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Title: A community study of pelvic floor muscle function in women
Author: Waterfield, Ann Elisabeth
ISNI:       0000 0004 2721 8974
Awarding Body: Exeter and Plymouth Peninsula Medical School
Current Institution: Exeter and Plymouth Peninsula Medical School
Date of Award: 2011
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Previous studies have indicated that pelvic floor muscle training supervised by a trained health care professional is beneficial, both as treatment and prevention of stress urinary incontinence. Currently there are few reports available in the literature that address pelvic floor muscle condition in the general population of women, and none which have investigated this group irrespective of continence status. However, it is known that verbal and written information are often insufficient for women to learn to contract their pelvic floor muscles correctly. The overall aims of this thesis were to ascertain by objective measurement what proportion of community dwelling women know how to and are able to voluntarily contract their pelvic floor muscles (PFM), and whether a nurse who had undertaken a short course training programme could effectively instruct women to increase strength, endurance and muscular co-ordination of the PFM. This might help to reduce one of the modifiable risk factors for incontinence and pelvic organ prolapse, namely pelvic floor muscle weakness. The first objective was to estimate the prevalence of pelvic floor muscle weakness in a community dwelling sample of women in both urban and rural areas of south west Devon and north east Cornwall, UK, who were attending their General Practice for routine health checks. The subjects were recruited from a general population and were not necessarily symptomatic of any incontinence or pelvic organ prolapse. The second objective was to investigate the relative importance of a number of specific factors (such as age, parity, body mass index etc.) that might be associated with pelvic floor muscle weakness in the sample of women. The key objective outcome measure was perineometry (vaginal squeeze pressure), focussing on pelvic floor muscle strength and endurance of contraction. In order to first assess a correct contraction, digital palpation (Modified Oxford Score) was used. Subjects with weak muscles, (scoring 2 or less) could be assigned to the second study. The final objective was to evaluate the effectiveness of an educational programme of PFMT delivered by Primary Care Nurses compared to a pelvic floor specialist nurse, or a control group with no training, over 3 months. The first study was a survey of pelvic floor muscle condition which investigated objectives 1 and 2. The second study, a randomised controlled trial of PFMT, addressed the final objective. In the survey, 762 women from a range of urban and rural General Practices, aged 19- 76 (mean age 46) were assessed. Forty four percent were found to have weak pelvic floor muscles (PFM). This declines further with age, increasing parity, body mass index, and obstetric factors such as having had a forceps delivery and/or episiotomy. The association of a weak pelvic floor with incontinence has also been confirmed. Although the majority of women knew of pelvic floor exercises (87%), few were practicing them at the time of the study .The greatest adverse effect on pelvic floor muscle strength was the transition from nulliparity to first childbirth. Generalized linear modelling was used to investigate the combined effects of multiple explanatory variables. Some women had strong muscles despite advancing age, obesity or grand multiparity. Those who were physically and sexually active had a significantly increased likelihood of strong PFM. Of the 337 women with weak PFM, 97 declined to take part in the second study. Two hundred and forty subjects were randomised to one of three groups (75 Control, 84 Practice nurse, 8\ Specialist nurse) for the RCT. Both treatment groups showed a significant increase in pelvic floor strength after 3 months' training, compared with Controls (p
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available