Scandinavian Journal of Medicine & Science in Sports, Sep 30, 2019
Urinary incontinence (UI) is defined as any complaint of involuntary leakage of urine. 1 Stress u... more Urinary incontinence (UI) is defined as any complaint of involuntary leakage of urine. 1 Stress urinary incontinence (SUI) is the most prevalent form of UI in the female population and is defined as complaint of involuntary loss of urine on effort or physical exertion (eg, sporting activities), or on sneezing or coughing" 1 Systematic reviews of prevalence of UI in women find the prevalences between 24% and 45% to be most commonly reported, and SUI usually accounts for more than two thirds of undergroups of UI. 2 It has been suggested that the term "activity-related incontinence" might be used in some languages in order to avoid confusion with psychological stress. 1 Since the first report on UI in exercising young women in 1989, 3 there has been an increasing interest in the topic and multiple studies have been published from
Ultrasound in Obstetrics & Gynecology, Mar 1, 2013
I am grateful for this financial support. I want to express my sincere thanks to all participatin... more I am grateful for this financial support. I want to express my sincere thanks to all participating women and their children. Thank you for your interest in and enthusiasm for this study, for contributing your precious time to this project as first-time mothers and for showing up in spite of wind, rain and snow. I very much appreciate this. Writing this thesis has been a period of enormous learning for me, not only in the scientific arena, but also on a personal level. I would like to reflect on the people who have supported and helped me so much throughout this period. First and foremost, I want to thank my principal supervisor Professor Marie Ellström Engh, MD, PhD, senior author of all papers, who guided me with patience and care. You gave me the opportunity to come to Norway and become a part of this wonderful project and team. I greatly appreciate your outstanding support, your extensive professional knowledge and your enthusiasm for both science and clinical work. You believed in me, gave me the freedom and confidence to develop and implement my own ideas and always supported me, not only academically, but also emotionally along the rough road to finishing this thesis. I will be forever grateful for this. I would like to thank my co-supervisor Professor Kari Bø, PT, PhD, exercises scientist at the Norwegian School of Sports Sciences, co-author of all papers. I feel honoured to have had the opportunity of working with one of the most internationally recognised researchers in the field of pelvic floor rehabilitation. I have the greatest respect for your accomplishments in this IV field. Thank you for your scientific guidance and your effective and professional feedback on the manuscripts. A special thanks to Jette Staer-Jensen, MD, PhD, co-author of all papers and Gunvor Hilde, PT, PhD, co-author of all papers. Without you this thesis would never have been possible. You had already prepared the main study when I started. Getting to know you was one of the best things about this PhD project. Jette, thank you for all the hours spent developing the offline analysis protocol and analysing the ultrasound volumes, preparing abstracts and presentations, the time spent at conferences, for enriching discussions and continuous hard work. Thank you for your prudence and your sharp critical eye, your wonderful sense of humour-with you I shed tears of laughter-your endless warm support and for sharing the ups and downs of day-today work and of life in general. Gunvor, from the first day we met you opened your kind heart to me. You took care of me and made me feel welcome in this project and in Norway. Thank you for all the hours spent gathering clinical data and assessing ultrasound data, for your precise work, fruitful discussions, your immense methodological knowledge, valuable feedback on manuscripts, your kindness and friendship. My deep thanks go to Tone Breines Simonsen, midwife and project coordinator, for your tireless efforts. You did a splendid job in recruiting participants and managing clinical appointments and electronic questionnaires throughout the entire study period. Without you, there would have been a much higher volume of missing data. You have been outstanding. I would like to express my sincere thanks to the additional members of this project group: Kristin Gjestland, PT, project assistant, Cathrine Reimers, MD, fellow PhD student, and Merete Kolberg, PT, fellow PhD student. I consider myself fortunate to have been part of this excellent team. Thank you for bringing new ideas to this project, fruitful discussions, feedback on the manuscripts, and laughter. Kristin, thank you for your hard and motivated work, for the time we spent together gathering data, for teaching me logistic regression analysis and the hours spent analysing the data during our maternity leave. Many thanks to Ingeborg Hoff Braekken, PT, PhD and co-author of Paper I for teaching me three-and four-dimensional transperineal ultrasound, for valuable discussions and for your continued interest and support in the work. VII List of papers This thesis is based on the following papers: Siafarikas F, Staer-Jensen J, Braekken IH, Bo K, Engh ME. Learning process for performing and analyzing 3D/4D transperineal ultrasound imaging and interobserver reliability study.
