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At least 19 recordsLinked to original sources
PubMed2000

[The anatomy and function of the pelvic floor].

PELVIC FLOOR: Anatomy of the pelvic floor seemed to be clearly. In opposite the physiology of the Levator ani and the endopelvic fascia is not yet fully understood. Especially the anatomic form of the levator plate does not conform with physiologic concepts. PELVIC STRUCTURES: Pelvic structures can be divided in three groups: the hollow organs, the endopelvic fascia and the muscles. The M. levator ani is the muscle of the pelvic diaphragm. Its parts were given different names (Fig. 1, 4) depending on their function or localization. In anatomic studies the pelvic floor is described as basin-shaped. In contrast to the anatomic results based upon the evaluation of cadavers, dynamic MRI gave different concepts: at rest the levator ani probably has the shape of a dome and differ when contract. The urogenital diaphragm is mostly a fascia and contains only fair muscular components. Therefore, many authors do not accept the term "diaphragm" and the physiologic function is still a matter of discussion. The endopelvic fascia has to fix the organs in the pelvis and forms "streets" for vascular and nervous supply. CONCLUSION: Describing anatomic structures in the common planes (transversal, sagittal, frontal) will help to understand CT- and MRI-imaging.

Aged↗
PubMedDate not supplied

MR imaging of the pelvic floor.

Pelvic floor disorders are a common clinical problem. Clinical evaluation frequently underestimates the extent of the disease. Fluoroscopic colpocystodefecography (CCD) is an established tool for diagnosing disorders of the rectum and recto- anal junction. It is however less performant when it comes to evaluate the complex pelvic floor mechanism in all its aspects. MR defecography allows to evaluate all the compartments of the pelvis without being invasive. This article describes the clinical setting, the MR technique and provides guidelines for interpretation of a MR defecography study.

Constipation↗
PubMed2003

[Functional rehabilitation of the pelvic floor].

Pelvic floor revalidation is devoted to conserve perineal functions as statics, urinary continence and sexual harmony. The therapeutics includes preventive and curative actions, and is based upon muscular and neuromuscular properties of pelvic floor. The different steps are: information, local muscular work, behavioral education, biofeedback, functional electrostimulation, intraabdominal pressure control. The therapeutics is only continued if clinical improvement is demonstrated after 10 sessions.

Humans↗
PubMed2005

Relations between pregnancy-related low back pain, pelvic floor activity and pelvic floor dysfunction.

To assess the occurrence of pelvic floor dysfunction (PFD) in pregnancy- related low back and pelvic pain (PLBP) patients, a cross-sectional study was performed, comprising 77 subjects. Each subject underwent physical assessment, and filled in the Urogenital Distress Inventory completed with gynaecological questions. Differences in the presence of PFD between PLBP patients and healthy controls as well as differences in pelvic floor muscle activity were tested for significance. Interaction by age and vaginal delivery were tested. PFD occurred in 52% of all PLBP patients, significantly more than in the healthy control group. In PLBP patients a significantly increased activity of the pelvic floor muscles could be demonstrated with respect to healthy controls. The occurrence of PFD and PLBP was influenced by a confounding effect of age. Clinicians should be aware of the relation between PLBP and PFD and hence address both problems at the same time.

Adult↗
PubMed2004

Female pelvic floor anatomy: the pelvic floor, supporting structures, and pelvic organs.

The development of novel, less invasive therapies for stress urinary incontinence in women requires a thorough knowledge of the relationship between the pathophysiology of incontinence and anatomy. This article provides a review of the anatomy of the pelvic floor and lower urinary tract. Also discussed is the hammock hypothesis, which describes urethral support within the pelvis and provides an explanation of the continence mechanism.

Journal Article↗
PubMed1990

[Pain of the pelvic floor].

Pelvic floor pain may be caused by the levator syndrome, internal procidentia, coccygodynia, high occult abscess, tumors. In most cases the precise clinical investigation permits the diagnosis.

Anus Diseases↗
PubMed2002

Determining the displacement of the pelvic floor and pelvic organs during voluntary contractions using magnetic resonance imaging in younger and older women.

