A nurse-led long-term pelvic floor muscle training program in the management of female patients with overactive bladder e A study protocol for a randomized controlled trial

Background:Previous research has suggested that pelvic floor muscle training(PFMT)offers a therapeutic benefit in patients with overactive bladder.Methods:Weconducted a single-blind,randomized trial of pelvic floor muscle training(PFMT)as compared with usual care.The intervention group(n=54)received a 6-month a nurse-led long-term pelvic floor muscle training program(three sessions a day,15e20 times per session)and the control group(n?53)received usual care.All patients received 3-month solifenacin succinate tablets(5 mg e once daily).The treatment outcomes were measured by the Modified Oxford Scale(MOS),Overactive Bladder SymptomScore(OABSS)and the King's Health Questionnaire(KHQ)at baseline,3 months and 6 months respectively.Results:Of the 91 randomly assigned patients,46 patients in the PFMT group and 45 patients in the control group completed the trial.The trial revealed statistically significant differences between groups in pelvic muscle strength at 3 months following the intervention(p<0.05),but no significant difference was found between two groups in OABSS scores(p>0.05).In regards to quality of life,the experimental group showed significant improvements compared to the control group on 6 of 10 domains(p<0.05).At 6 months,there were significant improvements in OABSS scores and quality of life in the experimental group compared to the control group(p<0.05).No adverse events were observed.Conclusion:A nurse-led long-term(6 months)pelvic floor muscle training program may alleviate OAB symptoms effectively and improve the quality of life more than a short term(3 months)pelvic floor muscle training program combined with solifenacin succinate tablets.

Research Progress on Compliance of Pelvic Floor Muscle Training in Patients with Urinary Incontinence

This study describes the status quo and related factors of compliance with pelvic floor muscle training at home and abroad, and introduces in detail the current scale of compliance with pelvic floor muscle training at home and abroad, so as to provide a reliable and scientific method for clinical medical staff to objectively evaluate pelvic floor muscle training of patients with urinary incontinence, and also provide a basis for how to improve compliance with pelvic floor muscle training.

Effects of High Risk Pregnancy Factors on Pelvic Floor Muscle Weakness and Changes of PG, ACTH and CRP

Objective: To investigate the effects of different delivery modes on perinatal pelvic floor muscle strength, PG, ACTH and CRP of high-risk pregnant women. Methods: 380 high-risk pregnant women who gave birth in our hospital from March 2021 to February 2022 were selected as subjects, including 100 vaginal natural delivery, 156 forceps assisted delivery and 124 cesarean section. Pelvic floor pressure, PG, ACTH, CRP, IL-6, TNF-α and IL-4, IL-10 levels were evaluated and compared. The perinatal occurrence of pelvic floor functional disease (PFD) in high-risk pregnant women in each group was analyzed and evaluated. Results: There were statistical differences in the amount of postpartum blood loss (P 0.0001, F = 99.01), postpartum blood loss 24 h (P = 0.0004, F = 19.54) and hospital stay (P 0.0001, F = 70.81) among the three groups of high-risk women in natural vaginal delivery, forceps delivery and cesarean section. In addition, there were 72, 134 and 70 cases of abnormal pelvic floor fatigue in natural vaginal delivery, forceps assisted delivery and cesarean section (P 0.0001, χ2 = 30.16). There were 36, 79 and 21 cases of muscle injury, respectively (P 0.0001, χ2 = 34.16). There were 49, 98 and 43 cases of dysmuscular contraction, respectively (P 0.0001, χ2 = 21.94). There were 65, 120 and 41 cases with vaginal dynamic pressure 80 cm H2O (P 0.0001, χ2 = 56.86), respectively. The.

Evaluation of therapeutic effects of self-made pelvic floor muscle rehabilitation on elderly female stress urinary incontinence

Objective:Create a pelvic floor muscle rehabilitation program and explore its effects on stress urinary incontinence(SUI)in elderly women.Methods:Pelvic floor muscle rehabilitation was created based on Kaigl experiment and pelvic floor muscle training methods.20 elderly women aged 65-75 years with SUI were randomly recruited for 10 weeks of pelvic floor muscle rehabilitation.Self-control study was used to compare the 72-hour average frequency of urinary incontinence,the average score of urinary incontinence questionnaire-simple form(ICIQ-SF)of international urinary incontinence advisory committee,the severity index of urinary incontinence and the weight of 1 hour urine pad before and after rehibition.Results:After 10 weeks of pelvic floor muscle rehabilitation training,the 72-hour average frequency of urinary incontinence was 1.02±0.65 times,which was not statistically different from that before training(1.25±0.71,P>0.05).The score of ICIQ-SF was 5.95±1.32,which was significantly lower than that before training(7.0±1.38,P<0.05),and the urinary incontinence severity index was 2.75±0.89,which was significantly lower than that before training(3.95±1.32,P<0.01).The weight of 1 hour urine pad was 6.40±2.29 g and was significantly lower than that before training(P<0.01,8.37±2.24).Conclusion:Self-created pelvic floor muscle rehabilitation had the function of decreasing the quantity of urinary incontinence instead of the frequency of incontinence.