Context: Female lower urinary tract symptoms (LUTS) are a common presentation in urological pract... more Context: Female lower urinary tract symptoms (LUTS) are a common presentation in urological practice. Thus far, only a limited number of female LUTS conditions have been included in the European Association of Urology (EAU) guidelines compendium. The new non-neurogenic female LUTS guidelines expand the remit to include these symptoms and conditions. Objective: To summarise the management of underactive bladder (UAB), bladder outlet obstruction (BOO), and nocturia in females. Evidence acquisition: The literature search was updated in September 2021 and evidence synthesis was conducted using modified GRADE approach as outlined for all EAU guidelines. A new systematic review on BOO was carried out by the panel for purposes of this guideline.
Introduction and hypothesis Vaginal delivery may lead to tearing of the levator ani (LA) muscle f... more Introduction and hypothesis Vaginal delivery may lead to tearing of the levator ani (LA) muscle from its bony insertions (complete LA avulsion) and increased levator hiatus (LH) area, both risk factors for pelvic floor dysfunctions. Early active rehabilitation is standard treatment after musculo-skeletal injury. We hypothesized that pelvic floor muscle training (PFMT) early postpartum would reduce the presence of LA avulsions and reduce LH area. Methods We carried out a planned secondary analysis from a randomized controlled study. Primiparous women (n=175) giving birth vaginally were included 6 weeks postpartum, stratified on complete LA avulsion, and thereafter randomized to PFMT or control. The training participants (n=87) attended a supervised PFMT class once a week and performed home-based PFMT daily for 16 weeks. The control participants (n=88) received no intervention. Presence of complete LA avulsion, LH area at rest, maximal contraction, and maximal Valsalva maneuver were assessed by transperineal ultrasound. Betweengroup comparisons were analyzed by analysis of covariance for continuous data, and relative risk (RR) for categorical data. Results Six months postpartum, the number of women who had complete LA avulsion was reduced from 27 to 14 within the PFMT group (44% reduction) and from 28 to 17 within the control group (39% reduction). The between-group difference was not significant, RR 0.85 (95% CI 0.53 to 1.37). Further, no significant between-group differences were found for LH area at rest, during contraction, or Valsalva. Conclusions Supervised PFMT class combined with home exercise early postpartum did not reduce the presence of complete LA avulsion or LH area more than natural remission.
Introduction and aims Pelvic floor dysfunction (PFD) is a collection of signs, symptoms and condi... more 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.
Introduction and aims Pelvic floor dysfunction (PFD) is a collection of signs, symptoms and condi... more 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 athlet...
Objective There is a lack of consensus on which abdominal or pelvic floor muscle (PFM) exercises ... more Objective There is a lack of consensus on which abdominal or pelvic floor muscle (PFM) exercises to recommend for the treatment of diastasis recti abdominis (DRA). The objective of this study was to investigate the immediate effect of abdominal and PFM exercises on interrecti distance (IRD) in women with DRA who are parous. Methods In this cross-sectional study, 38 women who were parous, with a mean age of 36.2 years (SD = 5.2), diagnosed with DRA participated. IRD was assessed with 2-dimensional real-time ultrasonography during rest and during 8 randomly ordered different exercises. A paired t test was used to compare the IRD at rest with the IRD recorded during each exercise as well as the differences between exercises. Means with 95% CI are reported. Results Head lift and twisted curl-up exercises significantly decreased the IRD both above and below the umbilicus. Above the umbilicus, the mean IRD difference from rest during head lift was 10 mm (95% CI = 7 to 13.2), whereas durin...
Are there differences in the effectiveness of pelvic floor muscle training on pelvic floor muscle... more Are there differences in the effectiveness of pelvic floor muscle training on pelvic floor muscle strength and urinary incontinence symptoms in postmenopausal women who are and are not using hormone therapy? Design: Randomised, controlled trial with concealed allocation, blinded assessors, and intention-to-treat analysis. Participants: Ninety-nine postmenopausal women, 38 of whom were using daily systemic oestrogen/progestogen therapy. Intervention: The experimental group (n = 51) received an intensive supervised pelvic floor muscle training protocol, and the control group (n = 48) received no intervention. The randomisation was stratified by hormone therapy use. Outcome measures: Change in pelvic floor muscle strength assessed with manometry at 12 weeks. Prevalence and severity of urinary incontinence symptoms were assessed using questionnaires. Results: Eighty-eight women provided data that could be included in the analysis. Pelvic floor muscle training increased pelvic floor muscle strength by 8.0 cmH 2 O (95% CI 3.4 to 12.6) in women not using hormone therapy and by-0.9 cmH 2 0 (95% CI-6.5 to 4.8) in women using hormone therapy (interaction p = 0.018). A sensitivity analysis showed that the greater training effect in women who were not using hormone therapy was still apparent if the analysis was conducted on percentage change in strength rather than absolute change in strength. There was also a significantly greater effect of training in women not using hormone therapy on prevalence of urinary incontinence symptoms (ratio of odds ratios = 7.4; interaction p = 0.028). The difference in effects on severity of urinary incontinence symptoms was not statistically significant (interaction p = 0.37). Conclusion: Pelvic floor muscle training increases pelvic floor muscle strength more in women who are not using hormone therapy than in women using hormone therapy. Trial registration: ClinicalTrials.gov NCT02549729.
