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Breast cancer is currently the most diagnosed type of cancer in the world, with a five-year survival rate of 90%. Survivors develop genitourinary dysfunction symptoms due to cancer treatment, which implies that they have to endure physical and psychological sequelae, with a negative impact on their quality of life. We present a study protocol to verify the effect of radiofrequency (RF) and pelvic floor muscle training (PFMT) for the treatment of genitourinary dysfunction in breast cancer survivors. This is a double-blind, three-arm, randomised clinical trial (Registration: NCT06694519). Participants from two breast cancer associations from Alicante (Spain) will be randomly assigned to one of the three intervention groups (RF, PFMT, RF + PFMT). It will include survivors aged ≥ 18 years who present pelvic dysfunction assessed by the Pelvic Floor Distress Inventory questionnaire (PFDI20) ≥ 100. Pelvic muscle strength, pelvic function, vaginal symptoms, sexual function, self-esteem and quality of life will be evaluated before the intervention, with follow-up at 15 days, 6 months and 1 year after the intervention. RF could offer additional benefits to PFMT due to its proven effectiveness in the treatment of vaginal dryness and dyspareunia. The expected results will have a positive impact on the health and well-being of women with breast cancer, reducing the symptomatology associated with the disease and its treatment, and improving their quality of life, as well as providing value for the development of more effective treatment protocols. ClinicalTrials.gov NCT06694519.

Background Educational and self-care measures are important for women after gynecological pelvic cancer treatment. Pelvic floor muscle training exercises (PFMT) are a conservative treatment for pelvic floor (PF) dysfunction. The purpose is to evaluate the impact of a telerehabilitation and self-care program on PF dysfunctions, reports of urinary incontinence (UI), and physical–emotional factors of participants post-treatment for gynecological pelvic cancer. Methods Two-arm randomized clinical trial: an intervention group (IG) will evaluate the effect of a telerehabilitation program on women undergoing clinical practice of radiotherapy for the treatment of gynecological pelvic cancer and a control group (CG) will maintain the routine. Primary outcome is the prevalence of reports of UI, which will be assessed using the International Consultation on Incontinence Questionnaire—Short Form (ICIQ-SF). The secondary outcomes will be the severity and impact of UI on quality of life, location and perception of pain intensity, presence and intensity of dyspareunia, vaginal stenosis, fecal incontinence (FI), and levels of physical activity. Statistical analysis will be performed by intention-to-treat, and multivariate mixed effects analysis will be used to compare results. Discussion Activities in the context of telerehabilitation using PFMT and self-care can represent a viable and effective solution to minimize the side effects of gynecological cancer treatment and improve women’s quality of life.

Introduction and hypothesis This randomized controlled study with blinding allocation evaluated pelvic floor knowledge (PFK) and the presence of pelvic floor dysfunction (PFD) in women office workers. The effects of receiving pelvic floor muscle (PFM) health education on PFK and PFD were also evaluated. Methods Of 161 female volunteers, 145 (90.0 %, age range 18–69 years) responded. They were randomly allocated to three groups (group A 48, group B 48, group C 49). Online surveys were completed by all groups on three occasions using validated tools (Prolapse and Incontinence Knowledge Quiz, PFDI-20, PFIQ-7) and PFM exercise items. On completion of the baseline survey, groups A and B received an education intervention (group C was the control). Following this, all participants completed the second survey. Two months later, to allow time for the PFM exercises to have an effect, group A attended a re-education presentation, followed by the final survey administered to all groups. The results were analyzed using analysis of variance and Tukey’s test. Results Participants receiving both PFM exercise education interventions (group A) and those receiving only the first education intervention (group B) showed highly significant improvements in PFK compared with the control group (both p  < 0.001). The groups receiving PFM exercise education also showed a highly significant decrease in PFD symptoms ( p  < 0.001), and a significant increase in quality of life (QoL; p  < 0.05). Conclusions While the results of this study cannot be generalized to all women, low levels of PFK was associated with high a prevalence of PFD, and an increase in knowledge/awareness following education was significantly associated with an increase in QoL and a decrease in PFD symptoms.

Background Sexual dysfunction can have a negative impact on women’s quality of life and relationships. There is limited information about female sexual function and treatment, particularly during pregnancy and the postpartum period. The effect of pelvic floor muscle exercise (PFME) on sexual function (SF) has not been studied adequately. The purpose of this study is to investigate the effect of antenatal PFME on female SF during pregnancy and the first 3 months following birth. Methods/design This is a pragmatic, randomised controlled trial which will compare a structured antenatal PFME programme combined with standard antenatal care to standard antenatal care alone. Eligible women who are less than 22 weeks’ gestation will be recruited from the antenatal clinics of one hospital located in Western Sydney, Australia. A sample of 200 primiparous pregnant women who meet the inclusion criteria will be randomised to either control or intervention groups. This sample size will allow for detecting a minimum difference of 9% in the female SF score between the two groups. The duration of the PFME programme is from approximately 20 weeks’ gestation until birth. Female SF will be measured via questionnaires at < 22 weeks’ gestation, at 36 weeks’ gestation and at 3 months following birth. Baseline characteristics, such as partner relationship and mental health, will be collected using surveys and questionnaires. Data collected for secondary outcomes include the effect of PFME on childbirth outcomes, urinary and faecal incontinence symptoms and quality of life. Discussion The findings of this study will provide more information on whether a hospital-based antenatal PFME has any effect on female SF, urinary and faecal incontinence during pregnancy and the first 3 months following birth. The study will also provide information on the effectiveness of antenatal PFME on childbirth outcomes. Trial registration Australian New Zealand Clinical Trials registry, ACTRN12617001030369 . Registered on 17 July 2017.

