Search Results (46)

The CORE complex refers to the muscles of the core region of the body, including the abdominal muscles, lower back muscles, and diaphragm. Among the various techniques aimed at improving CORE strength and functionality, abdominal hypopressive techniques have gained popularity. Objectives: To evaluate the available scientific literature on the effects of AHT on the CORE complex. Methods: A systematic search was conducted in January 2025 in PubMed, Web of Science, PEDro, Cochrane, ClinicalTrials.gov and Scopus. Only randomized controlled trials (RCTs) involving adults were included. Two reviewers independently selected studies and extracted data. The review was registered in PROSPERO (CRD-42023424933) and followed PRISMA guidelines. Results: Of 258 studies identified, 13 of them met the eligibility criteria for the final review. Showing the application of abdominal hypopressive techniques could have positive effects on the pelvic floor, transverse abdominis muscle, lumbar region, and diaphragm. The average methodological quality of the articles is 6.6 according to the PEDro scale. The risk of bias was high in 12 articles. Conclusions: Although the results show improvements in the CORE muscles after applying abdominal hypopressive techniques, further research is necessary to confirm these findings, given the insufficient methodological quality of the scientific literature and its high risk of bias. Full article

Background: Pelvic floor muscle (PFM) dysfunctions, such as urinary incontinence (UI), significantly impact women’s quality of life. The abdominal hypopressive technique (AHT), a breathing and posture-based intervention, has emerged as a promising approach to improve PFM function. Despite growing evidence on its efficacy, limited research explores its effect on PFM contractility. Objective: This study aimed to evaluate the effects of an 8-week AHT program on pelvic floor muscle (PFM) strength in adult women with no prior experience with AHT. Methods: A randomized controlled trial was conducted with 42 females (mean age 43 ± 9 years) assigned to an experimental group (EG, n = 21) or a control group (CG, n = 21). The EG completed 24 AHT sessions (30 min/session, 3 sessions/week) over 8 weeks. PFM strength, measured via maximum voluntary contraction (MVC), was assessed pre- and post-intervention using the Phenix Biofeedback Kit. Secondary outcomes included load absorption and muscle efficiency. Muscle efficiency and load absorption were also registered. Results: After the 8-week intervention, significant improvements were observed in the EG for maximal voluntary contraction (MVC1 (from 672.2 ± 344.1 g/cm² to 890.3 ± 435.8 g/cm², p = 0.002) and load absorption (from 83.9 ± 36.8 to 103.1 ± 37.3, p = 0.001), with no significant changes in the CG. Between-group differences for MVC1 (p = 0.001), MVC2 (p = 0.016), and load absorption (p = 0.008) were statistically significant. High adherence (96%) and no adverse events were recorded. Conclusions: An 8-week AHT program significantly improved PFM strength, load absorption, and muscle efficiency in women from the present study comparing with the CG. AHT could be considered a safe, non-invasive, and effective intervention for pelvic floor rehabilitation, with potential benefits for addressing UI and enhancing pelvic floor functionality. Future research should focus on long-term outcomes and comparisons with alternative therapies. Full article

Background/Aims: The pelvic floor muscles are important structures involved in pelvic floor tone, pelvic organ support, and continence. The aim of this study was to perform an update on the pelvic floor muscle structure and function alterations of women with pelvic floor dysfunctions. Methods: A systematic search was undertaken in two electronic databases, PubMed/Medline and Ovid Discovery to find manuscripts (in English), published between 1 January 2002 and 31 July 2022, including all clinical studies using the following search terms: “muscle” or “extracellular matrix *” and “pelvic floor dysfunction *”. All clinical trials, observational, or animal studies examining the muscle and reporting pelvic floor dysfunction as a primary outcome were included. Case reports, literature reviews, conference papers and theses, and unpublished data were excluded. To ensure that no eligible articles were overlooked, the reference lists of all included papers underwent manual scrutiny. The bias level was estimated using Newcastle–Ottawa Scale (NOS) for cohort and case-control studies. A qualitative synthesis was performed. Results: The significant qualitative and quantitative heterogeneity between the studies did not allow for a quantitative analysis. Of the 30 articles selected with a total of 5592 women, 15 referred to the analysis of structural muscle defects, which included 3365 participants with urinary incontinence, pelvic organ prolapse, fecal incontinence, cistocele, rectocele, and sexual dysfunction; 10 manuscripts referred to the study of pelvic floor muscle function with a population of 2042 women, such as urinary incontinence, pelvic organ prolapse, fecal incontinence, and sexual dysfunction; and 5 papers evaluated cellular and/or molecular changes affecting the pelvic floor muscles, like urinary incontinence, pelvic organ prolapse, and rectocele, which included a total of 185 participants. Women with pelvic floor muscle defects are at greater risk of pelvic floor dysfunctions, and inversely, women with pelvic floor dysfunctions have more pelvic floor muscle defects than women without pelvic floor dysfunctions. These patients demonstrate a reduction in muscle tone, contraction strength, and resistance, a compromised neuromuscular activity, and an alteration of the normal composition and organization of the muscle cells. Conclusions: Women with pelvic floor dysfunction have anatomical muscle defects, disturbance of muscle function and cellular changes involving muscle cells and nerve fibers. Full article