Scandinavian Journal of Medicine & Science in Sports, 2019
Urinary incontinence (UI) is common among exercising women, but no studies have been found in rhy... more Urinary incontinence (UI) is common among exercising women, but no studies have been found in rhythmic gymnasts. The aims of the present study were to investigate the prevalence and risk factors for UI in rhythmic gymnasts and the impact of UI on performance. This was a cross‐sectional study including all rhythmic gymnasts competing at the highest national and international level in Norway. One hundred and thirty‐three gymnasts from 22 sports clubs were invited to participate. Background data and possible risk factors were collected via electronic questionnaires. UI was assessed by Urinary Incontinence short form (ICIQ‐UI SF). The "Triad‐specific self‐report questionnaire" was applied to assess the female athlete triad. Joint mobility was assessed by Beighton score. Logistic regression analysis was used to assess possible risk factors. One hundred and seven nulliparous rhythmic gymnasts (80.5% response rate) from 21 sports clubs, with mean age of 14.5 (SD 1.6) years, parti...
Background Diastasis recti abdominis affects a significant number of women during the prenatal an... more Background Diastasis recti abdominis affects a significant number of women during the prenatal and postnatal period. Objective The objective was to evaluate the effect of a postpartum training program on the prevalence of diastasis recti abdominis. Design The design was a secondary analysis of an assessor-masked randomized controlled trial. Methods One hundred seventy-five primiparous women (mean age = 29.8 ± 4.1 years) were randomized to an exercise or control group. The interrectus distance was palpated using finger widths, with a cutoff point for diastasis as ≥2 finger widths. Measures were taken 4.5 cm above, at, and 4.5 cm below the umbilicus. The 4-month intervention started 6 weeks postpartum and consisted of a weekly, supervised exercise class focusing on strength training of the pelvic floor muscles. In addition, the women were asked to perform daily pelvic floor muscle training at home. The control group received no intervention. Analyses were based on intention to treat. ...
Does an educational program with instructions for performing 'the Knack' improve voluntar... more Does an educational program with instructions for performing 'the Knack' improve voluntary contraction of the pelvic floor muscles, reduce reports of urinary incontinence, improve sexual function, and promote women's knowledge of the pelvic floor muscles? Randomised, controlled trial with concealed allocation, intention-to-treat analysis and blinded assessors. Ninety-nine women from the local community. The experimental group (n=50) received one lecture per week for 4 weeks, and instructions for performing 'the Knack'. The control group (n=49) received no intervention. The primary outcome was maximum voluntary contraction of the pelvic floor muscles measured using manometry. Secondary outcomes were: ability to contract the pelvic floor muscles measured using vaginal palpation; severity of urinary incontinence measured by the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) scored from 0 to 21; self-reported sexual function; and knowle...
Van der Walt 2008 An investigation of pelvic floor muscle strength in nulliparous women of differ... more Van der Walt 2008 An investigation of pelvic floor muscle strength in nulliparous women of different race groups. South African Society of Obstetrician and Gynaecologists, Cape Town, South Africa v ACKNOWLEDGEMENTS The author would like to thank and acknowledge the following people for their support and assistance throughout the duration of the project and writing of the thesis: Project supervisors: Mrs Susan Hanekom for her time, patience and understanding in difficult times during the project. Dr Gunter Rienhardt for his initiation of the project, continual support and encouragement. Professor Kari Bø for her valuable input during the planning of the study as well as her time and expert opinion. Professor Martin Kidd for his assistance with the statistical analysis. All the people at the University of Stellenbosch Obstetrics and Gynaecology department who helped with the execution of this project, and in particular Dr. Kobus van Rensburg. The women"s health lecturers at the participating universities, for their help in organizing the venues for testing and lectures. All the "brave" students who were willing to participate in the study and without whom, the study could not have been conducted. Professor Celie Eales for her encouragement and advice. Mrs Elbe Claasen and Mrs Karin Joubert, research assistants during the project. Dr Frank Muller from Biostim for importing the Perineometer and the balloon sensors and for sponsoring the books the participants received for their participation. My family, Corné my husband and children Simoné, Kari and Rozanne for supporting me throughout the process.
