Physical activity and the pelvic floor

[Robot-assisted minimally invasive sacrocolpopexy: a comprehensive review]

BACKGROUND

Sacrocolpopexy is a well-established surgical procedure for treatment of female genital prolapse and complex pelvic floor disorders. The introduction of robotic-assisted minimally invasive surgery has further optimised the precision, invasiveness and efficiency of the procedure.

PURPOSE

This review analyses the indications, surgical techniques, outcomes and management of complications of robotic sacrocolpopexy.

RESULTS

Robot-assisted sacrocolpopexy shows comparable anatomical and functional results to laparoscopic and open surgical approaches. Compared to laparotomy, minimally invasive techniques reduce perioperative morbidity and accelerate postoperative recovery.

CONCLUSION

Despite promising results, the treatment decision for robot-assisted sacrocolpopexy must be individually tailored to the severity of the prolapse, location of the prolapse, symptoms and availability of alternative treatment options under consideration of economic aspects.

Physical Activity, Quality of Life, and Pelvic Floor Disorders Before and After Hysterectomy for Gynecological Cancer: A Prospective Cohort Study

INTRODUCTION AND HYPOTHESIS

This study investigated physical activity (PA) levels and health-related quality-of-life (HRQoL) before and after, and associations between pelvic floor disorders (PFD) and PA/HRQoL after, hysterectomy for gynecological cancer.

METHODS

Secondary analysis of a longitudinal cohort study, with assessments before, 6 weeks, and 3 months after hysterectomy for gynecological cancer. The International Physical Activity Questionnaire-short form was used to assess PA and European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaire-C30 (QLQ-C30) to assess HRQoL. Changes over time were analyzed using generalized estimating equations or linear mixed models. Associations between PFD with PA and HRQoL were analyzed using logistic regressions and analyses of variance.

RESULTS

Of 126 participants, median age 63 years, most had endometrial (69%) and/or stage 1 cancer (72%) and underwent total hysterectomy (65%). Pre-surgery, 39% met PA guidelines, increasing to 53% 3 months post-surgery (+14%, 95% CI 2-25). Mean global health status/QoL domain scores from the QLQ-C30 did not change significantly (+4.4/100 points, 95% CI -0.8 to 9.6). Three months post-surgery, whether participants met PA guidelines was not associated with PFD. Participants with anal incontinence or double incontinence had lower global health status/QoL scores than participants without these symptoms (mean (SD) AI 61.4 (17.8) vs no AI 72.5 (18.7), p = 0.006; DI 61.5 (17.9) vs no DI 71.7 (18.8), p = 0.019).

CONCLUSION

PA levels were low pre- and post-surgery but worse preoperatively. This presents an opportunity for prehabilitation interventions to optimize physical function. There was no association between meeting PA guidelines and PFD. Global health status/QoL was slightly below population norms pre- and post-surgery. Lower HRQoL was associated with some symptoms of PFD.

Examining the Relationship Between Urinary Incontinence and Women's Physical Activity Engagement: Barriers and Disclosure Patterns

BACKGROUND

This study investigates the relationship between urinary incontinence (UI) and women's participation in physical activity (PA). Women are less active than men across their lifespan, and while interventions aim to bridge this gap, the unique challenge posed by UI remains underexplored. UI disproportionately affects women and often results in reduced self-confidence and avoidance of PA.

METHODS

Employing a mixed-methods design, the study utilised an online survey (n = 345) and semi-structured interviews (n = 14) to explore women's experiences of UI during PA and its perceived impact relative to other barriers.

RESULTS

Findings reveal that UI ranks prominently among barriers to PA, yet disclosure is infrequent without direct prompting. Participants highlighted anxiety, embarrassment, and the inadequacy of PA environments in accommodating UI-related needs as critical deterrents. Interviews further uncovered a lack of practitioner knowledge regarding UI, with many women favouring privacy-centric approaches to address their concerns.

CONCLUSIONS

The study underscores the necessity for tailored interventions, practitioner education, and inclusive PA environments to enhance participation and mitigate UI's impact. These findings contribute to broader efforts to promote gender equity in PA and improve women's health outcomes.

Cross-Cultural Adaptation and Validation of the Portuguese Version of the "Australian Pelvic Floor Questionnaire"

INTRODUCTION AND HYPOTHESIS

Pelvic floor dysfunction (PFD) is a common problem that occurs among women and increases with age and weight. This study was aimed at cross-culturally adapting and validating the original version of the Australian Pelvic Floor Questionnaire (APFQ) into Portuguese.

METHODS

The process of cultural and linguistic adaptation and validation followed the guidelines. The obtained Portuguese version was assessed by an expert panel of physiotherapists specialized in women's health. Women with pelvic floor dysfunction also participated in a cognitive pre-test (n = 9). A sample of 50 women with PFD completed the questionnaire to evaluate internal consistency, construct validity, reproducibility, floor/ceiling effects assessment, and standard error of measurement. Test-retest was assessed with a 2-week interval. The study was approved by the Ethics Commission and all participants signed an informed consent form.

RESULTS

Fifty women with a mean age of 53.90 (± 18.57) years, BMI of 27.5 (± 4.2), 55.6% with a bachelor's degree, and all with at least one child, participated in the study. The psychometric properties of the APFQ showed a high Cronbach's alpha for the four domains: bladder (0.837), bowel and sexual function (0.756), pelvic organ prolapse (0.840), and total score (0.714). In terms of reproducibility, intraclass coefficient domain values ranged from 0.934 to 0.976, with a total score of 0.948.

CONCLUSIONS

The APFQ was cultural and linguistically adapted and validated for Portuguese. The Portuguese version of the APFQ (APFQ_P) showed acceptable values of validity and good reliability. It can be used in both clinical evaluation and in research on pelvic floor dysfunction.

Individual Factors in Young Female Athletes' Bladder Health (the Y-FAB Study)

IMPORTANCE

Bladder health in high school and collegiate females is not well understood.

OBJECTIVE

The objective of this study was to compare toileting behaviors, lower urinary tract symptoms (LUTSs), and fluid intake in female athletes and nonathletes.

STUDY DESIGN

English-speaking nulliparous females aged 13-23 years were recruited. Participants completed the Toileting Behaviors: Women's Elimination Behaviors Scale, Bristol Female LUTS Questionnaire, and Beverage Questionnaire. Statistical analysis included univariable analyses and multivariable comparisons of athletes to nonathletes adjusting for age and fluid intake.

RESULTS

One hundred athletes and 98 nonathletes participated (mean age 20 ± 2, mean body mass index 23 ± 4). Athletes' sports were predominantly high impact. Dysmenorrhea and anxiety were higher in nonathletes ( P < 0.01) versus more stress fractures in athletes ( P < 0.001). Problematic toileting behaviors were prevalent regardless of athletic status; nonathletes were more likely to hold urine until home and empty away from home without the urge (both P = 0.04). Lower urinary tract symptoms were prevalent regardless of athletic status, including frequency (34.2%), hesitancy (33.3%), urgency (32.8%), stress incontinence (15.3%), and urgency incontinence (11.8%). Athletes had significantly more stress incontinence and urgency and higher incontinence subscores on univariable analysis, although the difference was attenuated after multivariable adjustment. Athletes consumed lower total fluids ( P = 0.03).

CONCLUSIONS

Problematic toileting behaviors and LUTSs were prevalent in high school and collegiate females, regardless of athletic status. Athletes had higher stress urinary incontinence and urgency and lower fluid intake. These findings support future work toward enhancing early bladder health interventions (screening, education, and LUTS prevention) among high school and collegiate females.

Sport practice and hemorrhoidal disease: results from a self-assessment questionnaire among athletes

BACKGROUND

Hemorrhoidal disease (HD) is a common proctologic disease. Dietary and lifestyle play a role in the genesis of the disease or in its progression to more severe forms, although the exact mechanism is still not fully understood. We performed a pilot observational cross-sectional analytical association study to evaluate the possible association between sport activities and HD.

METHODS

We included subjects aged 18 years old or more, competitive and non-competitive, practicing at least one sport activity, at least twice a week. Data were collected using an online questionnaire, developed on the Microsoft Teams communication platform.

RESULTS

Out of the 312 study participants, 34% reported HD. Among subjects who practiced cycling or horseback riding, 57% reported suffering from HD; among those practicing bodybuilding, 48% complained of HD. In the multivariate logistic regression analysis, age and bodybuilding practice showed a statistically significant association with HD.

CONCLUSIONS

Some sport activities could play a role in the onset or worsening of HD. Our results showed a positive association between cycling, horseback riding, bodybuilding, and HD occurrence. Given the numerous health benefits of physical activity, patients should be provided with correct information regarding the practice of sports in relation to their pathology.

Unveiling the depths of pelvic organ prolapse: From risk factors to therapeutic methods (Review)

Pelvic organ prolapse (POP) is a condition where one or more pelvic organs (such as the uterus, bladder and rectum) descend from their normal anatomical positions into the vagina, primarily due to the weakening of the pelvic floor support structures. While not life-threatening, POP can substantially diminish the patient's quality of life and lead to serious social and psychological complications. Researchers have explored novel directions regarding the etiology, mechanism and treatment of POP. However, existing literature on the subject often lacks comprehensive and systematic overviews. To address this gap and enhance researchers' understanding of POP, the present study reviewed the risk factors and molecular mechanisms of POP [including matrix metalloproteinases (MMPs) and tissue inhibitors of MMPs, transforming growth factor β, advanced glycation end products (AGEs)/receptor for AGE, phosphoinositide 3-kinase/protein kinase B, fibulin, lysyl oxidase-like 1, homeobox A11, collagen α-1 (XVIII) chain, Wnt signaling pathways and estrogen receptor α], as well as therapeutic approaches, such as lifestyle interventions, physical methods, pharmacotherapy, stem cell transplantation and surgical techniques. The present review aims to provide new insights for future research and contribute to the advancement of diagnosis and treatment strategies for POP.