Efficacy of biofeedback on stress urinary incontinence in women receiving pelvic floor muscle training: a meta-analysis

Background:To systematically evaluate the effect of pelvic floor muscle training with biofeedback v.s.pelvic floor muscle exercise alone on stress urinary incontinence in women.Methods:PubMed,the Cochrane Library,Web of Science,Ovid,Ebsco,PEDro,WanFang Data,VIP and CNKI databases were electronically searched to collect randomized controlled trials that meet inclusion criteria.After quality assessment,meta-analysis was conducted by RevMan 5.3 software.Results:A total of 8 randomized controlled trials were included.The results of meta-analysis supported the effectiveness of biofeedback on improving pelvic floor muscle strength(MD=4.67,95%CI(1.86,7.49),P=0.001),increasing short(up to 1 hour)pad test(SMD=−1.11,95%CI(−1.84,−0.37),P=0.003),enhancing quality of life(SMD=−0.34,95%CI(−0.67,−0.01),P=0.04)and social activity index(MD=0.1,95%CI(0.06,0.15),P<0.001).Conclusion:Pelvic floor muscle training with biofeedback could improve pelvic floor muscles’strength and help these patients integrate into society,more high quality studies are required to verify above conclusions.

Does Surgery Benefit Postmenopausal Overweight Women with Pelvic Floor Dysfunction?

Introduction: Pelvic floor muscle function of 30 overweight postmenopausal women prior to and after colporrhahpy was monitored in this study. Material and Methods: Patients diagnosed with cystokele or combined cystorectokele was involved. 1 mg oral estriol and local estriol cream were administered for 30 days preoperatively. Pelvic floor muscle function was monitored by surface electromyography 1 month before (1st) 1 day prior to surgery (2nd), and six weeks after the surgery (3rd measurement). Body composition parameters (intra- and extracellular water and body fat) were also measured. Results: The ability to relax significantly improved (p = 0.03) in the preoperative period (between 1st and 2nd occasions). Six weeks after surgery a non-significant (p = 0.054) decrease in average muscle activity was detected when compared with values obtained before the surgery. Muscle-activity declined significantly from the first to the last measurements (p = 0.005). Conclusion: Our results confirm that postmenopausal obese women who undergo anterior or posterior colporrhaphy need a follow-up concerning pelvic floor muscle function and suggest that physiotherapy started the earliest possible may aid in preserving postoperative functionality on the long run.

Intervention Study on the Exercise Order of Combined Aerobic ＆ Resistance Training in the Elderly

When combined aerobic and resistance training into the same session is performed, the exercise order may lead to different effects with respect to factors such as muscle strength, hormone responses, energy metabolism, and vascular function. The purpose of this study was to examine the effects of exercise order of combined aerobic and resistance training into the same session on body composition, muscle strength and arterial stiffness in the elderly. Thirty-one elderly subjects （70.5 ± 3.5 years） were randomly assigned to 3 groups; AR： aerobic before resistance training, RA： resistance before aerobic training and CON： no training. Subjects trained 2 times per week for 10 weeks. Resistance training consisted of 3 sets of 8-12 repetitions for 5 different exercises, 70%-80% of one repetition maximum （1RM）. Aerobic exercise consisted of cycling at 60% of heart rate reserve （HRR）. Significant interaction effects were observed in body fat percentage （P 〈 0.01） and 1RM （P 〈 0.01）. However, no significant differences were observed between AR and RA. In contrast, pulse wave velocity （PWV） significantly reduced in the RA （8.8± 2.1 m/s to 7.6 ± 1.9 m/s, P 〈 0.05）, while PWV increased in the AR （7.9 ± 2.8 m/s to 10.0 ± 2.6 m/s, P 〈 0.01）, and there was significant difference between AR and RA （P 〈 0.05）. In conclusion, no effects of the exercise order were observed in body composition and muscle strength. However, aerobic exercise after resistance training reduced arterial stiffness and difference of exercise order was observed.

