通过盆底测试仪压力气囊评估盆底肌力的有效性研究

目的 探讨应用盆底测试仪压力气囊测试最大阴道收缩压(MVCP)与手测肌力检查评估盆底肌力的相关性和一致性。方法 前瞻性选取于2018年6月至2019年7月在北京协和医院体检、因盆底功能障碍性疾病(PFD)就诊及产后1年内随访的女性，分别为非PFD组、PFD组及产后组。由同一名医生对受试者进行手测肌力检查，包括改良牛津肌力分级(MOS)和肛提肌检测分级(LAT);再依据随机数字表对受试者进行随机互盲分组，由两名盆底治疗师作为检查者，以交叉顺序使用盆底测试仪的压力气囊进行MVCP评估，每名检查者对同一受试者进行两次评估。采用Spearman秩相关系数(r)进行相关性评价，采用组内相关系数(ICC)、Bland-Altman分析进行一致性评价。结果 非PFD组163例、PFD组154例和产后组151例受试者完成所有评估。在全部受试者中，盆底测试仪记录的MVCP与MOS和LAT之间相关性强(r=0.779～0.814,P<0.001),MVCP结果在同一检查者内存在高度一致性[分别为ICC=0.815,95%CI(0.782,0.843)和ICC=0.818,95%CI(0.785,0....     

产科因素对产后早期女性发生盆底功能障碍性疾病的影响

目的分析产科因素对产后早期女性发生盆底功能障碍性疾病(PFD)的影响。方法回顾性分析2016年7月至2019年12月于本院门诊复查的300例产后6～8周妇女临床资料,通过盆腔器官脱垂定量分期量表(POP-Q)、国际尿失禁咨询委员会尿失禁问卷表简表(ICIQ-SF)评估盆腔脏器脱垂(POP)、压力性尿失禁(SUI)发生情况,经单因素、多因素Logistic回归模型分析影响产后早期女性发生PFD的因素。结果 300例产妇产后6-8周出现46例POP(15.33%)、82例SUI(27.22%);POP组年龄、分娩方式、分娩前BMI、会阴裂伤、第二产程停滞或延长、巨大胎儿占比相比非POP组,差异有统计学意义(P0.05);SUI组年龄、分娩方式、会阴裂伤、第二产程停滞或延长、巨大胎儿、孕期SUI占比相比非SUI组,差异有统计学意义(P0.05);经非条件多项Logistic回归分析证实,年龄≥35岁、阴道分娩、分娩前BMI≥25kg/m2、会阴裂伤、第二产程停滞或延长、巨大胎儿均可能是影响POP发生的危险因素(OR1,P0.05),年龄≥35岁、阴道分娩、会阴裂伤、第二产程停滞或延长、巨大胎儿、孕期SUI均可能是影响SUI发生的危险因素(OR1,P0.05)。结论年龄、分娩方式、会阴裂伤、第二产程停滞或延长、巨大胎儿等产科因素均可能增加早期女性PFD的发生风险,故应正确识别并及时处理上述风险因素,以预防PFD发生。     

椎管内阻滞用于分娩镇痛对产后早期盆底功能的影响

目的探讨椎管内阻滞用于分娩镇痛对初产妇早期盆底功能和盆底功能障碍性疾病(PFD)发生的影响。方法随机选择我院阴道分娩并于分娩后6~8周复查的初产妇292例,根据分娩方式均分为椎管内阻滞分娩镇痛组(A组)和非镇痛组(B组),检测盆底肌力、疲劳度和动态压力以评估产后早期盆底功能;采用一般问卷调查和盆底器官脱垂(POP-Q)法了解产后早期PFD发生情况,记录两组产妇早期盆底功能受损及压力性尿失禁(SUI)、盆腔器官脱垂(POP)的发生率。结果产后6~8周盆底功能受损发生率A组为87例(59.6%),B组为94例(64.4%),两组盆底功能受损发生率差异无统计学意义;产后6~8周POP的发生率A组为55例(37.7%),B组为61例(41.8%);SUI的发生率A组6例(4.1%),B组为5例(3.4%);两组POP、SUI发生率差异无统计学意义。结论阴道分娩可使产后早期发生盆底功能损伤,椎管内分娩镇痛不增加产后早期盆底损伤的风险并有改善女性盆底功能受损的可能。     

