scholarly journals Identifying the Pathway to Conservative Pelvic Floor Physiotherapy in a Tertiary Public Hospital in Australia: A Retrospective Audit

2017 ◽  
Author(s):  
Tara Beaumont ◽  
Kate Goode
Keyword(s):  
Pelvic Organ Prolapse ◽  
Pelvic Floor ◽  
Healthcare Provider ◽  
Best Practice ◽  
Conservative Therapy ◽  
Pelvic Floor Dysfunction ◽  
Pelvic Organ ◽  
Prolapse Symptoms ◽  
Tertiary Healthcare ◽  
Local Healthcare

Introduction: Incontinence and/or pelvic organ prolapse symptoms are prevalent in women in Australia and the estimated healthcare cost is considerable. Internationally accepted best practice evidence supports a trial of conservative Physiotherapy treatment with a Physiotherapist trained in the management of pelvic floor dysfunction before surgical options should be considered. Existing referral pathways in the tertiary healthcare system to access conservative Physiotherapy treatment require direct referral from Gynaecology staff. Objective: To identify the pathway to conservative pelvic floor physiotherapy for women referred to a tertiary hospital in Australia with incontinence and/or pelvic organ prolapse symptoms following existing referral pathways. Results: Attendance data for the period January to June 2015 identified 63 women as being primarily referred for incontinence and/or pelvic organ prolapse by their local healthcare provider. Half of these 63 women (n = 31) were referred on to Physiotherapy for conservative management; the other half were not. The time between local healthcare provider referral to specialist Gynaecology appointment ranged from 49 days to 351 days (average 169.6 days). Of the 31 women referred to Physiotherapy, the majority (n = 22, 70.9%) were referred on the day of their initial Gynaecology consultation, the 9 remaining women waited between 2 to 126 days for Physiotherapy referral. The shortest pathway from local healthcare provider referral to Physiotherapy consultation was 64 days; the longest pathway was 402 days. Of the 31 women who were not referred to Physiotherapy, 18 (58%) proceeded directly to surgery. Conclusion: This audit demonstrates that existing referral pathways for women referred with incontinence and/or pelvic organ prolapse create lengthy delays between local healthcare provider referral and access to Physiotherapy services. Only half of those women who would be appropriate for a trial of conservative therapy are being referred to Physiotherapy which is in direct contrast to the widely accepted best practice guidelines for the management of pelvic floor dysfunction mandating conservative therapy as a first line approach for these conditions. The opportunity to implement an advanced scope model of care that promotes more timely access and earlier commencement of conservative Physiotherapy for these women would significantly improve the clinical care pathway for this cohort of patients in the tertiary healthcare setting.

scholarly journals Quo Vadis Urogynecology 2020 – Innovative Treatment Concepts for Urinary Incontinence and Pelvic Organ Prolapse

2021 ◽  
Vol 81 (02) ◽  
pp. 183-190
Author(s):  
Gert Naumann
Keyword(s):  
Urinary Incontinence ◽  
Pelvic Organ Prolapse ◽  
Pelvic Floor ◽  
Professional Training ◽  
Pelvic Floor Dysfunction ◽  
Estrogen Therapy ◽  
Pelvic Organ ◽  
Alloplastic Materials ◽  
Wide Range ◽  
Quo Vadis

AbstractThe current treatment for urinary incontinence and pelvic organ prolapse includes a wide range of innovative options for conservative and surgical therapies. Initial treatment for pelvic floor dysfunction consists of individualized topical estrogen therapy and professional training in passive and active pelvic floor exercises with biofeedback, vibration plates, and a number of vaginal devices. The method of choice for the surgical repair of stress urinary incontinence consists of placement of a suburethral sling. A number of different methods are available for the surgical treatment of pelvic organ prolapse using either a vaginal or an abdominal/endoscopic approach and autologous tissue or alloplastic materials for reconstruction. This makes it possible to achieve optimal reconstruction both in younger women, many of them affected by postpartum trauma, and in older women later in their lives. Treatment includes assessing the patientʼs state of health and anesthetic risk profile. It is important to determine a realistically achievable patient preference after explaining the individualized concept and presenting the alternative surgical options.