Introduction and hypothesis Pelvic floor disorders (PFD), including urinary incontinence, anal in... more Introduction and hypothesis Pelvic floor disorders (PFD), including urinary incontinence, anal incontinence, and pelvic organ prolapse, are common and have a negative effect on the quality of life of women. Treatment is associated with morbidity and may not be totally satisfactory. Prevention of PFDs, when possible, should be a primary goal. The purpose of this paper is to summarise the current literature and give an evidence-based review of the prevention of PFDs Methods A working subcommittee from the International Urogynecological Association (IUGA) Research and Development (R&D) Committee was formed. An initial document addressing the prevention of PFDs was drafted, based on a review of the English-language literature. After evaluation by the entire IUGA R&D Committee, revisions were made. The final document represents the IUGA R&D Committee Opinion on the prevention of PFDs. Results This R&D Committee Opinion reviews the literature on the prevention of PFDs and summarises the findings with evidence-based recommendations. Conclusions Pelvic floor disorders have a long latency, and may go through periods of remission, thus making causality difficult to confirm. Nevertheless, prevention strategies targeting modifiable risk factors should be incorporated into clinical practice before the absence of symptomatology.
BJOG : an international journal of obstetrics and gynaecology, Jan 25, 2015
To investigate associations between levator hiatus area and levator ani muscle function during pr... more To investigate associations between levator hiatus area and levator ani muscle function during pregnancy and major levator ani muscle defects postpartum. Observational prospective cohort study. University hospital, Norway. A cohort of 234 nulliparous women at 21 and 37 weeks of gestation, and at 6 weeks postpartum. Ultrasound measurements of the levator hiatus at rest, during pelvic floor muscle contraction, and during the Valsalva manoeuvre were taken at 21 and 37 weeks of gestation. Levator ani muscle function was estimated as the percentage changes in levator ani muscle length from rest to contraction, and the level of muscle stretch during the Valsalva manoeuvre. Major levator ani muscle defects were diagnosed at 6 weeks postpartum using tomographic ultrasound imaging. Associations between ultrasound measurements antepartum and major levator ani muscle defects postpartum. Women with major levator ani muscle defects postpartum had significantly smaller levator hiatus area at rest...
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 2013
To evaluate the learning process for acquiring three- and four-dimensional (3D/4D) transperineal ... more To evaluate the learning process for acquiring three- and four-dimensional (3D/4D) transperineal ultrasound volumes of the levator hiatus (LH) dimensions at rest, during pelvic floor muscle (PFM) contraction and on Valsalva maneuver, and for analyzing the ultrasound volumes, as well as to perform an interobserver reliability study between two independent ultrasound examiners. This was a prospective study including 22 women. We monitored the learning process of an inexperienced examiner (IE) performing 3D/4D transperineal ultrasonography and analyzing the volumes. The examination included acquiring volumes during three PFM contractions and three Valsalva maneuvers. LH dimensions were determined in the axial plane. The learning process was documented by estimating agreement between the IE and an experienced examiner (E) using the intraclass correlation coefficient. Agreement was calculated in blocks of 10 ultrasound examinations and analyzed volumes. After the learning process was com...
What evidence is there for alternative exercises to specific pelvic floor muscle training for tre... more What evidence is there for alternative exercises to specific pelvic floor muscle training for treatment of stress urinary incontinence in women? A systematic review was conducted with searches of PubMed and PEDro to January 2013. The quality of randomised trials was evaluated using the PEDro scale. Each type of exercise was classified as being in a Development Phase, Testing Phase, or Refinement and Dissemination Phase. Women with stress or mixed urinary incontinence with predominantly stress urinary incontinence. Exercise regimens other than pelvic floor muscle training. The primary outcome was urinary leakage. Seven randomised controlled trials were found: three on abdominal training, two on the Paula method, and two on Pilates exercise. The methodological quality score ranged between 4 and 8 with a mean of 5.7. There was no convincing evidence for the effect of these exercise regimens so they remain in the Testing Phase. Because no randomised trials were found for posture correct...
