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Anal incontinence after caesarean and vaginal delivery in Sweden: a national population-based study.

https://arctichealth.org/en/permalink/ahliterature299811
Source
Lancet. 2019 Mar 23; 393(10177):1233-1239
Publication Type
Comparative Study
Journal Article
Observational Study
Date
Mar-23-2019
Author
Charlotta Larsson
Charlotta Linder Hedberg
Ewa Lundgren
Lars Söderström
Katarina TunÓn
Pär Nordin
Author Affiliation
Department of Surgical and Perioperative Sciences, University of Umeå and Hospital of Östersund, Östersund, Sweden.
Source
Lancet. 2019 Mar 23; 393(10177):1233-1239
Date
Mar-23-2019
Language
English
Publication Type
Comparative Study
Journal Article
Observational Study
Keywords
Adult
Birth weight
Cesarean Section - adverse effects - methods
Delivery, Obstetric - adverse effects - methods
Fecal Incontinence - diagnosis - epidemiology - etiology
Female
Humans
Male
Maternal Age
Pelvic Floor Disorders - diagnosis - epidemiology - etiology
Pregnancy
Risk factors
Sweden - epidemiology
Abstract
Elective caesarean delivery is increasing rapidly in many countries, and one of the reasons might be that caesarean delivery is widely believed to protect against pelvic floor disorders, including anal incontinence. Previous studies on this issue have been small and with conflicting results. The aim of present study was to compare the risk of developing anal incontinence in women who had a caesarean delivery, in those who had a vaginal delivery, and in two age-matched control groups (nulliparous women and men).
In this observational population-based study, we included all women in the Swedish Medical Birth Register who gave birth by caesarean delivery or vaginal delivery during 1973-2015 in Sweden and were diagnosed with anal incontinence according to ICD 8-10 in the Swedish National Patient Register during 2001-15. Exclusion criteria were multiple birth delivery, mixed vaginal and caesarean delivery, and four or more deliveries. We compared the diagnosis of anal incontinence between women previously delivered solely by caesarean delivery and those who solely had delivered vaginally. We also compared it with two age-matched control groups of nulliparous women and men from the Swedish Total Population Register. Finally, we analysed risk factors for anal incontinence in the caesarean delivery and vaginal delivery groups.
3?755?110 individuals were included in the study. Between 1973 and 2015, 185?219 women had a caesarean delivery only and 1?400?935 delivered vaginally only. 416 (0·22 %) of the 185?219 women in the caesarean delivery group were diagnosed with anal incontinence compared with 5171 (0·37%) of 1?400?935 women in the vaginal delivery group. The odds ratio (OR) for being diagnosed with anal incontinence after vaginal delivery compared with caesarean delivery was 1·65 (95% CI 1·49-1·82; p
Notes
CommentIn: Lancet. 2019 Mar 23;393(10177):1183-1184 PMID 30799058
PubMed ID
30799061 View in PubMed
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Anatomic and functional assessment and risk factors of recurrent prolapse after vaginal sacrospinous fixation.

