Ultrasonic Diagnosis and Analysis of the Effect of Labor Analgesia on Early Pelvic Floor Function and Pelvic Floor Dysfunction

2021 ◽  
Vol 11 (7) ◽  
pp. 1903-1910
Author(s):  
Xiaolan Wang ◽  
Fan Yang ◽  
Wenjuan Chen ◽  
Xiaohong Yuan
Keyword(s):  
Pelvic Floor ◽  
Pelvic Floor Muscle ◽  
Pelvic Floor Dysfunction ◽  
Levator Ani ◽  
Pelvic Floor Muscles ◽  
Labor Analgesia ◽  
Natural State ◽  
Levator Ani Muscle ◽  
Pelvic Floor Function ◽  
Floor Function

Pelvic floor dysfunction disease (PFD) is a common pelvic organ dysfunction disease in the clinic of obstetrics and gynecology. Its cause is mainly the damage, defects and dysfunction of the pelvic floor support structure. Not only is the pathogenesis complicated, but also various symptoms coexist, which seriously affects the physical and mental health of female patients. Mechanical injury of the pelvic floor fascia tissue and levator ani muscles is the anatomical basis of PFD after birth; early postpartum pelvic floor examination and treatment can prevent and control the occurrence or development of PFD. Spinal canal anesthesia has good analgesic effect during labor and delivery, has little effect on mothers and infants, and is widely used. However, there are few domestic and foreign reports on the effect of labor analgesia on the pelvic floor. Labor analgesia relaxes the pelvic floor muscles, unblocks the birth canal, and the influence on the pelvic floor muscles is worth exploring. Based on the pelvic floor muscle strength screening to understand the changes in the function of the pelvic floor muscles, combined with the three-dimensional pelvic floor ultrasound examination, the pelvic floor structure and the levator ani muscle are clearly imaged, and the pelvic floor muscle structure is evaluated in the natural state and the analgesic muscle relaxation state. This study used a combination of the two to evaluate the effect of labor analgesia on pelvic floor function of primiparous women; provide individualized intervention treatment for high-risk groups screened; provide clinical basis for the prevention and treatment of PFD.

scholarly journals Episiotomy: the biomechanical impact of multiple small incisions during a normal vaginal delivery

2019 ◽  
Vol 9 (5) ◽  
pp. 20190027 ◽  
Author(s):  
Dulce Oliveira ◽  
Maria Vila Pouca ◽  
João Ferreira ◽  
Teresa Mascarenhas
Keyword(s):  
Pelvic Floor ◽  
Pelvic Floor Dysfunction ◽  
Levator Ani ◽  
Symphysis Pubis ◽  
Pelvic Floor Muscles ◽  
Point Of View ◽  
Normal Vaginal Delivery ◽  
Tissue Integrity ◽  
Levator Trauma ◽  
Reaction Forces

Childbirth-related injuries are one of the main causes of pelvic floor dysfunction. To attempt to avoid serious tears during delivery, an episiotomy can be performed. In this study, we intended to investigate the biomechanical performance of the pelvic floor muscles after performing different episiotomies using a physics-based computational model which includes the pelvic floor muscles and the fetus. Previous biomechanical studies have analysed the mechanical effects of single incisions of different lengths; in this study, we intend to analyse the implications of multiple small incisions, evaluating the reaction forces, the stress on the muscles and the loss of tissue integrity sustained by the pelvic floor. The obtained results predict that an episiotomy delivery reduces the likelihood of macroscopic levator trauma by decreasing the stress on the region of insertion of the rectal area of the levator ani in the symphysis pubis . From the mechanical point of view, multiple incisions do not bring benefits compared to larger incisions. However, nothing can be ascertained about the clinical benefit of such an approach.

scholarly journals Attachment of the levator ani muscle extends to the superior ramus of the pubic bone through electrophysiological and anatomical examinations

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hung-Yen Chin ◽  
Chih-Wei Peng ◽  
Ming-Ping Wu ◽  
Chih-Hwa Chen ◽  
Yu-Ting Feng ◽  
...  
Keyword(s):  
Pelvic Floor ◽  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Pelvic Floor Muscle ◽  
Levator Ani ◽  
Pubic Bone ◽  
Levator Ani Muscle ◽  
Cadaver Dissection ◽  
Inferior Border ◽  
Stimulation Of