Scandinavian Journal of Medicine & Science in Sports, Sep 30, 2019
Urinary incontinence (UI) is defined as any complaint of involuntary leakage of urine. 1 Stress u... more Urinary incontinence (UI) is defined as any complaint of involuntary leakage of urine. 1 Stress urinary incontinence (SUI) is the most prevalent form of UI in the female population and is defined as complaint of involuntary loss of urine on effort or physical exertion (eg, sporting activities), or on sneezing or coughing" 1 Systematic reviews of prevalence of UI in women find the prevalences between 24% and 45% to be most commonly reported, and SUI usually accounts for more than two thirds of undergroups of UI. 2 It has been suggested that the term "activity-related incontinence" might be used in some languages in order to avoid confusion with psychological stress. 1 Since the first report on UI in exercising young women in 1989, 3 there has been an increasing interest in the topic and multiple studies have been published from
Ultrasound in Obstetrics & Gynecology, Mar 1, 2013
I am grateful for this financial support. I want to express my sincere thanks to all participatin... more I am grateful for this financial support. I want to express my sincere thanks to all participating women and their children. Thank you for your interest in and enthusiasm for this study, for contributing your precious time to this project as first-time mothers and for showing up in spite of wind, rain and snow. I very much appreciate this. Writing this thesis has been a period of enormous learning for me, not only in the scientific arena, but also on a personal level. I would like to reflect on the people who have supported and helped me so much throughout this period. First and foremost, I want to thank my principal supervisor Professor Marie Ellström Engh, MD, PhD, senior author of all papers, who guided me with patience and care. You gave me the opportunity to come to Norway and become a part of this wonderful project and team. I greatly appreciate your outstanding support, your extensive professional knowledge and your enthusiasm for both science and clinical work. You believed in me, gave me the freedom and confidence to develop and implement my own ideas and always supported me, not only academically, but also emotionally along the rough road to finishing this thesis. I will be forever grateful for this. I would like to thank my co-supervisor Professor Kari Bø, PT, PhD, exercises scientist at the Norwegian School of Sports Sciences, co-author of all papers. I feel honoured to have had the opportunity of working with one of the most internationally recognised researchers in the field of pelvic floor rehabilitation. I have the greatest respect for your accomplishments in this IV field. Thank you for your scientific guidance and your effective and professional feedback on the manuscripts. A special thanks to Jette Staer-Jensen, MD, PhD, co-author of all papers and Gunvor Hilde, PT, PhD, co-author of all papers. Without you this thesis would never have been possible. You had already prepared the main study when I started. Getting to know you was one of the best things about this PhD project. Jette, thank you for all the hours spent developing the offline analysis protocol and analysing the ultrasound volumes, preparing abstracts and presentations, the time spent at conferences, for enriching discussions and continuous hard work. Thank you for your prudence and your sharp critical eye, your wonderful sense of humour-with you I shed tears of laughter-your endless warm support and for sharing the ups and downs of day-today work and of life in general. Gunvor, from the first day we met you opened your kind heart to me. You took care of me and made me feel welcome in this project and in Norway. Thank you for all the hours spent gathering clinical data and assessing ultrasound data, for your precise work, fruitful discussions, your immense methodological knowledge, valuable feedback on manuscripts, your kindness and friendship. My deep thanks go to Tone Breines Simonsen, midwife and project coordinator, for your tireless efforts. You did a splendid job in recruiting participants and managing clinical appointments and electronic questionnaires throughout the entire study period. Without you, there would have been a much higher volume of missing data. You have been outstanding. I would like to express my sincere thanks to the additional members of this project group: Kristin Gjestland, PT, project assistant, Cathrine Reimers, MD, fellow PhD student, and Merete Kolberg, PT, fellow PhD student. I consider myself fortunate to have been part of this excellent team. Thank you for bringing new ideas to this project, fruitful discussions, feedback on the manuscripts, and laughter. Kristin, thank you for your hard and motivated work, for the time we spent together gathering data, for teaching me logistic regression analysis and the hours spent analysing the data during our maternity leave. Many thanks to Ingeborg Hoff Braekken, PT, PhD and co-author of Paper I for teaching me three-and four-dimensional transperineal ultrasound, for valuable discussions and for your continued interest and support in the work. VII List of papers This thesis is based on the following papers: Siafarikas F, Staer-Jensen J, Braekken IH, Bo K, Engh ME. Learning process for performing and analyzing 3D/4D transperineal ultrasound imaging and interobserver reliability study.
