OBJECTIVES: Pelvic floor dysfunction is common among pregnant and postpartum women and significantly impacts quality of life. This study aims to translate the German Pelvic Floor Questionnaire for Pregnant and Postpartum Women into Chinese and to evaluate its reliability and validity in the Chinese population. METHODS: The questionnaire was translated using the Brislin model. A cross-sectional study was conducted among pregnant and postpartum women to assess the content validity, construct validity, Cronbach's α coefficient, test-retest reliability, and split-half reliability of the Chinese version. RESULTS: A total of 72 women were included, with 6.9% being pregnant and 93.1% postpartum; the age was (32.3±3.6) years. The Chinese version of the questionnaire contains 4 dimensions and 45 items. The content validity index of individual items ranged from 0.833 to 1.000, with a scale-level content validity index of 0.977 and intraclass correlation coefficients (ICCs) exceeding 0.90. The overall Cronbach's α coefficient was 0.891, with subscale coefficients ranging from 0.732 to 0.884 (all ICCs>0.70). The test-retest reliability of the total scale was 0.833, and for the 4 dimensions, bladder, bowel, prolapse, and sexual function, the values were 0.776, 0.579, 0.732, and 0.645, respectively. The split-half reliability was 0.74. CONCLUSIONS The Chinese version of the questionnaire demonstrated good reliability and validity, indicating its applicability in assessing pelvic floor dysfunction and associated risk factors during pregnancy and postpartum.
Humans ; Female ; Surveys and Questionnaires ; Pregnancy ; Adult ; Postpartum Period ; Psychometrics ; Pelvic Floor Disorders/diagnosis* ; Cross-Sectional Studies ; Quality of Life ; Pelvic Floor/physiopathology* ; Reproducibility of Results ; China ; Translations ; Young Adult

Pelvic floor biofeedback is a major non-surgical treatment for anorectal dysfunction and has been recommended in several foreign guidelines. There is no consensus on the clinical practice of pelvic floor biofeedback in China currently. There are controversies in indications, contraindications and formulation of protocols. Launched by Pelvic Floor Medicine Specialty Committee of World Federation of Chinese Medicine Societies and Anorectal Branch of Chinese Medical Doctor Association, Chinese experts on this field were convened to write the Chinese expert consensus on pelvic floor biofeedback for anorectal dysfunction based on relevant references and combined the latest evidence and experts' clinical experience. This consensus recommends that before the use of pelvic floor biofeedback therapy, the patient's condition and pelvic floor function should be fully evaluated, and the guiding role of doctors and pelvic floor therapists should be emphasized to guide the standardized use of pelvic floor biofeedback therapy.
Humans ; Pelvic Floor/physiopathology* ; Biofeedback, Psychology/methods* ; China ; Consensus ; Fecal Incontinence/therapy* ; Pelvic Floor Disorders/therapy*

Urogynecology and Reconstructive Pelvic Surgery has long been recognized specialty in the field of obstetrics and gynecology and it is not new to any of us. In 1979, the American College of Obstetrics and Gynecology officially recognized this field as a subspecialty. In the Philippines, however, urogynecology is still in its infancy stage. Urogynecology concerns problems of the female genital tract and lower urinary and lower intestinal tract disorders. More commonly, we provide care to women with various pelvic floor disorders such as pelvic organ prolapse, fecal incontinence, and bladder control problems, specifically urinary incontinence. They are, at present, aspects of women’s health that are frequently neglected or ignored. With the recent emphasis on women’s health and quality of life, caring for women with various pelvic floor disorders would become an increasingly important aspect of women’s healthcare. Moreover, for a rapidly growing and aging population, the demand for such care will inevitably escalate.
Pelvic Floor Disorders

The pelvic floor disorder disease (PFDD) typically originates from supportive tissue defects or injuries in the pelvic floor with a wide spectrum of symptoms such as urinary incontinence, pelvic organ prolapse, sexual dysfunction, fecal incontinence and chronic pelvic pain. But its etiology is complex, involving multiple systems and organs. So the best management of PFDD requires the implementation of multidisciplinary team (MDT). Pelvic floor centers have been developed abroad to provide pelvic floor services. In the setting of PFDD, the concept of MDT starts lately and develops slowly in China. The MDT approach was demonstrated to improve general rehabilitation, psychological state and quality of life. However, there is no unified standardization for MDT diagnosis and treatment of PFDD at home and abroad. Meanwhile, the personnel composition, responsibilities, training, and operation mode of the MDT need to be further developed. Perfecting the management mode of MDT team members, establishing standardized training programs and assessment criteria play crucial role in the future development of MDT in PFDD.
China ; Fecal Incontinence ; Humans ; Pelvic Floor ; Pelvic Floor Disorders/therapy* ; Pelvic Organ Prolapse/therapy* ; Quality of Life ; Urinary Incontinence