Background and Objectives: The aim of this study was to compare the effects of pelvic floor muscle contraction training (PFMCT) using verbal education, digital vaginal palpation (DVP), or perineometer on the common errors made during pelvic floor muscle contraction (PFMC) in women. Materials and Methods: A total of 48 women participated, and they were randomly assigned to three groups (Group I: PFMCT with verbal education, n = 16; Group II: PFMCT with DVP, n = 16; and Group III: PFMCT with perineometer, n = 16). Participants who had not previously received PFMCT were evaluated for pelvic floor muscle strength using the Modified Oxford Scale (MOS), and pelvic floor muscle activation was assessed with electromyographic biofeedback (EMG-BF). Possible errors during pelvic floor muscle contraction (gluteal, adductor and/or abdominal muscle contractions, stop breathing (breath holding), enhanced inhaling, and straining) were evaluated through inspection, palpation, or EMG-BF. After pre-training evaluations, all participants received training on pelvic floor. After this general training, each group received PFMCT using the specific training method for their group. After the training, the same evaluations were repeated. The sessions were conducted one-on-one and lasted for an average of one hour. Results: After the training, MOS values increased in Group II and Group III, while EMG-BF values only increased in Group II (p < 0.05). The number of incorrect movements during PFMC decreased after the training in all three groups (p < 0.05). The abdominal muscle contraction value monitored by EMG-BF only decreased in Group II (p < 0.05). Conclusions: Our study demonstrated that the PFMCT applied using the DVP method was more effective in creating more accurate and stronger muscle contractions and reducing common errors when compared to pre- and post-training values. Significant differences were observed between the groups in terms of performance improvements, with Group II showing the most notable progress. These results support the potential for DVP to yield better outcomes when used in PFMT. Full article

Background/Objectives: Female pelvic floor dysfunction (FPFD) is a prevalent condition affecting postpartum women. This study aims to evaluate the effectiveness of a 10-week combined aerobic and resistance training exercise prescription in improving pelvic floor muscle strength and function in postpartum women with FPFD. Methods: Thirty postpartum women diagnosed with FPFD underwent a 10-week exercise intervention. This study adopted a single-group pre–post design. Pelvic floor muscle electromyography assessment indicators were measured before and after the intervention. Results: The exercise intervention significantly improved the maximum value of fast-twitch muscle fibers (type II) and the average value of slow-twitch muscle fibers (type I) while reducing resting tension and variability. Conclusions: A 10-week combined aerobic and resistance training exercise prescription effectively improves pelvic floor muscle strength in postpartum women. It enhances the maximum value of fast-twitch (type II) muscle fibers, reduces rise and recovery times, and improves slow-twitch (type I) muscle fiber function, including increasing the mean value and reducing variability, rise time, and recovery time. Full article

Background/Objectives: Approximately 30% of women experience pelvic pain one year after vaginal delivery, and this increases to 50% during vaginal intercourse. Multimodal physiotherapy is the first-line treatment for myofascial pain of the pelvic floor muscles (PFM), often incorporating emerging technologies like radiofrequency, despite limited evidence supporting its use. The RASDOP study aims to (i) evaluate the effectiveness of multimodal physiotherapy combining therapeutic education, PFM training, and myofascial pain syndrome (MPS) management with or without radiofrequency, in reducing pain and improving sexual function postpartum; and (ii) explore the barriers and facilitators influencing adherence and perceived self-efficacy towards physiotherapy treatment in women with postpartum pelvic pain. Methods: This study employs a randomized clinical trial with a blinded examiner and two parallel groups, followed by a qualitative phenomenological study. A total of 124 postpartum women with pelvic pain (≥4 cm on the visual analogue scale) will be randomized into two groups: a multimodal physiotherapy group (therapeutic education, MPS treatment, and PFM training) and a radiofrequency + multimodal physiotherapy group (same treatment with additional non-ablative radiofrequency). Both groups will receive 12 supervised individual sessions. Assessments will be conducted pre- and post-intervention, and at 3-, 6-, and 12-month stages post-treatment. Primary outcomes include pain intensity and sexual function, while secondary outcomes involve PFM tone, strength, MPS presence, levator ani length, and distress caused by pelvic floor dysfunction. The qualitative study will utilize semi-structured interviews and focus groups analyzed thematically. Results: Radiofrequency is expected to enhance pain relief, sexual function, and PFM relaxation. Insights into adherence and barriers will aid in personalizing physiotherapy interventions. Conclusions: The RASDOP study will provide evidence on the safety and efficacy of radiofrequency in postpartum pelvic pain treatment and shed light on women’s experiences to improve therapeutic outcomes. Full article

