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Matteo C, Roome K, Roberts N, Hill G, Hill H. A women-centred exploration of postpartum perineal pain when the perineum is diagnosed as intact: A French Gadamerian research study. Midwifery 2024; 129:103909. [PMID: 38134575 DOI: 10.1016/j.midw.2023.103909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/23/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Postpartum perineal pain is a frequent symptom (90%) with consequences on postnatal health regardless of whether the perineum remains intact. The impact of that pain on both short and long-term health has been studied and literature suggests midwives have a role to play in addressing this issue. However, the determinants of perineal pain when no lesions are identified are under researched and there is little understanding of women's views on this topic. AIM AND OBJECTIVES The aim of the study was to gain an understanding of postpartum perineal pain when the perineum is considered to be intact. The objectives were •To gain an understanding of postpartum pain and its consequences on health and well-being •To explore women's views and understanding of perineal pain postpartum •To gain an understanding of the determinants of postpartum perineal pain when no anatomic lesion is diagnosed. METHODS A Gadamerian hermeneutic approach was used to achieve a shared understanding of the issue. Participants were recruited from two maternity hospitals in the French area of Vaucluse. All women aged 18 to 45 years old, having given birth vaginally to a single live child and diagnosed with an intact perineum, were invited to participate in face-to-face interviews. Eleven participants were interviewed once, six of whom agreed to a second interview which took place over the telephone due to Covid lockdown. FINDINGS The findings identified three major themes 1. Can't honestly call it pain, 2. Reassurance in normality, 3. Managing the unexpected. The use of the word pain to describe perineal sensations in postpartum was questioned by the participants, who used inner resources to deal with these sensations. Fostering self-confidence, having the possibility to explain the sensations and qualifying them as normal were some approaches women usedto manage their postpartum perineal sensations in a positive manner.
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Affiliation(s)
- Caroline Matteo
- Department of Midwifery, Faculté des Sciences Médicales et Paramédicales, Aix-Marseille Universite Campus Nord, Ecole de Maïeutique, Chemin des Bourrely, 51 BVD Pierre Dramard, Marseille 13015, France.
| | - Karen Roome
- Department of Nursing and Community Health, Room A405, School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, Scotland G4 0BA, United Kingdom
| | - Nicola Roberts
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, United Kingdom
| | - Gordon Hill
- School of Health & Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, United Kingdom
| | - Hazel Hill
- Department of Nursing & Community Health, School of Health & Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, United Kingdom
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Huber M, Larsson C, Lehmann J, Strigård K, Lindam A, Tunón K. Sonographic postpartum anal sphincter defects and the association with pelvic floor pain and dyspareunia. Acta Obstet Gynecol Scand 2023; 102:1290-1297. [PMID: 37350333 PMCID: PMC10540925 DOI: 10.1111/aogs.14606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/09/2023] [Accepted: 05/15/2023] [Indexed: 06/24/2023]
Abstract
INTRODUCTION Pelvic floor pain and dyspareunia are both important entities of postpartum pelvic pain, often concomitant and associated with perineal tears during vaginal delivery. The association between postpartum sonographic anal sphincter defects, pelvic floor pain, and dyspareunia has not been fully established. We aimed to determine the prevalence of postpartum anal sphincter defects using three-dimensional endoanal ultrasonography (3D-EAUS) and evaluate their association with symptoms of pelvic floor pain and dyspareunia. MATERIAL AND METHODS This prospective cohort study followed 239 primiparas from birth to 12 months post delivery. Anal sphincters were assessed with 3D-EAUS 3 months postpartum, and self-reported pelvic floor function data were obtained using a web-based questionnaire distributed 1 year after delivery. Descriptive statistics were compared between the patients with and without sonographic defects, and the association between sonographic sphincter defects and outcomes were analyzed using logistic regression. RESULTS At 3 months postpartum, 48/239 (20%) patients had anal sphincter defects on 3D-EAUS, of which 43 (18%) were not clinically diagnosed with obstetric anal sphincter injury at the time of delivery. Patients with sonographic defects had higher fetal weight than those without defects, and a perineum <2 cm before the suture was a risk factor for defects (odds ratio [OR], 6.9). Patients with sonographic defects had a higher frequency of dyspareunia (OR, 2.4), and pelvic floor pain (OR, 2.3) than those without defects. CONCLUSIONS Our results suggest an association between postpartum sonographic anal sphincter defects, pelvic floor pain, and dyspareunia. A perineal height <2 cm, measured by bidigital palpation immediately postdelivery, was a risk factor for sonographic anal sphincter defect. We suggest offering pelvic floor sonography around 3 months postpartum to high- risk women to optimize diagnosis and treatment of perineal tears and include perineum <2 cm prior to primary repair as a proposed indication for postpartum follow-up sonography.
