scholarly journals Management of Dyspareunia and Associated Levator Ani Muscle Overactivity

2007 ◽  
Vol 87 (7) ◽  
pp. 935-941 ◽  
Author(s):  
Kimberly A Fisher
Keyword(s):  
Pelvic Floor ◽  
Rating Scale ◽  
Physical Therapist ◽  
Management Strategies ◽  
Levator Ani ◽  
Pelvic Floor Muscles ◽  
Future Research ◽  
Levator Ani Muscle ◽  
Home Based ◽  
And Function

Background and PurposeMusculoskeletal dysfunction is a known cause of dyspareunia and a reason for referral for physical therapist management. The purpose of this case report is to describe the physical therapist management of a patient with dyspareunia and overactivity of the pelvic-floor muscles with a limited number of visits and a focus on self-management strategies.Case DescriptionThis case involved a 30-year-old married woman with levator ani muscle overactivity and dyspareunia that was 1 year in duration.InterventionThe therapist explained the anatomy and function of the pelvic-floor muscles during intercourse, instructed the patient on how to control the levator ani muscles, and instructed her on vaginal self-dilation techniques.OutcomesThe patient attended 3 physical therapy sessions over a period of 9 weeks. She performed vaginal self-dilation at home. She rated pain during intercourse as 0/10 on a verbal rating scale and had no remaining tenderness in the levator ani muscles at discharge.DiscussionSome women with dyspareunia may improve with an intervention that emphasizes education and vaginal self-dilation techniques. Future research should compare home-based and clinic-based treatments.

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.

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.

scholarly journals P26.02: Correlation of ultrasound evidence of levator ani trauma with clinical functional testing of pelvic floor muscles

2010 ◽  
Vol 36 (S1) ◽  
pp. 269-270
Author(s):  
A. Bord ◽  
S. Yagel ◽  
L. Shick-Naveh ◽  
M. Lipschuetz ◽  
R. Drai-Hassid ◽  
...  
Keyword(s):  
Pelvic Floor ◽  
Levator Ani ◽  
Pelvic Floor Muscles ◽  
Functional Testing ◽  
Ultrasound Evidence

scholarly journals Various significant connections of the male pelvic floor muscles with special reference to the anal and urethral sphincter muscles

2019 ◽  
Vol 95 (3) ◽  
pp. 305-312 ◽  
Author(s):  
Janyaruk Suriyut ◽  
Satoru Muro ◽  
Phichaya Baramee ◽  
Masayo Harada ◽  
Keiichi Akita
Keyword(s):  
Pelvic Floor ◽  
Anal Sphincter ◽  
External Anal Sphincter ◽  
Complex Structure ◽  
Levator Ani ◽  
Levator Ani Muscle ◽  
Urethral Sphincter ◽  
External Urethral Sphincter ◽  
Lateral Aspect ◽  
Close Relationship

AbstractThe male pelvic floor is a complex structure formed by several muscles. The levator ani muscle and the perineal muscles are important components of the pelvic floor. The perineal muscles comprise the external anal sphincter, bulbospongiosus, superficial transverse perineal muscles, and ischiocavernosus. Although the connections of the muscles of the pelvic floor have been reported recently, the anatomical details of each muscle remain unclear. In this study, we examined the male pelvic floor to clarify the connection between the muscles related to function. Fifteen male pelvises were used for microscopic dissection, and three male pelvises were used for histological examination. On the lateral aspect, the perineal muscles were connected to each other. Bundles of the levator ani muscle extended to connect to the perineal muscles. In addition, the extended muscle bundle from the levator ani muscle and the perineal muscles surround the external urethral sphincter. On the medial aspect, the levator ani muscle and the external anal sphincter form the anterior and posterior muscular slings of the anal canal. The connection between the perineal muscles and levator ani muscle indicates a possible close relationship between the functions of the urethra and anus.

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