AbstractMyofascial pelvic pain (MFPP) of pelvic floor muscles is a common cause of chronic pelvic pain (CPP). The pathological mechanisms and treatments of MFPP are complex and still unclear until now. The levator ani muscle (LAM) is the major pelvic floor muscle. The purpose of this study was to examine the fascia and attachment of LAM through the electromyogram (EMG) and cadaver dissection. Electrophysiological stimulation of the obturator fascia above the arcus tendinous levator ani (ATLA) could trigger contraction and electrophysiological changes in LAM insertion. The LAM of embalmed adult cadavers was examined especially in the area above the ATLA. Some skeletal muscle fibers were found above the ATLA within the obturator fascia and were confirmed by Masson’s trichrome section staining. Our electromyography (EMG) and anatomical data implied that the attachment of LAM aponeurosis extended beyond ATLA to the inferior border of the superior ramus of the pubic bone. The new discovered attachment of LAM could provide a reference position for clinical diagnosis and treatment of MFPP or CPP.

scholarly journals MRI comparative study of levator ani muscle changes in nulliparous and multiparous females

2019 ◽  
Vol 50 (1) ◽  
Author(s):  
Heba Azzam ◽  
Manal Halim ◽  
Hany El-Assaly ◽  
Aya Heiba
Keyword(s):  
Pelvic Floor ◽  
Treatment Plan ◽  
Pelvic Floor Dysfunction ◽  
Levator Ani ◽  
Control Group ◽  
Puborectalis Muscle ◽  
Levator Ani Muscle ◽  
Vaginal Deliveries ◽  
Significant Difference ◽  
Muscle Changes

Abstract Background Pelvic floor dysfunction is known to be among the principal factors influencing public health, regarding frequency, cost and effect on women’s quality of life. Radiographic assessment of the pelvic floor function and anatomy plays a vital role in the recognition of pelvic floor defects. The aim of this study is to detect the postpartum-related levator ani muscle changes thus defining the relationship between the vaginal deliveries and the etiology of pelvic floor dysfunction in order to provide guidelines to decrease the incidence of pelvic floor injuries during parturition and guide the treatment plan. Results There was a significant difference in the puborectalis muscle thickness between the case and control groups in the right puborectalis (P value ≤ 0.001) and in the left puborectalis (P value (≤ 0.001) as well as significant midpoint thickness (P value = 0.03) with 46.2% puborectalis muscle injury in the case group compared with none in the control group. Conclusion Pelvic floor MRI is highly recommended as it is a contrast-free modality that allows for both anatomical and functional analysis. Its incorporation in the routine postpartum assessment will allow early detection of abnormalities even in asymptomatic cases thus ensuring proper management and preventing the development of pelvic floor dysfunction predisposed to by repeated vaginal deliveries.

Biofeedback for Pelvic Muscle Dysfunction

Biofeedback ◽  
2016 ◽  
Vol 44 (2) ◽  
pp. 55-57
Author(s):  
Debbie Callif
Keyword(s):  
Pelvic Floor ◽  
Pelvic Pain ◽  
Control Strategies ◽  
Pelvic Floor Muscle ◽  
Pelvic Floor Dysfunction ◽  
Bowel Function ◽  
Pelvic Floor Muscles ◽  
Muscle Dysfunction ◽  
Reduction Techniques ◽  
Obturator Internus

Biofeedback for pelvic floor muscle dysfunction provides a practical and effective intervention for elimination disorders. Dysfunction in the pelvic floor muscles can affect bladder and bowel function and can cause pelvic pain. According to the National Association of Continence, there are 25 million Americans affected by bladder or bowel incontinence. Surface electromyographic (sEMG) sensors monitor the electrical activity of the pelvic floor muscles. Additional muscle co-contractions of the obturator internus, hip adductors, and transverse abdominis can facilitate improvements in symptoms affected by pelvic floor dysfunction. Pelvic floor therapy incorporates urge reduction techniques and functional control strategies. Dietary and lifestyle recommendations are also provided. The Biofeedback Certification International Alliance (BCIA) is the primary certifying body in the fields of biofeedback and neurofeedback. BCIA has a Blueprint of Knowledge specific for certification in pelvic muscle dysfunction biofeedback (PMDB). The Blueprint outlines the fundamental science, history, and theory of sEMG biofeedback as used for elimination disorders and chronic pelvic pain. You can find more information on PMDB at www.bcia.org.