https://arctichealth.org/en/permalink/ahliterature185342
Source
Acta Obstet Gynecol Scand. 2003 May;82(5):471-8
Publication Type
Article
Date
May-2003
Author
Kari Nieminen
Heini Huhtala
Pentti K Heinonen
Author Affiliation
Department of Obstetrics and Gynecology, Tampere University Hospital and Medical School and School of Public Health, University of Tampere, Tampere, Finland. kn37975@uta.fi
Source
Acta Obstet Gynecol Scand. 2003 May;82(5):471-8
Date
May-2003
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Aged, 80 and over
Antibiotic Prophylaxis
Broad Ligament - surgery
Female
Finland
Gynecologic Surgical Procedures - adverse effects - methods
Humans
Middle Aged
Multivariate Analysis
Pelvic Floor - surgery
Proportional Hazards Models
Pulmonary Embolism - etiology
Quality of Life
Recurrence
Retrospective Studies
Risk factors
Sacrococcygeal Region - physiopathology - surgery
Time Factors
Urinary Tract Infections - etiology
Uterine Prolapse - physiopathology - surgery
Vagina - surgery
Abstract
To identify risk factors in recurrence and to evaluate anatomic and functional results of vaginal sacrospinous ligament fixation and pelvic floor reconstruction for genital prolapse.
One hundred and thirty-eight women underwent surgery for uterovaginal or vault prolapse. Follow-up data were available for 122 cases; 83% were examined and others were interviewed by telephone. The median (range) follow-up was 24 (1-141) months. Cox regression was used to identify risk factors associated with recurrence; uni- and multivariate regression was used to identify risk factors underlying postoperative infections because infections were found to be a risk factor of recurrence. Recurrence-free survival was estimated using the Kaplan-Meier method.
Seven (5%) patients suffered severe cardiopulmonary complications including one postoperative death due to a pulmonary embolism. Twenty-six (21%) patients suffered a recurrence, 14 with cystocele. Ten patients with recurrence were symptomatic and six underwent a re-operation. The Cox regression model showed that vaginal cuff infection raised the odds ratio (OR) for recurrence to 6.13 [confidence interval (CI) 1.80-20.83] and urinary tract infection to 3.65 (CI 1.40-9.47). In both uni- and multivariate analysis, lack of intravenous antibiotic prophylaxis, age less than 73 years and vaginal ulcerations were statistically significant risk factors for postoperative infection. Eleven (33%) out of 33 sexually active women reported improvement and three (9%) complained of dyspareunia.
Transvaginal sacrospinous ligament fixation with pelvic floor repair is an effective means of correcting both vault prolapse and uterine procidentia. Women who wish to preserve coital function will also benefit from this operation. Postoperative infection is an independent and most important individual risk factor underlying recurrence. Prophylactic antibiotics seem to be effective in reducing the rate of postoperative infections.
PubMed ID
12752079 View in PubMed
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Are postpartum women in denmark being given helpful information about urinary incontinence and pelvic floor exercises?

https://arctichealth.org/en/permalink/ahliterature97878
Source
J Midwifery Womens Health. 2010 Mar-Apr;55(2):171-4
Publication Type
Article
Author
Inge Lise Hermansen
Bev O'Connell
Cadeyrn J Gaskin
Author Affiliation
Department of Obstetrics and Gynaecology, Regional Hospital Viborg, PO Box 130, DK-8800 Viborg, Denmark. inge.lise.hermansen@viborg.RM.dk
Source
J Midwifery Womens Health. 2010 Mar-Apr;55(2):171-4
Language
English
Publication Type
Article
Keywords
Adult
Denmark
Exercise Therapy
Female
Health Knowledge, Attitudes, Practice
Humans
Mothers - education - psychology
Nurse-Patient Relations
Pelvic Floor - physiology
Postpartum Period
Pregnancy
Pregnancy Complications - prevention & control
Urinary Incontinence - prevention & control - psychology
Young Adult
Abstract
INTRODUCTION: The aim of this study was to determine where and from whom postpartum women recalled receiving information about urinary incontinence (UI) and pelvic floor exercises (PFEs), the helpfulness of this information, and their preferred sources of help with UI. METHODS: Women who had recently given birth in a Danish hospital (N = 439) were mailed a survey that elicited information about their experiences of receiving information about UI and PFEs. RESULTS: Surveys were returned from 266 women, representing a response rate of 61%. Although almost all participants recalled receiving information about PFEs (95%), only half (55%) recalled being provided with information about UI. Midwives were the health care professionals who most commonly provided women with information about UI (33%) and PFEs (55%). Women generally perceived the information as being helpful, with the information from physiotherapists obtaining the highest mean ratings for helpfulness. Postpartum women indicated that they would prefer to consult with continence nurses or general nurses if they experienced UI. Health care professionals did not consistently provide postpartum women with information on UI and PFEs. DISCUSSION: A coordinated multidisciplinary approach is needed to ensure that women are adequately informed about the risk of developing UI after childbirth and the ways in which this condition can be managed or resolved.
PubMed ID
20189136 View in PubMed
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Can pelvic floor muscle training reverse pelvic organ prolapse and reduce prolapse symptoms? An assessor-blinded, randomized, controlled trial.

