scholarly journals Comprehensive assessment of the pelvic floor in women: new approaches to the prediction of pelvic organ prolapse

2020 ◽  
Vol 69 (3) ◽  
pp. 13-16
Author(s):  
Ilnur I. Musin
Keyword(s):  
Pelvic Floor ◽  
Pelvic Floor Dysfunction ◽  
Genital Prolapse ◽  
Risk Groups ◽  
Vaginal Wall ◽  
Pelvic Floor Muscles ◽  
Comprehensive Assessment ◽  
Reproductive Age ◽  
Blood Microcirculation ◽  
The Future

Hypothesis/aims of study. Despite the growing prevalence of pelvic floor dysfunction in women in the postpartum period, there is still no consensus on its etiology and pathogenesis. The prerequisite for serious disorders to occur in the future is the initial stages of pelvic floor dysfunction after childbirth, despite the fact that they occur without severe symptoms and, remaining undiagnosed in a timely manner, further reduce the quality of life of women. Despite the availability of information on causal relationships between childbirth and the appearance of pelvic floor dysfunctions, this knowledge among women of reproductive age is still limited, which warrants further study. A number of methods have been developed to assess the pelvic floor, among which are non-invasive techniques, including a quantitative assessment of the strength of contractions of the pelvic floor muscles, as well as techniques that assess the microcirculation of the vaginal wall. The aim of this study was to evaluate the parameters of the strength of contractions of the pelvic floor muscles and to identify possible correlations between the obtained parameters. Study design, materials and methods. The study was carried out using methods for measuring the blood microcirculation of the vaginal wall using laser Doppler blood flowmetry in women after the first birth. Results. We obtained indicators of the strength of contractions of the pelvic floor muscles and indicators of the blood microcirculation of the vaginal wall in primary women, and we revealed the dependence of the obtained indicators on the weight and age of the mother, as well as the weight of the fetus at birth. Conclusion. The obtained indicators will allow a comprehensive assessment of the pelvic floor in primiparous women, as well as to identify possible risk groups for genital prolapse development in the future.

Evaluation of implant-associated complications after mesh-implants setting in pelvic floor reconstruction

GYNECOLOGY ◽  
2019 ◽  
Vol 21 (5) ◽  
pp. 69-73
Author(s):  
Alfiya G Yashchuk ◽  
Ilnur I Musin ◽  
Raisa A Naftulovich ◽  
Elena M Popova ◽  
Irina B Fatkullina ◽  
...  
Keyword(s):  
Pelvic Organ Prolapse ◽  
Pelvic Floor ◽  
Blood Circulation ◽  
Pelvic Organ ◽  
Vaginal Wall ◽  
Anterior Vaginal Wall ◽  
Pelvic Floor Muscles ◽  
Reproductive Age ◽  
Doppler Flowmetry ◽  
Mesh Implant

Relevance. According to world data, nowadays prevalence of pelvic floor dysfunction and pelvic organ prolapsed reaches 28%. Most specialists relate pregnancy and delivery to main factors of pelvic prolapse development. Due to lifespan growth frequency of pelvic organ prolapse development increases. According to FDA data annually in the world is made more than 100 000 surgeries with synthetic implants, herewith heavy complications occur in 3.4% and mild complications occur in 14.8% of all cases. About 58% of surgeries are made to women under the age of 60, 13% of patients needs re-intervention during next 5 years. It should be noted that in cases of relapse more than 30% of women need re-intervention. Aim. Evaluate implant-associated complications after mesh-implants setting. Materials and methods. We have made retrospective analysis of mesh-implant use in 458 patients with pelvic organ prolapse in 2018-2018 yy. on the base of Bashkir State Medical University clinic. In order to assess quality of life after mesh-implant setting, we used the following questionnaires: Incontinence Questionnaire Short Form (ICIQ-SF), and also Female Sexual Function Index (FSFI). In order to assess blood microcirculation indices after surgery, we used laser Doppler flowmetry evaluation from anterior vaginal wall. Results. All in all, there were revealed 13 (2.84%) implant-associated complications. In 4 patients ICIQ-SF points were from 3 to 15, which indicates manifestation of urgent urine incontinence signs. According to FSFI questionnaire, sexually active women have 31.5 points. Basic factor, which provokes pelvic floor muscles dysfunction is delivery. Besides, in group of women of reproductive age, pelvic floor muscles dysfunction (PFMD) is associated with the presence of concomitant gynecologic diseases (uterine myoma, endometriosis, ovarian tumors). In the group of women older than 45 years with the presence of somatic pathology - obesity and impaired blood circulation. According to LDF data from anterior vaginal wall women with PFMD have low blood circulation indices, herewith the lowest indices are registered in the group of women older than 45 years.