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 Sexual function in women with pelvic floor disorders

2013 ◽  
Vol 7 (9-10) ◽  
pp. 199 ◽  
Author(s):  
Rebecca G. Rogers
Keyword(s):  
Urinary Incontinence ◽  
Pelvic Organ Prolapse ◽  
Stress Urinary Incontinence ◽  
Sexual Function ◽  
Pelvic Floor ◽  
Pelvic Floor Disorders ◽  
Pelvic Floor Dysfunction ◽  
Pelvic Organ ◽  
The Impact

Pelvic floor disorders (PFDs) can impact sexual function. This summary provides an overview of the impact of stress urinary incontinence and pelvic organ prolapse and their treatments on sexual function. In general, interventions that successfully address PFDs will generally improve sexual function as well. However, there are patients whose sexual function will remain unchanged despite treatment, and a small but significant minority who will report worsened sexual function following treatment for their pelvic floor dysfunction.

scholarly journals bFGF Activates Integrin β1 and Subsequently Upregulates Collagens via the p-MEK1/2/p-ERK1/2 Signaling Pathway in L929 Cells

2021 ◽  
Author(s):  
Lian Yang ◽  
Shasha Hong ◽  
Yang Li ◽  
Tingting Wang ◽  
Li Hong
Keyword(s):  
Pelvic Organ Prolapse ◽  
Pelvic Floor ◽  
Signaling Pathway ◽  
Pelvic Floor Dysfunction ◽  
Underlying Mechanism ◽  
Pelvic Organ ◽  
Integrin Β1 ◽  
L929 Cells ◽  
Signal Transduction Protein ◽  
Special Project

Abstract The substantial loss of collagen in the supporting tissues of the pelvic floor is characteristic of pelvic organ prolapse (POP). A bFGF-induced collagen increase has been widely recognized by scholars, but the role of bFGF in pelvic floor dysfunction and the mechanism by which bFGF promotes collagen have not been reported. Here, we elucidated this mechanism. After bFGF stimulation, L929 cells showed significantly increased expression of collagen, integrin β1, and MEK1/2 signaling proteins. Our previous studies showed that integrin β1 plays an important role in electric stimulation-induced collagen expression, which suggests an underlying mechanism. By overexpressing and silencing integrin β1, we proved that integrin β1 is also an important signal transduction protein of bFGF that promotes collagen through the MEK1/2 pathway, which is a classic collagen-promoting pathway. In summary, these findings suggest that bFGF can stimulate the expression of collagen through the integrin β1/p-MEK1/2/p-ERK/1/2 signaling pathway in L929 cells. Keyword Pelvic organ prolapse; bFGF; integrinβ1; ERK1/2; Collagen Special project for Chinese women's pelvic floor dysfunction prevention and treatment (no. 201817092) and the Natural Science Foundation of Hubei Province（no.2019CFB149）.

scholarly journals Role of Magnetic Resonance defecography in assessment of pelvic floor dysfunction

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M S Moussa ◽  
Y I Abdelkhaleq ◽  
S M Botros ◽  
A A Montasser
Keyword(s):  
Pelvic Organ Prolapse ◽  
Physical Examination ◽  
Pelvic Floor ◽  
Pelvic Floor Dysfunction ◽  
Pelvic Organ ◽  
Magnetic Resonance Defecography ◽  
Facial Defect ◽  
Floor Failure ◽  
Muscle Tear

Abstract Purpose to assess the role of the role of MR defecography in assessment of pelvic floor failure . Methods and Material Thirty-six patients (twenty-seven female and nine male) with female and male patients, complaining of stress urinary incontinence, constipation, fecal incontinence or pelvic organ prolapse. Results MRI revealed 18 cystocele (50%), compared to physical examination 2 cases(5.6%),MRI revealed 28 rectocele ( 77.8%) compared to physical examination that showed 13 (36.1%) , MRI revealed 10 uterine descent (40.7%), compared to physical examination 6 (22.2%) I, MRI revealed 7 enterocele (19.4%) compared to physical examination that was negative. MRI revealed level I/II facial defect in and level III facial defect in, 19 cases of Intussusception (52.8%), urethral hypermobility in 14 (38.9%), sphincteric defect 7 (19.4%), levator angle weakness in 30 cases (83.3%), iliococcygeaus muscle tear in 5 cases (13.9%), puborectalis tear in 3 cases (8.3%),anorectal decent in 26 cases (72.2%), genital hiatus width in 23 (63.9%) Conclusion Dynamic MR imaging is a necessary tool in the diagnosis of multicompartment pelvic organ prolapse and it provides good concordance with clinical examination

scholarly journals Correlation of Pelvic Organ Prolapse Quantification Technique with Pelvic Floor Dysfunction Symptoms