Impact of Lifestyle Modifications on the Prevention and Treatment of Pelvic Organ Prolapse

INTRODUCTION AND HYPOTHESIS

This manuscript is a part of the International Urogynecology Consultation (IUC) on pelvic organ prolapse (POP) chapter three, committee three, on the impact of lifestyle modifications (i.e., weight loss, treatment of constipation, activity restriction, etc.) on the prevention and treatment of POP.

MATERIALS AND METHODS

An international group containing ten female pelvic medicine specialists and one university-based medical librarian performed a systematic search of the literature in Medline using the MeSH terms: pelvic organ prolapse (ID: D056887), cystocele (ID: D052858), uterine prolapse (ID: D014596), rectocele (ID: D020047), and women (ID: D014930) to identify studies addressing lifestyle modifications as prevention or treatment for POP on 10/18/21. Relevant studies were included in this review.

RESULTS

A total of 18,483 studies were identified in the initial literature search; 187 full-text articles were deemed pertinent and independently reviewed and double-screened by ten reviewers. After full-text review, information from 86 articles was included in this review.

CONCLUSION

Women may consider various lifestyle modifications to help prevent and treat POP, even if it is challenging to quantify the efficacy of these interventions.

Prevalence and Experience of Urinary Incontinence Among Elite Female Gaelic Sports Athletes

INTRODUCTION AND HYPOTHESIS

This study was aimed at identifying the prevalence and experience of urinary incontinence (UI) among elite female Gaelic sports athletes in Ireland.

METHODS

A cross-sectional study comprising an anonymous online survey of elite Gaelic sports (Camogie and Ladies Gaelic Football) players. Players were asked about their background information, knowledge of the pelvic floor and practice of pelvic floor muscle training (PFMT), as well as their experiences of UI. The prevalence and severity of UI was assessed using the International Consultation on Incontinence Questionnaire-UI Short Form (ICIQ-UI-SF) questionnaire. Logistic regression was used to evaluate risk factors.

RESULTS

A total of 185 players responded (25 ± 5 years) and 95.3% (n = 176) were nulliparous. Forty-one percent (n = 75) of players had learned about PFMT and 13% (n = 24) had performed PFMT within the last 4 weeks. The ICIQ-UI-SF was completed by 159 players, with UI reported by 61.6% (n = 98), 52% (n = 51) of whom experienced stress urinary incontinence (SUI). A significant association was found between UI and longer weekly sporting activity time (OR 1.05, 95% CI 1.002 to 1.008). Parous players were more likely to experience UI (p = 0.025). Jumping and sprinting activities were the most commonly reported triggers, with pre-voiding and wearing protection (liners, pads) the most commonly adopted UI management strategies. Only ten players reported receiving treatment for UI.

CONCLUSIONS

Urinary incontinence is prevalent among this cohort of elite female Gaelic sports athletes. Many players used strategies to manage their UI whereas few sought help for what is a treatable condition. Findings suggest the need for education of players regarding pelvic floor health and treatment options available.

Pelvic Floor Disorders Among U.S. Military Active-Duty Females

IMPORTANCE

Women are a growing cohort within the U.S. military. Pelvic floor health is a component of health maintenance for which support needs vary by sex. The American Journal of Obstetrics & Gynecology reports that 1 in 4 women is affected by moderate to severe pelvic floor dysfunction (PFD). Understanding the specific experience of female service members is warranted for health care optimization and preservation of force readiness.

OBJECTIVE

We aimed to identify the prevalence, incidence, and risk factors associated with incident PFD in active-duty females during an 11-year window.

STUDY DESIGN

We used the Medical Assessment and Readiness System at Womack Army Medical Center, which includes medical record and personnel data from 2011 to 2022. Pelvic floor dysfunction diagnoses were identified using diagnosis codes and analyzed with respect to demographic parameters.

RESULTS

Between 2011 and 2022, 32,996 of 550,303 active-duty females were diagnosed with PFD (period prevalence: 6.00%). Using 2011-2012 as a washout period, 27,046 of 486,558 participants were diagnosed during 1,879,990.90 person-years of follow-up (incidence rate: 14.39 cases per 1,000 person-years). The incidence rate of PFD increased in both new and established active-duty females. Increasing time since service entry was the strongest, statistically significant independent predictor of PFD. Three or more deployments and specific physical fitness scoring were also predictors of PFD.

CONCLUSIONS

The incidence rate of PFD among female service members is increasing, and multiple military-specific factors predict PFD. As the percentage of women in active-duty service continues to grow, additional investigation is needed to confirm PFD trends, illuminate other predictors, and prevent adverse outcomes.

Adherence to Mediterranean diet and female urinary incontinence: Evidence from the NHANES database

BACKGROUND

Urinary incontinence (UI) is a common condition in female. Oxidative stress and inflammation levels play important roles in UI progression. Mediterranean diet (MD) as a healthy anti-inflammatory dietary pattern has been reported to be associated with several inflammatory diseases. This study aimed to assess the association between the adherence to Mediterranean diet (aMED) and female UI.

METHODS

Data of study women aged ≥18 years old and diagnosed as stress UI and urgency UI were extracted from the National Health and Nutrition Examination Survey (NHANES) 2005-2018. Dietary intake information was obtained by 24-h dietary recall interview. Covariates included sociodemographic information, physical examination, and history of diseases and medication were extracted from the database. The weighted univariable and multivariate logistic regression models were used to assess the association between aMED and different types of UI, with odds ratios (ORs) and 95% confidence intervals (CIs). Subgroup analysis were further evaluated this association based on different age, body mass index (BMI), neutrophil to lymphocyte ratio (NLR), depression and smoking.

RESULTS

Totally, 13,291 women were included, of whom 5,921 (44.55%) had stress UI, 4276 (32.17%) had urgency UI and 2570 (19.34%) had mixed UI. After adjusted all covariates, high aMED score was associated with the lower odds of urgency (OR = 0.86, 95%CI: 0.75-0.98) and mixed UI (OR = 0.84, 95%CI: 0.70-0.99), especially in female, aged 45-60 years old, NLR ≥1.68 and had smoking history. No relationship was found between the aMED and stress UI (P >0.05).

CONCLUSION

Greater aMED was connected with the low odds of urgency UI and mixed UI among female. Adherence to an anti-inflammatory diet in daily life are a promising intervention to be further explored in female UI.

Replacement of sedentary behavior with various physical activities and the risk of all-cause and cause-specific mortality

BACKGROUND

Sedentary behavior (SB) has emerged as a significant health concern that deserves attention. This study aimed to examine the associations between prolonged sedentary behavior and the risk of all-cause and cause-specific mortality as well as to explore desirable alternatives to sitting in terms of physical activity (PA).

METHODS

Two prospective cohort investigations were conducted using the UK Biobank and NHANES datasets, with a total of 490,659 and 33,534 participants, respectively. Cox proportional hazards regression models were used to estimate the associations between SB and the risk of all-cause and cause-specific mortality due to cancer, cardiovascular disease (CVD), respiratory diseases, and digestive diseases. In addition, we employed isotemporal substitution models to examine the protective effect of replacing sitting with various forms of PA.

RESULTS

During the average follow-up times of 13.5 and 6.7 years, 36,109 and 3057 deaths were documented in the UK Biobank and NHANES, respectively. Both cohorts demonstrated that, compared with individuals sitting less than 5 h per day, individuals with longer periods of sitting had higher risks of all-cause and cause-specific mortality due to cancer, CVD, and respiratory diseases but not digestive diseases. Moreover, replacing SB per day with PA, even substituting 30 min of walking for pleasure, reduced the risk of all-cause mortality by 3.5% (hazard ratio [HR] 0.965, 95% confidence interval [CI] 0.954-0.977), whereas cause-specific mortality from cancer, CVD, and respiratory diseases was reduced by 1.6% (HR 0.984, 95% CI 0.968-1.000), 4.4% (HR 0.956, 95% CI 0.930-0.982), and 15.5% (HR 0.845, 95% CI 0.795-0.899), respectively. Furthermore, the protective effects of substitution became more pronounced as the intensity of exercise increased or the alternative duration was extended to 1 h.

CONCLUSIONS

SB was significantly correlated with substantially increased risks of all-cause mortality and cause-specific mortality from cancer, CVD, and respiratory diseases. However, substituting sitting with various forms of PA, even for short periods involving relatively light and relaxing physical activity, effectively reduced the risk of both overall and cause-specific mortality.

Association Between Physical Activity and Pelvic Floor Disorders in Parous Ugandan Women

INTRODUCTION AND HYPOTHESIS

The aim was to assess the association between the degree of physical activity (PA) and the presence of pelvic floor disorders (PFDs) in a cohort of parous Ugandan women.

METHODS

In this cross-sectional study, PFDs were measured using symptom assessment, standardized questionnaires (Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire), and a standardized physical examination (POP-Q and cough stress test [CST]). Degree of PA was assessed using the International Physical Activity Questionnaire. Interquartile ranges were used to describe the age, parity, and body mass index (BMI) of participants. To examine the association between PA and PFDs, a log transformation was applied to the weekly minutes of PA variable and a logistic regression model was constructed with weekly minutes of moderate/vigorous PA, age, BMI, and parity as the predictors.

RESULTS

A total of 159 women were enrolled. Median age was 35 (IQR 32-37), median parity 4 (IQR 3-5), and median BMI 29.0 (IQR 24-33). The prevalence of PFD as determined by symptom assessment was 28% (n=44). The most frequent stage of prolapse identified by POP-Q was stage II (57%, n=91). Thirty-six percent of the women (n=58) reported vigorous PA. Ninety-nine percent of the cohort (n=158) reported moderate PA. When controlling for age, parity, and BMI there was a significant positive association between PFD (defined as a combination of stage II prolapse, positive CST, and urinary incontinence (UI)) and moderate PA (OR 2.20, 95% CI 1.08-5.14, p value 0.045).

