Search Results (13)

Background: Pelvic floor dysfunction, more prevalent in women but affecting both genders, impairs sphincter control and sexual health, and causes pelvic pain. Pelvic floor muscle (PFM) training is the first-line treatment for urinary incontinence, supported by robust evidence. Rehabilitative ultrasound imaging (RUSI) serves as a visual biofeedback tool, providing real-time imaging to enhance PFM training, motor learning, and treatment adherence. Aim: This narrative review evaluates the role and efficacy of RUSI in pelvic floor rehabilitation. Method: A comprehensive search of PubMed, Cochrane, and MEDLINE was conducted using keywords related to pelvic floor rehabilitation, ultrasound, and biofeedback, limited to English-language publications up to July 2025. Systematic reviews, meta-analyses, and clinical trials were prioritized. Results: Transperineal and transabdominal ultrasound improve PFM function across diverse populations. In post-prostatectomy men, transperineal ultrasound-guided training enhanced PFM contraction and reduced urinary leakage. In postpartum women with pelvic girdle pain, transabdominal ultrasound-guided biofeedback combined with exercises decreased pain and improved function. Ultrasound-guided pelvic floor muscle contraction demonstrated superior performance compared to verbal instruction. Notably, 57% of participants who were unable to contract the pelvic floor muscles with verbal cues achieved a correct contraction with ultrasound biofeedback, and this approach also resulted in more sustained improvements in PFM strength. Compared to other biofeedback modalities, RUSI demonstrated outcomes that are comparable to or superior to those of alternative methods. However, evidence is limited by a lack of standardized protocols and randomized controlled trials comparing RUSI with other modalities. Conclusions: RUSI is an effective visual biofeedback tool that enhances outcomes of PFM training in pelvic floor rehabilitation. It supports clinical decision-making and patient engagement, particularly in cases where traditional assessments are challenging. Further research, including the development of standardized protocols and comparative trials, is necessary to optimize the clinical integration of this method and confirm its superiority over other biofeedback methods. Full article

Background/Objectives: Postpartum women frequently experience nonspecific low back pain (NSLBP), yet the impact of delivery mode on the function of local core muscles, particularly the transversus abdominis (TrA) and lumbar multifidus (LM), is not well understood, limiting the development of targeted rehabilitation strategies. To compare NSLBP intensity and TrA and LM strength in women who underwent cesarean delivery (CD) or vaginal delivery (VD), and to examine the associations between pain intensity and muscle strength. Methods: An analytical cross-sectional study was conducted on 36 women divided into two groups: 18 who underwent CD (Group A) and 18 who underwent VD (Group B). NSLBP intensity was assessed using the visual analogue scale, while TrA and LM strength were measured via a pressure biofeedback unit. Results: The two groups showed non-significant differences in age (p = 0.342), BMI (p = 0.429), or parity (p = 0.894), confirming comparable baseline characteristics. NSLBP intensity was significantly higher in the CD group (p = 0.000), and they exhibited weaker TrA (p = 0.009) strength than the VD group; however, there was a non-significant difference in LM strength (p = 0.602). The Spearman correlation analysis revealed non-significant associations between NSLBP intensity and TrA and LM strength in the CD group (p = 0.702, 0.129, respectively) and in the VD group (p = 0.149, 0.877, respectively). Conclusions: Women undergoing CD experienced higher NSLBP intensities and weaker TrA strength than those undergoing VD, while LM strength remained similar between groups. However, NSLBP intensity showed non-significant associations with TrA or LM strength in either group, suggesting that other biomechanical or neuromuscular factors may contribute to the increased post-CD NSLBP. These findings highlight the need for targeted rehabilitation strategies beyond core muscle strengthening alone. Full article

Background: Diastasis recti abdominis (DRA) is a common postpartum condition typically managed with rehabilitation exercises. Given its high prevalence and postpartum barriers in attending in-person sessions, telerehabilitation may offer a feasible alternative. This small pilot study evaluates the preliminary effectiveness and user satisfaction of a 12-week telerehabilitation exercise program for women with postpartum DRA. Methods: Parous women with DRA participated in a 12-week trunk stabilization program, including synchronous and asynchronous sessions, from April 2024 to May 2025. The primary outcome was satisfaction (Telehealth Usability Questionnaire—TUQ_Greek and two additional custom-made questions). Secondary outcomes included inter-recti distance (IRD), trunk muscle endurance tests, body image (BISS_Greek), and adherence to exercise. Results: Thirteen participants aged 37.54 ± 5.49 completed the pilot intervention. Satisfaction was high (TUQ_Greek = 6.28 ± 0.60), with 84.62% (11/13 subjects) rating telerehabilitation as very satisfactory. Statistically significant reductions in IRD were observed at 2 cm (large effect, d = 1.00; 95% CI [0.12 to 0.47]) and 5 cm (large effect, d = 0.81; 95% CI [0.08 to 0.58]) above the umbilicus (p < 0.05). Post-intervention, most trunk muscle endurance tests improved significantly (p < 0.05) at 4 and 12 weeks (large effect, η² = 0.44 to–0.56). Body image (BISS_Greek) also improved post-intervention (p < 0.05, medium to large effect, d = −0.73; 95% CI [(–1.75 to –0.16]). Mean adherence reached 71.37%. Conclusions: This small pilot supports the feasibility and acceptability of a telerehabilitation program as well as its effectiveness in improving key clinical outcomes. However, since this was a small pilot, generalizability might be limited by the small sample size and should be confirmed in larger studies. Full article

