Bladder neck mobility and functional evaluation of the pelvic floor in primiparae according to the type of delivery.
ABSTRACT In this study, 91 primiparous women were selected, with a period of post-delivery variable from 45 to 60 days. These patients were divided according to the type of delivery into three groups: I--consisting of 32 patients who had vaginal delivery; II--comprised 29 patients who were subjected to forceps; III--formed by 30 women who were subjected to cesarean section. Patients with a previous pregnancy were not included, so that the possible previous alterations of the pelvic floor did not interfere with the present evaluation. Patients with a pre-term pregnancy, fetus below 2,500 g or above 4,000 g, anomalous presentations, twin pregnancy, diabetes mellitus, systhemic arterial hypertension, hypertensive disease specific of pregnancy, endocrinopathies and neuropathies were also excluded. After 45 to 60 days from delivery the patients were subjected to anamnesis, gynecological examination, functional evaluation of the pelvic floor (FEAF), Q-Tip test and ultrasound of the bladder neck. As for the functional evaluation of the pelvic floor, it was observed that the patients with cesarean section presented better indexes compared to those who were subjected to forceps. The Q-Tip test showed that in both the patients from group I and group II bladder neck mobility was greater than in those from group III. Concerning bladder neck topography in relation to public symphysis and its mobility, which were evaluated by ultrasound, it was observed that at rest all the groups had the neck in a supra-pubic position, with no differences among them. Yet, during the required strain, the bladder neck stayed in the infra-pubic position with major frequency in group I. Bladder neck mobility was greater in the vaginal delivery group in relation to the other groups. It was also noticed that the group undergoing cesarean section showed less mobility. The obtained results lead us to conclude that despite the fact that vaginal delivery may cause displacement of the urethro-vesical junction during strain, and consequently greater bladder neck mobility, it is the attending physician's role to minimize the damage to the pelvic floor, thus avoiding the emergence of a predisposing factor to future stress urinary incontinence.
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ABSTRACT: Myofascial Release (MFR) and Fascial Unwinding (FU) are widely used manual fascial techniques (MFTs), generally incorporated in treatment protocols to release fascial restrictions and restore tissue mobility. However, the effects of MFT on pain perception, and the mobility of fascial layers, have not previously been investigated using dynamic ultrasound (US) in patients with neck pain (NP) and low back pain (LBP). a) To show that US screening can be a useful tool to assess dysfunctional alteration of organ mobility in relation to their fascial layers, in people with non-specific NP or LBP, in the absence of any organ disease; b) To assess, by dynamic US screening, the change of sliding movements between superficial and deep fascia layers in the neck, in people with non-specific NP, before and after application of MFTs c) To assess, by dynamic US screening, the variation of right reno-diaphragmatic (RD) distance and of neck bladder (NB) mobility, in patients with non-specific LBP, before and after application of MFTs d) To evaluate 'if' and 'at what degree' pain perception may vary in patients with NP or LBP, after MFTs are applied, over the short term. An Experimental group of 60 subjects, 30 with non-specific NP and 30 with non-specific LBP, were assessed in the area of complaint, by Dynamic Ultrasound Topographic Anatomy Evaluation (D.US.T.A.-E.), before and after MFTs were applied in situ, in the corresponding painful region, for not more than 12 min. The results were compared with those from the respective Sham-Control group of 30 subjects. For the NP sub-groups, the pre- to post- US recorded videos of each subject were compared and assessed randomly and independently by two blinded experts in echographic screening. They were asked to rate the change observed in the cervical fascia sliding motions as 'none', 'discrete' or 'radical'. For the LBP sub-groups, a pre- to post- variation of the right RD distances and NB mobility were calculated on US imaging and compared. For all four sub-groups, a Short-Form McGill Pain Assessment Questionnaire (SF-MPQ) was administered on the day of recruitment as well as on the third day following treatment. The Chi square test has shown a significant correlation (0.915) with a p-Value < 0.0001 between the two examiners' results on US videos in NP sub-groups. The ANOVA test at repeated measures has shown a significant difference (p-Value < 0.0001) within Experimental and Control groups for the a) pre- to post- RD distances in LBP sub-groups, b) pre- to post- NB distances in LBP sub-groups; as well as between groups as for c) pre- to post- SF-MPQ results in NP and LBP sub-groups. Dynamic US evaluation can be a valid and non-invasive instrument to assess and monitor effective sliding motion of fascial layers in vivo. MFTs are effective manual techniques to release area of impaired sliding fascial mobility, and to improve pain perception over a short term duration in people with non-specific NP or LBP.Journal of bodywork and movement therapies 10/2011; 15(4):405-16. DOI:10.1016/j.jbmt.2010.11.003