The therapeutic effect of pelvic floor muscle exercise on urinary incontinence after radical prostatectomy:a meta-analysis

Pelvic floor muscle exercise(PFME)is the most common con servative manageme nt for urinary incon tine nee(Ul)after radical prostatectomy(RP).However,whether the PFME guided by a therapist(G-PFME)can contribute to the recovery of urinary continenee for patients after RP is still controversial.We performed this meta-analysis to investigate the effectiveness of G-PFME on Ul after RP and to explore whether the additional preoperative G-PFME is superior to postoperative G-PFME alone.Literature search was con ducted on Cochra ne Library,Embase,Web of Scie nee,and PubMed,to obtai n all re leva nt randomized controlled trials published before March 1,2018.Outcome data were pooled and an a lyzed with Review Man ager 5.3 to compare the conti nence rates of G-PFME with control and to compare additional preoperative G-PFME with postoperative G-PFME.Twenty-two articles with 2647 patients were included.The conti nence rates of G?PFME were all superior to con trol at d iff ere nt follow-up time points,with the odds ratio(OR)(95%confidence interval[Cl])of 2.79(1.53-5.07),2.80(1.87-4.19),2.93(1.19-7.22),4.11(2.24-7.55),and 2.41(1.33-4.36)at 1 mon th,3 months,4 months,6 months,and 12 months after surgery,respectively.However,there was no difference between additional preoperative G-PFME and postoperative G-PFME,with the OR(95%Cl)of 1.70(0.56-5.11)and 1.35(0.41-4.40)at 1 month and 3 months after RP,respectively.G-PFME could improve the recovery of urinary continence at both early and Iong-term stages.Starting the PFME preoperatively might not produce extra benefits for patients at early stage,compared with postoperative PFME.

Evaluation of the effect of an antenatal pelvic floor muscle exercise programme on female sexual function during pregnancy and the first 3 months following birth: study protocol for a pragmatic randomised controlled trial

BACKGROUND Sexual dysfunction can have a negative impact on women′s quality of life and relationships. There is limited information about female sexual function and treatment, particularly during pregnancy and the postpartum period. The effect of pelvic floor muscle exercise (PFME) on sexual function (SF) has not been studied adequately. The purpose of this study is to investigate the effect of antenatal PFME on female SF during pregnancy and the first 3 months following birth.

Activity of deep and superficial pelvic floor muscles in women in response to different verbal instructions: a preliminary investigation using a novel electromyography electrode

INTRODUCTION Verbal instructions are used clinically to encourage activation of the pelvic floor muscles (PFM). Whether separate layers of PFM activate differently in response to instructions remains unknown. AIM To test the hypotheses that (i) instructions that aimed to bias activity of a specific muscle layer would increase activation of the targeted layer to a greater extent than the other layer,(ii) activity of individual PFM layers would differ between instructions, and (iii) PFM activity would be symmetrical for all instructions.

An inverse approach to identifying the in vivo material parameters of female pelvic floor muscles using MRI data

Dear Editor,Pelvic floor（PF）dysfunctions comprise of a wide spectrum of interrelated clinical conditions and represent an important health problem.The PF supporting system can be regarded as a loaded structure with a complex geometry that supports the increase of abdominal pressure and maintain normal position of pelvic organs（Figure 1A）.

Task-specific differences in respiration-related activation of deep and superficial pelvic floormuscles

BACKGROUND AND OBJECTIVE 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.

Now anyone can kegel: one-time office teaching of pelvic floor muscle exercises

OBJECTIVE In women with pelvic floor disorders, we sought to determine time-to-teach (TTT) correct pelvic floor muscle (PFM) contraction, prevalence of inappropriate muscle contractions, and the association between TTT with PFM strength (PFMS). METHODS From August 2017 to April 2018, patients from 2 pelvic floor disorder clinics participated in a prospective study examining PFMS. Assessment of PFMS was performed to obtain TTT, inappropriate accessory muscle, and Modified Oxford Grading Scale scores for pelvic floor muscle contractions 1 to pelvic floor muscle contractions 2.