Background and Objectives: Pelvic floor dysfunction and sexual health issues are common postpartum due to weakened pelvic muscles, significantly impacting women’s quality of life (QoL). Pelvic floor muscle training (PFMT) is a widely used approach to address these issues. This study aimed to compare the effectiveness of two rehabilitation methods—vibrating vaginal cones (VCG) and PFMT exercises (CG)—in improving pelvic floor muscle strength, reducing dyspareunia, and enhancing sexual function in postpartum women. Materials and Methods: This 1-year retrospective observational analysis evaluated 57 postpartum women presenting with perineal muscle relaxation and sexual dysfunction. Participants were assessed 3 months postpartum (T0) and after 3 months of therapy (T1) at the Pelvic Floor Rehabilitation Clinic of Santa Chiara Hospital, Pisa. Outcomes were measured using the pubococcygeus (PC) test for pelvic floor strength and the Female Sexual Function Index (FSFI) for sexual function. Results: The results revealed significant improvements in pelvic floor muscle strength and sexual function across both groups. While both interventions effectively reduced dyspareunia, the VCG group demonstrated superior outcomes, with 96.67% of participants reporting no pain compared to 80.95% in the CG. FSFI scores improved significantly in both groups, with greater enhancements in arousal, desire, and pain domains observed in the VCG group (p < 0.01). Vaginal cone therapy also resulted in slightly higher gains in overall pelvic floor strength. Conclusions: These findings suggest that vibrating vaginal cones may be a promising option for postpartum pelvic floor rehabilitation, with potential benefits for improving sexual satisfaction and reducing pain. Full article

The first line of treatment for urinary incontinence is pelvic floor muscle (PFM) training, aimed at reducing leakage episodes by strengthening these muscles. However, many women struggle with performing correct PFM contractions or have misconceptions about their contractions. To address this issue, we present a novel PFM contraction quality assessment system. This system combines a PFM contraction detector with a maximal PFM contraction performance classifier. The contraction detector first identifies whether or not a PFM contraction was performed. Then, the contraction classifier autonomously quantifies the quality of maximal PFM contractions across different features, which are also combined into an overall rating. Both algorithms are based on artificial intelligence (AI) methods. The detector relies on a convolutional neural network, while the contraction classifier uses a custom feature extractor followed by a random forest classifier to predict the strength rating based on the modified Oxford scale. The AI algorithms were trained and tested using datasets measured by vaginal dynamometry, combined in some cases with digital assessment results from expert physiotherapists. The contraction detector was trained on one dataset and then tested on two datasets measured with different dynamometers, achieving 97% accuracy on the first dataset and 100% accuracy on the second. For the contraction performance classifier, the results demonstrate that important clinical features can be extracted automatically with an acceptable error. Furthermore, the contraction classifier is able to predict the strength rating within a $\pm 1$ scale point with 97% accuracy. These results demonstrate the system’s potential to enhance PFM training and rehabilitation by enabling women to monitor and improve their PFM contractions autonomously. Full article

Background and Objectives: Urinary incontinence (UI) is the involuntary loss of urine caused by a weakness in the pelvic floor muscles (PFMs) that affects urethral closure. Myostatin, which prevents the growth of muscles, is a protein expressed by human skeletal muscle cells. Indeed, it has been observed that myostatin concentration rises during skeletal muscle inactivity and that suppressing serum myostatin promotes muscle growth and strength. Furthermore, therapeutic interventions that reduce myostatin signalling may lessen the effects of aging on skeletal muscle mass and function. For this reason, the aim of the study was to assess if flat magnetic stimulation technology affects serum myostatin levels, as myostatin can block cell proliferation at the urethral sphincter level. Materials and Methods: A total of 19 women, 75% presenting stress urinary incontinence (SUI) and 25% urgency urinary incontinence (UUI), were enrolled. A non-invasive electromagnetic therapeutic system designed for deep pelvic floor area stimulation was used for eight sessions. Results: The ELISA (enzyme linked immunosorbent assay) test indicated that the myostatin levels in blood sera had significantly decreased. Patients’ ultrasound measurements showed a significant genital hiatus length reduction at rest and in a stress condition. The Pelvic Floor Bother Questionnaire consistently revealed a decrease in mean scores when comparing the pre- and post-treatment data. Conclusions: Effective flat magnetic stimulation reduces myostatin concentration and genital hiatus length, minimizing the severity of urinary incontinence. The results of the study show that without causing any discomfort or unfavourable side effects, the treatment plan significantly improved the PFM tone and strength in patients with UI. Full article