https://arctichealth.org/en/permalink/ahliterature99392
Source
Am J Obstet Gynecol. 2010 Aug;203(2):170.e1-7
Publication Type
Article
Date
Aug-2010
Author
Ingeborg Hoff Braekken
Memona Majida
Marie Ellström Engh
Kari Bø
Author Affiliation
Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway. ingeborg.brekken@nih.no
Source
Am J Obstet Gynecol. 2010 Aug;203(2):170.e1-7
Date
Aug-2010
Language
English
Publication Type
Article
Keywords
Adult
Confidence Intervals
Cross-Over Studies
Double-Blind Method
Exercise Therapy - methods
Female
Follow-Up Studies
Hospitals, University
Humans
Middle Aged
Muscle Contraction - physiology
Muscle, Skeletal - physiology - ultrasonography
Norway
Odds Ratio
Patient compliance
Pelvic Floor
Pelvic Organ Prolapse - complications - rehabilitation - ultrasonography
Quality of Life
Reference Values
Risk assessment
Severity of Illness Index
Statistics, nonparametric
Treatment Outcome
Urinary Incontinence, Stress - etiology - prevention & control
Abstract
OBJECTIVE: The aim of this study was to investigate the effectiveness of pelvic floor muscle training in reversing pelvic organ prolapse and alleviating symptoms. STUDY DESIGN: This assessor-blinded, parallel group, randomized, controlled trial conducted at a university hospital and a physical therapy clinic randomly assigned 109 women with prolapse stages I, II, and III to pelvic floor muscle training (n = 59) or control (n = 50). Both groups received lifestyle advices and learned "the Knack." In addition, pelvic floor muscle training comprised individual physical therapy sessions and home exercise. Student t test, Mann-Whitney U test, odds ratio, and effect size were used to compare groups. RESULTS: Eleven (19%) women in the pelvic floor muscle training group improved 1 Pelvic Organ Prolapse Quantification System stage vs 4 (8%) controls (P = .035). Compared with controls, the pelvic floor muscle training group elevated the bladder (difference: 3.0 mm; 95% confidence interval, 1.5-4.4; P
PubMed ID
20435294 View in PubMed
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Can the PFDI (Pelvic Floor Distress Inventory) or PFIQ (Pelvic Floor Impact Questionnaires) be used to predict outcome in pelvic reconstructive surgery?

https://arctichealth.org/en/permalink/ahliterature107420
Source
Prog Urol. 2013 Sep;23(11):940-5
Publication Type
Article
Date
Sep-2013
Author
V. Letouzey
G. Mercier
S. Adjoussou
E. Bohoussou
P. Mares
R. de Tayrac
Author Affiliation
Gynecology and obstetrics department, Caremeau university hospital, place Pr R.-Debré, 30900 Nimes, France. Electronic address: Vincent.go@wanadoo.fr.
Source
Prog Urol. 2013 Sep;23(11):940-5
Date
Sep-2013
Language
English
Publication Type
Article
Keywords
Aged
Canada
Colposcopy - methods
Female
Follow-Up Studies
Humans
Middle Aged
Pelvic Floor - physiopathology - surgery
Pelvic Organ Prolapse - diagnosis - physiopathology - surgery
Predictive value of tests
Prospective Studies
Quality of Life
Questionnaires
Reconstructive Surgical Procedures - methods
Reproducibility of Results
Retrospective Studies
Sensitivity and specificity
Severity of Illness Index
Surgical Mesh
Treatment Outcome
Uterine Prolapse - physiopathology - surgery
Vagina - surgery
Abstract
To determine a syndrome score threshold on PFDI or PFIQ predictive of a significant improvement in post-operative functional results.
A retrospective case review (Canadian Task Force Classification II-2).
University and research hospital.
Women diagnosed with pelvic organ prolapse and repaired with synthetic vaginal mesh.
Quality of life was arbitrarily considered to have improved significantly if the score decreases by more than 50% between pre-operatively and 36 months post-operatively. We investigated the pre-operative cut-off score predictive of no quality of life improvement at M36 from a prospective trial for surgical pelvic organ prolapse treatment.
The most accurate pre-operative cut-off score predicting a failure to improve quality of life at 36 months post-operatively was 62/300 (PFDI Score). This cut-off value had a positive predictive value of 83.6% and specificity of 62.1%. No significant threshold was obtained from the PFIQ score.
The intensity of symptoms before surgery may interfere as a predictive factor for outcome.
PubMed ID
24010925 View in PubMed
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Cesarean section and risk of pelvic organ prolapse: a nested case-control study.