剪切波弹性成像评价绝经后盆腔器官脱垂患者肛提肌弹性

目的 观察剪切波弹性成像(SWE)评估无肛提肌损伤的绝经后盆腔器官脱垂(POP)患者肛提肌弹性的价值。方法 将40名定量POP(POP-Q)结果为0~Ⅲ度的绝经后女性分为POP 0组、POP Ⅰ组、POP Ⅱ组及POP Ⅲ组,行盆底超声检查排除肛提肌损伤,应用SWE测量静息状态下双侧肛提肌的杨氏模量,计算双侧平均值;比较组间基本资料及肛提肌杨氏模量差异,采用Pearson相关性分析评价左、右侧肛提肌及其平均杨氏模量与POP-Q分度的关系。结果 组间年龄、身高、体质量及体质量指数差异均无统计学意义(P均＞0.05);POP 0组至POP Ⅲ组左、右侧肛提肌及其平均杨氏模量逐渐增加,两两比较差异均有统计学意义(P均＜0.05)。相关性分析显示,左、右侧肛提肌及其平均杨氏模量均与POP-Q分度呈正相关(r=0.814、0.799、0.809,P均＜0.01)。结论 SWE可用于评估无肛提肌损伤绝经后POP患者静息状态下肛提肌弹性功能。     

超声检查评估产后早期女性腹直肌及盆底结构与功能

目的探讨超声检查评估产后早期女性腹直肌及盆底结构与功能的价值。方法对产后6～8周的102名初产妇均行经会阴盆底超声检查和腹部超声检查,检测最大瓦氏动作状态下肛提肌裂孔面积,分别测量脐、脐上3 cm及脐下3 cm水平腹直肌间距(IRD),采用Spearman相关性分析观察最大瓦氏动作状态下肛提肌裂孔面积与IRD之间的相关性。结果经会阴盆底超声检查示,102名产妇中47名盆底未见明显异常(无PFD组),55例诊断为PFD(PFD组)。无PFD组最大瓦氏动作下肛提肌裂孔面积为(14.52±2.72)cm~2,PFD组(22.78±5.51)cm~2,组间差异有统计学意义(t=9.81,P0.05)。无PFD组脐水平IRD小于PFD组(P0.05),2组脐上3 cm及脐下3 cm水平IRD差异均无统计学意义(P均0.05)。产妇最大瓦氏动作状态下肛提肌裂孔面积与脐水平IRD呈正相关(r_s=0.42,P0.01)。结论超声检查可有效评估产后早期女性腹直肌及盆底结构与功能;腹直肌间距增加可能对女性盆底结构与功能造成不良影响。     

四子散热熨对压力性尿失禁患者盆底功能康复的影响

目的 探讨四子散热熨对轻中度压力性尿失禁患者盆底功能的康复作用。方法 将女性轻中度压力性尿失禁患者随机分为对照组(n=39)和观察组(n=38)。对照组采用常规康复护理,观察组在对照组基础上采用四子散热熨,每次20 min, 3次/周,连续干预4周。干预前后评估患者盆底肌肉功能、盆底组织形态和尿失禁总体情况,干预1个月后随访时评估患者尿失禁总体情况和尿失禁疗效。结果 干预后观察组盆底表面肌电值前静息阶段、快速收缩阶段和后静息阶段康复效果和肛提肌裂孔面积显著优于对照组;干预后与随访时,观察组尿失禁总体评分显著优于对照组,干预后观察组尿失禁疗效显著优于对照组(P<0.05,P<0.01)。结论 四子散热熨能促进轻中度压力性尿失禁患者盆底功能康复,改善尿失禁。     