Possibilities of using neodymium laser (Nd:YAG) in patients with concomitant diseases which are accompanied by pathological discharge from the genital tract

GYNECOLOGY ◽  
2020 ◽  
Vol 22 (4) ◽  
pp. 75-81
Author(s):  
Olga A. Pauzina ◽  
Inna A. Apolikhina ◽  
Darya A. Malyshkina
Keyword(s):  
Drug Therapy ◽  
Pelvic Floor ◽  
Genital Tract ◽  
Vaginal Discharge ◽  
Muscle Tone ◽  
Pelvic Floor Muscle ◽  
Pelvic Floor Dysfunction ◽  
Vaginal Wall ◽  
Neodymium Laser ◽  
Frequent Relapses

Background. Pathological vaginal discharge is the most common disorder in women after giving birth who have vaginal relaxation syndrome and vaginal wall prolapse, as well as in women during menopause. To date, there are no clear treatment regimens for mixed vulvovaginal infections, and the use of only drug therapy in patients with pelvic organ prolapse and genitourinary syndrome of menopause in combination with diseases which are accompanied by pathological vaginal discharge does not give a long lasting result and is characterized by frequent relapses. In this regard, the use of laser methods in combination with drug therapy may lead to the recovery of vaginal microbiocenosis and a decrease in the number of relapses of diseases which are accompanied by pathological discharge from the genital tract. Results. Description. This article presents a clinical case and description of the experience of using a neodymium laser for the treatment of a patient with recurrent mixed vulvovaginitis, 2nd- degree vaginal wall prolapse, loss of pelvic floor muscle tone, vaginal relaxation syndrome and sexual dysfunction using neodymium laser. The woman received 3 procedures of exposure to a neodymium laser with an interval of 2830 days. After 3 procedures of exposure to a neodymium laser, the patient has a good clinical efficacy in the recovery of vaginal microbiocenosis. Conclusions. An innovative technique of exposure to Nd:YAG neodymium laser in the practice of a gynecologist has shown high clinical efficiency in the treatment of not only pelvic floor dysfunction, but also mixed vulvovaginitis. And, despite this aspect of the use of laser technologies requires further study, we can use a neodymium laser in combination with traditional drug therapy to treat diseases which are accompanied by pathological discharge from the genital tract in cases of ineffective drug monotherapy and frequent relapses.

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.

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.

Factors associated with symptoms of pelvic floor dysfunction six years after primary operation of genital prolapse

2008 ◽  
Vol 87 (9) ◽  
pp. 910-915 ◽  
Author(s):  
Kristina Crafoord ◽  
Adam Sydsjö ◽  
Thomas Johansson ◽  
Jan Brynhildsen ◽  
Preben Kjølhede
Keyword(s):  
Pelvic Floor ◽  
Pelvic Floor Dysfunction ◽  
Genital Prolapse ◽  
Primary Operation ◽  
Factors Associated

scholarly journals Task-specific differences in respiration-related activation of deep and superficial pelvic floor muscles

2019 ◽  
Vol 126 (5) ◽  
pp. 1343-1351 ◽  
Author(s):  
Rafeef Aljuraifani ◽  
Ryan E. Stafford ◽  
Leanne M. Hall ◽  
Wolbert van den Hoorn ◽  
Paul W. Hodges
Keyword(s):  
Pelvic Floor ◽  
Deep Layer ◽  
Pelvic Floor Dysfunction ◽  
Muscle Layer ◽  
Superficial Layer ◽  
Pelvic Floor Muscles ◽  
Abdominal Pressure ◽  
Quiet Breathing ◽  
Abdominal Organs ◽  
Deep Layers

The female pelvic floor muscles (PFM) are arranged in distinct superficial and deep layers that function to support the pelvic/abdominal organs and maintain continence, but with some potential differences in function. Although general recordings of PFM activity show amplitude modulation in conjunction with fluctuation in intra-abdominal pressure such as that associated with respiration, it is unclear whether the activities of the two PFM layers modulate in a similar manner. This study aimed to investigate the activation of the deep and superficial PFM during a range of respiratory tasks in different postures. Twelve women without pelvic floor dysfunction participated. A custom-built surface electromyography (EMG) electrode was used to record the activation of the superficial and deep PFM during quiet breathing, breathing with increased dead space, coughing, and maximal and submaximal inspiratory and expiratory efforts. As breathing demand increased, the deep PFM layer EMG had greater coherence with respiratory airflow at the frequency of respiration than the superficial PFM ( P = 0.038). During cough, the superficial PFM activated earlier than the deep PFM in the sitting position ( P = 0.043). In contrast, during maximal and submaximal inspiratory and expiratory efforts, the superficial PFM EMG was greater than that for the deep PFM ( P = 0.011). These data show that both layers of PFM are activated during both inspiration and expiration, but with a bias to greater activation in expiratory tasks/phases. Activation of the deep and superficial PFM layers differed in most of the respiratory tasks, but there was no consistent bias to one muscle layer.NEW & NOTEWORTHY Although pelvic floor muscles are generally considered as a single entity, deep and superficial layers have different anatomies and biomechanics. Here we show task-specific differences in recruitment between layers during respiratory tasks in women. The deep layer was more tightly modulated with respiration than the superficial layer, but activation of the superficial layer was greater during maximal/submaximal occluded respiratory efforts and earlier during cough. These data highlight tightly coordinated recruitment of discrete pelvic floor muscles for respiration.

