scholarly journals Overview of pelvic floor failure and associated problems

2012 ◽  
Vol 26 (1) ◽  
pp. 2
Author(s):  
Khaled Refaat ◽  
Constanze Fischer-Hammadeh ◽  
Mohamad Eid Hammadeh
Keyword(s):  
Pelvic Floor ◽  
Uterine Prolapse ◽  
Pelvic Floor Muscle ◽  
Clinical Importance ◽  
Pelvic Organ ◽  
Management Options ◽  
Floor Failure ◽  
Common Group ◽  
Clinically Significant ◽  
Clinical Conditions

Pelvic organ prolapse POP, including anterior and posterior vaginal prolapse, uterine prolapse, and enterocele, is a common group of clinical conditions affecting millions of women worldwide. The aim of this review is to highlight the clinical importance of prolapse, its pathophysiology, and different modalities for diagnosis and treatment. POP includes a range of disorders, from asymptomatic disturbed vaginal anatomy to complete vaginal eversion associated with considerable degrees of urinary, defecatory, and sexual dysfunction. The pathophysiology of prolapse is multifactorial however genetically susceptible women are more exposed to life events that result in the development of clinically significant prolapse. The evaluation of women with prolapse requires a comprehensive approach, with focusing on the function in all pelvic compartments based on a detailed patient history, physical examination, and investigations. Although prolapse is associated with many symptoms, few are specific for prolapse; it is often a challenge for the clinician to determine which symptoms are prolapse-specific and will therefore improve or resolve after prolapse treatment. Prolapse treatment is based on specific symptoms moreover its management options fall into two broad categories: nonsurgical, which includes pelvic floor muscle training and pessary use; and surgical, which can be reconstructive or obliterative. Associated symptoms require additional management. All women with prolapse can be treated and their symptoms improved, even if not completely resolved.

Nonsurgical Management Options for Pelvic Organ Prolapse: Review of the Current Evidence

2018 ◽  
Author(s):  
Nathan Kow
Keyword(s):  
Pelvic Organ Prolapse ◽  
Pelvic Floor ◽  
Uterine Prolapse ◽  
Pelvic Floor Muscle ◽  
Treatment Options ◽  
Pelvic Organ ◽  
Current Evidence ◽  
Management Options ◽  
Nonsurgical Management ◽  
First Line Therapy

Pelvic organ prolapse (POP) is a common disorder that impacts a woman’s quality of life and has been projected to increase in the near future. Although many different treatments are currently available, healthcare practioners should be familiar with the common nonsurgical options that are considered the first-line therapy. Advances in nonsurgical interventions have traditionally included pessaries and pelvic floor muscle therapy.  These optiosn have not changed much over time, however there have been recent trials providing more evidence with regards to their efficacy.  The objective of this article is to review the current evidence for nonsurgical treatment options for POP.  This review contains 2 tables and 19 references Key Words: pelvic floor muscle training, pelvic floor physical therapy, pelvic organ prolapse, pessary, kegel excercises, uterine prolapse, cystocele, rectocele

Urogynaecology and pelvic floor

2017 ◽  
Keyword(s):  
Pelvic Floor ◽  
Clinical Skills ◽  
Pelvic Floor Muscle ◽  
Bowel Function ◽  
Pelvic Organ ◽  
Management Options ◽  
Safety Communication ◽  
Bladder Retraining ◽  
Surgical History ◽  
Initial Reading

This task assesses the following clinical skills: … ● Patient safety ● Communication with patients and their relatives ● Information gathering ● Applied clinical knowledge … You are a ST5 doctor in the urogynaecology clinic. You are asked to see Amanda Scott, who is a 64- year- old woman. She has been referred by her GP with mixed urinary incontinence which has not responded to supervized pelvic floor muscle training, bladder retraining and Tolterodine. She is para 2 with two spontaneous vaginal deliveries. She has no significant medical or surgical history. Previous examination did not reveal any pelvic organ prolapse. A urodynamic study was performed before her clinic appointment (see Fig 19.1). Amanda wishes to know more about the urodynamic findings and management options available to her. You will have ten minutes for the initial discussion. Once you have finished discussion with Amanda the assessor will ask you some questions. You have 10 minutes for this task (+ 2mins initial reading time). Please read instruction to candidate and actor. There are some marks on the process mark sheet for the actor to assign at the end of the station. Record your overall clinical impression of the candidate for each domain (i.e. should this performance be pass, borderline, or a fail). You are Amanda Scott, a 64- year- old mother of two. You have been experiencing a sudden, desperate need to pass urine and urine leakage if you don’t get to the toilet on time for the last three years. You also have episodes of unwanted loss of urine on coughing, laughing, physical exercise, and sexual intercourse. Your bowel function is normal and you are not aware of any vaginal ‘bulge’. You went through the ‘change’ (menopause) at the age of 52. You had two uneventful normal (vaginal) births. You are healthy without any previous operations. You have seen a physiotherapist for pelvic floor exercises and you have tried a drug for your bladder called Tolterodine (one 2mg tablet twice a day). Unfortunately, you haven’t seen any improvement of your symptoms.