盆底功能障碍性疾病患者阴道前后壁中蛋白基因产物9.5和血管活性肠肽的表达研究

目的本试验通过比较压力性尿失禁(SUI)、盆腔器官脱垂(POP)患者及对照组的阴道前后壁蛋白基因产物9.5(PGP9.5)及血管活性肠肽(VIP)的分布变化来寻找盆底失神经支配的进一步证据,分析VIP与SUI及POP发生的关系。方法40例患者分为SUI组(13例)、POP组(14例)和无症状对照组(13例),取阴道前后壁黏膜制成冰冻切片,用半定量免疫组化的方法对阴道前后壁PGP9.5、VIP进行研究。结果(1)阴道壁中PGP9.5表达强度大于VIP。(2)对照组中PGP9.5(P=0.016)和VIP(P=0.033)在阴道前壁的表达显著高于后壁,而在其他组则无显著差异。(3)SUI组与对照组相比,阴道前壁PGP9.5的表达显著降低(P=0.016)。(4)SUI组和对照组中阴道前后壁PGP9.5与年龄呈负相关,SUI组阴道前壁PGP9.5表达还与腹部漏尿点压力(ALPP)呈正相关(r=0.590,P=0.034),POP组中VIP在前、后壁的表达与年龄(r=-0.837,r=-0.560)、绝经年限(r=-0.841,r=-0.594)呈负相关。(5)各组的PGP9.5和VIP的表达均与体重指数(BMI)无相关性。结论阴道壁的神经损伤主要发生在前壁,这不仅与SUI的发生有关,也是SUI与POP的病理生理学差异。阴道黏膜中VIP的阳性率较低,其分布与血管的关系密切,在POP组与年龄和绝经年限相关,提示绝经后生殖道血供减少,盆底组织薄弱,易使POP病情进展,但是否发生SUI,还有其他因素参与。     

腹腔镜全子宫切除术后盆底康复治疗的疗效评价

目的评价腹腔镜全子宫切除术后盆底康复治疗对患者盆底功能和生活质量的影响。方法选取2011年1~9月因子宫非脱垂良性疾病于我院行腹腔镜全子宫切除术150例,随机分为A、B、C三组,每组50例,术后给予不同的治疗方案,A组进行电刺激+生物反馈+阴道哑铃治疗,B组做Kegel训练,C组无特殊处理。采用盆腔器官脱垂定量分度法(Pelvic Organ Prolapse Quantitation,POP-Q)评估术后5年阴道壁及穹隆脱垂(pelvic organ prolapse,POP),1 h尿垫试验检测压力性尿失禁(stress urinary incontinence,SUI)的情况;术前、术后6个月和术后1年手检和机检评估术后盆底肌力变化,采用盆底障碍影响简易问卷7和中国女性性生活质量问卷评价术后患者的生活质量和性生活质量。结果 A组术后盆底Ⅰ类肌(χ~2=4.882,P=0.027)和Ⅱ类肌(χ~2=4.882,P=0.027)肌力较术前明显改善,生活质量(t=-0.727,P=0.471)和性生活质量(t=1.549,P=0.128)无下降;B组术后Ⅰ类肌肌力下降(χ~2=4.244,P=0.039),生活质量(t=-9.220,P=0.000)和性生活质量(t=5.108,P=0.000)下降,POP发生率[20%(10/50)]较A组[4%(2/50)]升高(χ~2=6.061,P=0.014);C组术后盆底Ⅰ类肌(χ~2=5.086,P=0.024)和Ⅱ类肌(χ~2=5.002,P=0.025)肌力均下降,生活质量(t=-13.472,P=0.000)和性生活质量(t=10.748,P=0.000)均明显下降,且POP和SUI的发生率较A组明显升高[POP 20%(10/50)vs.4%(2/50),χ~2=6.061,P=0.014;SUI 22%(11/50)vs.4%(2/50),χ~2=7.162,P=0.007]。结论腹腔镜全子宫切除术后合理的盆底康复治疗有助于改善盆底功能及生活质量,可以减少POP和SUI的发生,电刺激+生物反馈+阴道哑铃训练效果更佳。     