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Affiliation(s)
- Malin Huber
- Department of Clinical Sciences, Obstetrics and GynecologyUmeå UniversityUmeåSweden
| | - Charlotta Larsson
- Department of Surgical and Perioperative SciencesUmeå UniversityUmeåSweden
| | - Jan‐P Lehmann
- Department of SurgeryÖstersund HospitalÖstersundSweden
| | - Karin Strigård
- Department of Surgical and Perioperative SciencesUmeå UniversityUmeåSweden
| | - Anna Lindam
- Unit of Research, Education and Development, Department of Public Health and Clinical Medicine, Östersund HospitalUmeå UniversityUmeåSweden
| | - Katarina Tunón
- Department of Clinical Sciences, Obstetrics and GynecologyUmeå UniversityUmeåSweden
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Diggles A. The "Mother Load" and Return to Sport: A Case Report of Returning to Professional Netball Following Cesarean Section. Int J Sports Phys Ther 2023; 18:228-239. [PMID: 36793569 PMCID: PMC9897013 DOI: 10.26603/001c.65894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 10/10/2022] [Indexed: 02/04/2023] Open
Abstract
Background Increasing numbers of elite female athletes are competing in professional sport, and many wish to become pregnant and return to competitive sport after childbirth. Athletes have a higher risk of pelvic floor dysfunction (PFD) than non-athletes (54% versus 7%) and there is also an increased prevalence in post-partum women compared to nulliparous women (35% versus 2.8-7.9%). Additionally, PFD has been shown to influence athletic performance. High quality evidence for elite athletes is lacking, and there are no exercise guidelines specifically for these women to prepare or effectively guide their safe return to sport (RTS). The purpose of this case report is to detail the management of an elite athlete who presented following cesarean section (CS) with the goal of RTS within 16 weeks. Case Description A 27-year-old primiparous Caucasian professional netballer presented at four weeks post- caesarean section (CS) for RTS screening and assessment of pelvic floor muscle (PFM) function. Assessment included readiness and fear of movement screening, dynamic pelvic floor muscle function, structural integrity of the CS wound, levator hiatal dimensions, bladder neck descent, and early global neuromuscular screening. Measures were collected at four weeks, eight weeks, and six months post-partum. The post-partum athlete demonstrated alterations in pelvic floor muscle function, reduced lower limb power and psychological readiness. A functionally staged dynamic and sport specific pelvic floor muscle training program was implemented and adapted to the patient for her early post-partum timeline. Results Rehabilitation strategies were effective in achieving the primary outcome of RTS at 16 weeks post-partum with no adverse events reported at 6 months follow-up. Discussion This case highlights the need for a holistic and individualised RTS management approach that includes women's and pelvic health risk factors in a professional athlete. Level of Evidence 5.
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Ebrahimian A, Bilandi RR, Bilandī MRR, Sabzeh Z. Comparison of the effectiveness of virtual reality and chewing mint gum on labor pain and anxiety: a randomized controlled trial. BMC Pregnancy Childbirth 2022; 22:49. [PMID: 35045813 PMCID: PMC8772130 DOI: 10.1186/s12884-021-04359-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 12/23/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Childbirth pain and anxiety are often unnatural, as opposed to being one of the most practical ways to use non-pharmacological methods. The aim of this study was to compare the effectiveness of virtual reality and chewing mint gum on childbirth pain and anxiety. METHODS This is a single-blind, three-group clinical trial study on 93 mothers referred to Allameh Bohlool Gonabadi and Sajjadieh Torbate Jam Hospitals for natural childbirth in 2018-2019. Subjects were randomly divided into three groups of chewing gum, virtual reality, and control using six blocks. Chewing gum interventions in one group and virtual reality in the other group were performed twice in 4-5 cm and 7-8 cm dilatations for 20 min. In the control group, no intervention except routine care was performed. The research tools included Visual Analogue Scale of Pain and Spielberger's Anxiety Inventory. Data were analyzed using SPSS) version 22(, ANOVA, Kruskal-Wallis, Chi-square and Tukey tests. Significance level was considered 0.05 in this study. RESULTS The main result was differences in pain and anxiety before and after the intervention. There was no significant difference between pre-intervention pain and anxiety scores in the three groups, but there was a significant difference between pain and anxiety scores immediately and 30 min after the intervention. CONCLUSION The results of this study showed that virtual reality and chewing mint gum intervention reduce pain and anxiety in the first stage of childbirth. TRIAL REGISTRATION IRCT20181214041963N1 .