Context: Female lower urinary tract symptoms (LUTS) are a common presentation in urological pract... more Context: Female lower urinary tract symptoms (LUTS) are a common presentation in urological practice. Thus far, only a limited number of female LUTS conditions have been included in the European Association of Urology (EAU) guidelines compendium. The new non-neurogenic female LUTS guidelines expand the remit to include these symptoms and conditions. Objective: To summarise the management of underactive bladder (UAB), bladder outlet obstruction (BOO), and nocturia in females. Evidence acquisition: The literature search was updated in September 2021 and evidence synthesis was conducted using modified GRADE approach as outlined for all EAU guidelines. A new systematic review on BOO was carried out by the panel for purposes of this guideline.
Introduction and hypothesis Vaginal delivery may lead to tearing of the levator ani (LA) muscle f... more Introduction and hypothesis Vaginal delivery may lead to tearing of the levator ani (LA) muscle from its bony insertions (complete LA avulsion) and increased levator hiatus (LH) area, both risk factors for pelvic floor dysfunctions. Early active rehabilitation is standard treatment after musculo-skeletal injury. We hypothesized that pelvic floor muscle training (PFMT) early postpartum would reduce the presence of LA avulsions and reduce LH area. Methods We carried out a planned secondary analysis from a randomized controlled study. Primiparous women (n=175) giving birth vaginally were included 6 weeks postpartum, stratified on complete LA avulsion, and thereafter randomized to PFMT or control. The training participants (n=87) attended a supervised PFMT class once a week and performed home-based PFMT daily for 16 weeks. The control participants (n=88) received no intervention. Presence of complete LA avulsion, LH area at rest, maximal contraction, and maximal Valsalva maneuver were assessed by transperineal ultrasound. Betweengroup comparisons were analyzed by analysis of covariance for continuous data, and relative risk (RR) for categorical data. Results Six months postpartum, the number of women who had complete LA avulsion was reduced from 27 to 14 within the PFMT group (44% reduction) and from 28 to 17 within the control group (39% reduction). The between-group difference was not significant, RR 0.85 (95% CI 0.53 to 1.37). Further, no significant between-group differences were found for LH area at rest, during contraction, or Valsalva. Conclusions Supervised PFMT class combined with home exercise early postpartum did not reduce the presence of complete LA avulsion or LH area more than natural remission.
Introduction and aims Pelvic floor dysfunction (PFD) is a collection of signs, symptoms and condi... more 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.
Introduction and aims Pelvic floor dysfunction (PFD) is a collection of signs, symptoms and condi... more 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 athlet...
Objective There is a lack of consensus on which abdominal or pelvic floor muscle (PFM) exercises ... more Objective There is a lack of consensus on which abdominal or pelvic floor muscle (PFM) exercises to recommend for the treatment of diastasis recti abdominis (DRA). The objective of this study was to investigate the immediate effect of abdominal and PFM exercises on interrecti distance (IRD) in women with DRA who are parous. Methods In this cross-sectional study, 38 women who were parous, with a mean age of 36.2 years (SD = 5.2), diagnosed with DRA participated. IRD was assessed with 2-dimensional real-time ultrasonography during rest and during 8 randomly ordered different exercises. A paired t test was used to compare the IRD at rest with the IRD recorded during each exercise as well as the differences between exercises. Means with 95% CI are reported. Results Head lift and twisted curl-up exercises significantly decreased the IRD both above and below the umbilicus. Above the umbilicus, the mean IRD difference from rest during head lift was 10 mm (95% CI = 7 to 13.2), whereas durin...
Are there differences in the effectiveness of pelvic floor muscle training on pelvic floor muscle... more Are there differences in the effectiveness of pelvic floor muscle training on pelvic floor muscle strength and urinary incontinence symptoms in postmenopausal women who are and are not using hormone therapy? Design: Randomised, controlled trial with concealed allocation, blinded assessors, and intention-to-treat analysis. Participants: Ninety-nine postmenopausal women, 38 of whom were using daily systemic oestrogen/progestogen therapy. Intervention: The experimental group (n = 51) received an intensive supervised pelvic floor muscle training protocol, and the control group (n = 48) received no intervention. The randomisation was stratified by hormone therapy use. Outcome measures: Change in pelvic floor muscle strength assessed with manometry at 12 weeks. Prevalence and severity of urinary incontinence symptoms were assessed using questionnaires. Results: Eighty-eight women provided data that could be included in the analysis. Pelvic floor muscle training increased pelvic floor muscle strength by 8.0 cmH 2 O (95% CI 3.4 to 12.6) in women not using hormone therapy and by-0.9 cmH 2 0 (95% CI-6.5 to 4.8) in women using hormone therapy (interaction p = 0.018). A sensitivity analysis showed that the greater training effect in women who were not using hormone therapy was still apparent if the analysis was conducted on percentage change in strength rather than absolute change in strength. There was also a significantly greater effect of training in women not using hormone therapy on prevalence of urinary incontinence symptoms (ratio of odds ratios = 7.4; interaction p = 0.028). The difference in effects on severity of urinary incontinence symptoms was not statistically significant (interaction p = 0.37). Conclusion: Pelvic floor muscle training increases pelvic floor muscle strength more in women who are not using hormone therapy than in women using hormone therapy. Trial registration: ClinicalTrials.gov NCT02549729.