CONCLUSIONS

Pelvic floor disorders are common among parous Ugandan women and are associated with moderate PA when controlling for age, BMI, and parity. Understanding the risk factors associated with PFD in this population may better equip providers to screen and care for individuals.

Quality of life and its associated factors among women with pelvic organ prolapse who attend gynecology clinics Southern Ethiopia 2022

INTRODUCTION

Pelvic organ prolapse is the implosion of one or more pelvic floor structures which affect womens quality of life by compromising overall health, physical, social, structural, functional and emotional well-being.

OBJECTIVE

To assess the quality of life and its associated factors among women with pelvic organ prolapse who attend gynecology clinics at Gurage zone hospitals, Southern Ethiopia 2022.

METHODS

Facility-based cross-sectional study was applied in gurage zone hospital from April, 30 to Jun 30, 2022. Systematic random sampling was employed to select 416 women. Interview based structured questionnaires were applied to collect the data. The collected data were analyzed using Statistical Produte and Service Solution. Binary and multivariable logistic regressions were fitted to assess the association between dependent and independent variables. P-value < 0.05 was used to declare the final statistical significance.

RESULT

The mean (SD) score of quality of life in this study was 53.57 (21.59). The most affected domains were general health perception and physical limitation (mean (SD) score 67.45 29.24) and (64.26 32.36)) respectively. Had no formal education (AOR = 1.50, 95% CI: 1.02, 3.12), stage III/IV POP (AOR = 2.02, 95% CI: 1.19, 3.60), constipation (AOR = 3.51, 95% CI: 2.12, 7.21), urge urinary incontinence (AOR = 3.89, 95% CI: 2.32, 6.95), and not did regular physical exercise (AOR = 2.18, 95% CI: 1.41, 3.37) were significantly associated with poor quality of life.

CONCLUSION

More than half of the participants in this study had impaired quality of life. The factor associated with quality of life was had no formal education, stage III/IV, constipation, urge urinary incontinence, and regular physical activity. It is recommended to have access education, counseling regular physical activity, detection, and management of its comorbidity.

Bidirectional Relationships between Sarcopenia and Pelvic Floor Disorders

Sarcopenia and pelvic floor disorders (PFDs) are prevalent and often cooccurring conditions in the aging population. However, their bidirectional relationship and underlying mechanisms remain underexplored. This narrative review aims to elucidate this relationship by exploring potential causative interplays, shared pathophysiological mechanisms, and common risk factors. A comprehensive literature search was conducted to identify relevant studies focusing on epidemiological associations, interaction mechanisms, and implications for patient care. While epidemiological studies demonstrate associations between sarcopenia and PFDs, our findings reveal a cyclical relationship where sarcopenia may exacerbate PFDs through mechanisms such as decreased muscle strength and mobility. Conversely, the presence of PFDs often leads to reduced physical activity due to discomfort and mobility issues, which in turn exacerbate the muscle atrophy associated with sarcopenia. Additionally, shared risk factors such as physical inactivity, nutritional deficiencies, metabolic syndrome, and menopausal hormonal changes likely contribute to the onset and progression of both conditions. These interactions underscore the importance of concurrently integrated care approaches that address both conditions. Effective management requires comprehensive screening, the recognition of contributing factors, and tailored exercise regimens supported by a multidisciplinary approach. Future research should focus on longitudinal studies tracking disease progression and evaluating the efficacy of multidisciplinary care models in optimizing patient outcomes.

Pelvic Floor Muscle Training on Stress Urinary Incontinence in Power- and Weightlifters: a Pilot Study

INTRODUCTION AND HYPOTHESIS

Stress urinary incontinence (SUI) is defined as involuntary leakage of urine on physical effort and is prevalent among power- and weightlifters. However, there is scant knowledge on treatment options for this population. The aim of this pilot study was to evaluate the potential outcomes and feasibility of a pelvic floor muscle training (PFMT) program on SUI in nulliparous female power- and weightlifters.

METHODS

This was a case-series study, including one weightlifter and two powerlifters aged 21-32 years. The participants conducted 12 weeks of PFMT at home, with weekly follow-up by a physiotherapist. Change in total score of the International Consensus of Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI-SF) was the primary outcome. Secondary outcome was perceived change assessed by the Patient Global Impression of Improvement (PGI-I) Scale and impact on sport participation. PFM strength, endurance, and resting pressure was measured using vaginal manometry. Feasibility was evaluated as adherence to training and self-efficacy (Self Efficacy Scale for Practicing Pelvic Floor Exercises).

RESULTS

One athlete reduced their ICIQ-UI-SF score and experienced improvement in symptoms. One athlete reported no change, and one reported a worsening of symptoms. All three participants improved PFM strength and endurance, completed the testing, and 12 weeks of PFMT, but adherence varied between 40 and 80%. Participants reported a lack of time and energy and forgetting to perform the exercises, as reasons for low adherence.

CONCLUSION

There were varying effects of a 12-week PFMT program on SUI in three strength athletes. The results can create the basis for a future randomized controlled trial.

Pelvic floor disorders among amateur runners

BACKGROUND

Sports and physical activity are known risk factors for pelvic floor dysfunction (PFD). The aim of this study is to examine the impact of amateur running on PFD, quality of life (QoL), and sexual function.

METHODS

Amateur runners were contacted through social media. Their PFD, sexual function, and QoL were evaluated by self-reporting validated questionnaires (PFDI-20, PISQ-12, IIQ-7). They were divided by degree of effort into two categories, 'High effort' and 'Moderate effort'. The differences between the two groups were examined by a Mann-Whitney U Test, T-Test, and Chi-square test.

RESULTS

180 women were included. A high incidence of PFD was found among 'High effort' runners in comparison to 'Moderate effort' runners. In addition, women who scored above the median in the PFDI-20 showed significantly greater impairment in QoL and sexual function. Interestingly, the 'High effort' group reported experiencing higher intensity orgasms compared with women in the 'Moderate effort' group. A correlation was also found between the weekly running distance and the intensity of orgasm experienced (P value = 0.004).

CONCLUSION

'High effort' runners present a higher incidence of PFD in comparison to 'Moderate effort' runners. Professional pelvic floor muscle training counselling should be considered even for amateur runners. Future interventional physical therapy studies should be carried out in order to investigate preventative strategies.

The Impact of Exercising on Pelvic Symptom Severity, Pelvic Floor Muscle Strength, and Diastasis Recti Abdominis After Pregnancy: A Longitudinal Prospective Cohort Study

OBJECTIVE

The objective of this study was to evaluate whether early postpartum exercise is associated with changes in pelvic symptom severity, pelvic floor muscle strength, and diastasis recti abdominis (DRA) from 3 to 12 months postpartum.

METHODS

In this prospective cohort study, 504 participants with and without pelvic symptoms (pelvic girdle pain, stress urinary incontinence, vaginal heaviness) were followed. At 3, 6, 9, and 12 months postpartum, we assessed pelvic symptoms, exercise behavior (by questionnaires), pelvic floor muscle strength (by vaginal palpation), and DRA (by caliper measurement). Based on the 3-months questionnaire, participants were categorized as nonexercisers (n = 105), minimal low-impact exercisers (n = 249), regular low-impact exercisers (n = 117), and high-impact exercisers (n = 32). Between-group differences and within-group changes from 3 to 12 months were calculated using Chi-square tests, Kruskal-Wallis tests, and Friedman analysis of variance.

RESULTS

At 3 months, no differences in symptom prevalence were seen between the groups. Nonexercisers reported higher pelvic girdle pain severity and had weaker pelvic floor muscles. The within-group analysis showed that pelvic girdle pain severity did not change in nonexercisers or high-impact exercisers, but decreased in minimal and regular low-impact exercisers. Stress urinary incontinence increased in nonexercisers from 3 to 12 months, while it remained unchanged in regular low-impact and high-impact exercisers, and decreased in minimal low-impact exercisers. Across all groups, vaginal heaviness and DRA decreased, and pelvic floor strength increased from 3 to 12 months.

CONCLUSION

The study indicates that early low-impact exercising is associated with reduced pelvic girdle pain severity during the first postpartum year. Minimal low-impact exercisers also showed a slight reduction in stress urinary incontinence. Conversely, nonexercisers reported an increase in stress urinary incontinence between 3 and 12 months postpartum.

IMPACT

Physical therapists should encourage women to start with low-impact exercise early after pregnancy.

LAY SUMMARY

This study highlights the positive effects of starting gentle, low-impact exercise early after childbirth to reduce pelvic girdle pain and urinary incontinence.

Quality of life and anxiety 12 and 36 months after surgical SUI treatment in postmenopausal women

BACKGROUND

Stress urinary incontinence (SUI) is a common condition that affects a significant group of postmenopausal women, lowering quality of life, leading to embarrassment, social isolation, and decreased physical activity. SUI can be treated with medication, behavioral changes, pelvic floor muscle exercises, or surgical intervention. This study aimed to assess the changes in quality of life, acceptance of illness, and impact on physical activity, in patients after the transobturator tape (TOT) procedure following long-term assessment.

MATERIAL AND METHODS

Forty-five women aged 71.52 ± 4.12 years took part in our follow-up project at 12 and 36 months after surgical intervention. The World Health Organization Quality of Life Questionnaire (WHOQOL-BREF), Acceptance of Illness Scale Questionnaire (AIS), and International Physical Activity Questionnaire (IPAQ) were used in the study.

