Peri-partum and pelvic floor dysfunction.
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Abstract:
Pelvic floor muscles (PFM) are the layer of muscles that support the pelvic organs and span the bottom of the pelvis. Weakened PFM mean the internal organs are not fully supported and can lead to difficulties controlling the release of urine, faeces or flatus. Pregnancy and vaginal birth are a recognised cause of PFM weakness; however it has been shown that PFM exercises, if carried out correctly and routinely, can reduce the severity of symptoms. Midwives need to be pro-active in teaching PFM exercises and identifying women who may need to be referred on for more specialist treatment.Keywords:
Pelvic Floor Dysfunction
Post partum
Peri
Pelvic Floor Disorders
Pelvic Floor Muscle
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Training of pelvic-floor muscles reduced the incidence of postpartum urinary incontinence in a recent Norwegian study (see Obstet Gynecol 2003; 101:313), but some women fear that strengthening these muscles can create an obstruction to vaginal delivery. Now, researchers have examined secondary outcomes from that study to evaluate the effects of pelvic-floor-muscle training on labor and delivery.
Initially, the researchers randomized 301 primiparous …
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The pelvic floor muscles (PFMs) are the layer of muscles that support the pelvic organs and play an important role in continence. Weakened PFMs will not fully support the internal organs, which can lead to difficulties controlling the release of urine, faeces or flatus and can cause prolapse to occur. Pregnancy and vaginal delivery are a recognised cause of PFM weakness; however, it has been shown that PFM exercises, if carried out correctly and routinely, can reduce the severity of symptoms. Midwives need to be pro-active in teaching PFM exercises and identifying women who may need to be referred for more specialist treatment. We describe an initiative to support midwives with these tasks.
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Dysfunction of the pelvic floor muscles (PFMs) leads to a range of functional clinical problems, including urinary and faecal incontinence, some defecatory disorders, erectile dysfunction and pelvic organ prolapse. Rehabilitation of these muscles has demonstrated a reduction in symptoms and enhancement of quality of life in those who suffer from it. It is therefore important that gastrointestinal nurses have an understanding of the key aspects of PFM assessment and exercise regimens in order to teach and support patients to undertake effective pelvic floor muscle rehabilitation.
Pelvic Floor Dysfunction
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Pelvic Floor Dysfunction
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The offering of pelvic floor muscle exercises to all women during their first pregnancy is recommended by National Institute for Health and Care Excellence (NICE) guidelines. Pelvic floor muscles suffer significant trauma throughout pregnancy and childbirth, which may sometimes lead to urinary incontinence postpartum. However, it is uncertain how effective pelvic floor muscle exercises are in treating this incontinence. Several trials have been analysed to try to understand this question. Issues such as when the exercises were undertaken, how often they were performed and in what circumstances they were carried out, have all been considered. While it is still uncertain whether they are effective in reducing urinary incontinence postpartum, as they are non-invasive and fairly simple to carry out, they are still the first-line management for urinary incontinence postpartum with other treatments being considered if this is ineffective.
Nice
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Pelvic organ prolapse and urinary incontinence affect approximately 6-11% and 6-40% of women, respectively. These pathologies could result from a weakness of pelvic floor muscles (PFM) caused by previous deliveries, aging or surgery. It seems reasonable that improving PFM efficacy should positively impact both pelvic floor therapy and surgical outcomes. Nonetheless, the existing data are inconclusive and do not clearly support the positive impact of preoperative pelvic floor muscle training on the improvement of surgical results. The restoration of deteriorated PFM function still constitutes a challenge. Thus, further well-designed prospective studies are warranted to answer the question of whether preoperative PFM training could optimize surgical outcomes and if therapeutic actions should focus on building muscle strength or rather on enhancing muscle performance.
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Pelvic floor muscle exercises are the mainstay of physiotherapy for urinary incontinence and can be taught by all health professionals. If the patient fails to respond to a three-month course of pelvic floor exercises, or if she cannot perform a voluntary contraction of the pelvic floor muscles, biofeedback, electrical stimulation and vaginal cone therapy may be appropriate. This review discusses the evidence supporting the use of physiotherapy in the treatment of urinary incontinence. It also reports on the prevalence of the different types of urinary incontinence and describes the need for vaginal examination to determine the contractility of the pelvic floor muscles, including the PERFECT scheme.
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