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.

Previous studies mainly focused on the relationship between the size of the prolapse and injury to the supporting tissues, but the strain and stress distributions of the supporting tissues as well as high-risk areas of injury are still unknown. To further investigate the effect of supporting tissues on organs and the interactions between organs, this study focused on the relationship between high intra-abdominal pressure and the compliance of the pelvic floor support system in a normal woman without pelvic organ prolapse (POP), using a finite element model of the whole pelvic support system. A healthy female volunteer (55 years old) was scanned using magnetic resonance imaging (MRI) during rest and Valsalva maneuver. According to the pelvic structure contours traced by a gynecologist and anatomic details measured from dynamic MRI, a finite element model of the whole pelvic support system was established, including the uterus, vagina with cavity, cardinal and uterosacral ligaments, levator ani muscle, rectum, bladder, perineal body, pelvis, and obturator internus and coccygeal muscles. This model was imported into ANSYS software, and an implicit iterative method was employed to simulate the biomechanical response with increasing intra-abdominal pressure. Stress and strain distributions of the vaginal wall showed that the posterior wall was more stable than the anterior wall under high intra-abdominal pressure. Displacement at the top of the vagina was larger than that at the bottom, especially in the anterior–posterior direction. These results imply potential injury areas with high intra-abdominal pressure in non-prolapsed women, and provide insight into clinical managements for the prevention and surgical repair plans of POP.

The coordination of bladder function with behavior depends on distributed neural circuits, but cortical activity associated with detrusor overactivity (DO) remains incompletely understood. We used miniature two-photon calcium imaging to record neuronal activity in the primary motor cortex (M1) of freely moving mice during urination. Individual neurons were classified as Direct-ON, Direct-OFF, or Direct-Other according to a permutation-based comparison between their calcium activity and synchronized urination behavior. In DO mice, Direct-OFF neurons exhibited increased activity around urination onset, whereas Direct-ON neurons exhibited increased activity around urination termination. Differences in the spatial distribution of these functionally classified neuronal populations were also observed. Trospium chloride altered urination behavior, while selected abnormalities in M1 neuronal activity and spatial organization remained detectable. Pyridostigmine bromide did not produce clear changes in the measured behavioral or neuronal abnormalities. In trospium-treated DO mice, region-wide chemogenetic inhibition of M1 was associated with additional changes in urination frequency and duration. Because functionally defined ON/OFF neuronal subtypes were not selectively manipulated and a DO plus chemogenetic-inhibition-only group was not included, the present findings identify altered M1 neuronal dynamics as a cortical correlate of bladder dysfunction but do not establish M1 activity as its primary cause or demonstrate the therapeutic efficacy of combined pharmacological and chemogenetic intervention.

Background/Objectives: Pregnancy and childbirth are independent risk factors for pelvic floor injury. The choice of delivery position, as an interventionable factor during labor, has received much attention. This study aimed to assess the impact of sitting delivery on pelvic floor function by observing the outcomes of the perineum, duration of the second stage of labor, integrity of pelvic floor structure, and postpartum pelvic floor function. The goal was to provide scientific evidence for optimizing delivery management and reducing the risk of pelvic floor injury. Methods: This was a non-randomized study (based on patient choice). A total of 222 primiparous women who delivered at our hospital from February to August 2023 were selected and divided into the control group (n = 88) and the sitting group (n = 134). The second stage of labor in the control group was delivered in the traditional bladder lithotomy position, while the sitting group delivered in a sitting position. The duration of the second stage of labor, delivery method, degree of perineal laceration, postpartum 2 h bleeding volume, and the occurrence of urinary incontinence and sexual dysfunction 1 year after delivery were observed in both groups. Results: The rate of perineal lateral incision in the sitting group was lower than that in the control group (24.6% vs. 48.9%, aOR = 0.37, p < 0.001); the adjusted mean difference in second-stage duration was −11.65 min (95% CI: −25.35 to 2.05, p = 0.095), indicating no statistically significant difference after adjustment. In unadjusted subgroup analysis, a larger point estimate for reduction was observed in women aged < 30 years (median difference −16.0 min, p = 0.033), but the interaction test was not significant. For urinary incontinence and sexual dysfunction, there were no statistically significant differences between the two groups. Conclusions: Sitting delivery was associated with a lower episiotomy rate and, in unadjusted analysis, a shorter second stage (although the adjusted difference was not significant), and it did not increase the incidence of urinary incontinence or sexual dysfunction at one year postpartum.