Pelvic floor dysfunction
Dotaz
Zobrazit nápovědu
5th ed. xx, 587 s., [4] s. obr. příl. : il., tab. ; 24 cm
15 sv. : ill.
- MeSH
- gynekologická onemocnění MeSH
- pánevní dno MeSH
- ženské urogenitální nemoci MeSH
- Publikační typ
- periodika MeSH
- Konspekt
- Gynekologie. Porodnictví
- NLK Obory
- gynekologie a porodnictví
Palpační zhodnocení stavu pánevního dna by mělo být jedním ze základních vyšetření prováděných všemi odborníky, kteří se podílejí na léčbě močové inkontinence, fekální inkontinence, prolapsu pánevních orgánů, sexuálních dysfunkcí, pelvic pain sy. Je nejenom základní podmínkou stanovení správné diagnózy a optimálního léčebného postupu, ale umožňuje rovněž hodnocení výsledků terapie. Cílem práce je podat přehled vyšetřovacích metod funkčního stavu pánevního dna s důrazem na jednoduché palpační vaginální vyšetření podle tzv. PERFECT. schématu.
Palpation evaluation of the pelvic floor condition should be among the basic examinations performed by all specialists, who participate in the therapy of urinary incontinence, fecal incontinence, pelvic organ prolapse, sexual dysfunctions, pelvic pain syndrome etc. It is not only the precondition for the establishment of correct diagnosis and optimal therapeutic procedure, but makes it possible to evaluate the results of therapy. The work was intended to present a survey of examination methods for evaluating functional condition of pelvic floor with emphasis to simple palpation vaginal examination according to the PERFECT scheme.
- MeSH
- diagnostické techniky a postupy MeSH
- lidé MeSH
- pánevní dno anatomie a histologie MeSH
- Check Tag
- lidé MeSH
INTRODUCTION AND HYPOTHESIS: Pregnancy and childbirth predispose to pelvic floor dysfunction (PFD), coinciding with functional and anatomical changes in the pelvic floor. To some extent, these can be assessed by transperineal ultrasound (TPUS), yet the correlation between ultrasound findings and symptoms has not been well elucidated. We hypothesised that pregnant women with PFD would show different findings at TPUS. METHODS: This is a planned secondary analysis of a prospective cohort study. Pregnant women were asked to fill out standardised questionnaires on PFD and undergo TPUS at 12-14 weeks and 28-32 weeks of gestation. We compared bladder neck descent, urethral rotation, retrovesical angle, pelvic organ descent, genital hiatus dimensions and the presence of anal sphincter defects between women with and those without PFD using t test and Fisher's exact test. Linear mixed-effects models were used to assess the correlation between TPUS findings and PFD severity. As this is a secondary subgroup analysis of participants who underwent TPUS, no sample size was determined upfront. RESULTS: At Valsalva, women with urinary incontinence had more pronounced bladder neck descent (p = 0.02) and urethral rotation (p < 0.01), as well as wider retrovesical angles (p = 0.04) and larger genital hiatus areas (p < 0.01). After controlling for age, BMI and parity, the retrovesical angle was the only persistent predictor of urinary incontinence. No correlation was observed between any TPUS marker and symptoms of either prolapse or anorectal dysfunction. CONCLUSIONS: In pregnant women, symptoms of urinary incontinence, but not of prolapse and anorectal dysfunction, are associated with differences in pelvic floor anatomy at TPUS.
- MeSH
- anální kanál diagnostické zobrazování MeSH
- dospělí MeSH
- inkontinence moči diagnostické zobrazování etiologie patofyziologie MeSH
- komplikace těhotenství * diagnostické zobrazování patofyziologie MeSH
- lidé MeSH
- onemocnění dna pánevního * diagnostické zobrazování patofyziologie etiologie MeSH
- pánevní dno * diagnostické zobrazování patofyziologie MeSH
- prospektivní studie MeSH
- těhotenství MeSH
- ultrasonografie MeSH
- uretra diagnostické zobrazování patofyziologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
OBJECTIVE: To compare the prevalence of pelvic floor dysfunction symptoms, including pelvic organ prolapse (POP), urinary incontinence (UI), and fecal incontinence (FI) among primiparous women after vaginal and cesarean delivery. METHODS: In a prospective cohort study at a University hospital in the Czech Republic, singleton primiparas with cephalic presentation who delivered at term were enrolled between 2002 and 2007. In 2013, 5-10 years after delivery, women who had not delivered again completed an internet-based survey about current symptoms of POP, UI, and FI, which were evaluated using validated questionnaires. The relative risk (RR) of POP, UI, and FI symptoms was calculated. RESULTS: Complete questionnaire data were obtained from 641 women who delivered vaginally and 224 who delivered by cesarean. The mean UI score (ICIQ-SF) was 2.3 ± 3.6 in the vaginal group and 1.0 ± 2.7 in the cesarean group (P=0.005). The mean POP scores (POPDI-6) were 2.2 ± 2.3 and 2.1 ± 2.0, respectively (P=0.944). The mean Wexner scores to evaluate FI were 1.3 ± 1.7 and 1.0 ± 1.5, respectively (P=0.220). The RR of pelvic floor dysfunction after vaginal delivery was highest for women with UI symptoms (RR 1.15, 95% confidence interval 0.92-1.42). CONCLUSION: Significant differences in the occurrence of symptoms of UI were observed after vaginal delivery as compared with cesarean delivery. ClinicalTrials.gov: NCT02661867.