IMPACT OF PELVIC FLOOR MUSCLE TRAINING ON POST OPERATIVE THIRDDEGREE PELVIC ORGAN PROLAPSE MANAGEMENT: A CASE REPORT

2021 ◽  
pp. 55-57
Author(s):  
Doss Prakash S ◽  
Sivan Aathira ◽  
Gupte Aditi ◽  
Tayade Amrapali
Keyword(s):  
Urinary Incontinence ◽  
Pelvic Organ Prolapse ◽  
Pelvic Floor ◽  
Pelvic Floor Muscle Training ◽  
Uterine Prolapse ◽  
Pelvic Floor Muscle ◽  
Pelvic Organ ◽  
Reproductive Age ◽  
Muscle Training ◽  
Sling Procedure

Pelvic organ prolapse is one of the common conditions in women with reproductive age group. In the developing countries pelvic organ prolapse poses as a common problem of the women population. We present a case of 21-year-old female with third degree uterine prolapse operated with laparoscopic sling procedure. The patient evaluation revealed weakness of pelvic oor muscles and urinary incontinence. She underwent threeweeks of structured and comprehensive Pelvic Floor Muscle Training (PFMT) in the department of Community Physiotherapy. The PFMT protocol included patient education primarily motivating the patient to adhere to the exercises. She was prescribed with relaxation technique, core muscle training and pelvic oor muscle strengthening exercises. There was a signicant improvement in the pelvic oor muscle strength after three weeks of therapy and there was a signicant improvement in the urinary incontinence. Presentation of this case clearly demonstrates the importance of pelvic oor muscle training in improving the strength of the pelvic oor muscles and controlling the urinary incontinence thereby improving quality of life

scholarly journals Pelvic-Floor Dysfunction Prevention in Prepartum and Postpartum Periods

Medicina ◽  
2021 ◽  
Vol 57 (4) ◽  
pp. 387
Author(s):  
Karolina Eva Romeikienė ◽  
Daiva Bartkevičienė
Keyword(s):  
Clinical Trials ◽  
Pelvic Organ Prolapse ◽  
Pelvic Floor ◽  
Randomized Clinical Trials ◽  
Pelvic Floor Muscle Training ◽  
Pelvic Floor Muscle ◽  
Pelvic Floor Dysfunction ◽  
Pelvic Organ ◽  
Cochrane Library ◽  
Muscle Training

Every woman needs to know about the importance of the function of pelvic-floor muscles and pelvic organ prolapse prevention, especially pregnant women because parity and labor are the factors which have the biggest influence on having pelvic organ prolapse in the future. In this article, we searched for methods of training and rehabilitation in prepartum and postpartum periods and their effectiveness. The search for publications in English was made in two databases during the period from August 2020 to October 2020 in Cochrane Library and PubMed. 77 articles were left in total after selection—9 systematic reviews and 68 clinical trials. Existing full-text papers were reviewed after this selection. Unfinished randomized clinical trials, those which were designed as strategies for national health systems, and those which were not pelvic-floor muscle-training-specified were excluded after this step. Most trials were high to moderate overall risk of bias. Many of reviews had low quality of evidence. Despite clinical heterogeneity among the clinical trials, pelvic-floor muscle training shows promising results. Most of the studies demonstrate the positive effect of pelvic-floor muscle training in prepartum and postpartum periods on pelvic-floor dysfunction prevention, in particular in urinary incontinence symptoms. However more high-quality, standardized, long-follow-up-period studies are needed.

scholarly journals Predictors of Success for Pelvic Floor Muscle Training in Pelvic Organ Prolapse

2018 ◽  
Vol 99 (1) ◽  
pp. 109-117 ◽  
Author(s):  
Marian Wiegersma ◽  
Chantal M C R Panman ◽  
Liesbeth C Hesselink ◽  
Alec G A Malmberg ◽  
Marjolein Y Berger ◽  
...  
Keyword(s):  
Pelvic Organ Prolapse ◽  
Pelvic Floor ◽  
Pelvic Floor Muscle Training ◽  
Pelvic Floor Muscle ◽  
Pelvic Organ ◽  
Predictors Of Success ◽  
Muscle Training

scholarly journals Pelvic floor muscle training for women with pelvic organ prolapse: the PROPEL realist evaluation