OBJECTIVE: Women with pelvic floor disorders and urinary incontinence (UI) are at an increased risk of sexual dysfunction. The purpose of this study was to investigate the effect of surgery for UI on sexual function. METHODS: We retrospectively reviewed the charts of 82 women who underwent mid-urethral transobturator tape (TOT) surgery between March 2010 and December 2014. The Pelvic Floor Distress Inventory-20 (PFDI-20) and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire-12 (PISQ-12) were administered pre- and postoperatively. RESULTS: We observed a significant increase in the total postoperative PISQ-12 scores compared to the preoperative scores (from 27.1±7.3 to 30.5±6.8, P < 0.001). Improved sexual function was confirmed in the physical (13.3±4.5 vs. 15.8±3.5, P < 0.001) and partner-related domains (6.7±2.6 vs. 7.4±2.4, P=0.001). Coital incontinence and preoperative urinary distress inventory score were significant factors influencing postoperative sexual function in women undergoing TOT surgery for UI after adjusting for age, body mass index, menopause, and preoperative PISQ-12 score in multivariate regression analysis. CONCLUSION: TOT surgery for UI correction resulted in significant improvement in sexual function.
Body Mass Index ; Female ; Humans ; Menopause ; Pelvic Floor ; Pelvic Floor Disorders ; Retrospective Studies ; Sexual Dysfunction, Physiological ; Suburethral Slings ; Urinary Incontinence

OBJECTIVES: Nerve-sparing radical hysterectomy has been implemented in order to reduce pelvic floor dysfunctions in women undergoing radical surgery for cervical cancer. Here, we aimed to investigate if the adoption of laparoscopic surgery impacts on patients' outcomes. METHODS: Data of consecutive patients affected by cervical cancer who had laparoscopic nerve-sparing radical hysterectomy were matched 1:1 with an historical cohort of patients undergoing open procedure. A propensity-score matched algorithm was applied. RESULTS: Thirty-five patients' pairs (70 patients: 35 undergoing laparoscopic vs. 35 undergoing open abdominal nerve-sparing radical hysterectomy) were included. Demographic and baseline oncologic characteristics were balanced between groups. Patients undergoing laparoscopic surgery had similar operative time than patients undergoing open abdominal procedures (249 [±91.5] vs. 223 [±65.0] minutes; p=0.066). Laparoscopic approach correlated with lower blood loss (30.5 [±11.0] vs. 190 [90.4] mL; p < 0.001) and shorter hospital stay (3.2 [±1.2] vs. 5.4 [2.0] days; p=0.023). Patients undergoing laparoscopy experienced a lower 30-day pelvic floor dysfunction rate than patients having open surgery. Moreover, they experienced shorter recovery of bladder function than patients having open procedures (median, 7 vs. 9 days; p=0.004, log-rank test). CONCLUSIONS: Laparoscopic approach resulted in a faster recovery of bladder function in comparison to open surgery for patients undergoing nerve-sparing radical hysterectomy.
Cohort Studies ; Female ; Humans ; Hysterectomy ; Laparoscopy ; Length of Stay ; Minimally Invasive Surgical Procedures ; Operative Time ; Pelvic Floor ; Urinary Bladder ; Urination Disorders ; Uterine Cervical Neoplasms