RESULTS

At 36 months after surgery, SUI using TOT showed a significant improvement in health acceptance. Also, there was a number of patients who reported a high level of acceptance according to the AIS.

CONCLUSION

Elderly women with SUI, after treatment by TOT, showed a significant improvement in health acceptance 3 years after the procedure.

Clinical and exercise professional opinion of return-to-running readiness after childbirth: an international Delphi study and consensus statement

Female athletes have identified a lack of guidance as a barrier to successfully returning to running postpartum, and existing guidelines are vague. Our aim was to define the current practice of determining postpartum run-readiness through a consensus survey of international clinicians and exercise professionals in postpartum exercise to assist clinicians and inform sport policy changes.A three-round Delphi approach was used to gain international consensus from clinicians and exercise professionals on run-readiness postpartum. Professionals who work with postpartum runners participated in an online survey to answer open-ended questions about the following postpartum return-to-running topics: definitions (runner and postpartum), key biopsychosocial milestones that runners need to meet, recommended screening, timeline to initiate running, support items, education topics and factors that contribute to advising against running. Consensus was defined as ≥75% participant agreement.One hundred and eighteen professionals participated in round I, 107 participated in round II (response rate 90.6%) and 95 participated in round III (response rate 80.5%). Responses indicated that, following a minimum 3-week period of rest and recovery, an individualised timeline and gradual return to running progression can be considered. Screening for medical and psychological concerns, current physical capacity, and prior training history is recommended prior to a return to running.This study proposes recommendations for the initial guidance on return-to-running postpartum, framed in the context of current research and consensus from professionals. Future research is needed to strengthen and validate specific recommendations and develop guidelines for best practice when returning-to-running after childbirth.

Clinical and exercise professional opinion on designing a postpartum return-to-running training programme: an international Delphi study and consensus statement

Returning to running postpartum presents challenges such as musculoskeletal pain and pelvic floor dysfunction for some females, but there is little guidance on developing and progressing postpartum training programmes. This study aims to establish expert consensus recommendations on designing and modifying a postpartum return-to-running training programme, highlight costs and access to qualified professionals as potential barriers and discuss clinical, research and sports policy implications.A three-round Delphi survey of clinical and exercise professionals working with postpartum runners was conducted. Round I consisted of open-ended questions related to designing the training plan, modifications based on biopsychosocial factors, key muscle groups to train and referral and payment sources. Rounds II and III involved Likert-scale voting to identify consensus (≥75% agreement).118 participants completed Round I, 107 completed Round II (response rate 90.6%) and 95 completed Round III (response rate 80.5%). Consensus was reached in 42/47 (89%) statements, including recommendations for a period of relative rest, gradual increases in duration and intensity, starting with a walk-run protocol and incorporating strength training. Training should be modified based on musculoskeletal or pelvic symptoms, sleep, mental health, lactation or energy availability concerns. Cost and access to experienced postpartum running professionals were identified as potential barriers for runners to receive care.Consensus recommendations for a postpartum return-to-running programme include an individualised exercise prescription, gradual increases in physical activity, walk-run protocols and targeted muscle strengthening. Further research and improved access to clinical and exercise professionals are needed to inform and facilitate best practices.

Pelvic floor symptoms among premenopausal women with pelvic organ prolapse in the Democratic Republic of the Congo

INTRODUCTION AND HYPOTHESIS

Most of the literature on pelvic organ prolapse (POP) has been generated from postmenopausal patients in high-income countries. In the Democratic Republic of the Congo (DRC), a significant proportion of patients who present for surgical management of POP are premenopausal. Little is known about the impact of POP on pelvic floor symptoms in this population. The objective was to describe pelvic floor symptoms and sexual function among premenopausal patients presenting for POP surgery in DRC.

METHODS

We performed a prospective cohort study of symptomatic premenopausal patients undergoing fertility-sparing POP surgery at a large referral hospital in the DRC. Pelvic floor symptoms were evaluated with the Pelvic Floor Distress Inventory Questionnaire and sexual function with the Pelvic organ prolapse/urinary Incontinence Sexual Questionnaire. Data are presented as means with standard deviations or counts with percentages.

RESULTS

A total of 107 patients were recruited between April 2019 and December 2021. All had either stage III (95.3%) or stage IV (4.7%) prolapse. Ages were 34.2 ± 6.7 years; 78.5% were married. A majority of patients experienced low abdominal pain (82.2%), heaviness or dullness (95.3%), and bulging or protrusion of the prolapse (92.5%). Almost two-thirds of patients reported no longer being sexually active, and 80% stated that they were not sexually active because of POP. Of the 37 sexually active patients (34.6%), nearly all reported significant sexual impairment because of the prolapse, with only 4 reporting no sexual impairment.

CONCLUSIONS

This study represents one of the largest prospective series of patients with premenopausal POP. Our results highlight the severity of pelvic floor symptoms and the negative effects on sexual function among this patient population with POP.

Is there an association between physical activity and lower urinary tract symptoms in adolescent girls? Results from the Avon Longitudinal Study of Parents and Children

INTRODUCTION AND HYPOTHESIS

Lower urinary tract symptoms (LUTS) are common among adolescent girls. Physical activity (PA) has been implicated as both a risk (high-impact PA) and protective factor (low-impact, moderate to vigorous intensity PA) for LUTS in adult women, but its role in adolescent girls is unclear. This study investigated the prospective association between physical activity and LUTS risk in adolescent girls.

METHODS

The sample comprised 3,484 female participants in the Avon Longitudinal Study of Parents and Children. Multivariate logistic regression models were used to examine daily minutes of moderate to vigorous PA (MVPA) at ages 11 and 15 years in relation to LUTS at ages 14 and 19 respectively. MVPA was assessed by 7-day accelerometer data. LUTS were assessed by questionnaire. MVPA were analyzed as continuous (minutes/day) and categorical variables (<10th percentile, 10-89th percentile, ≥90th percentile).

RESULTS

Prevalence of LUTS ranged from 2.0% for bedwetting to 9.5% for nocturia at age 14 and from 2.0% for straining to urinate to 35.5% for interrupted urine flow at age 19. Physical activity was not associated with LUTS at either time-point.

CONCLUSIONS

Given the prevalence of LUTS in female adolescent populations, although this study did not find an association with accelerometer-measured MVPA, other aspects of PA that may serve as risk or protective factors deserve investigation.

Pelvic floor muscle training with biofeedback or feedback from a physiotherapist for urinary and anal incontinence after childbirth - a systematic review

BACKGROUND

Childbirth is one of the biggest risk factors for incontinence. Urinary and anal incontinence can cause pain and social limitations that affect social life, cohabitation, and work. There is currently no up-to-date literature study on the effect of pelvic floor muscle training with feedback from a physiotherapist, which involves verbal instructions based on vaginal and anal digital palpation, compared to treatment without feedback (e.g., recommendations for pelvic floor muscle training).

AIM

The objective of this systematic review was to examine the scientific evidence regarding the impact of pelvic floor muscle training (PFMT) with feedback from a physiotherapist and/or biofeedback on urinary and anal incontinence in women during the first six months following vaginal delivery, compared to treatment without feedback.

METHODS

The literature search was conducted in the databases PubMed, Cochrane, and CINAHL. In addition, a manual search was conducted. The search terms consisted of MeSH terms and synonyms in the respective search block including population, intervention, and study design, as well as the terms pelvic floor and postpartum. An evaluation of each included study was conducted for methodological quality, evidence value, and clinical relevance.

RESULTS

Eight studies were included, three of which showed a significant difference between groups, in favor of the intervention group that received pelvic floor muscle training with feedback from a physiotherapist and/or biofeedback. Due to the varying results and insufficient quality for the majority of the studies, the scientific basis was considered insufficient.

CONCLUSION

The scientific evidence for pelvic floor muscle training with feedback from a physiotherapist or biofeedback on postpartum urinary and anal incontinence compared to treatment without feedback is considered insufficient. Further research on the subject is needed. The study is registered in PROSPERO CRD42022361296.

Transperineal pelvic floor ultrasound for assessing posterior pelvic injury and prolapse in postpartum women

OBJECTIVE

To analyze the association between transperineal pelvic floor ultrasound findings and posterior pelvic injury and prolapse in postpartum women.

METHODS

A total of 108 postpartum women received treatment from January 2020 and December 2022 were divided into 2 groups, with 53 cases in a pelvic floor disorder (PFD) group and 55 cases in the no PFD group according to whether they developed PFD after delivery. The relationship between ultrasound data and the Pelvic Floor Distress Inventory (PFDI-20) scores was analyzed by Pearson correlation. The diagnostic value of transperineal pelvic floor ultrasound for PFD was analyzed by using the receiver operating characteristic curve, and the relationship between transperineal pelvic floor ultrasound parameters and PFD was analyzed by using the RR hazard ratio.

RESULTS

The distance from the bladder neck to the posterior inferior border of the pubic symphysis, the distance from the cervix to the posterior inferior border of the pubic symphysis, and the shortening rate during retraction were shorter or lower in the PFD group than those in the no PFD group. Additionally, bladder descent, cervical subluxation, urethral rotation, anterior and posterior diameters of the static levator ani muscle (LAM), anterior and posterior diameters of the retracted LAM, anterior and posterior diameters of the LAM in the maximal Valsalva maneuver, and PFDI-20 scores in the PFD group were longer or higher than those of the no PFD group (P<0.01). Shortening rate during retraction, bladder descent, cervical subluxation, urethral rotation, and elongation at maximal Valsalva maneuver were positively correlated with the PFDI-20 score (R = 0.027, 0.053, 0.102, 0.002, 0.011, 0.123, respectively, all P<0.05).

CONCLUSIONS

The degree of bladder descent, cervical subluxation, urethral rotation, shortening rate during retraction, and elongation at maximal Valsalva maneuver are closely related to the PFD I-20 score.