OBJECTIVES: To: (i) visualize the effect of sustained voluntary contractions on the anatomical configuration of the pelvic floor (PF) muscles using magnetic resonance imaging (MRI); (ii) examine the effect of ageing on the range of displacement of the PF contents secondary to contraction and simulating incontinence exercises; and (iii) introduce the concept of contractile change in volume (DeltaPF-V) using three-dimensional (3D) reconstruction from axial, sagittal and coronal MRI. SUBJECTS AND METHODS: Two groups of continent women volunteers, familiar with correct PF contraction, were evaluated. The mean (sd) age in group I was 34 (6) years and that of group II 55 (9) years; the mean parities were 0.7 and 2.2, respectively. MRI was conducted with the women supine and data were obtained in the axial, sagittal and coronal planes. In each plane, images were obtained with the PF relaxed and subsequently with the PF contracted over 10-20 s. Image processing was used to enhance the anatomical boundaries of the pelvic organs and to measure the displacement produced by the contraction. Displacements, observed between each image pair, were colour-coded to highlight the geometric differences between a relaxed and contracted PF and to facilitate measuring displacement. Data measured from each group were pooled and the range of motion expressed as the mean (sd), compared using Student's t-test. RESULTS: Digitally processed imaging allowed an accurate comparison between the relaxed and contracted PF, and highlighted the differences between them. From these views, the levator ani displaced the vagina asymmetrically in nine of the 11 older subjects, and in six of the 17 younger subjects. The values from the imaging in the sagittal and coronal plane for the two groups were: levator ani displacement, 7.4 (1.1) and 1.4 (0.2) cm (P < 0.002), superior bladder wall, 4.2 (0.5) and 1.0 (0.1) cm (P < 0.002). There were also significant differences in the range of displacement produced by voluntary PF contraction in the internal structures; external outlines did not reflect these changes. The maximum displacement of the gluteal surface in the coronal plane did not change significantly; in group I it was 3.9 (1.8) to 2.9 (0.7) cm. From the 3D re-construction, DeltaPF-V for the younger women was significantly larger, at 23.3 (3.9) mL (P < 0.01) than in the older women, at 9.1 (4.4) mL. CONCLUCION: The range of motion over which voluntary PF contractions displace the bladder and vagina is age-dependent, being higher in younger than in older subjects. It remains to be established whether range of movement is a limitation caused by neuronal factors, decrease in muscle strength/mass, or the substitution of spaces with fat (restricting free movement), or other factors.

Adult↗
PubMed1997

Use of a saline breast implant to cover the pelvic floor.

Pelvic exenteration is one of the most radical procedures in the repertoire of gynecologic oncology procedures. Postoperative complications include sepsis, hemorrhage, formation of adhesions resulting in bowel obstruction, and fistulas resulting from large denuded pelvic surfaces. To date there is no clear consensus as to the best way to cover the pelvis after the destructive phase of an exenteration. Herein, we present a different approach to pelvic coverage by placement of a 300 cc saline breast implant. Use of a saline-filled breast implant to fill the pelvis represents a possible approach to addressing the denuded pelvic space created during extensive gynecologic surgery.

Adult↗
PubMed1995

Pelvic-floor rehabilitation, Part 2: Pelvic-floor reeducation with interferential currents and exercise in the treatment of genuine stress incontinence in postpartum women--a cohort study.