Scandinavian Journal of Medicine & Science in Sports, 2019
Urinary incontinence (UI) is common among exercising women, but no studies have been found in rhy... more Urinary incontinence (UI) is common among exercising women, but no studies have been found in rhythmic gymnasts. The aims of the present study were to investigate the prevalence and risk factors for UI in rhythmic gymnasts and the impact of UI on performance. This was a cross‐sectional study including all rhythmic gymnasts competing at the highest national and international level in Norway. One hundred and thirty‐three gymnasts from 22 sports clubs were invited to participate. Background data and possible risk factors were collected via electronic questionnaires. UI was assessed by Urinary Incontinence short form (ICIQ‐UI SF). The "Triad‐specific self‐report questionnaire" was applied to assess the female athlete triad. Joint mobility was assessed by Beighton score. Logistic regression analysis was used to assess possible risk factors. One hundred and seven nulliparous rhythmic gymnasts (80.5% response rate) from 21 sports clubs, with mean age of 14.5 (SD 1.6) years, parti...
Background Diastasis recti abdominis affects a significant number of women during the prenatal an... more Background Diastasis recti abdominis affects a significant number of women during the prenatal and postnatal period. Objective The objective was to evaluate the effect of a postpartum training program on the prevalence of diastasis recti abdominis. Design The design was a secondary analysis of an assessor-masked randomized controlled trial. Methods One hundred seventy-five primiparous women (mean age = 29.8 ± 4.1 years) were randomized to an exercise or control group. The interrectus distance was palpated using finger widths, with a cutoff point for diastasis as ≥2 finger widths. Measures were taken 4.5 cm above, at, and 4.5 cm below the umbilicus. The 4-month intervention started 6 weeks postpartum and consisted of a weekly, supervised exercise class focusing on strength training of the pelvic floor muscles. In addition, the women were asked to perform daily pelvic floor muscle training at home. The control group received no intervention. Analyses were based on intention to treat. ...
Does an educational program with instructions for performing 'the Knack' improve voluntar... more Does an educational program with instructions for performing 'the Knack' improve voluntary contraction of the pelvic floor muscles, reduce reports of urinary incontinence, improve sexual function, and promote women's knowledge of the pelvic floor muscles? Randomised, controlled trial with concealed allocation, intention-to-treat analysis and blinded assessors. Ninety-nine women from the local community. The experimental group (n=50) received one lecture per week for 4 weeks, and instructions for performing 'the Knack'. The control group (n=49) received no intervention. The primary outcome was maximum voluntary contraction of the pelvic floor muscles measured using manometry. Secondary outcomes were: ability to contract the pelvic floor muscles measured using vaginal palpation; severity of urinary incontinence measured by the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) scored from 0 to 21; self-reported sexual function; and knowle...
Van der Walt 2008 An investigation of pelvic floor muscle strength in nulliparous women of differ... more Van der Walt 2008 An investigation of pelvic floor muscle strength in nulliparous women of different race groups. South African Society of Obstetrician and Gynaecologists, Cape Town, South Africa v ACKNOWLEDGEMENTS The author would like to thank and acknowledge the following people for their support and assistance throughout the duration of the project and writing of the thesis: Project supervisors: Mrs Susan Hanekom for her time, patience and understanding in difficult times during the project. Dr Gunter Rienhardt for his initiation of the project, continual support and encouragement. Professor Kari Bø for her valuable input during the planning of the study as well as her time and expert opinion. Professor Martin Kidd for his assistance with the statistical analysis. All the people at the University of Stellenbosch Obstetrics and Gynaecology department who helped with the execution of this project, and in particular Dr. Kobus van Rensburg. The women"s health lecturers at the participating universities, for their help in organizing the venues for testing and lectures. All the "brave" students who were willing to participate in the study and without whom, the study could not have been conducted. Professor Celie Eales for her encouragement and advice. Mrs Elbe Claasen and Mrs Karin Joubert, research assistants during the project. Dr Frank Muller from Biostim for importing the Perineometer and the balloon sensors and for sponsoring the books the participants received for their participation. My family, Corné my husband and children Simoné, Kari and Rozanne for supporting me throughout the process.