盆底超声评估初次经阴道分娩与剖宫产产后盆底功能

目的观察盆底超声评估阴道分娩与剖宫产初次产后盆底功能的价值。方法选取176名产妇,根据初次分娩方式将其分为经阴道分娩组(n=100)和剖宫产组(n=76);对比2组静息态及最大瓦尔萨尔瓦动作下超声各参数,包括肛提肌裂孔左右径、前后径及面积,左、右侧耻骨直肠肌厚度及膀胱颈移动度,观察盆底超声评估初次产后盆底功能的价值。结果静息态及最大瓦尔萨尔瓦动作下,经阴道分娩组肛提肌裂孔左右径、前后径及面积均大于剖宫产组(P均<0.05),左、右侧耻骨直肠肌厚度均小于剖宫产组(P均<0.05);阴道分娩组膀胱颈移动度大于剖宫产组(t=2.177,P=0.031)。结论盆底超声对评估初次产后盆底功能具有一定价值;初次经阴道分娩对盆底功能的影响大于剖宫产;肛提肌裂孔面积增大、膀胱颈移动度增大及耻骨直肠肌厚度变薄可早期提示产后盆底功能障碍可能。     

女性盆底肌磁共振弥散张量成像价值分析

目的探讨磁共振弥散张量成像(DTI)在女性盆底肌成像应用中的可行性。方法筛选35名无孕育史、无盆底疾病的年轻志愿者(对照组)和35名初产妇(研究组),分别行盆底肌常规磁共振成像(MRI)扫描和DTI扫描,测量肛提肌和肛门括约肌复合体的部分各向异性分数(FA)值,计算其平均值。并使用计算机软件描绘肛提肌和肛门括约肌复合体的三维纤维示踪图。结果对照组35名志愿者肛提肌平均FA值是(0.41±0.02),研究组35名初产妇肛提肌平均FA值是(0.34±0.03),差异有统计学意义(P0.05);对照组肛门括约肌复合体平均FA值为(0.70±0.03),研究组为(0.65±0.03),差异有统计学意义(P0.05)。DTI三维失踪成像可清晰显示初产妇肛提肌、肛门括约肌的肌肉形态改变。结论 DTI可以对女性盆底肌进行量化分析和三维形态学观察,有利于女性盆底肌肉损伤的早期诊断,值得临床推广。     

Dynamic assessment of pelvic floor function in women using the intravaginal device test

The aim of the study was to assess pelvic floor function and dysfunction using intravaginal devices (IVD test). One hundred and eighty-five patients were evaluated, 65 (35.1%) in the control group without genital prolapse and 120 (64.9%) in the study group, with prolapse. Anatomic changes were evaluated on a scale described by Halban, and functional classification based on palpation of the muscles of the pelvic floor during contraction. Additionally, weighted vaginal devices were used to assess pelvic floor function. Statistic analysis was performed with the Spearman-Pearson correlation coefficient, the ² test and the response/ operator characteristic curve. There was an acceptable correlation between the IVD test and the functional classification of 0.75. Using this classification, the IVD test showed 86.58% sensitivity, 75.72% specificity, and had a positive predictive value 73.95% and a negative predictive value of 87.64%. Significant differences between pelvic floor muscle activity in those patients with and without genital prolapse were observed (X²=58.28, P=<0.005). It was concluded that pelvic floor assessment can be done through the evaluation of active muscle strength or pelvic floor integrity using the functional classification and the IVD test.EDITORIAL COMMENT: In 1988, Peattie and Plevnick introduced the use of weighted vaginal cones to exercise the pelvic floor muscles and treat stress urinary incontinence [1]. Contreras-Ortiz and Nuñez build on this earlier work, using a similar technique to assess pelvic floor muscle function and integrity. Specifically, pelvic floor function is assessed by a combination of digital palpation of the pubococcygeus muscle at rest and during contraction; pelvic floor integrity is assessed by the patient's ability to retain a weighted cone vaginally for 1 minute. Scoring of these two parameters can then be objectively followed for therapeutic response to treatment for urinary incontinence or pelvic relaxation. Many of us forget to palpate the pubococcygeus muscle at rest and during an elicited contraction during baseline or follow-up examination. As this study indicates, simple assessment of pelvic floor function and integrity is possible, and should be used both clinically and in research.     