scholarly journals Influence of a protocol of Pilates exercises on the contractility of the pelvic floor muscles of non-institutionalized elderly persons

2017 ◽  
Vol 20 (4) ◽  
pp. 484-492 ◽  
Author(s):  
Ligia Muniz de Souza ◽  
Ana Beatriz Gomes de Souza Pegorare ◽  
Gustavo Christofoletti ◽  
Suzi Rosa Miziara Barbosa
Keyword(s):  
Pelvic Floor ◽  
Elderly Women ◽  
Paired Comparison ◽  
Pelvic Floor Dysfunction ◽  
Voluntary Contraction ◽  
Pelvic Floor Muscles ◽  
Elderly Persons ◽  
Mato Grosso ◽  
Significant Difference ◽  
Pilates Method

Abstract Objective: To investigate the influence of a protocol of Pilates exercises on the functionality and contractility of the pelvic floor muscles (PFM) of older women living in the city of Campo Grande, Mato Grosso, Brazil. Method: Ten women (median age of 63.4±4.5 years) with little or no pelvic floor dysfunction were subjected to 24 sessions of Pilates exercises lasting one hour each, for 12 weeks. The pressure of the pelvic floor muscles (PFM) was assessed using a perineometer (cmH20) and contractility was assessed with the PERFECT scheme. Data were described as median ± interquartile range and inferential analysis was performed using the Wilcoxon paired test, with a significance level of 5%. Results: In view of the proposed treatment, the degree of voluntary contraction of the PFM of the participants increased from 79.0±83.5 to 90.0±82.0 cmH20, with a statistically significant difference in paired comparison (p=0.012). According to the PERFECT scheme, there was an increase in contraction time (from 5.0±0.1 to 7.0±4.7 seconds) and in the number of fast repetitions (from 7.0±4.5 to 8.0±4.7), with a statistically significant difference for both variables (p=0.017 and p=0.008, respectively). Conclusion: The results indicate that the Pilates method increased the contractility and pressure of the PFM of elderly women with little or no PFM impairment. Further studies are required to determine whether the Pilates method is an effective method for the treatment of women with severe pelvic floor dysfunction.

Clinical and anamnestic and biological candidates for participation in the mechanisms of genital prolapse formation in women

2021 ◽  
Vol 20 (1) ◽  
pp. 82-88
Author(s):  
N. M. Milyaeva ◽  
V. V. Kovalev ◽  
E. A. Bortnik ◽  
E. V. Sivov ◽  
E. V. Kudryavtseva ◽  
...  
Keyword(s):  
Pelvic Organ Prolapse ◽  
Pelvic Floor ◽  
Pelvic Floor Dysfunction ◽  
Scientific Research ◽  
Genital Prolapse ◽  
Pelvic Organ ◽  
Prediction And Prevention ◽  
Pubmed Database ◽  
Mechanisms Of Formation

Introduction. The article presents an overview of the results of modern evidence-based scientific research on the mechanisms of formation of genital prolapse as one of the fundamental causes of pelvic floor muscle insufficiency in women. A systematic analysis of the current literature data on the involvement of clinical, anamnestic and pathogenetic motives in the development of pelvic organ prolapse in women was carried out.Objective: to expand the understanding of the role of anamnestic and biological factors in the pathogenesis of genital prolapse in women.Material and method. The review includes the scale of publications of domestic and foreign authors included in the PubMed database on this topic with a search depth of 20 years. The criteria for inclusion of articles for the system analysis were articles corresponding to the topic chosen for the study of the problem of gynecology, namely, the pathogenesis of genital prolapse in women with a search depth of twenty years. The criteria for exclusion from the study are the age of published scientific works, exceeding a twenty-year period, and inconsistency with the chosen top.Results. The conducted analysis demonstrates the fundamental role of epigenetic factors and molecular genetic predisposition in patients in the progression of genital prolapse which makes it possible to develop personalized prediction and prevention of pelvic floor dysfunction in women, prevention of social burnout.Conclusion. Further study of the mechanisms of formation, determination of the most significant molecular and genetic polymorphisms that increase the risk of pelvic organ prolapse in women, is a promising vector of scientific research. These studies will help to form a pathophysiological basis that allow for a thorough examination to identify a predisposition to the development of a severe disease long before its occurrence.

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