Pelvic floor muscle (PFM) strength is a critical factor for optimal pelvic floor function. Fluctuations in strength values based on different phases of the menstrual cycle (MC) could signify a need for a paradigm shift in evaluating, approaching, and planning training. This research aims to examine and contrast the pelvic floor muscle strength during different phases of the menstrual cycle. A prospective observational study employing digital assessment with the modified Oxford scale and vaginal dynamometry measurements was performed, in order to assess the baseline strength and the contraction strength of the PFMs in eumenorrheic females at three different phases of the MC: the early follicular phase (EFP), the late follicular phase (LFP), and the mid-luteal phase (MLP). During two complete cycles, tympanic temperature and body weight were measured and the urinary luteinizing hormone concentration was tested to determine the time of ovulation. In total, 216 dynamometric measurements of PFM strength were obtained from eighteen nulliparous women (25.72 ± 5.03 years). There were no differences between the baseline strength (p = 0.886) and the contraction strength (p = 0.756) with the dynamometric speculum. In the post hoc analysis, the baseline strength, contraction strength, and strength showed no significant differences between MC phases. As no differences in PFM strength in women were found, the PFMs do not seem to be weaker at any time during the menstrual cycle. It appears that the assessment, establishment, and monitoring of a PFM training program could be initiated at any point in the cycle. Full article

Sarcopenia and pelvic floor disorders (PFDs) are prevalent and often cooccurring conditions in the aging population. However, their bidirectional relationship and underlying mechanisms remain underexplored. This narrative review aims to elucidate this relationship by exploring potential causative interplays, shared pathophysiological mechanisms, and common risk factors. A comprehensive literature search was conducted to identify relevant studies focusing on epidemiological associations, interaction mechanisms, and implications for patient care. While epidemiological studies demonstrate associations between sarcopenia and PFDs, our findings reveal a cyclical relationship where sarcopenia may exacerbate PFDs through mechanisms such as decreased muscle strength and mobility. Conversely, the presence of PFDs often leads to reduced physical activity due to discomfort and mobility issues, which in turn exacerbate the muscle atrophy associated with sarcopenia. Additionally, shared risk factors such as physical inactivity, nutritional deficiencies, metabolic syndrome, and menopausal hormonal changes likely contribute to the onset and progression of both conditions. These interactions underscore the importance of concurrently integrated care approaches that address both conditions. Effective management requires comprehensive screening, the recognition of contributing factors, and tailored exercise regimens supported by a multidisciplinary approach. Future research should focus on longitudinal studies tracking disease progression and evaluating the efficacy of multidisciplinary care models in optimizing patient outcomes. Full article

Background: Exercise can stress the pelvic floor muscles (PFMs). This study sought to assess the strength of the PFMs according to the level of physical exercise. Methods: An analytical observational study was carried out using digital palpation and dynamometry measurements to assess PF strength. Healthy nulliparous women were stratified according to physical exercise (physically active and sedentary) and level of physical exercise (elite, amateur, and sedentary). Results: Fifty-four women were analyzed, with a mean age of 25.64 (5.33) years and a BMI of 21.41 (2.96) kg/m². Differences in the passive force and strength were observed between both groups of women (p < 0.05), and the strength was around two times higher in physically active women (p < 0.05). The strength was similar between elite female athletes and sedentary women (p > 0.05), but statistical differences were found with amateurs (p < 0.05). The PFM strength (p = 0.019) of elite female athletes (0.34 N) was almost half that of amateurs (0.63 N) and twice as strong as that of sedentary women (0.20 N). However, these differences were not significant using digital palpation (p = 0.398). Conclusions: Women who exercise generally have greater PFM strength than women who do not exercise. Physical exercise could strengthen the PFM; however, the high intensity demanded by high-level sports does not seem to proportionally increase the strength of the PFMs. Full article