AbstractObjectiveTo assess the effectiveness of pelvic floor muscle training (PFMT) plus electromyographic biofeedback or PFMT alone for stress or mixed urinary incontinence in women.DesignParallel group randomised controlled trial.Setting23 community and secondary care centres providing continence care in Scotland and England.Participants600 women aged 18 and older, newly presenting with stress or mixed urinary incontinence between February 2014 and July 2016: 300 were randomised to PFMT plus electromyographic biofeedback and 300 to PFMT alone.InterventionsParticipants in both groups were offered six appointments with a continence therapist over 16 weeks. Participants in the biofeedback PFMT group received supervised PFMT and a home PFMT programme, incorporating electromyographic biofeedback during clinic appointments and at home. The PFMT group received supervised PFMT and a home PFMT programme. PFMT programmes were progressed over the appointments.Main outcome measuresThe primary outcome was self-reported severity of urinary incontinence (International Consultation on Incontinence Questionnaire-urinary incontinence short form (ICIQ-UI SF), range 0 to 21, higher scores indicating greater severity) at 24 months. Secondary outcomes were cure or improvement, other pelvic floor symptoms, condition specific quality of life, women’s perception of improvement, pelvic floor muscle function, uptake of other urinary incontinence treatment, PFMT self-efficacy, adherence, intervention costs, and quality adjusted life years.ResultsMean ICIQ-UI SF scores at 24 months were 8.2 (SD 5.1, n=225) in the biofeedback PFMT group and 8.5 (SD 4.9, n=235) in the PFMT group (mean difference −0.09, 95% confidence interval −0.92 to 0.75, P=0.84). Biofeedback PFMT had similar costs (mean difference £121 ($154; €133), −£409 to £651, P=0.64) and quality adjusted life years (−0.04, −0.12 to 0.04, P=0.28) to PFMT. 48 participants reported an adverse event: for 23 this was related or possibly related to the interventions.ConclusionsAt 24 months no evidence was found of any important difference in severity of urinary incontinence between PFMT plus electromyographic biofeedback and PFMT alone groups. Routine use of electromyographic biofeedback with PFMT should not be recommended. Other ways of maximising the effects of PFMT should be investigated.Trial registrationISRCTN57756448.

To evaluate the effectiveness of pelvic floor muscle training (PFMT) on pelvic floor muscle (PFM) function and quality of life (QoL) in women with stress urinary incontinence (SUI) and pelvic organ prolapse (POP). This study will be a randomized, controlled, parallel, and blinded clinical trial. The final sample will consist of 32 women diagnosed with SUI and cystocele (stage I and II). All volunteers will be assessed and reassessed using the same protocol: assessment form, gynecological examination, functional evaluation of PFM, and questionnaires to assess quality of life, urinary function, and sexual function. All volunteers will be evaluated for satisfaction levels post-treatment. The intervention will be PFMT, totaling 16 sessions to be conducted twice a week. Reevaluation will take place at the end of treatment and 1 month after completion of PFMT. Descriptive analysis and repeated measures ANOVA will be used for result analysis. A significance level of p<0.05 will be considered for all statistical tests. This study has been submitted to the Ethics in Research Committee of the Federal University of Rio Grande do Norte and approved under protocol number 5.826.563. It has been registered with the Brazilian Clinical Trials Registry ReBec (RBR-49p6g3t). It is expected that these studies will provide a deeper understanding of the efficacy of PFMT in women with SUI and cystocele. Additionally, it aims to provide more insights into the efficacy of PFMT prior to surgery.