Prediction Index of Levator Ani Muscle Avulsion After Vaginal Delivery: An Evidence-Based Appraisal

2018 ◽  
Vol 24 (8) ◽  
pp. 6214-6217
Author(s):  
Budi Iman Santoso ◽  
Adly Nanda Al-Fattah ◽  
Raymond Surya ◽  
Surrahman Hakim
Keyword(s):  
Pelvic Floor ◽  
Vaginal Delivery ◽  
Pelvic Floor Dysfunction ◽  
Levator Ani ◽  
Influential Factors ◽  
Cochrane Library ◽  
Levator Ani Muscle ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Levator Ani Muscle Avulsion

Pelvic floor dysfunction (PFD) due to vaginal delivery is related to tear of levator ani muscle (LAM) that potentially lead to the impairment of quality of life among women. A number of attempts to predict LAM injury after vaginal delivery had been conducted. This study aims to appraise the accuracy of several prediction index determining LAM injury after vaginal delivery. We conducted a search in Cochrane Library®, Pubmed®, and Medline® with the keywords of “pelvic floor dysfunction” AND “vaginal delivery” AND “prediction.” Critical appraisal determining the validity, importance, and applicability (VIA) was conducted by 2 independent authors. After 6 weeks to 3 months’ duration of follow up, the incidence of LAM avulsion was varied from 15.4% to 35.6% from three studies. Multivariate analysis showed that forceps delivery, OASIS, and active second stage (OR 3.8; 3.1; 1.61; respectively) as the most influential factors for LAM incidence. Maternal age and time spent in active pushing were also contributed to LAM incidence. OASIS and second stage of labor could be used as the most influential components of prediction index for LAM incidence. Prediction indexes for LAM incidence are developed. OASIS and second stage of labor are acknowledged as two most influential variables among three appraised studies.

Gastrointestinal obstruction in the course of incarcerated rectal prolapse – a case report

Nowa Medycyna ◽  
2019 ◽  
Vol 26 (2) ◽  
Author(s):  
Przemysław Ciesielski ◽  
Mateusz Sala ◽  
Paweł Siekierski ◽  
Małgorzata Kołodziejczak
Keyword(s):  
Rectal Prolapse ◽  
Intestinal Obstruction ◽  
Pelvic Floor ◽  
Bowel Movement ◽  
Pelvic Floor Muscle ◽  
Effective Treatment Option ◽  
Pelvic Floor Function ◽  
Urgent Surgery ◽  
Gastrointestinal Obstruction ◽  
Floor Function

Full thickness rectal prolapse is rare among young individuals. In most cases, rectal prolapse occurs only during bowel movement and the prolapsed rectum returns spontaneously afterwards. In rare cases, however, increased oedema makes it impossible for the rectum to return and may cause lower intestinal obstruction. We describe a case of a 50-year-old male with intestinal obstruction due to incarcerated rectal prolapse. The patient was qualified for an urgent surgery using the Altemeier’s technique. Perineal rectal resection is a method that has been used for many years. It is dedicated mostly to patients at an advanced age who additionally require levator repair due to pelvic floor muscle failure, which is relatively easy to perform using this access. In the presented case, however, perineal access was the only one possible regardless of the pelvic floor function. The surgery itself and the postoperative period were uneventful, and the functional treatment outcome was excellent. Conclusion: the Altemeier’s procedure is an effective treatment option for intestinal obstruction due to incarcerated rectal prolapse.

scholarly journals Efficacy of pelvic floor muscle training and hypopressive exercises for treating pelvic organ prolapse in women: randomized controlled trial

2012 ◽  
Vol 130 (1) ◽  
pp. 5-9 ◽  
Author(s):  
Bruno Teixeira Bernardes ◽  
Ana Paula Magalhães Resende ◽  
Liliana Stüpp ◽  
Emerson Oliveira ◽  
Rodrigo Aquino Castro ◽  
...  
Keyword(s):  
Pelvic Organ Prolapse ◽  
Pelvic Floor ◽  
Pelvic Floor Muscle Training ◽  
Pelvic Floor Muscle ◽  
Controlled Trial ◽  
Levator Ani ◽  
Pelvic Organ ◽  
Levator Ani Muscle ◽  
Muscle Training ◽  
Randomized Controlled

CONTEXT AND OBJECTIVE: Previous studies have shown that women with pelvic floor dysfunctions present decreased cross-sectional area (CSA) of the levator ani muscle. One way to assess the effects of training programs is to measure the CSA of the muscle, using ultrasonography. The aim here was to evaluate the efficacy of pelvic floor muscle training and hypopressive exercises for increasing the CSA of the levator ani muscle in women with pelvic organ prolapse. DESIGN AND SETTING: Prospective randomized controlled trial at the Urogynecology outpatient clinic of Universidade Federal de São Paulo. METHODS: Fifty-eight women with stage II pelvic organ prolapse were divided into three groups for physiotherapy: a pelvic floor muscle training group (GI); a hypopressive exercise group (GII); and a control group (GIII). The patients underwent transperineal ultrasonographic evaluation using a transducer of frequency 4-9 MHz. The (CSA) of the levator ani muscle was measured before physiotherapy and after 12 weeks of treatment. RESULTS: The groups were homogeneous regarding age, number of pregnancies, number of vaginal deliveries, body mass index and hormonal status. Statistically significant differences in CSA were found in GI and GII from before to after the treatment (P < 0.001), but not in relation to GIII (P = 0.816). CONCLUSIONS: The CSA of the levator ani muscle increased significantly with physiotherapy among the women with pelvic organ prolapse. Pelvic floor muscle training and hypopressive exercises produced similar improvements in the CSA of the levator ani muscle.