Restrictions and distress in daily, social, and sexual functioning, and intimate relationships in women with pelvic floor complaints: A mixed-method study

Women with pelvic floor complaints experience restrictions and distress in their daily, social, and sexual functioning, and their intimate relationships. We interviewed forty-eight women to unravel differences between women receiving and not receiving pelvic physical therapy and between pregnant, parous, and nulliparous women in preparation for theory development. We analyzed data in a mixed-method design using NVivo and Leximancer. Sexual dysfunction, relationship dynamics, the nature and severity of restrictions and distress, and coping strategies appear to vary between women receiving and not receiving therapy. Specific combinations of restrictions and distress are present in pregnant, parous, and nulliparous women, and might influence women's decision to seek help.

Impact and Influence of Urinary Incontinence on Physical Activity Levels

Background

The benefits of physical activity are numerous on both physical and mental levels. Urinary incontinence (UI) can influence physical activity level; among US women, nearly two out of three view this problem as a barrier to physical activity, meaning that they do not exercise, exercise less, or even have to change their activity routines to accommodate this pelvic floor dysfunction.

Objective

To determine whether UI influences the pattern of physical activity and whether a greater impact of urinary symptoms could influence the level of physical activity.

Design setting and participants

An observational study was carried out with women in 2021 and 2022 in Spain.

Outcome measurements and statistical analysis

The main dependent variable was level physical activity, as measured by the International Physical Activity Questionnaire (IPAQ). The Urogenital Distress Inventory (UDI-6) scale was used to determine the presence of UI and its impact. Sociodemographic, health status, lifestyle and obstetric data were obtained. Bivariate and multivariate analyses were performed using binary logistic regression, obtaining adjusted odds ratio (aOR) with its 95% confidence interval (95% CI).

Results and limitations

A total of 1446 women participated, of whom 55.8% (807) had UI and 25.7% (371) reported low physical activity. Mixed incontinence (aOR: 1.53; 95% CI: 1.09-2.15) overall and a greater intensity of urinary symptoms (UDI-6 score; aOR: 1.014; 95% CI: 1.01-1.02) in the group of women with incontinence were statistically associated with a higher frequency of low physical activity. Other variables related to low physical activity were age, body mass index, pelvic pain, and income level (p < 0.001).

Conclusions

Mixed-type UI is associated with low-level physical activity or inactivity in the whole group of women, while among women with UI, the greater impact of the symptoms increases the probability of low physical activity or inactivity.

Patient summary

In this report, it is analyzed how urinary incontinence affects physical activity. It was found that women who suffer from mixed-type urinary incontinence have a low level of physical activity or inactivity, while those who experience a greater impact of urinary incontinence symptoms have an increased likelihood of having low physical activity or inactivity.

Lifestyle factors, metabolic factors and socioeconomic status for pelvic organ prolapse: a Mendelian randomization study

BACKGROUND

Previous observational studies have reported that lifestyle factors, metabolic factors and socioeconomic status are associated with the development of female pelvic organ prolapse (POP); however, whether these associations are causal remains unclear. The current study aimed to assess the causal effect of lifestyle factors, metabolic factors and socioeconomic status on POP risk.

METHODS

We conducted a two-sample Mendelian randomization (MR) study based on summary-level data from the largest available genome-wide association studies (GWAS) to evaluate whether lifestyle factors, metabolic factors and socioeconomic status are causally related to POP. We used single nucleotide polymorphisms that are strongly associated with exposure at the genome-wide significance level (P < 5 × 10-8) as instrumental variables from genome-wide association studies. The method of random-effect inverse-variance weighting (IVW) was used as the primary analysis method, supplemented with the weighted median, MR-Egger and the MR pleiotropy residual sum and outlier applied to verify the MR assumptions. Two-step MR was conducted to investigate potential intermediate factors that are on the causal pathway from exposure to POP.

RESULTS

There were associations with POP for genetically predicted waist-to-hip ratio (WHR) (odds ratio (OR) 1.02, 95% confidence interval (CI) 1.01-1.03 per SD-increase, P < 0.001), WHR adjusted for body mass index (WHRadjBMI) (OR 1.017, 95% CI 1.01-1.025 per SD-increase, P < 0.001) and education attainment (OR 0.986, 95% CI 0.98-0.991 per SD-increase) in the meta-analysis. Additionally, genetically predicted coffee consumption (OR per 50% increase 0.67, 95% CI 0.47-0.96, P = 0.03), vigorous physical activity (OR 0.83, 95% CI 0.69-0.98, P = 0.043) and high-density lipoprotein cholesterol (HDL-C) (OR 0.91, 95% CI 0.84-0.98 per SD-increase, P = 0.049) were inversely associated with POP in the FinnGen Consortium. The mediation analysis showed that the indirect effects of education attainment on POP were partly mediated by WHR and WHRadjBMI, with a mediated proportion of 27% and 13% in the UK Biobank study, respectively.

CONCLUSIONS

Our study provides MR evidence of a robust causal association of WHR, WHRadjBMI and education attainment with POP.

Strenuous physical activity, exercise, and pelvic organ prolapse: a narrative scoping review

INTRODUCTION AND HYPOTHESIS

High-intensity physical activity and exercise have been listed as possible risk factors for pelvic organ prolapse (POP). The aim of the present study is to conduct a literature review on the prevalence and incidence of POP in women who engage in regular physical activity. In addition, we review the effects of a single exercise or a single session of exercise on pelvic floor support. Finally, the effect of exercises on POP in the early postpartum period is reviewed.

METHODS

This is a narrative scoping review. We searched PubMed and Ovid Medline, the Physiotherapy Evidence Database (PEDro), and the Cochrane Database of Systematic Reviews up to May 2022 with the following MeSH terms: "physical activity" AND "exercise" AND "pelvic floor" AND "pelvic organ prolapse".

RESULTS

Eight prevalence studies were retrieved. Prevalence rates of symptomatic POP varied between 0 (small study within different sports) and 23% (Olympic weightlifters and power lifters). Parity was the only factor associated with POP in most studies. Three studies evaluated the pelvic floor after a single exercise or one session of exercise and found increased vaginal descent or increased POP symptoms. One prospective cohort study reported the development of POP after 6 weeks of military parashot training, and one randomized trial reported increased POP symptoms after transverse abdominal training. There is scant knowledge on exercise and POP in the postpartum period.

CONCLUSIONS

Prevalence of POP in sports varies widely. Experimental and prospective studies indicate that strenuous exercise increased POP symptoms and reduced pelvic floor support.

Nonoperative Management of Pelvic Organ Prolapse

Pelvic organ prolapse (POP) is defined as the descent of one or more of the anterior, posterior, or apical vagina. It is a common condition, with up to 50% of women having prolapse on examination in their lifetimes. This article provides an overview of the evaluation and discussion of nonoperative management of POP for the obstetrician-gynecologist (ob-gyn), with consideration of recommendations from the American College of Obstetricians and Gynecologists, the American Urogynecologic Society, and the International Urogynecological Association. The initial evaluation of POP requires a history documenting whether the patient is experiencing symptoms and what they are, and discovery of which symptoms they believe are attributable to prolapse. Examination determines the vaginal compartment(s) and to what degree prolapse exists. In general, only patients who have symptomatic prolapse or medical indication should be offered treatment. Although surgical options exist, all patients who are symptomatic and desire treatment should be offered nonsurgical treatment first, including pelvic floor physical therapy or a pessary trial. Appropriateness, expectations, complications, and counseling points are reviewed. Educational opportunities between the patient and the ob-gyn include disentangling common beliefs that the bladder is dropping or that concomitant urinary or bowel symptoms are necessarily caused by prolapse. Improving patient education can lead to a better understanding of their condition and better alignment of treatment goals and expectations.

Pelvic Floor Pressures Differ Based on Location in the Pelvis and Body Position: A Cadaver Mode

Background: The pelvic floor is a bowl-shaped complex of multiple muscles and fascia, which functions to support the pelvic organs, and it aids in controlling continence. In pelvic floor disease, this complex becomes weakened or damaged leading to urinary, fecal incontinence, and pelvic organ prolapse. It is unclear whether the position of the body impacts the forces on the pelvic floor. Purpose: The primary objective of this work is to measure force applied to the pelvic floor of a cadaver in sitting, standing, supine, and control positions. The secondary objective is to map the forces across the pelvic floor. Methods: An un-embalmed female cadaver without pelvic floor dysfunction was prepared for pelvic floor pressure measurement using a pressure sensory array placed on top of the pelvic floor, and urodynamic catheters were placed in the hollow of the sacrum, the retropubic space, and at the vaginal apex. Pressure measurements were recorded with the cadaver in the supine position, sitting cushioned without external pelvic floor support, and standing. Pressure array data were analyzed along with imaging of the cadaver. Together, these data were mapped into a three-dimensional reconstruction of the pressure points in pelvic floor and corresponding pelvic organs. Results: pressures were higher at the symphysis than in the hollow of the sacrum in the standing position. Pressure array measurements were lowest in the standing position and highest in the sitting position. Three-dimensional reconstruction confirmed the location and accuracy of our measurements. Conclusions: The findings of increased pressures behind the symphysis are in line with the higher incidence of anterior compartment prolapse. Our findings support our hypothesis that the natural shape and orientation of the pelvis in the standing position shields the pelvic floor from downward forces of the viscera.

Effect of Kegel Exercises on Lower Urinary Tract Symptoms in Young Gymnasts: A Prospective Cohort Study

IMPORTANCE

Lower urinary tract symptoms (LUTS) have been shown to exist in young athletes. The use of pelvic floor muscle training as a preventive strategy at an early age may be useful to avoid possible pelvic floor dysfunction in the future.