Background: Pregnancy and lactation-associated osteoporosis is a rare cause of severe skeletal fragility in young women typically presenting with vertebral compression fractures during late pregnancy or postpartum. Its rarity and lack of risk factors often delay diagnosis. Case presentation: The patient was a 34-year-old pregnant Italian woman, presenting with severe osteoporosis related to pregnancy and lactation. The patient presented for the first time at the Outpatient clinic of the Rehabilitation Unit in the Department of Public Health at the University of Federico II, Naples in March 2024, exhibiting severe symptoms indicative of osteoporosis, along with acute lower back pain. During the anamnesis, it was revealed that the patient was unable to bend forward, with reduced flexion and extension movements. The symptoms began during the third trimester. Management and diagnosis: In terms of diagnosis, clinical exams were conducted to confirm the disease. The MRI exam showed fractures and vertebral variations, with significant findings including calcification. Additionally, DXA indicated lower values compared to normal Treatment included: breastfeeding cessation, correction of calcium and vitamin D deficiencies, and bisphosphonate injection therapy. It is noteworthy that the rehabilitative approach has been recommended throughout pharmacological treatment and especially upon its suspension. Ultimately, the primary cause of this condition was pregnancy as bone resorption increases during pregnancy. Outcome: Following clodronate treatment completion, the patient showed full clinical recovery and significant radiological improvement. Follow-up DXA one year after diagnosis revealed normalized bone density and the patient had gained autonomy in activities of daily living with no further symptoms. Full article

Background: Pelvic girdle pain (PGP) is described in the literature as a subgroup of low back pain (LBP), characterized by pain localized between the posterior iliac crest and the gluteal fold, particularly near the sacroiliac joints. This condition can manifest in different forms non-specific PGP, occurring during pregnancy or postpartum (pregnancy-related PGP), which represents the most prevalent form and non-pregnancy-related PGP, resulting from mechanical alterations caused by trauma or microtrauma. Specific PGP, associated with identifiable causes such as fractures, infections, or arthritis. Over the years, research has focused on identifying the most effective approaches for managing this condition and addressing its associated biopsychosocial impairments. The aim of this narrative review is to determine the types of motor control exercises (MCEs) used to reduce short-term pain in patients with PGP and to assess whether these exercises are designed in accordance with the principles of motor control (MC) theories. Methods: A narrative review was conducted through searches in various medical and rehabilitation databases, including MEDLINE (via PubMed), PEDro, Scopus, and Web of Science. The inclusion criteria of the review encompassed case studies, case reports, editorials, original research articles, randomized controlled trials (RCTs), and systematic reviews (SRs). Results: Six articles met the eligibility criteria, comprising two SRs and four RCTs, all of which were included in the qualitative analysis. Among these, two studies examine MCEs for non-pregnancy-related PGP, while all the other studies focus on pregnancy-related PGP. The exercises described focused on lumbar–pelvic stabilization or deep spinal muscle activation. Among the six included studies, five did not report statistically significant changes in pain outcomes, while only one study demonstrated a statistically significant improvement. Conclusions: The analysis highlighted that the exercises currently employed are generally unspecific and not systematically structured according to the principles outlined in MC theories. The available evidence, combined with the incorrect design of these exercises, does not allow for definitive conclusions regarding the efficacy of MCEs in reducing short-term pain in patients with both pregnancy-related and non-pregnancy-related PGP. Full article