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Affiliation(s)
- Atefeh Ebrahimian
- Department of Midwifery, Faculty of Medicine, Social Development & Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Khorasan Razavi, Iran
- School of Nursing & Midwifery, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran
| | - Roghaieh Rahmani Bilandi
- Department of Midwifery, Faculty of Medicine, Social Development & Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Khorasan Razavi, Iran.
| | - Mohammad Reza Rahmani Bilandī
- Department of Midwifery, Faculty of Medicine, Gonabad University of Medical Sciences, Gonabad, Khorasan Razavi, Iran
| | - Zahra Sabzeh
- Department of Midwifery, Gonabad University of Medical Sciences, Gonabad, Khorasan Razavi, Iran
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Influence of a Virtual Exercise Program throughout Pregnancy during the COVID-19 Pandemic on Perineal Tears and Episiotomy Rates: A Randomized Clinical Trial. J Clin Med 2021; 10:jcm10225250. [PMID: 34830530 PMCID: PMC8621123 DOI: 10.3390/jcm10225250] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/04/2021] [Accepted: 11/09/2021] [Indexed: 12/15/2022] Open
Abstract
The complications associated with COVID-19 confinement (impossibility of grouping, reduced mobility, distance between people, etc.) influence the lifestyle of pregnant women with important associated complications regarding pregnancy outcomes. Therefore, perineal traumas are the most common obstetric complications during childbirth. The aim of the present study was to examine the influence of a supervised virtual exercise program throughout pregnancy on perineal injury and episiotomy rates during childbirth. A randomized clinical trial design (NCT04563065) was used. Data were collected from 98 pregnant women without obstetric contraindications who attended their prenatal medical consultations. Women were randomly assigned to the intervention (IG, N = 48) or the control group (CG, N = 50). A virtual and supervised exercise program was conducted from 8-10 to 38-39 weeks of pregnancy. Significant differences were found between the study groups in the percentage of episiotomies, showing a lower episiotomy rate in the IG (N = 9/12%) compared to the CG (N = 18/38%) (χ2 (3) = 4.665; p = 0.031) and tears (IG, N = 25/52% vs. CG, N = 36/73%) (χ2 (3) = 4.559; p = 0.033). A virtual program of supervised exercise throughout pregnancy during the current COVID-19 pandemic may help reduce rates of episiotomy and perineal tears during delivery in healthy pregnant women.
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Quaghebeur J, Petros P, Wyndaele JJ, De Wachter S. Pelvic-floor function, dysfunction, and treatment. Eur J Obstet Gynecol Reprod Biol 2021; 265:143-149. [PMID: 34492609 DOI: 10.1016/j.ejogrb.2021.08.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/15/2021] [Accepted: 08/24/2021] [Indexed: 10/20/2022]
Abstract
The pelvic floor functions as a holistic entity. The organs, bladder, bowel, smooth and striated muscles, nerves, ligaments and other connective tissues are directed cortically and reflexly from various levels of the nervous system. Such holistic integration is essential for the system's multiple functions, for example, pelvic girdle stability, continence, voiding/defecation, and sexuality. Pelvic floor dysfunction (PFD) is related to a variety of pelvic pain syndromes and organ problems of continence and evacuation. Prior to treatment, it is necessary to understand which part(s) of the system may be causing the dysfunction (s) of Chronic Pelvic Pain Syndrome (CPPS), pelvic girdle pain, sexual problems, Lower Urinary Tract Symptoms (LUTS), dysfunctional voiding, constipation, prolapse and incontinence. The interpretation of pelvic floor biomechanics is complex and involves multiple theories. Non-surgical treatment of PFD requires correct diagnosis and correctly supervised pelvic floor training. The aims of this review are to analyze pelvic function and dysfunction. Because it is a holistic and entirely anatomically based system, we have accorded significant weight to the Integral Theory's explanations of function and dysfunction.