Pelvic floor disorders among indigenous women living in Xingu Indian Park, Brazil

Introduction and hypothesis  Current assessment for pelvic floor disorders (PFDs) allows comparison between different communities. Methods  A total of 377 indigenous women living in Xingu Indian Park were evaluated. The pelvic organ prolapse quantification (POP-Q) was the system used to quantification the staging of pelvic support. The pelvic floor muscle strength was assessed by a perineometer. Logistic regression analysis was used to determine risk factors that were associated with prolapse. Results  Only 5.8% of women reported urinary incontinence. The overall distribution of POP-Q stage system was the following: 15.6% stage 0, 19.4% stage I, 63.9% stage II and 0.8% stage III. Parity and age were the risk factors for pelvic organ prolapse (p < 0.0001). Conclusions  Urinary incontinence was uncommon in Xingu indigenous women. Like non-indigenous communities, age and parity were the most important risk factors to the genital prolapse.     

The effect of postpartum pelvic floor muscle exercise in the prevention and treatment of urinary incontinence

The aim of this study was to evaluate the effect of postpartum pelvic floor muscle exercise in the prevention and treatment of urinary incontinence. A prospective comparison design of 99 matched pairs (n=198) of mothers, a training group and a control group, was used. Eight weeks postpartum the training group attended an 8-week intensive pelvic floor muscle exercise course, training in groups led by a physical therapist for 45 minutes once a week. In addition they were asked to exercise at home at least three times per week. The control group followed the ordinary written postpartum instructions from the hospital. Pelvic floor muscle strength was measured pretreatment at the eighth, and post-treatment at the 16th week after delivery, using a vaginal balloon catheter connected to a pressure transducer. Vaginal palpation and observation of inward movement of the balloon catheter during contraction were used to test the ability to perform correct the pelvic floor muscle contraction. Urinary leakage was registered by interview, specially designed instruments to measure how women perceive SUI, and a standardized pad test. At baseline (8 weeks postpartum) there was no significant difference in the number of women with urinary incontinence in the training group compared to the control group. At 16 weeks postpartum, after the 8-week treatment period, there was a significant (P<0.01) difference in favor of the training group. In addition, a significantly greater improvement in pelvic floor muscle strength between test 1 and test 2 was found in the training group compared to the control group. The results show that a specially designed postpartum pelvic floor muscle exercise course is effective in increasing pelvic floor muscle strength and reducing urinary incontinence in the immediate postpartum period. EDITORIAL COMMENT: This paper is one of only a few looking at the efficacy of a rigorous pelvic floor muscle exercise training regime to help women with incontinence in the postpartum period. Whether or not these results will translate long-term into a lower incidence of urinary incontinence as these women age, is unknown, and may never be known. However, this paper points out that there is a definite benefit from pelvic floor muscle exercise for the treatment of postpartum incontinence, and we can use this information to more strongly counsel our patients in the use of these exercises.     

The effect of pelvic floor training on sexual function of treated patients

The aim of this study was to determine the effects of improvements in urinary incontinence resulting from pelvic floor rehabilitation on the sexual function of patients. The study involved 42 clinic patients who received pelvic floor rehabilitation treatment. Their sexual histories were obtained through face-to-face interviews. Pelvic muscle strength was measured with a perineometer. Improvement in incontinence was measured with the pad test. Seventeen women reported decreased sexual desire before the treatment; 5 of these indicated improvement after treatment. Nine of 17 women who experienced dyspareunia prior to treatment reported an improvement afterwards, and four women reported complete relief from pain. Five of 15 women who complained of difficulty in reaching climax before the treatment experienced improvement in this area. In conclusion, an improvement in sexual desire, performance during coitus and achievement of orgasm were observed in women who received pelvic floor muscle rehabilitation. No change was seen in the arousal and resolution stages of sexual activity.Abbreviation FES Functional electrical stimulationEditorial Comment: Previous studies suggest that the prevalence of sexual dysfunction is high amongst women with urinary incontinence. Some data exist about the effect of surgical treatment of urinary incontinence and its effect on sexual function. Data also exist that women with sexual dysfunction due to painful conditions improve with pelvic floor therapy. It could be expected that women with urinary incontinence and sexual dysfunction show better overall improvement of both conditions when treated with pelvic floor therapy rather than with surgery. Patients in this study showed improvement in urinary incontinence with pelvic floor therapy. They also had a marked decrease in dyspareunia. Overall, there was improvement in sexual function, particularly an increase in desire. Unfortunately, the study does not address whether this improvement appears to be related to a decrease in incontinence, a decrease in pain with intercourse or an additive effect.     