BACKGROUND AND PURPOSE: This descriptive cohort study investigated a physical therapy program of pelvic-floor neuromuscular electrostimulation (NMES) combined with exercises, with the aim of developing a simple, inexpensive, and conservative treatment for postpartum genuine stress incontinence (GSI). SUBJECTS: Eight female subjects with urodynamically established GSI persisting more than 3 months after delivery participated in the study. The subjects ranged in age from 24 to 37 years (X = 32, SD = 4.2). METHODS: This was a descriptive multiple-subject cohort study. Each subject received a total of nine treatment sessions during 3 consecutive weeks, consisting of two 15-minute sessions of NMES followed by a 15-minute pelvic-floor muscle exercise program. Patients also practiced daily pelvic-floor exercises during the 3-week treatment period. The treatment intervention was measured using three separate variables. Maximum muscle contractions (pretraining, during training, and post-training) were measured indirectly as pressure, using perineometry. Urine loss pretraining and posttraining was measured by means of a Pad test. Self-reported frequency of incontinence was recorded daily throughout the period of the study, using a diary. Data were analyzed using a one-way repeated-measures analysis of variance (ANOVA), a Wilcoxon signed-ranks test, and a Friedman two-way ANOVA by ranks. RESULTS: The results indicated that maximum pressure generated by pelvic-floor contractions was greater and both the quantity of urine loss and the frequency of incontinence were lower following the implementation of the physical therapy program. Five subjects became continent, and three others improved. A follow-up survey 1 year later confirmed the consistency of these results. CONCLUSION AND DISCUSSION: The results suggest that the proposed physical therapy program may influence postpartum GSI. Further studies are needed to validate this simple, inexpensive, and conservative physical therapy protocol. [Dumoulin C, Seaborne DE, Quirion-DeGirardi C, Sullivan SJ. Pelvic-floor rehabilitation, part 2: pelvic-floor reeducation with interferential currents and exercise in the treatment of genuine stress incontinence in postpartum women--a cohort study.

Adult↗
PubMed2006

Responsiveness of the Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ) in women undergoing vaginal surgery and pessary treatment for pelvic organ prolapse.

OBJECTIVE: This study was undertaken to evaluate the responsiveness of the Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ) in women with pelvic organ prolapse undergoing surgical and nonsurgical management. STUDY DESIGN: The responsiveness of the prolapse, urinary and colorectal scales of the PFDI and PFIQ were assessed in 2 independent populations: (1) 42 women with stage II or greater prolapse enrolled in an ongoing multicenter randomized trial comparing 2 different pessaries (Pessary group) and (2) 64 women with stage III or greater prolapse who underwent vaginal reconstructive surgery (Surgery group). All subjects completed the PFDI and PFIQ at baseline and again either 3 months (Pessary group) or 6 months (Surgery group) after initiation of treatment. Responsiveness was assessed with standardized response mean (SRM), effect size (ES), and the paired t test. RESULTS: In the Pessary group, there was a significant improvement in the prolapse and urinary scales of the PFDI, with each demonstrating moderate responsiveness (prolapse: SRM 0.69, ES 0.68; urinary: SRM 0.57, ES: 0.50, P < .001 for each). The colorectal scale of the PFDI and each of the 3 scales of the PFIQ demonstrated no significant change in scores with pessary use. In the Surgery group, there was a significant improvement in the prolapse, urinary, and colorectal scales of both the PFDI and PFIQ (P < .01 for each). The prolapse and urinary scales of the PFDI demonstrated excellent responsiveness with SRM and ES 1.20 or greater for the prolapse scale and equal to1.05 for the urinary scales. The colorectal scale of the PFDI and the urinary and prolapse scales of the PFIQ demonstrated moderate responsiveness (SRM 0.61-0.70 and ES 0.56-0.60) after surgery. Subjects who had a recurrence of their prolapse develop after surgery (6%) had significantly less improvement in the prolapse scale of the PFDI than those who did not. After controlling for preoperative prolapse stage and baseline quality of life scores, subjects in the Surgery group had significantly greater improvement in each of the scales of the PFDI and the prolapse and urinary scales of the PFIQ than did the Pessary group (P < .05 for each). CONCLUSION: The PFDI and PFIQ are responsive to change in women undergoing surgical and nonsurgical treatment for pelvic organ prolapse. The PFDI is more responsive than the PFIQ.

Aged↗
PubMed2003

Pelvic floor muscle strength and response to pelvic floor muscle training for stress urinary incontinence.