Urinary incontinence affects approximately 200 million people worldwide. The objective of this study was to investigate the effect of pelvic floor muscle (PFM) training with biofeedback (BF) in women with urinary incontinence in comparison to PFM training alone. The primary outcome was PFM strength with secondary outcomes being the severity of incontinence, other PFM parameters, quality of life (QoL), social life, satisfaction and adherence to treatment. Randomized controlled trials (RCTs) published from 2005 to 2023 in PubMed, MEDLINE, Scopus and Google Scholar were searched and evaluated with the PEDro scale. Nine moderate and two high methodological quality RCTs were selected. There was a statistically significant improvement in all parameters. In five studies, muscle strength and the severity of incontinence were statistically better in the BF group compared to the non-BF group. In most studies, no differences were found for QoL and social life between the groups. For adherence to treatment, the results were ambiguous. Τhe remaining variables (endurance, precontraction, function, adherence and satisfaction) had few studies to support the results. There was moderate level evidence that the group utilizing PFM exercises with BF showed significant improvements in the management of urinary incontinence. Concerning muscle strength and the severity of incontinence, findings were inconclusive, as only in some studies the results were statistically better in the BF group compared to the non-BF group. Full article

Background: Low anterior resection syndrome (LARS) is a series of bowel dysfunction symptoms, including altered bowel frequency, irregular bowel rhythms, fecal incontinence, and constipation. LARS occurs in 80% of patients undergoing sphincter-preserving surgery, affecting patients’ quality of life along with social avoidance. Different measurements and treatments have been raised to deal with LARS, but no systematic standard has been developed. Objective and Methods: To promote the standardization of clinical trials and clinical management of LARS, this review summarizes the latest findings up until 2023 regarding the diagnostic criteria, assessment protocols, and treatment modalities for postoperative LARS in rectal cancer. Results: The diagnostic criteria for LARS need to be updated to the definition proposed by the LARS International Collaborative Group, replacing the current application of the LARS score. In both clinical trials and clinical treatment, the severity of LARS should be assessed using at least one symptom assessment questionnaire, the LARS score or MSKCC BFI, and at least one scale related to quality of life. Anorectal manometry, fecoflowmetry, endoscopic ultrasonography, and pelvic floor muscle strength testing are recommended to be adopted only in clinical trials. After analysis of the latest literature on LARS treatment, a stepwise classification model is established for the standardized clinical management of LARS. Patients with minor LARS can start with first-line treatment, including management of self-behavior with an emphasis on diet modification and medication. Lamosetron, colesevelam hydrochloride, and loperamide are common antidiarrheal agents. Second-line management indicates multi-mode pelvic floor rehabilitation and transanal irrigation. Patients with major LARS should select single or several treatments in second-line management. Refractory LARS can choose antegrade enema, neuromodulation, or colostomy. Conclusions: In clinical trials of LARS treatment between 2020 and 2022, the eligibility criteria and evaluation system have been variable. Therefore, it is urgent to create a standard for the diagnosis, assessment, and treatment of LARS. Failure to set placebos and differentiate subgroups are limitations of many current LARS studies. Randomized controlled trials comparing diverse therapies and long-term outcomes are absent, as well. Moreover, a new scale needs to be developed to incorporate the patient’s perspective and facilitate outpatient follow-up. Though the establishment of a stepwise classification model for LARS treatment here is indispensable, the refinement of the guidelines may be improved by more standardized studies. Full article

Background and objectives: Involuntary loss of urine owed to dysfunction of the detrusor muscle or muscles of the pelvic floor is known as urinary incontinence (UI). In this study, ultrasound monitoring was employed for the first time to measure the usefulness and safety of electromagnetic stimulation for women with Stress or Urge UI. Materials and Methods: A total of 62 women were enrolled, with a mean age of 55.1 (±14.5); 60% of them were menopausal and presented with urinary incontinence (UI). Eight validated questionnaires were used to evaluate Stress UI, prolapse, overactive bladder urge, faecal incontinence, and quality of life, and the whole study population was tested with ultrasounds at the beginning and at the end of the treatment cycle. The device used was a non-invasive electromagnetic therapeutic system composed of a main unit and an adjustable chair applicator shaped for deep pelvic floor area stimulation. Results: Ultrasound measurements and validated questionnaires revealed a consistent and statistically significant (p < 0.01) improvement of the mean scores when pre- and post-treatment data were considered. Conclusions: Study results showed that the proposed treatment strategy led to a significant improvement in Pelvic Floor Muscle (PFM) tone and strength in patients with UI and pelvic floor disorders, without discomfort or side effects. The demonstration was qualitatively carried out with validated questionnaires and quantitatively with ultrasounds exams. Thus, the “chair” device we used represents valuable and effective support that could be widely employed in the gynaecological field for patients affected by different pathologies. Full article