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Affiliation(s)
- Jörgen Quaghebeur
- Department of Urology, University of Antwerp, Edegem, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Edegem, Belgium.
| | - Peter Petros
- Faculty of Medicine, University of New South Wales, Kensington, Sydney, Australia
| | | | - Stefan De Wachter
- Department of Urology, University of Antwerp, Edegem, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Edegem, Belgium
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Wu TF, Huang LH, Lai YF, Chen GD, Ng SC. Early postpartum biofeedback assisted pelvic floor muscle training in primiparous women with second degree perineal laceration: Effect on sexual function and lower urinary tract symptoms. Taiwan J Obstet Gynecol 2021; 60:78-83. [PMID: 33495013 DOI: 10.1016/j.tjog.2020.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2020] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To evaluate the short-term effect of routine early postpartum electromyographic biofeedback assisted pelvic floor muscle training on sexual function and lower urinary tract symptoms. MATERIALS AND METHODS From December 2016 to November 2017, primiparous women with vaginal delivery, who experienced non-extended second-degree perineal laceration were invited to participate. Seventy-five participants were assigned into a pelvic floor muscle training (PFMT) group or control group. Women in the PFMT group received supervised biofeedback-assisted pelvic floor muscle training at the 1st week and 4th week postpartum. Exercises were performed at home with the same protocol until 6 weeks postpartum. The Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire (PISQ-12) and the Urinary Distress Inventory short form questionnaire (UDI-6) were used to evaluate sexual function and lower urinary tract symptoms respectively at immediate postpartum, 6 weeks, 3 months, and 6 months postpartum. RESULTS Forty-five women (23 in PFMT group,22 in control group) completed all questionnaires at 6 months postpartum. For overall sexual function and the three sexual functional domains, no statistically significant difference was found in PISQ scores from baseline to 6 weeks, 3 months, and 6 months postpartum between the PFMT and control groups. For postpartum lower urinary tract symptoms, all symptoms gradually improved over time for both groups without a statistically significant difference between groups. CONCLUSION Our study showed that supervised biofeedback-assisted pelvic floor muscle training started routinely at one week postpartum did not provide additional improvement in postpartum sexual function and lower urinary tract symptoms.
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Affiliation(s)
- Ting-Feng Wu
- Department of Obstetrics and Gynecology, Lee Women's Hospital, Taichung, Taiwan; Department of Obstetrics and Gynecology, Veterans General Hospital, Taichung, Taiwan
| | - Li-Hua Huang
- Department of Nursing, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yu-Fen Lai
- Department of Physical Therapy, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Gin-Den Chen
- Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Soo-Cheen Ng
- Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
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Otero Torres L, Da Cuña Carrera I, González González Y. Papel de las distintas modalidades de fisioterapia en mujeres con dispareunia: una revisión bibliográfica. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2020. [DOI: 10.1016/j.gine.2020.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Alsobayel H, Buragadda S, Aljuaid S, Basamad L, Alshehri S, Alhenaki M, Murayshed H, Melam GR. Sociodemographic factors associated with postpartum physical activity levels in working women. Women Health 2019; 60:60-71. [PMID: 31046650 DOI: 10.1080/03630242.2019.1610828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Postpartum physical activity is important but is often neglected owing to conflicting priorities. Given the poor activity levels in the general Saudi population, women are especially likely to have poor postpartum activity levels. This study measured postpartum physical activity of Saudi working women and investigated the relationship between physical activity levels and sociodemographic factors. Study design: Cross-sectional study. This was a cross-sectional study conducted between January and June 2017. Working, postpartum Saudi women completed an online questionnaire including demographic information and the International Physical Activity Questionnaire (IPAQ)-short form. Of 486 women responding to the online invitation, 142 (29.2%) were eligible and participated. Based on IPAQ data, 23 (16.2%), 31 (21.8%), and 88 (62.0%) participants performed high, moderate or low levels of physical activity, respectively. No significant associations were found between the physical activity levels and sociodemographic factors. The most common factors discouraging physical activity were lack of time (21.2%) and childcare responsibilities (19.1%). The majority of participating working Saudi women had low postpartum physical activity levels. No sociodemographic factors were significantly associated with the level of physical activity. Measures may be required to promote postpartum physical activity among Saudi women.