AIMS: Several randomized controlled trials have demonstrated that pelvic floor muscle training is effective to treat stress urinary incontinence. The aim of the present study was to compare muscle strength increase and maximal strength in responders and non-responders to pelvic floor muscle training. MATERIALS AND METHODS: Fifty-two women with urodynamically proven stress incontinence who had participated in a six months randomized controlled trial on pelvic floor muscle training, mean age 45.4 years (range 24-64), participated in the study. The women were classified as responders and non-responders based on a combination of five effect variables covering urodynamic measurement, pad test with standardized bladder volume, and self-reports. Pelvic floor muscle strength was measured with a vaginal balloon connected to a fiber optic micro tip transducer (Camtech AS, Sandvika, Norway). RESULTS: There was a positive correlation between improvement in PFM maximal strength and improvement measured by leakage index (r = 0.34, P < 0.01), and reduction in urinary leakage measured by the pad test (r = 0.23, P = 0.05). The total sample of 52 women comprised 21 responders, 18 unclassifiable, and 13 non-responders. There was a statistically significant difference in maximal strength after the training period between responders and non-responders; 24.0 cm H2O (95% CI:18.1-29.9) versus 12.7 cm H2O (95% CI: 6.8-18.6) P < 0.001), and strength increase; 14.8 cm H2O (95% CI: 8.9-20.7) versus 5.0 cm H2O (95% CI: 2.6-12.6), respectively (P = 0.03). CONCLUSIONS: There was a positive relation between both pelvic floor muscle strength increase and maximal strength, and improvement of stress urinary incontinence.

Adult↗
PubMed1988

Pelvic floor physiology.

Pelvic floor physiology is poorly understood. The funnel shape of the pelvic floor and anal canal is uniquely developed to provide discriminatory continence of gas, liquid, and solid. Proximally, the pelvic floor consists of the pubococcygeus and iliococcygeus muscles. Distally, the anal canal is surrounded by the internal and external sphincter muscles. The anorectal ring is situated between the proximal pelvic floor and the distal anal canal. It is the site of the puborectalis muscle, which is anatomically, neurologically, and functionally merged with the deep portion of the external sphincter muscle. It is at this site that unique forces act to create both a flutter valve and the anorectal angle with the flap valve. Extrinsic pressures at this level reinforce both the flap valve and the flutter valve. Intrinsic pressures are generated by all of the surrounding muscles to produce a high-pressure zone. These factors are critical, but many other factors, such as rectal capacity, compliance, colonic transit, motility, and sensory mechanisms, also interact in a complex way to provide normal continence and defecation. Not surprisingly, no single test allows a complete assessment of the interactions of all these factors. Nevertheless, analysis of components thought to be important in pelvic floor physiology has contributed significantly to the understanding of normal as well as abnormal physiology. Although clinical evaluation continues to be the cornerstone of the diagnosis of pelvic floor disorders, anorectal physiological testing has contributed significantly to our understanding of the dynamics of the pelvic floor. With the refinement of existing techniques and the addition of new investigative tools, it is anticipated that knowledge of pelvic floor physiology will continue to grow.

Anal Canal↗
PubMed2003

Functional imaging of the pelvic floor.

INTRODUCTION/OBJECTIVE: Pelvic floor dysfunction and associated pelvic organ prolapse represent a major problem in our present-day society, mostly afflicting parous women. Magnetic resonance imaging (MRI) is assuming an increasingly important role in the more accurate delineation of the extent of the problem. This article briefly reviews one of the main radiological methods for the dynamic evaluation of the pelvic floor: functional cine MRI. METHODS AND MATERIAL: Out of the literature the smallest common denominator for functional cine MRI can be defined as follows: high field system; patient either in supine or sitting position; fast gradient echo sequence; midsagittal slice orientation; either a stack of slices or repeated measurements at the same slice position with the patient at rest or straining; image analysis using the pubococcygeal reference line. RESULTS: All except two publications stress the usefulness of functional cine MRI in the evaluation of patients with organ descent and prolapse. This well accepted method allows for the visualization of all relevant structures in the anterior, middle and posterior compartment. It is especially useful in the detection of enteroceles, and provides a reliable postoperative follow-up tool. Isolated urinary or stool incontinence are not an indication for functional cine MRI, as is the case in patients with equivocal clinical findings. To date it does not allow for real 3D imaging of the pelvic floor or sufficient determination of fascial defects. DISCUSSION: Functional cine MRI of the pelvic floor is a promising new imaging method for the detection of organ descent and prolapse in patients with equivocal clinical findings. The combination of function and morphology allows for an innovative view of the pelvic floor, and thus adds to our understanding of the various interactions of the structures.