Pelvic organ prolapse (POP) is a common condition that can significantly impact a woman's quality of life. Pelvic floor muscle training (PFMT) is recommended as a first-line conservative treatment for prolapse, but evidence on its effectiveness from low-resource settings is limited. This study aimed to assess the effect of midwife-led PFMT on prolapse symptoms and health-related quality of life (HRQoL) among women with mild-to-moderate POP in Ethiopia. A community-based, parallel-groups, two-arm cluster-randomized controlled trial was conducted in Dale and Wonsho districts of Sidama Region, Ethiopia. Women with symptomatic POP stages I-III were randomized by cluster to receive either midwife-led PFMT plus lifestyle counseling (intervention group) or lifestyle counseling alone (control group). The participants and counselors knew what the women were receiving, but they were not aware of the other group. The outcome assessors, who collected data at the end of intervention, were blinded to the participants' treatment allocation. The primary outcomes were changes in prolapse symptom score (POP-SS) and prolapse quality of life (P-QoL). Mixed-effects generalized linear model was used to determine the effect of PFMT on prolapse symptoms and P-QoL at 99% confidence level. Adjusted β coefficients were used as effect measures. The level of significance was adjusted for multiple comparisons. A total of 187 women were randomized to intervention (n = 86) from four clusters and control (n = 101) arms from another four clusters. At sixth months, the intervention group showed significantly greater improvements both in prolapse symptoms and P-QoL. The mean change difference in POP-SS was -4.11 (99% CI [-5.38, -2.83]; p <  0.001). Similarly, the mean change difference was: -8.86 (99% CI [-13.84, -3.89]; p < 0.001) in physical domain of P-QoL; -11.18 (99% CI [-15.03, -7.32]; p < 0.001) in psychological domain of P-QoL, and -9.01 (99% CI [-10.49, -5.54]; p < 0.001) in personal relationship domain of P-QoL. A significantly higher proportion (83.72%) of women in the intervention group perceived their condition as \"better\" after the intervention as compared to 41.58% in the control group. Women with earlier stages of prolapse (stages I and II) experienced higher benefits compared to those in stage III. A midwife-led PFMT combined with lifestyle counseling significantly improves prolapse symptoms and quality of life in mild-to-moderate POP. This strategy can be integrated into the existing maternal and reproductive health programs to address POP in low-income settings where access to trained specialist is limited. The trial was registered at the Pan African Clinical Trial Registry (https://pactr.samrc.ac.za) database, with the registration number PACTR202302505126575 (https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=24311).

Vaginal laxity (VL) is a common symptom of pelvic floor disorder, an underreported condition, and has a substantial impact on women's sex lives and relationships. The study aimed to determine the effect of transcutaneous tibial nerve stimulation (TTNS) on women with VL. Fifty women with vaginal laxity were chosen from an outpatient clinic in Egypt. They were randomly split into two equal categories (A and B). Group A ( n  = 25) received pelvic floor exercises (PFE), while Group B ( n  = 25) received TTNS and PFE. Every week, both groups performed three sessions for three months. The outcomes were evaluated both before and following treatment using ultrasound imaging to assess pelvic floor muscle (PFM) function and the Female Sexual Function Index to measure sexual function. Vaginal Laxity Questionnaire (VLQ) were used to examine vaginal looseness. The analysis demonstrated a significant improvement in vaginal laxity in both groups. Post-treatment comparisons revealed a statistically significant difference in VLQ scores and PFM strength between Groups B and A. These findings indicate that TTNS is notably more effective in improving PFM activity and VLQ scores in women with vaginal laxity.

Urinary incontinence is a common complication in stroke survivors for whom new interventions are needed. This study investigated the therapeutic effect of low-frequency (LF) repeated transcranial magnetic stimulation (rTMS) on the contralesional primary motor cortex (M1) in patients with poststroke urinary incontinence (PSI). A total of 100 patients were randomly assigned to the rTMS group or sham-rTMS group on basis of the intervention they received. Both groups underwent five treatment sessions per week for 4 weeks. Data from the urodynamic examination were used as the primary outcome. The secondary outcome measures were questionnaires and pelvic floor surface electromyography. After 4 weeks of intervention, the maximum cystometric capacity (MCC), maximum detrusor pressure (Pdet.max), residual urine output, overactive bladder score (OABSS) (including frequency, urgency, and urgency urinary incontinence), and the ICIQ-UI SF improved significantly in the rTMS group compared with those in the sham-rTMS group (P < 0.05). However, no changes in pelvic floor muscle EMG were detected in patients with PSI (both P > 0.05). Our data confirmed that 4 weeks of LF-rTMS stimulation on the contralateral M1 positively affects poststroke urinary incontinence in several aspects, such as frequency, urgency urinary incontinence, MCC, end-filling Pdet, OABSS, and ICIQ-UI SF scores.

IntroductionPostpartum lumbopelvic pain (LPP) is a prevalent condition among women following childbirth. Due to the importance of respiratory muscles in lumbopelvic stability, and the changes they undergo during pregnancy, this study aims to assess the effects of motor control training and breathing exercises on pain, disability and core muscle activity in women suffering from LPP after childbirth.Methods and analysis52 women with postpartum LPP will participate in this two-parallel-armed, superiority randomised controlled trial, comprising 24 treatment sessions. The intervention group consists of motor control training and breathing exercises, and the control group includes motor control training. The diaphragm excursion, pelvic floor and abdominal muscle activity, pain and disability will be evaluated using ultrasound imaging, visual analogue scale and Oswestry Disability Index, before and after the intervention, respectively.Ethics and disseminationEthical approval was obtained from the human research ethics committee of the Iran University of Medical Sciences (IR.IUMS.REC.1403.017). The study results will be submitted to a relevant journal and conferences.Trial registration numberThis clinical trial has been registered in the Iranian Registry of Clinical Trials on 21 May 2024 (registration number: IRCT20180916041051N2).