https://arctichealth.org/en/permalink/ahliterature89801
Source
Am J Obstet Gynecol. 2009 Mar;200(3):243.e1-4
Publication Type
Article
Date
Mar-2009
Author
Larsson Christina
Källen Karin
Andolf Ellika
Author Affiliation
Division of Obstetrics and Gynecology, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden. christina.larsson@ds.se
Source
Am J Obstet Gynecol. 2009 Mar;200(3):243.e1-4
Date
Mar-2009
Language
English
Publication Type
Article
Keywords
Case-Control Studies
Cesarean Section - adverse effects - statistics & numerical data
Female
Humans
Pelvic Floor
Pregnancy
Registries
Risk factors
Sweden - epidemiology
Uterine Prolapse - epidemiology
Abstract
OBJECTIVE: The objective of the study was to investigate the association between cesarean section and pelvic organ prolapse. STUDY DESIGN: The Swedish Hospital Discharge Registry was used to identify women with an inpatient diagnosis of pelvic organ prolapse, and the data were linked to the Swedish Medical Birth Registry. Odds ratios (ORs) were estimated using the Mantel-Haenzsel procedure and Cox analyses to estimate hazard ratios. The material was stratified for age and parity. RESULTS: A total of 1.4 million women were investigated. A strong and statistically significant association between cesarean section and pelvic organ prolapse was found. Adjusted OR was 0.18 (0.16-0.20) and overall hazard ratio 0.20 (0.18-0.22). CONCLUSION: Cesarean section is associated with a lower risk of pelvic organ prolapse than vaginal delivery.
PubMed ID
19254581 View in PubMed
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Coital incontinence and vaginal symptoms and the relationship to pelvic floor muscle function in primiparous women at 12 months postpartum: a cross-sectional study.

https://arctichealth.org/en/permalink/ahliterature263772
Source
J Sex Med. 2015 Apr;12(4):994-1003
Publication Type
Article
Date
Apr-2015
Author
Merete Kolberg Tennfjord
Gunvor Hilde
Jette Stær-Jensen
Franziska Siafarikas
Marie Ellström Engh
Kari Bø
Source
J Sex Med. 2015 Apr;12(4):994-1003
Date
Apr-2015
Language
English
Publication Type
Article
Keywords
Abdominal Muscles - physiopathology
Adult
Aged
Cross-Sectional Studies
Female
Health Behavior
Humans
Manometry
Muscle Strength - physiology
Norway
Parity
Pelvic Floor - physiopathology
Postpartum Period - physiology
Pressure
Questionnaires
Sexual Behavior
Urinary Incontinence - physiopathology
Vagina - physiopathology
Abstract
Symptoms related to sexual dysfunction postpartum are scarcely addressed in the literature, and the relationship to pelvic floor muscle (PFM) function is largely unknown.
The aim of this study was to investigate primiparous women 12 months postpartum and study: (i) prevalence and bother of coital incontinence, vaginal symptoms, and sexual matters; and (ii) whether coital incontinence and vaginal symptoms were associated with vaginal resting pressure (VRP), PFM strength, and endurance.
International Consultation on Incontinence Modular Questionnaire (ICIQ) sexual matters module and ICIQ-Vaginal Symptoms Questionnaire were used for questions on coital incontinence, vaginal symptoms, and sexual matters, respectively. PFM function was assessed by manometer (Camtech AS, Sandvika, Norway).
Coital incontinence, vaginal symptoms, and PFM function were the main outcome measures.
One hundred seventy-seven primiparous women, mean age 28.7 (standard deviation [SD] 4.3) participated. Of the 94% of women having sexual intercourse, coital incontinence was found for 1.2% whereas 34.5% reported at least one vaginal symptom interfering with the sexual life of primiparous women. Of the symptoms investigated, "vagina feels dry," "vagina feels sore," and "vagina feels loose or lax" were most prevalent, but the overall impact on the woman's sexual life was minimally bothersome, mean 1.4 out of 10 (SD 2.5). Women reporting "vagina feels loose or lax" had lower VRP, PFM strength, and endurance when compared with women without the symptom.
Twelve-month postpartum coital incontinence was rare, whereas the prevalence of vaginal symptoms interfering with sexual life was more common. The large majority of primiparous women in our study had sexual intercourse at 12 months postpartum and the reported overall bother on sexual life was low. Women reporting "vagina feels loose or lax" had lower VRP, PFM strength, and endurance when compared with women without the symptom.
PubMed ID
25648191 View in PubMed
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Comparison of two methods for measuring the pubococcygeal line from sagittal-plane magnetic resonance imaging.

