Disease relevance of Pelvic Floor

• Elevated cystatin C, by suppressing cysteine proteinase activity, may strengthen the vaginal wall and mitigate the potential for pelvic floor prolapse [1].
• RESULTS: Injection of BTX appears to have a positive therapeutic effect in multiple urological conditions, including detrusor hyperreflexia and detrusor external sphincter dyssynergia, and nonneurogenic conditions such as pelvic floor spasticity, refractory overactive bladder and, possibly, benign prostatic hyperplasia [2].
• We conclude that cisapride is effective in the treatment of some children with intractable constipation without pelvic floor dyssynergia [3].
• In spite of these differences, the histopathologic changes observed in the pelvic floor muscles of uPA-/- mice with rectal prolapse suggest that prolonged muscular stretching causes a primary myopathic injury [4].
• Treatments include oral medications that decrease nerve hypersensitivity (e.g., tricyclic antidepressants, selective serotonin reuptake inhibitors, anticonvulsants), pelvic floor biofeedback, cognitive behavioral therapy, local treatments, and (rarely) surgery [5].

High impact information on Pelvic Floor

• Duloxetine or duloxetine plus pelvic floor muscle training (PFMT) were more effective in reducing the median IEF than PFMT alone or no treatment in women with SUI [6].
• While the entire pelvic floor was imaged, special attention was paid to the contours of the levator ani muscle group which were drawn on T1-weighted axial and coronal images [7].
• Eliminating muscular contraction of the pelvic floor does not significantly alter VLPP results [8].
• CONCLUSIONS: Men with CPPS have more abnormal pelvic floor muscular findings compared with a group of men without pain [9].
• CONCLUSIONS: A combined conservative medical and computer game assisted pelvic floor muscle retraining program appears to have decreased the incidence of breakthrough urinary tract infections and facilitated reflux resolution in children with voiding dysfunction and vesicoureteral reflux [10].

Chemical compound and disease context of Pelvic Floor

• A possible effect of estrogen treatment of urinary incontinence must be mediated via other structures than the pelvic floor muscles [11].
• Initial management of stress urinary incontinence: pelvic floor muscle training and duloxetine [12].

Biological context of Pelvic Floor

• To resolve the lack of methodological clarity and the need for normative values for the use of pelvic floor motor evoked potentials (MEPs), 30 healthy women and 16 women with MS were studied [13].
• PURPOSE OF REVIEW: This review discusses recently published data concerning the anabolic effects of androgens on muscle and the mechanism by which testosterone regulates body composition with special emphasis on the anabolic effects of androgens on the muscles of the pelvic floor and lower urinary tract [14].
• MR-CCRG was performed with the patient in a supine position using a True FISP sequence (1 image/1.2 s; in-plane resolution 1.02 mm) during pelvic floor contraction, relaxation, and straining maneuvers [15].
• CONCLUSION: Despite the suggestion that benzodiazepines, especially diazepam, are useful for the relaxation of pelvic floor striated musculature in voiding dysfunctions, there was no effect on urodynamic variables when midazolam was used in a single dose intranasally [16].

Anatomical context of Pelvic Floor

• Previous physiological and behavioral studies have shown that the nucleus raphe obscurus (nRO) modulates pelvic floor reflex function (Yamanouchi and Kakeyama [1992] Physiol. Behav. 51:575-579; Beattie et al. [1996] Soc. Neurosci. Abstr. 22:722.4; Holmes et al. [1997] Brain Res. 759:197-204) [17].
• Serial macrosections of the bladder base, cervix, lower rectum and pelvic floor complex, cut in coronal (4 cases) and horizontal (10 cases) planes, were stained with azan-Mallory, and the remaining 4 were cut in the horizontal plane and plastinated using von Hagens E12 technique [18].
• CONCLUSION: Estrogen, but not raloxifene, increases collagen gene transcription and indicates stimulation of collagen synthesis in pelvic floor connective tissues [19].
• Immediately following injection into the subcutaneous tissues, the deeper tissues, of the pelvic floor are anesthetized by injecting 5 cm3 lidocaine solution with approximately 16 passes of a 25-gauge 1.5-inch needle entering perpendicular to the skin surface [20].
• These physiological studies demonstrate that in patients with MS who had anorectal dysfunction, there is a marked impairment of external anal sphincter function with moderate changes in pelvic floor musculature.(ABSTRACT TRUNCATED AT 250 WORDS)[21]

Associations of Pelvic Floor with chemical compounds

• In addition, the levator ani fibers diverted more laterally (42 vs 22 degrees), the pelvic floor in coronal view was more flat (103 vs 80 degrees) and the anus was more anteriorly displaced (2.8 vs 4.4 cm) [22].
• Analysis of regional norepinephrine content in the rabbit bladder after acute electrical pelvic floor stimulation [23].
• Furthermore, a review of the literature on estrogen receptors in the pelvic floor muscles is given [11].
• CONCLUSION: Raloxifene does not increase pelvic floor relaxation [24].
• Vicryl mesh in pelvic floor reconstruction [25].

Gene context of Pelvic Floor

• OBJECTIVE: The purpose of this study was to determine whether estrogen suppresses matrix metalloproteinase-2 and -9 proenzyme expression by fibroblasts that are derived from the supportive connective tissue of the pelvic floor [26].
• Future investigations are warranted to help define the role of elastin turnover in pelvic floor dysfunction [27].
• CONCLUSIONS: Our results indicate an altered metabolism of connective tissue in the periurethral region with a significant decrease of collagen and vitronectin expression in postmenopausal women with pelvic floor relaxation with and without GSI [28].
• Expression of LHR in the pelvic floor compartments suggests that high LH levels in postmenopausal women may contribute to the pelvic floor relaxation and increased incidence of pelvic floor disorders [29].
• These differences between normal and incontinent patients were significant (P = 0.01) using the Wilcoxon Rank Sum Test. The findings support the hypothesis that idiopathic (neurogenic) faecal incontinence is due to damage to the nerve supply of the pelvic floor musculature [30].

Analytical, diagnostic and therapeutic context of Pelvic Floor

• Electrical stimulation to the pelvic floor musculature (group 1) increased norepinephrine content both in the bladder base and the body (P < 0.01) [31].
• A new synthetic absorbable mesh made of polyglactin 910 (Vicryl) fiber was used to reconstruct the pelvic floor in seven women undergoing pelvic exenteration [25].
• Re: "The pelvic floor muscles: muscle thickness in healthy and urinary-incontinent women measured by perineal ultrasonography with reference to the effect of pelvic floor training. Estrogen receptor studies." Neurourol. Urodynam. 1997;16:237-275 [32].
• The secondary outcome measures included a Visual Analog Scale describing the perceived burden of incontinence, the Urogenital Distress Inventory, the Incontinence Impact Questionnaire, and pelvic floor muscle function measurements [33].
• Prophylactic perioperative use of clindamycin and metronidazole in vaginal hysterectomy without pelvic floor repair [34].

References