Prevalence and degree of bother from pelvic floor disorders in obese women

We aimed to determine the prevalence and bother from pelvic floor disorders (PFD) by obesity severity, hypothesizing that both would increase with higher degrees of obesity. We performed a secondary analysis of 1,155 females enrolled in an epidemiologic study that used a validated questionnaire to identify PFD. Prevalence and degree of bother were compared across three obesity groups. Logistic regression assessed the contribution of degree of obesity to the odds of having PFD. Prevalence of any PFD was highest in morbidly (57%) and severely (53%) obese compared to obese women (44%). Regression models demonstrated higher prevalence of pelvic organ prolapse, overactive bladder, stress urinary incontinence, and any PFD in morbidly compared to obese women and higher prevalence of stress urinary incontinence in severely obese compared to obese women. Degree of bother did not vary by degree of obesity. Prevalence of PFD increases with higher degrees of obesity.     

Pelvic floor muscle strength and thickness in continent and incontinent nulliparous pregnant women

The aim of the study was to measure pelvic floor muscle function in continent and incontinent nulliparous pregnant women. The study group consisted of 103 nulliparous pregnant women at 20 weeks of pregnancy. Women reporting urinary incontinence once per week or more during the previous month were classified as incontinent. Function was measured by vaginal squeeze pressure (muscle strength) and increment in thickness of the superficial pelvic floor muscles (urogenital diaphragm) assessed by perineal ultrasound. Seventy-one women were classified as continent and 32 women as incontinent. Continent women had statistically significantly higher maximal vaginal squeeze pressure and increment in muscle thickness when compared with incontinent women. There was a strong correlation between measurements of vaginal squeeze pressure and perineal ultrasound measurements of increment in muscle thickness. This study demonstrates statistically significant differences in pelvic floor muscle function measured by strength and thickness in continent compared with incontinent nulliparous pregnant women. Editorial Comment: This study evaluated pelvic floor muscle function in 103 nulliparous continent and incontinent women at 18–20 weeks gestation. Pelvic floor muscle strength was assessed by measuring vaginal squeeze pressure, and thickness of the urogenital diaphragm during both relaxation and contraction was measured using perineal ultrasound. The authors found a statistically significant higher vaginal squeeze pressure and higher mean increment in muscle thickness in the continent compared with incontinent group as well as a strong correlation between pelvic floor muscle strength and increment in thickness. Although describing several benefits of ultrasonography in assessing pelvic floor muscles, the authors did acknowledge the difficulty in identifying and measuring these muscles, and the learning curve involved with perineal ultrasound. Another limitation was the subjective classification of continence status based on self-reported symptoms. The implication of low pelvic floor muscle strength and thickness as risk factors for the development of urinary incontinence is beyond the scope of this study.     

Effects of pelvic floor exercises in middle aged women with a history of naïve urinary incontinence: a population based study

OBJECTIVE: To follow the effect of a 4-month pelvic floor exercise (PFE) program in women with na?ve urinary incontinence with vaginal electromyography (EMG), pressure and palpation and also to compare the initial findings with symptom-free women of the same age.METHODS: The pelvic floor function expressed with vaginal EMG, pressure and palpation was measured before, during and after 4 months of PFEs in 60 previously untreated incontinent women, 50 of whom completed the study. The patients' perception of the situation and the amount of leakage were estimated before and after PFE. The incontinent group was compared at baseline and after PFE with 28 healthy controls. All women in this study (age 53-63) were randomly recruited from a major population based study.RESULTS: At baseline, the incontinent women had significant reductions of both vaginal EMG activity and pelvic floor muscle condition as estimated by palpation compared to the healthy group. During training a successive, significant increase was seen in both EMG, pressure and palpation and the values eventually exceeded those of the healthy women. The measures reflecting improvement of pelvic floor function thus showed a consistent and progressive pattern. The degree of improvement was higher in those with initial high values in the muscle function tests than in the women with lower initial EMG values, pressures and findings on palpation. No differences were seen between patients with a history of stress incontinence and patients with an urge component, i.e. urge or mixed incontinence. Sixty-four percent of the women were satisfied and wanted no further treatment. The median leakage at pad-test decreased from 5 (range 0-328) to 1 (range 0-126) g/24h. The correlation between the vaginal and the pad-test measurements was weak.CONCLUSION: Women with urinary incontinence have a significant reduction of pelvic floor function as estimated with vaginal EMG and palpation as compared to symptom-free controls. A successive normalization of vaginal EMG, pressure and findings at palpation was seen during the 4-month training period. Incontinence of both stress type and with an urge component can be alleviated in most of the women with PFE. These methods might be useful for routine evaluation of the pelvic neuromuscular disorder present in incontinent women.     