2020 ◽  
Vol 8 (47) ◽  
pp. 1-104
Author(s):  
Margaret Maxwell ◽  
Karen Berry ◽  
Sarah Wane ◽  
Suzanne Hagen ◽  
Doreen McClurg ◽  
...  
Keyword(s):  
Pelvic Organ Prolapse ◽  
Pelvic Floor ◽  
Symptom Score ◽  
Pelvic Floor Muscle Training ◽  
Pelvic Floor Muscle ◽  
Pelvic Organ ◽  
Realist Evaluation ◽  
Muscle Training ◽  
Patient Reported ◽  
Study Sites

Background Pelvic organ prolapse is estimated to affect 41–50% of women aged > 40 years. A multicentre randomised controlled trial of individualised pelvic floor muscle training found that pelvic floor muscle training was effective in reducing symptoms of prolapse, improved quality of life and showed clear potential to be cost-effective. Provision of pelvic floor muscle training for prolapse has continued to vary across the UK, with limited availability of specialist physiotherapists to deliver it. Objectives This project aimed to study the implementation and outcomes of different models of delivery to increase the service provision of pelvic floor muscle training, and to follow up treatment outcomes for the original trial participants. Design A realist evaluation of pelvic floor muscle training implementation conducted within three full case study sites and two partial case study sites; an observational prospective cohort study comparing patient-reported outcomes pre and post intervention in all five sites; and a long-term follow-up study linking previous trial participants to routine NHS hospital data. Setting The setting for the realist evaluation was pelvic floor muscle training service delivery models in three NHS sites. The setting for the patient-reported outcome measures study was pelvic floor muscle training services in five NHS sites. Methods Realist evaluation qualitative data were collected at four time points in three case study sites to understand the implementation models, uptake, adherence and impact. Interviews involved service managers/leads, consultants, staff delivering pelvic floor muscle training and women receiving pelvic floor muscle training. Main outcomes measures Patient-reported outcomes were collected at baseline and at 6 and 12 months across five sites, including the Pelvic Organ Prolapse Symptom Score, health-related quality of life (measured using the EuroQol-5 Dimensions, five-level version, questionnaire), prolapse severity (measured using the Pelvic Organ Prolapse Quantification System), urinary incontinence (measured using International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form) and need for further treatment. Results A total of 102 women were recruited to the patient-reported outcome measures cohort study (target, n = 120), and 65 women had matched baseline and 6-month Pelvic Organ Prolapse Symptom Scores. The mean Pelvic Organ Prolapse Symptom Score was 10.18 (standard deviation 5.63) at baseline and 6.98 (standard deviation 5.23) at 6 months, representing a statistically significant and clinically meaningful difference. There was no statistically significant difference between the outcomes obtained from delivery by specialist physiotherapists and the outcomes obtained from delivery by other health-care professionals (mean change in Pelvic Organ Prolapse Symptom Score: –3.95 vs. –2.81, respectively). Services delivered using higher-band physiotherapists only were more costly than services delivered using other staff mixes. The effect of the original pelvic floor muscle training intervention, over a post-intervention period of > 10 years, was a reduction in the odds of any treatment during follow-up (odds ratio 0.61, 95% confidence interval 0.37 to 0.99). The realist evaluation revealed stark differences in implementation. The site with a specialist physiotherapy service resisted change because of perceived threats to the specialist role and concerns about care quality. Pelvic floor muscle training delivery by other health-care staff was easier when there was a lack of any existing specialist service; staff had prior training and interest in pelvic health; staff had support, autonomy, time and resources to deliver pelvic floor muscle training as part of their core role; and surrounding services supported a flow of pelvic floor muscle training referrals. Limitations The number of available matched pre and post outcomes for women and the lack of Pelvic Organ Prolapse Quantification System examinations were limitations of this study. Conclusions It is possible to train different staff to effectively deliver pelvic floor muscle training to women. Women’s self-reported outcomes significantly improved across all service models. Training should be adequately tailored to differential skill mix needs. Future work Future work should include further implementation of pelvic floor muscle training and should include pre- and post-outcome data collection using the Pelvic Organ Prolapse Symptom Score. Study registration This study is registered as Research Registry 4919. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 47. See the NIHR Journals Library website for further project information.

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