OBJECTIVES

The aim of the study was to describe LUTS in underaged gymnasts. We also aimed to evaluate the effects of a 12-week Kegel exercise intervention for LUTS and urinary incontinence (UI) and their relationship to bother.

STUDY DESIGN

A quasi-experimental (nonrandomized, noncontrolled) pre-post study was conducted. Nineteen gymnasts with a mean age of 13.21 ± 1.84 were selected from a gymnastics club in Madrid, Spain. Outcomes of LUTS and quality of life were measured using the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms validated questionnaire at baseline and at the end of the 12-week intervention.

RESULTS

The participants presented with certain LUTS such as urgency UI (57.7%) or stress UI (47.4%), which negatively affect their daily lives by feeling annoyed in various aspects (when practicing gymnastics, getting up during the night to urinate or feeling bladder pain among others). No significant differences in LUTS and quality of life variables were observed after the exercise intervention ( P > 0.05).

CONCLUSIONS

A high prevalence of LUTS was observed in a sample of underaged high-level gymnasts. The 12-week Kegel exercise intervention did not significantly reduce the presence of pelvic floor problems and even intensified some of them, probably because of an increased awareness. Pelvic floor muscle training as a preventive strategy at an early age seems to be necessary to avoid possible pelvic floor dysfunction in the future.

Pelvic Organ Prolapse and its Associated Factors Among Women: A Facility Based Cross-sectional Study

Pelvic organ prolapse is the downward descent of female organs, including the bladder, small bowel, and large bowel, resulting in the protrusion of the vagina, uterus, or both. This disorder, exclusive to women, causes psychological trauma and social withdrawal, leading to an increased rate of gynecologic surgery. To assess the Pelvic Organ Prolapse and its associated factors among Women Visiting public Hospitals in south west Ethiopia. An institution-based cross-sectional study was conducted among gynecologic patients. A total sample size of 408 was allocated to the institutions proportional to their previous month's case load. Data were collected using an interviewer-administered structured questionnaire. The collected data were coded and entered into EpiData version 3.1, then exported to SPSS version 20 for descriptive and inferential analysis. Adjusted odds ratios (AOR) along with a 95% confidence level were estimated, and a P-value < .05 was considered statistically significant. Out of the intended sample size, 393 women participated in the study, resulting in a response rate of 96.3%. The overall magnitude of pelvic organ prolapse among the study participants was 19.8% (95% CI: 16.0, 24.1). Factors significantly associated with pelvic organ prolapse were place of residence (AOR = 2.21, 95% CI: 1.11, 4.40), parity (AOR = 2.82, 95% CI: 1.39, 5.72), age at first pregnancy (AOR = 2.32, 95% CI: 1.27, 4.26), and place of delivery of the first child (AOR = 4.18, 95% CI: 1.97, 8.85). The prevalence of pelvic organ prolapse is high. Place of residence, parity, age at first pregnancy, and place of delivery of the first child were factors significantly associated with pelvic organ prolapse. Therefore, different stakeholders, programmers, and implementers should take aggressive steps to prevent early pregnancy, train health professionals to encourage women to use family planning, and promote institutional delivery.

Rumba Dance Combined with Breathing Training as an Exercise Intervention in the Management of Stress Urinary Incontinence in Postmenopausal Women: A Randomized Controlled Trial

Purpose: Stress urinary incontinence (SUI) refers to involuntary leakage from the urethra, synchronous with exertion/effort, sneezing or coughing, which has a negative effect on quality of life. Studies have shown that mild-to-moderate physical activities reduce the risk of SUI by multiple mechanisms. The objective of this study was to determine whether the Rumba dance combined with breathing training (RDBT) can reduce the severity of incontinence and improve the quality of life of patients with SUI. Methods: A randomized clinical trial was conducted with women who were sedentary, were postmenopausal, reported mild-to-moderate SUI on a 1-h pad test, were not already engaged in Rumba dance and did not receive estrogen replacement therapy. The patients were randomly assigned to the RDBT group (n = 13) or the control group (n = 11). The intervention included 90 min of RDBT three times per week for 16 weeks, and the vaginal resting pressure (VRP), pelvic floor muscle (PFM) strength and endurance, 1-h pad test, International Consultation on Incontinence Questionnaire—Urinary Incontinence Short Form (ICIQ—UI SF), and the Incontinence Quality of Life Questionnaire (I—QOL) were measured or completed at baseline and 16 weeks. None of the participants reported adverse events. Results: The mean (±SD) age of the participants was 55.75 ± 5.58 years. After 16 weeks, in the RDBT group, the urine leakage on the 1-h pad test was significantly decreased −2.91 ± 0.49 from the baseline (p = 0.000). The VRP increased from 76.00 ± 16.23 cmH2O to 95.09 ± 18.90 cmH2O (p = 0.000), the PFM endurance of class I (−3.15 ± 1.99% vs. −0.46 ± 0.97%, p = 0.000) and class II (−0.69 ± 0.95% vs. −0.23 ± 0.44%, p = 0.065) increased, and the grades of PFM strength of class I and class II were significantly enhanced (p < 0.01). Finally, the severity of self-reported incontinence (ICIQ—UI SF) significantly decreased from 6.12 ± 2.15 to 3.81 ± 1.68 (p = 0.000), and quality of life (I—QOL) improved from 75.73 ± 11.93 to 83.48 ± 7.88 (p = 0.005). Conclusion: A 16-week RDBT program can increase PFM strength and endurance to reduce the severity of incontinence symptoms and improve the quality of life in patients with SUI, demonstrating the feasibility of recruiting and retaining postmenopausal women with SUI into a RDBT therapeutic program.

Elite female athletes' experiences of symptoms of pelvic floor dysfunction: A systematic review

INTRODUCTION AND AIMS

Pelvic floor dysfunction (PFD) is a collection of signs, symptoms and conditions affecting the pelvic floor and urinary incontinence (UI) is the most common type of PFD. Recent systematic reviews have indicated a higher prevalence of UI among female athletes compared to their non-athletic counterparts. To date, no review has been undertaken to investigate female athletes' experiences of PFD. This review aims to offer insight and understanding, through aggregation, summary, synthesis and interpretation of findings from studies that report elite female athletes' experiences of symptoms of PFD.

METHODS

The review protocol was registered in PROSPERO in August 2020. A systematic search was conducted in Embase, MEDLINE (OVID), Cochrane Library, CINAHL, PsycINFO and Web of Science for studies published in the English language reporting elite female athletes' experiences of symptoms of PFD. This review included primary research studies that involved elite female athletes of any age or ethnicity.

RESULTS

Of the 1922 citations retrieved in the search, 32 studies met the methodological criteria for data extraction and analysis. Five main themes emerged: (1) triggers for symptoms of PFD; (2) strategies adopted by athletes to manage/mitigate symptoms of PFD; (3) impact on QOL/daily life; (4) impact on performance; (5) impact on emotions.

CONCLUSIONS

The findings of this review suggest a need to further explore the experiences of PFD among elite female athletes and it is suggested that future research should adopt qualitative methods or incorporate a qualitative component.

Graft-Versus-Host Disease Associated Post-operative Complications After Pelvic Reconstructive Surgery: A Case Report

Introduction: Graft-versus-host disease (GVHD) can occur after allogeneic bone marrow transplantation (BMT) and can affect the skin, gastrointestinal tract, lungs, liver, and vulvovaginal areas. Case Presentation: This case report described a 65-year-old multiparous patient with myelodysplastic syndrome who underwent a matched unrelated donor transplant approximately 3 years before her surgery. After her BMT she developed GVHD. She underwent anterior and posterior repair and uterosacral ligament suspension for stage III post-hysterectomy vaginal vault prolapse. Her postoperative course was complicated by mental status changes, abnormal liver function tests, and increasing abdominal distention. All her post-operative symptoms were resolved with conservative management. Conclusions: This case presentation highlights the potential atypical post-operative course of BMT patients with GVHD. The management of patients with GVHD relies heavily on the early involvement of hematologists.

A multisite focus group study of US adult women's beliefs and assumptions about bladder health and function

AIMS

This analysis explored and characterized the ideas adult women have about how the bladder works, the assumptions guiding their bladder-related behaviors, and the beliefs they hold about how their behaviors affect bladder health.

METHODS

This was a directed content analysis of qualitative data from the Study of Habits, Attitudes, Realities, and Experiences, a focus group study conducted at seven United States research centers (July 2017 to April 2018). Participants were 316 adult women organized by four age categories (age range: 18-93 years). Analysis and interpretation focused on the "bladder assumptions and beliefs" code using a transdisciplinary lens and inductive approach.

RESULTS

During their focus group discourse, participants exhibited a speculative mode of thinking about bladder health and function characterized by uncertainty about how the bladder works. They described the bladder as a mechanism for cleansing the body of impurities, viewing it as part of a larger interconnected bodily system to enable the body to stay healthy. They saw it as susceptible to anatomical changes, such as those related to pregnancy and aging. The women also postulated perceived relationships between bladder function and several health behaviors, including eating healthy foods, staying hydrated, engaging in physical activity and exercise, and adopting specific toileting and hygiene practices.

CONCLUSIONS

The findings underscore the importance of guidance from healthcare professionals and systematic community based educational programs for promoting women's understanding about bladder health and empowering them to exert agency to engage in healthy bladder behaviors.