Introduction and hypothesis Pelvic floor disorders (PFD), including urinary incontinence, anal in... more Introduction and hypothesis Pelvic floor disorders (PFD), including urinary incontinence, anal incontinence, and pelvic organ prolapse, are common and have a negative effect on the quality of life of women. Treatment is associated with morbidity and may not be totally satisfactory. Prevention of PFDs, when possible, should be a primary goal. The purpose of this paper is to summarise the current literature and give an evidence-based review of the prevention of PFDs Methods A working subcommittee from the International Urogynecological Association (IUGA) Research and Development (R&D) Committee was formed. An initial document addressing the prevention of PFDs was drafted, based on a review of the English-language literature. After evaluation by the entire IUGA R&D Committee, revisions were made. The final document represents the IUGA R&D Committee Opinion on the prevention of PFDs. Results This R&D Committee Opinion reviews the literature on the prevention of PFDs and summarises the findings with evidence-based recommendations. Conclusions Pelvic floor disorders have a long latency, and may go through periods of remission, thus making causality difficult to confirm. Nevertheless, prevention strategies targeting modifiable risk factors should be incorporated into clinical practice before the absence of symptomatology.
BJOG : an international journal of obstetrics and gynaecology, Jan 25, 2015
To investigate associations between levator hiatus area and levator ani muscle function during pr... more To investigate associations between levator hiatus area and levator ani muscle function during pregnancy and major levator ani muscle defects postpartum. Observational prospective cohort study. University hospital, Norway. A cohort of 234 nulliparous women at 21 and 37 weeks of gestation, and at 6 weeks postpartum. Ultrasound measurements of the levator hiatus at rest, during pelvic floor muscle contraction, and during the Valsalva manoeuvre were taken at 21 and 37 weeks of gestation. Levator ani muscle function was estimated as the percentage changes in levator ani muscle length from rest to contraction, and the level of muscle stretch during the Valsalva manoeuvre. Major levator ani muscle defects were diagnosed at 6 weeks postpartum using tomographic ultrasound imaging. Associations between ultrasound measurements antepartum and major levator ani muscle defects postpartum. Women with major levator ani muscle defects postpartum had significantly smaller levator hiatus area at rest...
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 2013
To evaluate the learning process for acquiring three- and four-dimensional (3D/4D) transperineal ... more To evaluate the learning process for acquiring three- and four-dimensional (3D/4D) transperineal ultrasound volumes of the levator hiatus (LH) dimensions at rest, during pelvic floor muscle (PFM) contraction and on Valsalva maneuver, and for analyzing the ultrasound volumes, as well as to perform an interobserver reliability study between two independent ultrasound examiners. This was a prospective study including 22 women. We monitored the learning process of an inexperienced examiner (IE) performing 3D/4D transperineal ultrasonography and analyzing the volumes. The examination included acquiring volumes during three PFM contractions and three Valsalva maneuvers. LH dimensions were determined in the axial plane. The learning process was documented by estimating agreement between the IE and an experienced examiner (E) using the intraclass correlation coefficient. Agreement was calculated in blocks of 10 ultrasound examinations and analyzed volumes. After the learning process was com...
What evidence is there for alternative exercises to specific pelvic floor muscle training for tre... more What evidence is there for alternative exercises to specific pelvic floor muscle training for treatment of stress urinary incontinence in women? A systematic review was conducted with searches of PubMed and PEDro to January 2013. The quality of randomised trials was evaluated using the PEDro scale. Each type of exercise was classified as being in a Development Phase, Testing Phase, or Refinement and Dissemination Phase. Women with stress or mixed urinary incontinence with predominantly stress urinary incontinence. Exercise regimens other than pelvic floor muscle training. The primary outcome was urinary leakage. Seven randomised controlled trials were found: three on abdominal training, two on the Paula method, and two on Pilates exercise. The methodological quality score ranged between 4 and 8 with a mean of 5.7. There was no convincing evidence for the effect of these exercise regimens so they remain in the Testing Phase. Because no randomised trials were found for posture correct...
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