- MeSH
- císařský řez škodlivé účinky MeSH
- dospělí MeSH
- internet MeSH
- lidé MeSH
- onemocnění dna pánevního epidemiologie etiologie MeSH
- parita * MeSH
- poruchy v puerperiu epidemiologie MeSH
- prolaps pánevních orgánů epidemiologie etiologie MeSH
- prospektivní studie MeSH
- průzkumy a dotazníky MeSH
- stupeň závažnosti nemoci MeSH
- těhotenství MeSH
- vedení porodu škodlivé účinky MeSH
- zdraví žen MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
- Geografické názvy
- Česká republika epidemiologie MeSH
INTRODUCTION AND HYPOTHESIS: First vaginal delivery severely interferes with pelvic floor anatomy and function. This study determines maternal and pregnancy-related risk factors for pelvic floor dysfunction (PFD), including urinary incontinence (UI), urgency, anal incontinence (AI), pelvic organ prolapse (POP) and levator ani muscle (LAM) avulsion. METHODS: This is a single-centre prospective observational cohort study on healthy women in their first singleton pregnancy. All underwent clinical and 3D transperineal ultrasound examination at 6 weeks and 12 months postpartum. Objective outcomes were POP-Q and presence or absence of LAM trauma. Functional outcomes were measured by the ICIQ-SF and PISQ 12. Multivariate regression was performed to determine birth and maternal habitus-related risk factors for UI, urgency, AI, dyspareunia, LAM avulsion and ballooning. RESULTS: Nine hundred eighty-seven women were included. Risk factors for UI were maternal age per year of age (OR: 1.09; 95% CI: 1.04-1.13; p = 0.0001) and BMI before pregnancy (OR: 1.08; 95% CI: 1.04-1.13; p = 0.001); for POP stage II+ maternal age (OR: 1.08; 95% CI: 1.08-1.14; p = 0.005). Avulsion was more likely after forceps (OR: 3.22; 95% CI:1.54-8.22; p = 0.015) but less likely after epidural analgesia (OR: 0.58; 95% CI: 0.37-0.90; p = 0.015) and grade I perineal rupture (OR: 0.50; 95% CI: 0.29-0.85; p = 0.012). Ballooning was more likely at increased maternal age (OR: 1.08; 95% CI: 1.02-1.13; p = 0.005), epidural (OR: 1.64; 95% CI: 1.06-2.55; p = 0.027) and grade I perineal rupture (OR: 1.79; 95% CI: 1.10-2.90; p = 0.018). CONCLUSION: Though maternal characteristics at birth such as age or BMI increase the risk of PFD, labour and birth factors play a similarly important role. The most critical risk factor for MLA avulsion was forceps delivery, while an epidural had a protective effect.
- MeSH
- dospělí MeSH
- fekální inkontinence etiologie MeSH
- inkontinence moči etiologie MeSH
- lidé MeSH
- onemocnění dna pánevního etiologie MeSH
- parita MeSH
- porod MeSH
- prospektivní studie MeSH
- těhotenství MeSH
- vedení porodu škodlivé účinky MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
Pánevní dno je součástí svalstva dutiny břišní. Účastní se na funkci pohybové (posturální i lokomoční), ale také při dýchání, vylučování a trávení. Dysfunkce v oblasti pánevního dna patří ve fyzioterapii k obtížně řešitelným úkolům. Autorka nabízí ve svém článku některé jednoduché postupy, které mohou napomoci při rehabilitaci funkce pánevního dna i dalších svalů břišní dutiny. Jsou to: dechová cvičení, cvičení na míči, hlazení, cvičení v představě, cvičení svalů pánevního dna, cvičení svalů oblasti pánve a břicha, úprava životosprávy a další. Na provádění těchto postupů se významně podílí sám pacient a jsou vhodné pro autoterapii.
Pelvic floor is a part of the abdomen musculature. It is concerned in the motor function (postural and locomotor) as well as in the respiration, secretion and digestion. Dysfunction located in the pelvic floor is regarded as a difficult task for the physiotherapy. To help the rehabilitation of the pelvic floor function and Other abdominal muscles some simple practices are suggested in the article. E.g. the respiration exercises, exercises with the ball, stroking, prostatic exercise, exercise of the pelvic floor muscle, exercise of the pelvic and abdominal muscles, the regulation of the regimen etc. The patient himself is joined at the practicing of these procedures, that's why they are proper for an auto therapy.
- MeSH
- břišní svaly MeSH
- cvičení metody MeSH
- lidé MeSH
- mechanika dýchání MeSH
- pánev MeSH
- pánevní dno MeSH
- rehabilitace metody MeSH
- Check Tag
- lidé MeSH
- MeSH
- lidé MeSH
- palpace MeSH
- pánev MeSH
- svalový tonus MeSH
- svaly patofyziologie MeSH
- terapie cvičením MeSH
- Check Tag
- lidé MeSH