Magnetic resonance assessment of pelvic anatomy and pelvic floor disorders after childbirth

To compare pelvic anatomy, using magnetic resonance imaging, between postpartum women with or without pelvic floor disorders. We measured postpartum bony and soft tissue pelvic dimensions in 246 primiparas, 6–12-months postpartum. Anatomy was compared between women with and without urinary or fecal incontinence, or pelvic organ prolapse; P < 0.01 was considered statistically significant. A deeper sacral hollow was significantly associated with fecal incontinence (P = 0.005). Urinary incontinence was marginally associated with a wider intertuberous diameter (P = 0.017) and pelvic arch (P = 0.017). There were no significant differences in pelvimetry measures between women with and without prolapse (e.g., vaginal or cervical descent to or beyond the hymen). We did not detect meaningful differences in soft tissue dimensions for women with and without these pelvic floor disorders. Dimensions of the bony pelvis do not differ substantially between primiparous women with and without postpartum urinary incontinence, fecal incontinence and prolapse.     

Correlation between vaginal stiffness index and pelvic floor disorder quality-of-life scales

The objective of this study was to determine if vaginal stiffness index, an in vivo vaginal biomechanical property, is correlated with pelvic floor disorder symptom distress, impact on quality of life, or sexual function as measured by disease-specific quality-of-life scales. Forty-eight women completed validated quality-of-life scales (pelvic floor distress inventory-short form, pelvic floor impact questionnaire, and pelvic organ prolapse/urinary incontinence sexual questionnaire) and underwent in vivo vaginal biomechanical testing. After bivariate relationships between vaginal stiffness index and demographic, obstetric, and gynecologic variables were explored, multiple linear regression controlling for pelvic organ prolapse quantitative (POP-Q) stage of prolapse was performed. The vaginal stiffness index was inversely correlated with pelvic organ prolapse distress severity (POPDI-6) after controlling for POP-Q stage of prolapse (p = 0.011, r = 0.67, r (2) = 0.450, beta = -2.3). These findings provide initial evidence for the construct validity of in vivo vaginal biomechanical testing for pelvic organ prolapse evaluation because an increasing vaginal stiffness index is correlated with decreasing symptomatic and anatomic severity of disease.     

Do Women Understand Urogynecologic Terminology?

OBJECTIVES: The aims of this study were to describe women's stated knowledge of the primary urogynecologic diagnostic terms (urinary incontinence, pelvic floor disorder, and pelvic organ prolapse) and to assess factors associated with knowledge. METHODS: Before any education about pelvic floor disorders, 376 women presenting to primary care-level gynecologic clinics were asked whether they knew what the terms urinary incontinence, pelvic organ prolapse, and pelvic floor disorder meant. χ(2) and t tests were used to compare characteristics of women with complete knowledge versus partial or no knowledge of terms. P < 0.05 was considered significant. RESULTS: Of all women, 25% knew all 3 terms and 18% knew none. Moreover, 80%, 52%, and 27% of women reported that they knew the meaning of the terms urinary incontinence, pelvic organ prolapse, and pelvic floor disorder, respectively. Of women with stress urinary incontinence symptoms, 88% knew the term urinary incontinence compared with 78% without stress urinary incontinence (P = 0.07). Of 41 women, 31 (76%) with the symptom of vaginal bulge knew the term pelvic organ prolapse compared with 49% without (P = 0.001). Only higher education and symptom of vaginal bulge were associated with complete knowledge of the 3 terms; 30% of women who completed college or higher reported complete knowledge compared with 18% who did not (P = 0.013). CONCLUSIONS: Public health campaigns using terms pelvic organ prolapse or pelvic floor disorders are unlikely to reach most women. Further education and research are needed to improve women's health literacy in urogynecology.