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ABSTRACT: Aim: To investigate the relationship between postoperative MRI findings and the severity score of incontinence in patients treated with pubovaginal sling surgery. Materials and methods: Fifty-two female patients treated with pubovaginal slings were included in the study. These patients' severity scores of incontinence were evaluated in the postoperative 6 th month. All the patients were examined using MRI on the same day. A T2-weighted sagittal image of the midline structures, including the symphysis, urethra, and coccyx, was obtained at rest and at maximal strain. The mobility of the bladder floor and change in the posterior urethrovesical angle were calculated for each patient. Relationships between the severity score of incontinence and mobility of the bladder floor and change in the posterior urethrovesical angle were analyzed using Spearman's rank correlation coefficients by means of SPSS. Results: A positive correlation was found between the severity score of incontinence and the mobility of the bladder neck and also between the score and the degree of posterior urethrovesical angle (r = 0.797, P = 0.000; r = 0.62, P = 0.000, respectively). There was also a positive correlation between the severity score of incontinence and the increase in posterior urethrovesical angle during Valsalva's maneuver (r = 0.47, P = 0.02). Conclusion: MRI is a non-invasive diagnostic method for the evaluation of bladder floor position, mobility of the bladder neck, and posterior urethrovesical angle in patients with stress urinary incontinence. It can play a major role in the postoperative follow up of stress urinary incontinence. MRI can also be used for the assessment of success in pubovaginal sling surgery. Pubovajinal sling operasyonu sonrası inkontinans şiddet indeksi ile MRG bulgularının karşılaştırılması Amaç: Bu çalışmanın amacı pubovajinal sling operasyonu ile tedavi edilen hastalarda postoperatif MRG bulguları ile inkontinans şiddet indeksi arasındaki ilişkiyi araştırmaktır. Yöntem ve gereç: Pubovajinal sling operasyonu geçirmiş 52 kadın hasta çalışmaya dahil edildi. Postoperatif altıncı ayda hastaların inkontinans şiddet indeksleri değerlendirildi. Aynı gün hastaların MRG incelemeleri de yapıldı. Hastalardan istirahatta ve maksimum ıkınma sırasında simfisis, üretra ve koksiksi de içerecek şekilde T2-A sagittal görüntüler elde edildi. Her hasta için mesane tabanının mobilitesi ve posterior üretrovezikal açı değişiklikleri hesaplandı. İnkontinans şiddet indeksi ile mesane tabanı mobilitesi ve posterior üretrovezikal açı değişiklikleri arasındaki ilişki SPSS programı ile Sperman's Rho korelasyon testi kullanılarak analiz edildi.
Article: [Pelvic floor and pregnancy].[Show abstract] [Hide abstract]
ABSTRACT: Congenital factor, obesity, aging, pregnancy and childbirth are the main risk factors for female pelvic floor disorders (urinary incontinence, anal incontinence, pelvic organ prolapse, dyspareunia). Vaginal delivery may cause injury to the pudendal nerve, the anal sphincter, or the anal sphincter. However the link between these injuries and pelvic floor symptoms is not always determined and we still ignore what might be the ways of prevention. Of the many obstetrical methods proposed to prevent postpartum symptoms, episiotomy, delivery in vertical position, delayed pushing, perineal massage, warm pack, pelvic floor rehabilitation, results are disappointing or limited. Caesarean section is followed by less postnatal urinary incontinence than vaginal childbirth. However this difference tends to disappear with time and following childbirth. Limit the number of instrumental extractions and prefer the vacuum to forceps could reduce pelvic floor disorders after childbirth. Ultrasound examination of the anal sphincter after a second-degree perineal tear is useful to detect and repair infra-clinic anal sphincter lesions. Scientific data is insufficient to justify an elective cesarean section in order to avoid pelvic floor symptoms in a woman without previous disorders.Gynécologie Obstétrique & Fertilité 05/2010; 38(5):332-46. · 0.58 Impact Factor