BACKGROUND/AIMS: Current evidence suggests the presence of motility or functional abnormalities in one area of the gastrointestinal tract increases the likelihood of abnormalities in others. However, the relationship of gastroparesis to chronic constipation (slow transit constipation and dyssynergic defecation) has been incompletely evaluated. METHODS: We retrospectively reviewed the records of all patients with chronic dyspeptic symptoms and constipation who underwent both a solid gastric emptying scintigraphy and a high-resolution anorectal manometry at our institution since January 2012. When available, X-ray defecography and radiopaque marker colonic transit studies were also reviewed. Based on the gastric emptying results, patients were classified as gastroparesis or dyspepsia with normal gastric emptying (control group). Differences in anorectal and colonic findings were then compared between groups. RESULTS: Two hundred and six patients met the inclusion criteria. Patients with gastroparesis had higher prevalence of slow transit constipation by radiopaque marker study compared to those with normal emptying (64.7% vs 28.1%, P = 0.013). Additionally, patients with gastroparesis had higher rates of rectocele (88.9% vs 60.0%, P = 0.008) and intussusception (44.4% vs 12.0%, P = 0.001) compared to patients with normal emptying. There was no difference in the rate of dyssynergic defecation between those with gastroparesis vs normal emptying (41.1% vs 42.1%, P = 0.880), and no differences in anorectal manometry findings. CONCLUSIONS: Patients with gastroparesis had a higher rate of slow transit constipation, but equal rates of dyssynergic defecation compared to patients with normal gastric emptying. These findings argue for investigation of possible delayed colonic transit in patients with gastroparesis and vice versa.
Colon ; Constipation ; Defecation ; Defecography ; Dyspepsia ; Gastric Emptying ; Gastrointestinal Tract ; Gastroparesis ; Humans ; Intussusception ; Manometry ; Pelvic Floor Disorders ; Prevalence ; Radionuclide Imaging ; Rectocele ; Retrospective Studies

OBJECTIVETo observe the multiple symptom distribution, severity and quality of life of female pelvic floor dysfunction(FPFD) patients with constipation as chief complaint.

METHODSOne hundred FPFD patients with constipation as chief complaint from Speciaty Outpatient Clinic, Pelvic Floor Center of Nanjing Municipal Hospital of Traditional Chinese Medicine between September 2015 and February 2017 were retrospectively enrolled in this study. A comprehensive medical history questionnaire survey and systematical evaluation of severity and quality of life of these patients with constipation was conducted. Constipation scoring system scale (CSS) and patient-assessment of constipation quality of life questionnaire (PAC-QOL) were applied to evaluate the constipation. Other scales included: (1)pain visual analogue scale (VAS) and short form-36 questionnaire (SF-36): if combined with chronic functional anal rectal pain; (2) international consultation on incontinence questionnaire-short form (ICIQ-SF) and urinary incontinence quality of life questionnaires (I-QOL):if combined with urinary incontinence; (3) fecal incontinence severity score scale (Wexner-FIS) and fecal incontinence quality of life questionnaire (FI-QOL):if combined with fecal incontinence.

RESULTSThe mean age of 100 FPFD patients was (57.9±13.9) (24-89) years and the mean disease course was (7.0±8.2)(0.5-40.0) years. Seventy-five cases (75%) were complicated with anal pain, 70 with urinary incontinence, 37 with rectocele, 19 with nocturia, 11 with urinary frequency, 10 with defecation incontinence. Complication with only one symptom was observed in 20 cases (20%), and with two or more symptoms was observed in 80 cases (80%). Pelvic floor relaxation syndrome patients were dominant (58 cases, 58%). The severity of constipation (CSS) was 6-22 (13.89±3.79) points and the quality of life (PAC-QOL) was 45-133 (87.13±18.57) points in FPFD patients. VAS and SF-36 of patients combined with chronic functional anal rectal pain were 1-8 (3.0±1.9) points and 14.4-137.0(71.5±31.4) points respectively. ICIQ-SF and I-QOL of patients combined with urinary incontinence were 1-17 (6.1±3.6) points and 52-110 (90.0±15.8) points respectively. Wexner-FIS and FI-QOL of patients combined with fecal incontinence were 1-11 (4.4±3.0) points and 52-116 (83.4±23.3) points respectively.

CONCLUSIONSThe symptoms of FPFD patients with constipation as chief complaint are complex. They are mainly complicated with anal diseases, then urinary incontinence, and mostly with more than 2 symptoms. Their quality of life is poor.