Relationship between exposure to cadmium, lead, and mercury and the occurrence of urinary incontinence in women

Cadmium, lead, and mercury are nephrotoxic metals that are commonly found as hazardous pollutants in many areas of the USA. We examined the relationship between exposure to cadmium, lead, and mercury with the occurrence of urgency urinary incontinence (UUI) and stress urinary incontinence (SUI) in women. This study was conducted using data on women > 20 years of age, collected between 2005 and 2016, who reported experiencing urinary incontinence in the National Health and Nutrition Examination Survey (NHANES). Restricted cubic spline analysis was used to characterize a dose-response relationship between continuous exposure to different nephrotoxic metals and the occurrence of UUI and SUI. A total of 4406 women were included in this study, with 2624 (59.6%) suffering from SUI and 3177 (72.1%) suffering from UUI in the weighted population. The results of our multivariate analysis indicated that age, race, marital status, body mass index (BMI), and exposure to nephrotoxic metals were risk factors for developing UI. The odds ratio (OR; 95% confidence interval) for developing UI was positively correlated with the exposure to cadmium and lead in women. The OR of SUI occurrence increased with increasing levels of cadmium in blood, with a peak at 4 µg/L. The OR of UUI occurrence increased with increasing levels of blood and urinary lead, with peaks at 7 µg/dL and 5 µg/L, respectively. The presence of mercury was not significantly correlated with the occurrence of SUI or UUI. Exposure to high levels of cadmium and lead, which are nephrotoxic metals, is associated with the occurrence of UI in women.

MRI biomarker of muscle composition is associated with severity of pelvic organ prolapse

BACKGROUND

The pathophysiology of pelvic organ prolapse is largely unknown. We hypothesized that reduced muscle mass on magnetic resonance defecography (MRD) is associated with increased pelvic floor laxity. The aim of this study was to compare the psoas and puborectalis muscle mass composition and cross-sectional area among patients with or without pelvic laxity.

METHODS

An observational retrospective study was conducted on women > age 18 years old who had undergone MRD for pelvic floor complaints from January 2020 to December 2020 at Stanford Pelvic Health Center. Pelvic floor laxity, pelvic organ descent, and rectal prolapse were characterized by standard measurements on MRD and compared to the psoas (L4 level) and puborectalis muscle index (cross-sectional area adjusted by height) and relative fat fraction, quantified by utilizing a 2-point Dixon technique. Regression analysis was used to quantify the association between muscle characteristics and pelvic organ measurements.

RESULTS

The psoas fat fraction was significantly elevated in patients with abnormally increased resting and strain H and M lines (p < 0.05) and increased with rising grades of Oxford rectal prolapse (p = 0.0001), uterovaginal descent (p = 0.001) and bladder descent (p = 0.0005). In multivariate regression analysis, adjusted for age and body mass index, the psoas fat fraction (not muscle index) was an independent risk factor for abnormal strain H and M line; odds ratio (95% confidence interval) of 17.8 (2-155.4) and 18.5 (1.3-258.3) respectively, and rising Oxford grade of rectal prolapse 153.9 (4.4-5383) and bladder descent 12.4 (1.5-106). Puborectalis fat fraction was increased by rising grades of Oxford rectal prolapse (p = 0.0002).

CONCLUSIONS

Severity of pelvic organ prolapse appears to be associated with increasing psoas muscle fat fraction, a biomarker for reduced skeletal muscle mass. Future prospective research is needed to determine if sarcopenia may predict postsurgical outcomes after pelvic organ prolapse repair.

Breathing, (S)Training and the Pelvic Floor—A Basic Concept

Background: The current scientific literature is inconsistent regarding the potential beneficial or deleterious effects of high-intensity physical activities on the pelvic floor (PF) in women. So far, it has not been established with certainty whether disparate breathing mechanisms may exert short- or long-term influence on the PF function in this context, although based on the established physiological interrelationship of breathing with PF activation, this seems plausible. Objective: To propose a basic concept of the influence of different breathing patterns on the PF during strenuous physical efforts. Methodical approaches: Review of the recent literature, basic knowledge of classical western medicine regarding the principles of muscle physiology and the biomechanics of breathing, additional schematic illustrations, and magnetic resonance imaging (MRI) data corroborate the proposed concept and exemplify the consequences of strenuous efforts on the PF in relation to respective breathing phases. Conclusion: The pelvic floor muscles (PFMs) physiologically act as expiratory muscles in synergy with the anterolateral abdominal muscles, contracting during expiration and relaxing during inspiration. Obviously, a strenuous physical effort requires an expiratory motor synergy with the PFM and abdominal muscles in a co-contracted status to train the PFM and protect the PF against high intra-abdominal pressure (IAP). Holding breath in an inspiratory pattern during exertion stresses the PF because the high IAP impinges on the relaxed, hence insufficiently protected, PFMs. It seems conceivable that such disadvantageous breathing, if performed regularly and repeatedly, may ultimately cause PF dysfunction. At any rate, future research needs to take into account the respective breathing cycles during measurements and interventions addressing PFM function.

Increasing physical activity levels following treatment for cervical cancer: an intervention mapping approach

PURPOSE

The purpose of this study was to utilise the intervention mapping (IM) protocol as a framework with which to develop an intervention underpinned by relevant behaviour change theory to promote physical activity (PA) following treatment for cervical cancer.

METHODS

The six steps of the IM protocol were followed. A qualitative semi-structured interview study and a rapid review of the literature were conducted along with the development of a logic model of the problem and a logic model of change to inform intervention development.

RESULTS

An intervention was developed which aims to increase PA levels following treatment for cervical cancer, tailored to address key findings from the IM needs assessment. These include embedding behavioural and social strategies that help participants to overcome perceived barriers to PA participation; goal setting strategies to gradually increase PA levels with a view of reaching relevant PA guidelines for cancer survivors and feedback to encourage self-assessment of well-being and PA capability.

CONCLUSION

This study maps the development of a novel PA intervention for those who have been treated for cervical cancer. The use of a systematic development framework was necessary as little insight exists regarding PA preferences after treatment for cervical cancer.

IMPLICATIONS FOR CANCER SURVIVORS

PA behaviour is associated with positive physical and psychological health outcomes for cancer survivors. Optimising targeted promotion of PA behaviour following treatment for cervical cancer may result in an enhanced survivorship experience through increased PA behaviour and improved quality of life (QOL).

Improving the Technique of Pelvic Floor Muscle Contraction in Active Nulliparous Women Attending a Structured High-Low Impact Aerobics Program-A Randomized Control Trial

Learning the correct technique of performing pelvic floor muscle (PFM) exercises is a very important factor influencing the effectiveness of this muscle group training. Correctly performed PFM contractions are involved in the urinary continence mechanism. In this study, we tested the hypothesis that a six-week high-low impact aerobics program, supported by one EMG biofeedback session and pelvic floor muscle training, improves the technique of PFM contraction. Participants were 42 active nulliparous women (age 22 ± 2 years, mean ± SD), randomly allocated into intervention (n = 18) and control (n = 24) groups. We analyzed the technique of PFM contractions, taking into account the order in which selected muscle groups were activated, so called 'firing order'. In both groups, we assessed the PFM contraction technique using surface electromyography (sEMG) and intravaginal probes, before and after six weeks of intervention. The intervention group received one biofeedback session on how to properly contract PFM and afterwards participated in a high-low impact aerobics program supplemented by PFM training. The control group did not receive any intervention. In the pre-test, 67% of the intervention group activated PFM first in order in short, quick contractions. After six weeks of training, this task was correctly performed by 100% of this group (p = 0.04). The proper performance of PFM short contraction in the control group was 75% and 67%, before and after intervention, respectively. In the intervention group we also observed statistically significant improvement in the PFM contraction technique in 10-s contractions. The presented intervention was beneficial for the improvement of PFM contraction. High-low impact aerobics, supplemented by one EMG biofeedback session and pelvic floor muscle training can be recommended for active nulliparous women.

Conceptualization and Inventory of the Sexual and Psychological Burden of Women With Pelvic Floor Complaints; A Mixed-Method Study

Introduction

Despite the fact that the literature reports various restrictions and types of distress in women with pelvic floor complaints, a comprehensive overview of women's sexual and psychological burden emerging from these complaints is lacking, which compromises our ability to assess and grasp the impact to women.

Aim

This study was performed to conceptualize women's sexual and psychological burden and create a more comprehensive overview on this topic from both women's and health care providers’ perspectives. Furthermore, this research intended to identify items to populate a to-be-developed instrument to assess sexual and psychological burden.

Methods

In Group Concept Mapping, 125 statements were used about restrictions and distress that women with pelvic floor complaints experienced. Women with, and health care providers with and without pelvic floor complaints (13 women and 3 men) sorted the statements into comprehensive self-labeled clusters and rated their nature and severity. Multidimensional scaling and hierarchical cluster analyses were performed to identify a conceptual model of coherent clusters of statements. Item-total correlations of severity scores were calculated to identify statements that can be used in future research to represent women's sexual and psychological burden.

Main Outcome Measure

A conceptual model emerged, and outcomes of item-total correlations were then examined again using the conceptual model.

Results

Seven distress clusters were identified, namely, loss of control, sexual distress, feeling insecure, feeling wronged, feeling helpless, feeling angry, and feeling disappointed. Feeling insecure appeared more pervasive than other distresses. Furthermore, 33 statements were identified that can be used in future research to develop an instrument to assess sexual and psychological burden representing both women's and health care providers’ perspectives.

Conclusion

The conceptual model and list of statements may concisely represent the sexual and psychological burden of women with pelvic floor complaints from both women's and health care providers’ perspectives on this topic.

Brand AM, Rosas S, Waterink W, et al. Conceptualization and Inventory of the Sexual and Psychological Burden of Women With Pelvic Floor Complaints; A Mixed-Method Study. Sex Med 2022;10:100504.

Relative and Maximal Intra-abdominal Pressure and Postpartum Pelvic Floor Outcomes in Primiparas Delivered Vaginally

OBJECTIVES

This study aimed to explore associations between relative and maximal intra-abdominal pressure (IAP) on pelvic floor outcomes in primiparas delivered vaginally.