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Affiliation(s)
- Hana Alsobayel
- Rehabilitation Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Syamala Buragadda
- Rehabilitation Health Sciences Department, College of Applied Medical, Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Shadia Aljuaid
- Students, Rehabilitation Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Lujain Basamad
- Students, Rehabilitation Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Shahad Alshehri
- Students, Rehabilitation Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Mai Alhenaki
- Students, Rehabilitation Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Hanen Murayshed
- Students, Rehabilitation Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Ganeswara Rao Melam
- Rehabilitation Health Sciences Department, College of Applied Medical, Sciences, King Saud University, Riyadh, Saudi Arabia
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Moya Esteban BM, Solano Calvo JA, Torres Morcillo C, Delgado Espeja JJ, González Hinojosa J, Zapico Goñi Á. Retrospective case review of combined local mepivacaine and steroid injections into vaginal trigger points for the management of moderate-to-severe perineal pain after childbirth. Arch Gynecol Obstet 2018; 299:501-505. [DOI: 10.1007/s00404-018-5000-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 12/04/2018] [Indexed: 12/22/2022]
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Tenfelde S, Tell D, Brincat C, Fitzgerald CM. Musculoskeletal Pelvic Pain and Sexual Function in the First Year After Childbirth. J Obstet Gynecol Neonatal Nurs 2018; 48:59-68. [PMID: 30503526 DOI: 10.1016/j.jogn.2018.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2018] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To characterize sexual function in women with and without musculoskeletal pelvic pain during the first year after childbirth. DESIGN Cross-sectional descriptive study. SETTING Outpatient women's health clinic in a Midwestern U.S. academic medical center. PARTICIPANTS Women who gave birth to singleton infants within the past year. METHODS Women were recruited from various outpatient settings. We obtained baseline demographic variables and used selected components from the Wilson and Cleary Health-Related Quality of Life model. Participants completed questionnaires related to sexual health, pain symptoms, and general quality of life. They were asked to indicate their pain on a pain diagram and to quantify it with the use of a numeric rating scale (NRS). Examiners used validated examination techniques to assess pelvic floor muscle tenderness, strength, and pelvic girdle pain. Participants who reported pelvic pain and had at least one positive physical examination finding were classified in the pain group. RESULTS Forty-five participants completed the study, and 20 participants were in the pain group. Most participants with pain had pelvic girdle pain (n = 15) and pelvic floor myofascial pain (n = 20). Participants with pain reported less sexual satisfaction (t[43] = 2.84, p = .007) and reduced quality of life (t[36] = 5.25, p < .001) compared with participants without pain. CONCLUSION Participants who experienced musculoskeletal pelvic pain in the first year after childbirth were significantly more likely to report problems with sexual function compared with their counterparts without pain.
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Common errors made in attempt to contract the pelvic floor muscles in women early after delivery: A prospective observational study. Eur J Obstet Gynecol Reprod Biol 2017; 220:113-117. [PMID: 29202394 DOI: 10.1016/j.ejogrb.2017.11.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 11/17/2017] [Accepted: 11/20/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The ability to perform a correct pelvic floor muscle contraction (PFMC) is necessary to start pelvic floor muscle training after delivery. COMMOV are "c"ontractions of "o"ther "m"uscles (m. rectus abdominus, the gluteal muscles, and the adductors), and other "mov"ements (pelvic tilt, breath holding, and straining) performed in addition to or instead of the PFMC. COMMOV are probably the most common errors in attempt to contract the pelvic floor muscles during the first days after delivery. The aims of this study were to observe the prevalence of COMMOV, to investigate whether COMMOV influence the ability to perform a PFMC, and whether verbal instructions are effective to unlearn the COMMOV postpartum. STUDY DESIGN A Prospective Observational Study was performed in women during the first through sixth day postpartum. PFMC and COMMOV were evaluated with visual observation. Women who did not show correct isolated PFMC received verbal instructions and were re-evaluated. Interobserver variability and agreement were calculated. Chi-square, Kappa, Risk Ratio, and McNemar were used. RESULTS A total of 382 women participated, 2.36 (±1.2) days postpartum. Twohundred sixteen, 57%, CI (52-62%), showed COMMOV. The chance to perform a correct PFMC was 2.65 times higher without COMMOV (p=0.0001). Verbal feedback was effective (57% reduced to 3%) to abandon COMMOV during PFMC. CONCLUSION COMMOV are common errors performed during attempts to contract the pelvic floor muscles after delivery. They can reduce the ability to contract the pelvic floor muscles, but can easily been unlearned with visual observation and verbal feedback.
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