methods We carried out a planned secondary analysis from a randomized controlled study. Primiparous women (n=175) giving birth vaginally were included 6 weeks postpartum, stratified on complete LA avulsion, and thereafter randomized to PFMT or control. The training participants (n=87) attended a supervised PFMT class once a week and performed home-based PFMT daily for 16 weeks. The control participants (n=88) received no intervention. Presence of complete LA avulsion, LH area at rest, maximal contraction, and maximal Valsalva maneuver were assessed by transperineal ultrasound. Betweengroup comparisons were analyzed by analysis of covariance for continuous data, and relative risk (RR) for categorical data. Results Six months postpartum, the number of women who had complete LA avulsion was reduced from 27 to 14 within the PFMT group (44% reduction) and from 28 to 17 within the control group (39% reduction). The between-group difference was not significant, RR 0.85 (95% CI 0.53 to 1.37). Further, no significant between-group differences were found for LH area at rest, during contraction, or Valsalva. Conclusions Supervised PFMT class combined with home exercise early postpartum did not reduce the presence of complete LA avulsion or LH area more than natural remission.

Are there differences in the effectiveness of pelvic floor muscle training on pelvic floor muscle strength and urinary incontinence symptoms in postmenopausal women who are and are not using hormone therapy? Design: Randomised, controlled trial with concealed allocation, blinded assessors, and intention-to-treat analysis. Participants: Ninety-nine postmenopausal women, 38 of whom were using daily systemic oestrogen/progestogen therapy. Intervention: The experimental group (n = 51) received an intensive supervised pelvic floor muscle training protocol, and the control group (n = 48) received no intervention. The randomisation was stratified by hormone therapy use. Outcome measures: Change in pelvic floor muscle strength assessed with manometry at 12 weeks. Prevalence and severity of urinary incontinence symptoms were assessed using questionnaires. Results: Eighty-eight women provided data that could be included in the analysis. Pelvic floor muscle training increased pelvic floor muscle strength by 8.0 cmH 2 O (95% CI 3.4 to 12.6) in women not using hormone therapy and by-0.9 cmH 2 0 (95% CI-6.5 to 4.8) in women using hormone therapy (interaction p = 0.018). A sensitivity analysis showed that the greater training effect in women who were not using hormone therapy was still apparent if the analysis was conducted on percentage change in strength rather than absolute change in strength. There was also a significantly greater effect of training in women not using hormone therapy on prevalence of urinary incontinence symptoms (ratio of odds ratios = 7.4; interaction p = 0.028). The difference in effects on severity of urinary incontinence symptoms was not statistically significant (interaction p = 0.37). Conclusion: Pelvic floor muscle training increases pelvic floor muscle strength more in women who are not using hormone therapy than in women using hormone therapy. Trial registration: ClinicalTrials.gov NCT02549729.

Does an educational program with instructions for performing &#39;the Knack&#39; improve voluntary contraction of the pelvic floor muscles, reduce reports of urinary incontinence, improve sexual function, and promote women&#39;s knowledge of the pelvic floor muscles? Randomised, controlled trial with concealed allocation, intention-to-treat analysis and blinded assessors. Ninety-nine women from the local community. The experimental group (n=50) received one lecture per week for 4 weeks, and instructions for performing &#39;the Knack&#39;. The control group (n=49) received no intervention. The primary outcome was maximum voluntary contraction of the pelvic floor muscles measured using manometry. Secondary outcomes were: ability to contract the pelvic floor muscles measured using vaginal palpation; severity of urinary incontinence measured by the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) scored from 0 to 21; self-reported sexual function; and knowle...