Acute cardiovascular disorders are incriminated in up to 33% of maternal deaths, and the presence of sickle cell anemia (SCA) aggravates the risk of peripartum complications. Herein, we present a 24-year-old Caribbean woman with known SCA who developed a vaso-occlusive crisis at 36 weeks of gestation that required emergency Cesarean section. In the early postpartum period, she experienced fever with rapid onset of acute respiratory distress in the context of COVID-19 infection that required tracheal intubation and mechanical ventilatory support with broad-spectrum antibiotics and blood exchange transfusion. Shortly thereafter, transthoracic echocardiography documented severe biventricular dysfunction associated with raising levels of cardiac troponin and ECG signs of myocardial ischemia. Medical treatment with incremental dobutamine and noradrenaline infusion failed to improve cardiac output and blood gas exchange. After consultation with the regional cardiac center, a prompt decision was made to provide cardiac and respiratory support via implantation of femoral cannula and initiation of veno-arterial extracorporeal membrane oxygenation (ECMO, Cardiohelp^®). Under stable ECMO, the patient was transferred by helicopter to a specialized cardiac center. There were no signs of ongoing hemolysis, and progressive recovery of the right and left ventricular function facilitated forward blood flow through the aortic valve. Three days after implantation, ECMO was weaned, and the cannula were removed. One day later, the patient’s chest X-rays showed partial resolution of lung edema. The patient was successfully extubated, and non-invasive ventilation with pulmonary rehabilitation was initiated to speed up her functional recovery. 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

Background: Stress urinary incontinence (SUI) is a prevalent condition among women in Saudi Arabia, characterized by involuntary urine leakage during physical activities that increase abdominal pressure, such as coughing or sneezing. This systematic review and meta-analysis aimed to evaluate the prevalence of SUI and identify its key risk factors. Methods: A comprehensive search of PubMed, Scopus, and Web of Science was conducted for studies published up to July 2024, following PRISMA 2020 guidelines. Results: Ten observational studies involving 18,245 participants met the inclusion criteria, and study quality was assessed using the Newcastle–Ottawa Scale. A random-effects model was employed for meta-analysis, with subgroup and sensitivity analyses performed to address heterogeneity. The pooled prevalence of SUI was 26% (95% CI: 14–41%, I² = 99%, p < 0.001), with rates ranging from 3.3% to 50%. Subgroup analysis showed a prevalence of 17% (95% CI: 1–42%, I² = 99%, p < 0.001) in the general population and 33% (95% CI: 19–48%, I² = 99%, p < 0.001) in specific groups, such as postpartum women and those with low back pain. Significant risk factors included age, obesity, high parity, and chronic conditions like diabetes. Despite high heterogeneity, sensitivity analyses confirmed the robustness of these findings. Conclusions: The findings underscore the need for public health strategies focused on weight management, pelvic floor rehabilitation, and increased awareness about SUI. Effective preventive measures could significantly reduce the burden of SUI and improve the quality of life for women in Saudi Arabia. Full article

Carpal tunnel syndrome is a common entrapment neuropathy that can occur in the upper limbs during pregnancy. However, it is often undervalued and underdiagnosed because the symptoms can be mistaken for regular changes during pregnancy. Delay or absence of diagnosis and treatment can lead to permanent nerve damage, which can affect a woman’s quality of life during and after pregnancy. Although the treatment protocols are well established for carpal tunnel syndrome in patients from the general population, there is a different situation among pregnant and postpartum women that requires a preventive and personalized approach to manage this pathology. Unfortunately, the range of available treatment options is limited due to the pregnant woman’s physiological status and influenced by the high possibility of the complete resolution of this pathology in the postpartum period without any treatment. To limit the possibility of unfavorable evolution of this syndrome during pregnancy, an early diagnosis and personalized approach are mandatory in each case involving a multidisciplinary team of general practitioners, obstetricians, hand surgeons, rehabilitation physicians, physiotherapists, and occupational therapists. Full article

Background: There is a risk of pelvic floor dysfunction (PFD) from baby delivery. Many clinical guidelines recommend pelvic floor muscle training (PFMT) as the conservative treatment for PFD because pelvic floor muscles (PFMs) play a crucial role in development of PFD. However, there is disagreement about the method and intensity of PFM training and the relevant measurements. To pilot the study in PFM training, we designed a Pelvic Floor Workout (PEFLOW) for women to train their pelvic through entire body exercises, and we planned a trial to evaluate its effectiveness through comparing the outcomes from a group of postpartum women who perform PELFLOW at home under professional guidance online with the control group. Methods/design: The randomized controlled trial was projected to be conducted from November 2021 to March 2023. A total of 260 postpartum women would be recruited from the obstetrics departments of the study hospital and women would be eligible for participation randomized into experimental or control groups (EG/CG) if their PFM strength are scaled by less than Modified Oxford grading Scale (MOS) to be less than grade 3. Women in EG would perform a 12-week PEFLOW online under the supervision and guidance of a physiotherapist, while women in CG would have no interventions. Assessments would be conducted at enrollment, post intervention (for EG) or 18th to 24th week postpartum (for CG), and 1 year postpartum. Assessment would be performed in terms of pelvic floor symptoms, including MOS, cough stress test, urinary leakage symptoms, pelvic organ prolapse quantitation (POP-Q), and vaginal relaxation, clinic examinations including Pelvic floor electrophysiological test, Pelvic floor ultrasound and Spine X-ray, overall body test including trunk endurance test, handgrip test, body composition test, and questionnaires including International Physical Activity Questionnaire Score-Short Form(IPAQ-SF), Pelvic Floor Distress Inventory Questionnaire-20 (PFDI-20), Pelvic Floor Impact Questionnaire-7 (PFIQ-7), the 6-item Female Sexual Function Index (FSFI-6), and the Pittsburgh Sleep Quality Index (PSQI). Primary analysis will be performed to test our main hypothesis that PEFLOW is effective with respect to strengthen PFM strength. Discussion: This trial will demonstrate that pelvic floor-care is accessible to most women and clinical practice on PFD may change relevantly should this study find that Online PEFLOW approach is effective to improve PFMs. Trial registration: ClinicalTrials.gov, NCT05218239. Full article