METHODS

At 5-10 weeks and 1 year postpartum, we measured absolute IAP by vaginal sensor while participants lifted a weighted car seat (IAPLIFT) and performed isometric trunk flexion endurance (IAPTFE) and seated maximal strain (IAPSTRAIN). Primary outcomes, completed 1 year postpartum, included worse pelvic floor support (descent to or beyond the hymen) and positive symptom burden (bothersome symptoms in ≥2 of 6 domains on the Epidemiology of Prolapse and Incontinence Questionnaire). We calculated relative IAP (as absolute IAP/IAPSTRAIN).

RESULTS

Of 542 participants, 9.7% demonstrated worse support and 54.3% demonstrated symptom burden at 1 year postpartum. In multivariable analyses, absolute IAPLIFT and absolute IAPTFE at 5-10 weeks postpartum were not associated with worse support. As relative IAP at 5-10 weeks increased, the prevalence of worse support decreased (prevalence ratio [PR] of 0.77 [95% confidence intervals (CIs), 0.63-0.94] and PR of 0.79 [95% CI, 0.67-0.93]) per 10% increase for relative IAPLIFT and relative IAPTFE, respectively. This was largely due to IAPSTRAIN, which increased the prevalence of worse support (PR, 1.15 [95% CI, 1.06-1.25]) per 10 cm H2O increase. One year postpartum, only IAPSTRAIN increased the prevalence of worse support (PR, 1.11 [95% CI, 1.02-1.20]) per 10 cm H2O. Of all IAP measures at both time points, only absolute IAPLIFT at 1 year significantly increased the prevalence of symptom burden (PR, 1.11 [95% CI, 1.05-1.18]) per 10 cm H2O.

CONCLUSIONS

This exploratory analysis suggests that postpartum IAPSTRAIN may increase the prevalence of worse support in primiparas delivered vaginally.

Pelvic floor tissue damping during running using an intra-vaginal accelerometry approach

BACKGROUND

While cumulative loading of the pelvic floor during exercise appears to increase the risk of developing pelvic floor disorders, the pathophysiologic role of pelvic floor loading is poorly understood. The aim of this exploratory study was to present a method for evaluating vibrational frequency damping of the female pelvic floor and to investigate the potential utility of this approach in a preliminary evaluation.

METHODS

Female participants were instrumented with an intravaginal accelerometer and a hip-mounted accelerometer, then ran on a treadmill at 7 km/h and 10 km/h both before and after a 30-min self-selected pace. Displacement of the pelvic floor relative to the bony pelvis was calculated using double integration of the accelerometer data. Vibrational damping coefficients were calculated using a wavelet-based approach to determine the effect of continence status, parity, running speed and time on vibrational damping.

FINDINGS

Seventeen women (n = 10 reported regularly leaking urine while exercising, while n = 7 reported not leaking) completed the running protocol. No differences in vibrational damping were detected between continent and incontinent women when all frequency bands were evaluated together, however significant effects of parity, time, running speed and continence status were found within specific frequency bands. Parous women demonstrated less damping in the 25-40 Hz band compared to nulliparae, damping in the 13-16 Hz band was lower after the 30-min run, and incontinent women demonstrated lower damping in the 4.5-5.5 Hz band than continent women when running at 7 km/h.

INTERPRETATION

Intra-vaginal vibrational damping may be useful in detecting biomechanical mechanisms associated with pelvic floor disorders experienced by females during exercise.

Prevalence and factors associated with urinary incontinence in females with cystic fibrosis: An Italian single-center cross-sectional analysis

BACKGROUND

Individuals with cystic fibrosis (CF) are deemed to have a higher risk of developing urinary incontinence (UI), likely due to repeated increasing pressure on the pelvic floor. We aimed to determine the prevalence of female UI in a large CF referral center, and to assess the association between UI and severity of CF disease.

METHODS

We consecutively recruited female patients regularly attending our CF center, aged ≥6 years and with a confirmed diagnosis of CF. Prevalence, severity, and impact of UI were assessed by administering two validated questionnaires. Relationship between variables was evaluated by means of multiple correspondence analysis, whereas a logistic model was fitted to capture the statistical association between UI and independent variables.

RESULTS

UI was present in 51/153 (33%, 95% confidence interval [CI]: 26%-41%) females. Among children and adolescents, the prevalence was 12/82 (15%, 95% CI: 8%-25%) whereas among adults was 39/71 (55%, 95% CI: 43%-67%). The only explanatory variable associated with UI was age, with children presenting the lowest risk (odds ratio, 0.32; 95% CI: 0.05-0.93). Females presenting low or high nutritional status show higher profile risk of having UI.

CONCLUSIONS

Stress UI is a common complication in females with CF since childhood. Although it frequently occurs in older patients with a more severe phenotype, much attention should be paid to adults and to their nutritional status.

Physical activity and urinary incontinence during pregnancy and postpartum: A systematic review and meta-analysis

To assess the association of physical activity and urinary incontinence, or its recovery, during pregnancy and postpartum. A search of publications indexed in five major electronic databases (CENTRAL, PubMed, EMBASE, CINAHL and PEDro) was performed from their respective inception dates to the 30 March 2020 with a combination of keywords to identify studies of interest. Google Scholar was used for non-indexed literature. All studies comparing physical activity with standard care in pregnant and postpartum women were selected. Two reviewers independently selected studies, assessed quality and extracted data. Odds ratios with 95% confidence intervals were calculated using fixed effects or random effects models, for low and moderate heterogeneity between studies, respectively. Seven studies (n = 12479) were included. Data of four studies could be pooled for meta-analyses; subgroup and sensitivity analyses were not possible. Physical activity, either during pregnancy or postpartum, is not associated with urinary incontinence, OR 0.90 (95% CI: 0.69-1.18) and OR 1.31 (95% CI: 0.74-2.34), respectively. Due to a lack of available data, urinary incontinence recovering could not be assessed. The available low evidence does not show that physical activity during pregnancy or postpartum is associated with urinary incontinence. Moderate physical activity should therefore be encouraged for the evidence-based benefits on other obstetrical outcomes.

Are Two Meshes Better than One in Sacrocolpopexy for Pelvic Organ Prolapse? Comparison of Single Anterior versus Anterior and Posterior Vaginal Mesh Procedures

INTRODUCTION

Sacrocolpopexy (SC) is the main treatment option for the repair of anterior and apical pelvic organ prolapse (POP). Indications and technical aspects are not standardized, and the question remains whether it is necessary to place a mesh on both anterior and posterior vaginal walls, particularly in cases with only minor or no posterior compartment prolapse. The present study aimed to compare the anatomical and functional outcomes of single anterior mesh only versus anterior and posterior mesh procedures in SC.

MATERIALS AND METHODS

Our prospectively maintained database on POP was used to identify patients who had undergone either abdominal or mini-invasive SC from January 2006 to October 2019. Patients with symptomatic or unmasked stress urinary incontinence (SUI) were not included in the study and were treated using the pubo-vaginal cystocele sling procedure. Objective outcomes included clinical evaluation of pre-existing or de novo POP by the halfway system and POP-q classifications, as well as the development of de novo SUI. Subjective outcomes were assessed using the Pelvic Floor Impact Questionnaire (PFIQ-7) with questions on bladder, bowel, and vaginal functions. Persistent or de novo constipation and overactive bladder were defined as bowel symptoms and urinary urgency/frequency/urinary incontinence after surgery.

RESULTS

Ninety-five women with symptomatic anterior and apical POP underwent SC. Forty-one patients were treated with only anterior vaginal mesh (group A), and 54 with anterior and posterior mesh (group B). There were no differences between the pre- and post-operative characteristics of the 2 groups. In group B, there were 2 blood transfusions, 1 wound dehiscence, and 3 mesh erosions/extrusion after abdominal SC (Clavien-Dindo II), and in group A, there was 1 ileal lesion after laparoscopic SC (Clavien-Dindo III). There were no differences between the 2 groups in either anatomical or functional outcomes during 3 years of follow-up.

CONCLUSIONS

SC with single anterior vaginal mesh has similar results to SC with combined anterior/posterior mesh, regardless of the surgical approach. The single anterior mesh may reduce the risk of complications (mesh erosion/extrusion), and offers better subjective outcomes with improved quality of life. Anterior/posterior mesh may be justified in the presence of clinically significant posterior POP.

Stress Urinary Incontinence Among Young Nulliparous Female Athletes

Urinary incontinence (UI) is described as unintentional voiding of urine that is usually seen in post-partum and post-menopausal women due to the weakening of pelvic floor muscles (PFM). Recent studies have shown an increase in the prevalence of stress urinary incontinence (SUI) among young nulliparous female athletes. The association between UI and high-impact physical activity is due to increased intra-abdominal pressure during high-impact sports exceeding intra-urethral pressure. Usually, the levator ani muscle (LAM) helps in urethral closure. However, weakening or injury of LAM can reduce the pelvic support and cause UI in young female athletes. This study aims to assess the prevalence of SUI among young nulliparous athletes and also explore the association between SUI and athletic sports in young females. We searched PubMed and Google Scholar as databases to find specific articles about the topic. After the inclusion and exclusion criteria were applied, 52 articles were selected for this review. It is found that there is an increased UI prevalence, mainly SUI, among young nulliparous female athletes, especially in volleyball players and long-distance runners. Nulliparous athletes involved in high-impact exercises were found to have an increased cross-sectional area of LAM and puborectalis muscle width. SUI is usually under-reported and underdiagnosed due to lack of knowledge and unawareness, which can negatively affect the personal and social life of young females. PFM training is considered the first line of therapy among nulliparous athletes. However, it is unclear whether the high-impact effects of sports cause UI through PFM fatigue or PFM damage. More research is needed to better understand this effect.