Female↗
PubMed1994

Abdominal resection rectopexy with pelvic floor repair versus perineal rectosigmoidectomy and pelvic floor repair for full-thickness rectal prolapse.

A randomized trial was performed to compare abdominal resection rectopexy and pelvic floor repair (n = 10) with perineal rectosigmoidectomy and pelvic floor repair (n = 10) in elderly female patients with full-thickness rectal prolapse and faecal incontinence. There were no recurrences of full-thickness prolapse following resection rectopexy but one after rectosigmoidectomy. Continence to liquid and solid stool was achieved in nine patients, with faecal soiling reported in only two, after resection rectopexy and in eight, with soiling in six, following rectosigmoidectomy. The median (range) frequency of defaecation was only 1 (1-3) per day following resection rectopexy compared with 3 (1-6) per day after rectosigmoidectomy. There was an increase in the mean(s.d.) maximum resting pressure after resection rectopexy (19.3(15.28) cmH2O) compared with a reduction following rectosigmoidectomy (-3.4(13.75) cmH2O) (P = 0.003). Mean(s.d.) compliance was also greater after resection rectopexy than following rectosigmoidectomy (3.9(0.75) versus 2.2(0.78) ml/cmH2O, P < 0.001). Abdominal resection rectopexy gives better functional and physiological results than perineal rectosigmoidectomy.

Abdomen↗
PubMed1975

Urinary incontinence. Treatment with electrical stimulation of the pelvic floor.

Electrical pelvic floor stimulation may be administered either externally by the transrectal tampon or internally with the implantable pelvic floor stimulator. This treatment modality requires intact pelvic floor innervation and therefore is unsuccessful in patients with pelvic floor denervation. Pelvic floor stimulation has been successful in patients with stress and with congenital, iatrogenic, and postoperative urinary incontinence.

Adolescent↗
PubMed1977

Management of the pelvic floor after pelvic exenteration.

At the Mayo Clinic, 198 exenterative operations were performed from 1950 through 1971. Although the 5-year survival rate of all patients was 33%, bowel obstruction occurred in 11.6% of patients and intestinal fistula formation in 12.6%. The majority of patients with these complications had had previous pelvic irradiation. The difficulty in dealing with the large raw area in the pelvis is discussed with a review of the various methods that have been tried to date to reperitonealize the pelvis and thereby, it is hoped, prevent adhesions or fistula formation.

Animals↗
PubMed1999

Cortical magnetic stimulation in patients with genuine stress incontinence: correlation with results of pelvic floor exercises.

Pelvic floor training is an established conservative method of treatment in patients with genuine stress incontinence. It is not known why only a proportion of patients benefit from this form of treatment, while others with a comparable degree of incontinence do not. Since muscle awareness is of vital importance in pelvic floor training, we decided to investigate whether differences in outcome might be explained by differences in cortical control of the pelvic floor muscles. The function in the total motor pathway to the pelvic floor muscles was examined with cortical magnetic stimulation and circumvaginal EMG recording. Since lesions of the peripheral motor pathway have been demonstrated in patients with genuine stress incontinence, possible differences at this level were investigated by means of terminal pudendal motor latencies, using electrical nerve stimulation and anal recording EMG. We found that patients who succeeded with pelvic floor exercises for genuine stress incontinence had a significantly higher probability of response to cortical magnetic stimulation and significantly larger response amplitudes than the patients who did not benefit from training. The findings in the latter group did not differ from those of a healthy control group. No differences between the groups were found in the terminal pudendal motor latencies. We conclude that women with genuine stress urinary incontinence, successfully alleviated by a physiotherapeutic training program, have a higher degree of corticofugal control of their perineal muscles than women who do not succeed with the same treatment program and healthy controls. Neurourol. Urodynam. 18:437-445, 1999.

Adult↗