https://arctichealth.org/en/permalink/ahliterature133310
Source
Neurourol Urodyn. 2011 Nov;30(8):1613-9
Publication Type
Article
Date
Nov-2011
Author
Stéphanie Madill
An Tang
Stéphanie Pontbriand-Drolet
Chantal Dumoulin
Author Affiliation
Centre de Recherche de l'institut Universitaire do Gériatrie de Montréal, Montréal, Québec, Canada.
Source
Neurourol Urodyn. 2011 Nov;30(8):1613-9
Date
Nov-2011
Language
English
Publication Type
Article
Keywords
Aged
Anatomic Landmarks
Coccyx - anatomy & histology - physiology
Female
Humans
Joints - anatomy & histology - physiology
Magnetic Resonance Imaging
Middle Aged
Movement
Muscle Contraction
Observer Variation
Pelvic Floor - anatomy & histology - physiology
Quebec
Reproducibility of Results
Sacrum - anatomy & histology - physiology
Urethra - anatomy & histology
Uterus - anatomy & histology
Vagina - anatomy & histology
Abstract
The pubococcygeal line (PCL) is an important reference line for determining measures of pelvic organ support on sagittal-plane magnetic resonance imaging (MRI); however, there is no consensus on where to place the posterior point of the PCL. As coccyx movement produced during pelvic floor muscle (PFM) contractions may affect other measures, optimal placement of the posterior point is important. This study compared two methods for measuring the PCL, with different posterior points, on T2-weighted sagittal MRI to determine the effect of coccygeal movement on measures of pelvic organ support in older women.
MRI of the pelvis was performed in the midsagittal plane, at rest and during PFM contractions, on 47 community-dwelling women 60 and over. The first PCL was measured to the tip of the coccyx (PCLtip) and the second to the sacrococcygeal joint (PCLjnt). Four measures of pelvic organ support were made using each PCL as the reference line: urethrovesical junction height, uterovaginal junction height, M-line and levator plate angle.
During the PFM contraction the PCLtip shortened and lifted (P??0.05). The changes in the four measures of pelvic organ support were smaller when measured relative to the PCLtip as compared to those to the PCLjnt (P?
PubMed ID
21717498 View in PubMed
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Conservative management of urinary incontinence.

https://arctichealth.org/en/permalink/ahliterature166072
Source
J Obstet Gynaecol Can. 2006 Dec;28(12):1113-25
Publication Type
Article
Date
Dec-2006
Author
Magali Robert
Sue Ross
Scott A Farrel
William Andrew Easton
Annette Epp
Lise Girouard
Chandra Gupta
Francois Lajoie
Danny Lovatsis
Barry MacMillan
Joyce Schachter
Jane Schulz
David H L Wilkie
Author Affiliation
Calgary AB.
Source
J Obstet Gynaecol Can. 2006 Dec;28(12):1113-25
Date
Dec-2006
Language
English
French
Publication Type
Article
Keywords
Canada
Evidence-Based Medicine
Female
Humans
Life Style
Pelvic Floor - physiology
Societies, Medical
Treatment Outcome
Urinary Incontinence - therapy
Abstract
To outline the evidence for conservative management options for treating urinary incontinence.
Conservative management options for treating urinary incontinence include behavioural changes, lifestyle modification, pelvic floor retraining, and use of mechanical devices.
To provide understanding of current available evidence concerning efficacy of conservative alternatives for managing urinary incontinence; to empower women to choose continence therapies that have benefit and that have minimal or no harm.
Notes
Comment In: J Obstet Gynaecol Can. 2007 Mar;29(3):216-7; author reply 21717346489
PubMed ID
17169236 View in PubMed
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[Cutting down the waiting list for women with urinary incontinence and/or descending genitalia].

https://arctichealth.org/en/permalink/ahliterature215377
Source
Ugeskr Laeger. 1995 Apr 3;157(14):2012-4
Publication Type
Article
Date
Apr-3-1995
Author
I K Nielsen
A L Mouritsen
A. Berget
Author Affiliation
gynaekologisk/obstetrisk afdeling, Amtssygehuset i Gentofte.
Source
Ugeskr Laeger. 1995 Apr 3;157(14):2012-4
Date
Apr-3-1995
Language
Danish
Publication Type
Article
Keywords
Denmark
Efficiency, Organizational
Female
Humans
Pelvic Floor - physiopathology
Time Factors
Urinary Incontinence - complications - diagnosis - surgery
Waiting Lists
PubMed ID
7740642 View in PubMed
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64 records – page 1 of 7.