scholarly journals Postpartum sexual function; the importance of the levator ani muscle

2020 ◽  
Vol 31 (11) ◽  
pp. 2261-2267
Author(s):  
Anne-Marie Roos ◽  
Leonie Speksnijder ◽  
Anneke B. Steensma
Keyword(s):  
Regression Analysis ◽  
Sexual Dysfunction ◽  
Pelvic Floor ◽  
Vaginal Delivery ◽  
Sexual Functioning ◽  
Pelvic Floor Muscle ◽  
Linear Regression Analysis ◽  
Levator Ani ◽  
Transperineal Ultrasound ◽  
Levator Ani Muscle

Abstract Introduction and hypothesis Pelvic floor muscle function plays an important role in female sexual functioning. Smaller genital hiatal dimensions have been associated with sexual dysfunction, mainly dyspareunia. On the other hand, trauma of the levator ani muscle sustained during childbirth is associated with increased genital hiatus, which potentially can affect sexual functioning by causing vaginal laxity. This study aims to determine the association between levator hiatal dimensions and female sexual dysfunction after first vaginal delivery. Methods This is a secondary analysis of a prospective observational study. Two hundred four women who had a first, spontaneous vaginal delivery at term between 2012 and 2015 were recruited at a minimum of 6 months postpartum. Thirteen pregnant women were excluded. We analyzed the association of total PISQ-12 score, as well as individual sexual complaints (desire, arousal, orgasm and dyspareunia), with levator hiatal dimensions at rest, with maximum Valsalva and during pelvic floor muscle contraction as measured by 4D transperineal ultrasound. Statistical analysis was performed using linear regression analysis and Mann-Whitney U test. Results One hundred ninety-one women were evaluated at a median of 11 months postpartum. There was no significant association between total PISQ-12 score and levator hiatal dimensions. Looking at individual sexual complaints, women with dyspareunia had significantly smaller levator hiatal area and anterior-posterior diameter on maximum Valsalva. By using multivariate logistic regression analysis however we found dyspareunia was not independently associated with levator hiatal dimensions. Conclusions After first vaginal delivery sexual dysfunction is not associated with levator hiatal dimensions as measured by 4D transperineal ultrasound.

Three Dimensional Ultrasound of Pelvic Floor to Evaluate the Anatomical and Functional Changes of Primipara After Delivery

2020 ◽  
Vol 10 (6) ◽  
pp. 1370-1373
Author(s):  
Cheng Peng ◽  
Beihua Kong
Keyword(s):  
Pelvic Floor ◽  
Ultrasound Examination ◽  
Pelvic Floor Dysfunction ◽  
Three Dimensional ◽  
Levator Ani ◽  
3D Ultrasound ◽  
Control Group ◽  
Imaging Method ◽  
Levator Ani Muscle ◽  
Observation Group

Objective: During pregnancy and childbirth, a series of remodeling processes may lead to the occurrence of pelvic floor dysfunction. Our aim was to explore the influence of different delivery methods on pelvic floor in primipara after delivery through three-dimensional (3D) ultrasound examination. Method: A total of 48 primiparas were selected as the study object. Among which, 21 primiparas underwent cesarean section were selected as observation group, 27 primiparas in vaginal delivery were selected as the control group. The 3D ultrasound examination of pelvic floor was carried out 6–8 weeks postnatally to observe and compare the prolapse of anterior, middle and posterior pelvic organs of parturient women in Valsalva movement. The posterior ureterovesical angel (PUA), urethral tilt angel (UTA), cervical mouth position (CMP), and bladder neck position (BNP) were measured. The changes of hiatus of levator ani muscle in patients with anal constriction, rest and Valsalva were observed and measured. Result: Compared with the data in control group, the number of cases of anterior, middle and posterior pelvic organ exfoliation in observation group was lesser, the UTA and BNP were higher, the CMP was lower, and the area of hiatus of levator ani muscle was smaller both at the time of calm, contraction and Valsalva movements. Conclusion: The damage of pelvic floor in primipara during transvaginal delivery is great. The 3D ultrasound is an objective and simple imaging method to screen the diseases of pelvic floor dysfunction.

Sign in / Sign up

Export Citation Format

Share Document