To investigate the efficacy of exercise intervention using a real-time video conferencing platform (ZOOM) on inter-recti distance, abdominal muscle thickness, static trunk endurance, and maternal quality of life, 37 women with diastasis recti between six months and one year postpartum were randomly divided into the online (n = 19) and offline (n = 18) groups. The online group underwent 40-min trunk stabilization exercise sessions twice a week for six weeks, through a real-time video conference platform, while the offline group attended the same program in person. The inter-recti distance and muscle thickness between the abdominal muscles were measured by rehabilitation ultrasound imaging, the Torso endurance test was used to compare the static trunk endurance, and the maternal quality of life questionnaire (MAPP-QOL, score) was applied. Significant improvements were observed in the inter-recti distance between the rectus abdominis, abdominal muscle thickness, static trunk endurance, and maternal quality of life in both groups (p < 0.001); a more significant improvement was observed in the offline group. No significant differences were observed between groups except for the left rectus abdominis thickness and Psychological/Baby and Relational/Spouse-Partner subscale in the maternal quality of life index (p > 0.05). Exercise interventions delivered in a real-time videoconferencing platform are effective at improving the inter-recti distance, trunk stability, and quality of life in postpartum women and may be an alternate to face-to-face intervention. Full article

This study investigated the necessity for a parenting record handbook that is specifically tailored to the needs of low birth weight infants (LBWIs) and their families, especially mothers, who face parenting difficulties and challenges. The participants were 20 mothers, raising LBWIs, discharged from the neonatal intensive care unit. The mean age and weight of the children were 2.75 ± 0.35 years and 1417.50 ± 152.06 g, respectively; the mean duration of neonatal intensive care unit hospitalization was 78.75 ± 14.10 days. At the time of the study, 35% (7/20) were nursery children, 10% (2/20) were kindergarten children, 20% (4/20) were using rehabilitation centers, and 10% (2/20) were using the medical rehabilitation handbook. The needs of the mothers were investigated through focus group interviews or individual interviews, and content analyses were performed. The mothers required the promotion of peer support that assists the alleviation of mental burden and postpartum mental and physical care, as well as the publication of counseling service counters and reliable information sources for parenting difficulties in the parenting record handbook. The mothers required the publication and recording of the growth indicators of LBWIs, parenting records, information management of children since birth, and for the handbook to function as a multidisciplinary information sharing tool. In addition, the requirements for the parenting record handbook were the early provision of the parenting record handbook and measures to cope with poor maternal physical condition. The results of this study suggest that mothers with LBWIs require a parenting record handbook that can provide comprehensive maternal and child health assurance, starting from pregnancy, to resolve childcare difficulties for LBWIs, as well as mental support. Full article

Every woman needs to know about the importance of the function of pelvic-floor muscles and pelvic organ prolapse prevention, especially pregnant women because parity and labor are the factors which have the biggest influence on having pelvic organ prolapse in the future. In this article, we searched for methods of training and rehabilitation in prepartum and postpartum periods and their effectiveness. The search for publications in English was made in two databases during the period from August 2020 to October 2020 in Cochrane Library and PubMed. 77 articles were left in total after selection—9 systematic reviews and 68 clinical trials. Existing full-text papers were reviewed after this selection. Unfinished randomized clinical trials, those which were designed as strategies for national health systems, and those which were not pelvic-floor muscle-training-specified were excluded after this step. Most trials were high to moderate overall risk of bias. Many of reviews had low quality of evidence. Despite clinical heterogeneity among the clinical trials, pelvic-floor muscle training shows promising results. Most of the studies demonstrate the positive effect of pelvic-floor muscle training in prepartum and postpartum periods on pelvic-floor dysfunction prevention, in particular in urinary incontinence symptoms. However more high-quality, standardized, long-follow-up-period studies are needed. Full article