2019 ◽  
Vol 3 (3) ◽  
pp. 528-531
Author(s):  
Tarun Pradhan ◽  
Pappu Rijal ◽  
Baburam Dixit Thapa ◽  
Rabindra Dev Bhatta ◽  
Mohsina Hakkim ◽  
...  
Keyword(s):  
Pelvic Organ Prolapse ◽  
Pelvic Floor ◽  
Pelvic Floor Dysfunction ◽  
Pelvic Organ ◽  
Observer Variation ◽  
Anatomical Site ◽  
Significant Relation ◽  
Site Specific ◽  
Genital Hiatus ◽  
A Prospective Study

Introduction: Assessment of POP by POP-Q gives anatomical site-specific measurement, which helps in surgery, follow-up and reduces inter-observer variation. The Pelvic Floor Distress Inventory (PFDI) is condition-specific health-related quality of life questionnaires for women with pelvic floor disorders. Objective: To assess pelvic organ prolapse by POP-Q technique and to correlate pelvic floor distress inventory questionnaire with POP-Q segments. Methodology A prospective study was done from March 2014 to February 2015 after ethical approval from IRC, B.P. Koirala Institute of Health Sciences. All patients with pelvic organ prolapse were included after informed verbal consent. The patients were then asked questions as in pelvic floor distress inventory questionnaire (PFDI) and noted in performa. The patients were then examined by POP-Q technique and noted. The informations were entered in the MS excel chart and statistical analysis done using SPSS 11.5. Results: There were 72 patients enrolled. The mean age of patients was 53.65 years. Majority of patients were found to have stage 4 prolapse (43.1%). POP-Q examination showed majority of patients had anterior and apical compartment defect. Correlation between POP-Q points and urinary symptoms showed significant relation with points in anterior compartment, genital hiatus and perineal bodies. Correlation with POP-Q points with colorectal symptoms showed involvement of genital hiatus significantly with strain stool and incomplete bowel movement. Correlation with pelvic distress symptoms with POP-Q sites showed significant relation with bulging, push up vagina for urination and defecation. Conclusion: POP-Q site specific points showed significant correlation with symptoms from Pelvic Floor Distress Inventry (PFDI) questionnaires.

Quality of life and pelvic floor dysfunction symptoms after hysterectomy with or without pelvic organ prolapse

2014 ◽  
Vol 182 ◽  
pp. 16-21 ◽  
Author(s):  
Niina Humalajärvi ◽  
Pauliina Aukee ◽  
Matti V. Kairaluoma ◽  
Beata Stach-Lempinen ◽  
Harri Sintonen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pelvic Organ Prolapse ◽  
Pelvic Floor ◽  
Pelvic Floor Dysfunction ◽  
Pelvic Organ

scholarly journals Knowledge, Attitude and Practice of Physician toward Pelvic Floor Dysfunction KAP of Physician toward PFD

2019 ◽  
Vol 3 (1) ◽  
Keyword(s):  
Quality Of Life ◽  
Urinary Incontinence ◽  
Pelvic Organ Prolapse ◽  
Fecal Incontinence ◽  
Pelvic Floor ◽  
Pelvic Floor Dysfunction ◽  
Pelvic Organ ◽  
Attitude And Practice ◽  
Knowledge Attitude And Practice

Pelvic floor dysfunction (PFD) as a term includes underlying different sub-conditions the major ones are pelvic organ prolapse (POP), urinary incontinence (UI), fecal incontinence (FI), sexual function. The direct effect of dysfunction in these areas can affect the quality of life on a personal and healthy level in patients with PFD.

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