Supportive tissues of the vagina with special reference to a fibrous skeleton in the perineum: A review

With the aid of immunohistochemistry, the present review attempts to demonstrate the composite fibers and nerve topographical anatomy in the vaginal supportive tissues. Along the tendinous arch of the pelvic fasciae, distal parts of the pelvic plexus extend antero-inferiorly and issue nerves to the internal anal sphincter as well as the cavernous tissues. At the attachment of the levator ani muscle to the rectum, smooth muscles in the endopelvic fascia lining the levator ani merge with the longitudinal smooth muscle layer of the rectum to provide the conjoint longitudinal muscle coat or the longitudinal anal muscle (LAM: smooth muscle). However, at the rectovaginal interface, the longitudinal smooth muscle layer of the rectum continues to the LAM without any contribution of the endopelvic fascia. The bilateral masses of the perineal smooth muscles (PSMs) are connected by the perineal body, and the PSMs receive 1) the longitudinal anal muscle, 2) the internal and external anal sphincters and, 3) the perineal membrane lining the vestibular wall. Tensile stress from the levator ani seems to be transferred to the PSMs via the LAM. Because of their irregularly arrayed muscle fibers, instead of a synchronized contraction in response to nerve impulses, the PSMs are likely to act as a barrier, septum or protector against mechanical stress because, even without innervation, such smooth muscle fibers resist (not absorb) pressure, in accordance with Bayliss’ rule. The external anal sphincter, a strong striated muscle, inserts into the PSMs and seems to play a dynamic role in supporting the rectovaginal interface to maintain the antero-posterior length of the urogenital hiatus. However, we do not think that smooth muscles play an active traction role without cooperation from striated muscle. The fibrous skeleton composed of smooth muscle in the female perineum is explained in terms of a “catamaran” model.

Treatment of postpartum depression with integrated traditional Chinese and Western medicine nursing and electrical stimulation

BACKGROUND Postpartum depression(PPD)is a common psychological disease among puerperal women,and postpartum pelvic floor dysfunction is a common disease among pregnant women.The occurrence of postpartum pelvic floor dysfunction will increase the incidence of PPD.AIM To explore the therapeutic effect of integrated traditional Chinese and Western medicine nursing combined with electrical stimulation of pelvic floor muscles and the rectus abdominis on PPD.METHODS From April 2020 to January 2022,100 parturients with a rectus abdominis muscle separation distance>2.0 cm who underwent reexamination 6 wk after delivery at our hospital were selected as the research subjects.According to the random number table method,the patients were divided into either an observation group(n=50)or a control group(n=50).There was no significant difference in the general data between the two groups(P>0.05).Both groups were treated by electrical stimulation.The observation group was additionally treated by integrated traditional Chinese and Western medicine nursing.A self-designed Depression Knowledge Questionnaire was used to evaluate the awareness of knowledge on depression in all patients 3 wk after intervention.The Hamilton Depression Scale(HAMD)was used to evaluate the depression before intervention and 1 wk and 3 wk after intervention,and the Morisky Medication Adherence Scale(MMAS-8)was used to evaluate the medication compliance.SPSS19.0 was used for statistical analyses.RESULTS The rate of awareness of knowledge on depression in the observation group was significantly higher than that of the control group(P<0.05).The scores of MMAS-8 were comparable between the two groups before intervention(P>0.05),but were significantly higher in the observation group than in the control group at 1 wk and 3 wk after intervention(P<0.05).The HAMD scores were comparable between the two groups before intervention(P>0.05),but were significantly lower in the observation group than in the control group at 1 wk and 3 wk after intervention(P<0.05).CONCLUSION Integrated traditional Chinese and Western medicine nursing combined with electrical stimulation of pelvic floor muscles and the rectus abdominis is effective in the treatment of postpartum depression and worthy of clinical promotion.

All levels of providers can effectively and efficiently teach pelvic floor strength assessment at time of pelvic examination

OBJECTIVE In women who undergo provider-guided vaginal biofeedback of pelvic floor muscle strength, we sought to determine whether the level of the provider correlates with the patient′s ability to achieve adequate pelvic floor muscle contractions (PFMCs). METHODS From August 2017 to April 2018, patients from 2 urogynecology clinics were recruited to participate in an institutional review board-approved, prospective study examining PFMCs. Pelvic examination and teaching session were done by providers who had specific training on how to assess pelvic floor muscle strength using the validated, modified Oxford scale. Patients were asked to perform a baseline PFMC during a 2-digit pelvic examination. Thereafter, patients were counseled to relax their muscles, identify the levator ani muscles during provider teaching, and perform 3 consecutive provider-guided PFMCs. The strength of each PFMC was measured, and the time-to-teach (TTT) was recorded. The level of provider and TTT were correlated with PFMC1 to PFMC3 using Spearman correlation coefficient.