Adult ; Aged ; Aged, 80 and over ; Constipation ; etiology ; Fecal Incontinence ; etiology ; Female ; Humans ; Middle Aged ; Pelvic Floor ; Pelvic Floor Disorders ; complications ; diagnosis ; Quality of Life ; Retrospective Studies ; Surveys and Questionnaires ; Young Adult

OBJECTIVE: The study aimed to evaluate the contributions of levator ani muscle (LAM) injury, vesical neck movement, urethral length and mobility, and urethral sphincter dysfunction observed on magnetic resonance imaging (MRI) towards stress urinary incontinence (SUI) after vaginal delivery. MATERIALS AND METHODS: Fifty primiparous women after 6 months of delivery (15 with SUI and 35 without) and 35 nulliparous as continent controls underwent MRI at rest and Valsalva maneuver. A published levator ani scoring system was used to characterize morphological changes of LAM. The severity of the injury was divided into three categories as none, minor, and major. A series of common parameters including levator plate angle, iliococcygeal angle, and levator hiatus were used to describe the functional conditions of LAM. Urethral mobility was defined based on the rotation of the urethra between Valsalva and rest status. Vesical neck movement was evaluated by its distance to the pubococcygeal line. Urethral sphincter dysfunction was defined as the widening of the proximal urethra and/or funneling at the urethrovesical junction during Valsalva. RESULTS: Primiparous incontinent (PI) women had additional major levator ani defects (33.3% vs. 17.1%) while less minor defects (0.7% vs. 31.4%) than primiparous continent (PC) women. Vesical neck downward movement in PI women was more obvious than PC women (28.5 mm vs. 24.2 mm, p = 0.006). Urethral mobility was more active in primiparous women than in nulliparous continent controls (57.4 vs. 52.4), whereas no difference was observed on urethral mobility in the primiparous group (p = 0.25). Urethral sphincter dysfunction and funneling were present in 80% of PI women versus 22.9% in PC women (p < 0.001). CONCLUSION: The MRI findings revealed that de novo SUI was associated with major LAM injury, vesical neck downward movement as well as urethral sphincter dysfunction. Vesical neck funneling on sagittal images can be treated as a valuable predictor for SUI. The intervention for the PI should focus on the elevation of vesical neck, rehabilitation of LAM as well as recovery of the urethral sphincter muscle.
Female ; Humans ; Magnetic Resonance Imaging* ; Neck ; Pelvic Floor Disorders ; Pelvic Floor* ; Rehabilitation ; Urethra ; Urinary Incontinence* ; Valsalva Maneuver

OBJECTIVES: To investigate if vitamin D receptor (VDR) gene polymorphisms and circulating vitamin D levels are associated with pelvic floor disorders (PFDs). METHODS: In this case-control study, 25-hydroxy-vitamin D (25[OH]D) serum levels were analyzed in 47 females with PFDs and 87 healthy females (controls), respectively. The VDR gene polymorphisms were determined by using polymerase chain reaction and performing digestions with 4 restriction enzymes i.e., ApaI, TaqI, FokI, and BsmI. Vitamin D levels of patients were divided into <20 ng/mL, 20 to 30 ng/mL, and ≥30 ng/mL categories. RESULTS: Our correlative analysis of VDR polymorphisms as a function of the presence of PFD showed that ApaI and BsmI polymorphisms were significantly associated with PFD in vitamin-D-deficiency and insufficiency groups (P < 0.05). Mean vitamin D levels did not differ between the PFD case (13.01 ± 0.84 ng/mL) and control (15.11 ± 1.04 ng/mL) groups (P > 0.05). However, there was a significant difference in the distribution of vitamin D levels between study group and controls using Pearson's χ2 test (<20 ng/mL, 20–30 ng/mL, and >30 ng/mL: 87.2%, 12.8%, and 0% in the study group and 75.9%, 16.1%, and 8.0% in controls, respectively, P < 0.05). Taken together, our observations suggest that vitamin D levels could be associated with PFDs and that 2 polymorphisms (i.e., ApaI and BsmI) in the VDR gene may contribute to an increased prevalence of PFDs in women with insufficient levels of vitamin D. CONCLUSIONS: Examining vitamin D levels and performing a VDR genotype analysis may be helpful for assessing PFD risk.
Case-Control Studies ; Female ; Genotype ; Humans ; Pelvic Floor Disorders ; Pelvic Floor ; Polymerase Chain Reaction ; Prevalence ; Receptors, Calcitriol ; Vitamin D Deficiency ; Vitamin D ; Vitamins