盆底超声评估妊娠、分娩和盆底肌锻炼对产妇盆底功能的影响

目的探讨盆底超声评估妊娠、分娩和盆底肌锻炼对产妇盆底功能的影响。方法选择2019年1月至2023年1月我院收治的104例产妇,根据干预方式不同分为对照组(n=50)和研究组(n=54)。对照组给予常规妊娠指导和护理,研究组则在妊娠28周后加用盆底肌锻炼。比较两组产后8周的盆底功能和盆底超声检查结果。结果研究组盆底肌力等级显著优于对照组,压力性尿失禁发生率显著低于对照组(P<0.05)。研究组CD、LHD-d、LHLR-d、RAD、BND显著低于对照组(P<0.05)。结论盆底超声可评估妊娠、分娩和盆底肌锻炼产妇的盆底功能;盆底肌锻炼能够显著改善产妇的盆底功能,减少盆腔结构变化,降低压力性尿失禁发生率。

线上产后康复促进项目活动方案的设计及实施

目的探讨线上产后康复促进项目活动方案对产妇产后母乳喂养、形体恢复的效果。方法以便利抽样法抽取符合纳入及排除标准的产妇70例,将产妇随机分为产康组与对照组各35例。对照组实施常规产褥期护理及随访,产康组按照线上产后康复促进项目活动方案实施护理干预。产后6个月比较两组纯母乳喂养率、婴儿体格发育情况、产妇盆底肌肌力及形体恢复情况。结果产后6个月,纯母乳喂养率对照组为42.86%,产康组为88.57%,两组差异有统计学意义(P<0.05)。产康组产妇臀围、腰围显著小于对照组,而盆底肌肌力评分显著高于对照组(均P<0.05)。两组婴儿身长及体质量差异无统计学意义(均P>0.05)。结论对产妇实施线上产后康复促进项目,可提升产妇纯母乳喂养率,促进产后形体恢复、改善盆底肌肌力。

中药督脉熏蒸联合生物反馈训练对产后盆底功能障碍患者盆底肌肌力及尿动力学的影响

目的:观察中药督脉熏蒸联合生物反馈训练治疗产后盆底功能障碍(PPFD)的效果。方法:选取PPFD患者180例,依照随机数字表法分为中药熏蒸组(A组)、生物反馈训练组(B组)、联合治疗组(C组)3组,每组60例。3组均给予常规治疗,即凯格尔运动法及阴道哑铃盆底肌肉锻炼。在常规治疗基础上A组再给予中药督脉熏蒸治疗;B组再给予生物反馈训练;C组再给予中药督脉熏蒸联合生物反馈训练,均治疗8周。治疗前后比较3组患者的盆底肌肌力、尿动力学、盆底神经肌电生理指标、盆底功能障碍影响问卷简版(PFIQ-7)、盆底症状影响量表简版(PFDI-20)、盆腔器官脱垂与尿失禁性功能问卷简版(PISQ-12)评分。结果:治疗后,3组患者的盆底肌肌力正常率、尿道最大闭合压力(MUCP)、功能尿道长度(FUL)、膀胱顺应性(BC)、应力性漏尿点压力(SLPP)、快肌收缩最大值、10s慢肌收缩平均值、PISQ-12评分均高于治疗前(P<0.05),且C组高于A组、B组(P<0.05);3组患者PFIQ-7、PFDI-20均低于治疗前(P<0.05),且C组低于A组、B组(P<0.05)。结论:中药督脉熏蒸联合生物反馈训练可减轻PPFD相关症状,改善PPFD患者盆底功能、性功能。

隔姜温和灸联合盆底肌训练及生物反馈电刺激治疗产后压力性尿失禁33例

目的观察隔姜温和灸联合盆底肌训练及生物反馈电刺激治疗产后压力性尿失禁(PSUI)的疗效。方法选取2021年6月—2022年6月于福建中医药大学附属人民医院整合盆底医学中心就诊的PSUI患者66例,采用SPSS 26.0软件生成随机序列和信封法分为对照组和观察组,每组33例。对照组进行盆底肌训练、生物反馈电刺激和健康教育,观察组在对照组治疗基础上联合八髎穴隔姜温和灸,每次30 min,隔日1次,2组均连续干预10次。比较2组治疗前后1 h漏尿量、尿道内口漏斗形成率和泌尿生殖障碍量表简表(UDI-6)评分,比较2组治疗前后和治疗后1个月尿失禁生活质量问卷(I-QOL)评分。结果与治疗前比较,2组治疗后1 h漏尿量、UDI-6评分均明显降低(P<0.05),治疗后和治疗后1个月I-QOL评分明显升高(P<0.05);观察组治疗后尿道内口漏斗形成率明显降低(P<0.05)。与对照组比较,观察组治疗后1 h漏尿量和UDI-6评分均明显降低(P<0.05),治疗后和治疗后1个月I-QOL评分明显升高(P<0.05)。结论隔姜温和灸能有效改善PSUI患者漏尿量,减轻尿失禁症状,提高生活质量,促进产后盆底功能康复。