الفهرس 
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Abstract
Pregnancy and childbirth appears to be one of the most common risk factors that contribute to altered long term pelvic floor muscle function in later life where the hormonal changes that occur during pregnancy and intra-abdominal pressure generated by the growing uterus as well as the mechanical strain imposed by the delivery process and improper management during post-partum period may lead to partial denervation of the pelvic floor and injury to the muscle and adjacent connective tissue. These effects can cause weakness of the pelvic floor muscles and leading to pelvic floor muscle dysfunction (PFMD).
Women with weak pelvic floor muscles (PFMD) usually suffer from stress urinary incontinence (SUI), fecal incontinence (FI), pelvic organ prolapse (POP) or sexual disturbance. These symptoms are rarely life threatening but are debilitating and can greatly affect women’s activities of daily living and quality of life including physical, psychological and social well-being of the women .Today, Disorders of the pelvic floor muscles are highly prevalent condition among women and the cost of dealing with these issues will also increase.
So that, there are several strategies that can be applied to decrease PFMD without any surgical intervention, these strategies mainly focus on lifestyle modifications; medications; manipulation such as Pessary as well as Physical therapy such as pelvic floor muscle training (kegel’s exercise) which is considered the most widely used method of improving PFM strength. As a result, recently in response to solve these problems and to increase PFMT (kegel’s exercise) effectiveness, Electromagnetic stimulation chair (EMSC) has been introduced as type of passive kegel exercises in addition to active training by using birth ball.
This study aimed to:
Compare the effect of electromagnetic stimulation chair with or without birth ball on pelvic floor muscle dysfunction.
Research hypotheses:
Women who practice active training of pelvic floor muscles by using birth ball with electromagnetic stimulation chair exhibit less signs and symptoms of pelvic floor muscle dysfunction and increased muscle strength than women who receive passive training by using electromagnetic stimulation chair alone.
Women who practice active training of pelvic floor muscles by using birth ball with electromagnetic stimulation chair exhibit low recurrence of signs and symptoms of pelvic floor muscle dysfunction than women who receive passive training by using electromagnetic stimulation chair alone.
Materials and methods:
The study was conducted at pelvic floor rehabilitation clinic (private clinic).
Subjects: A convenient sample of 40 women was selected from the previously mentioned setting according to Epi-info. The 40 subjects were divided randomly into two equal groups, study group1 (20) and study group 2 (20).
Tools:
Three tools were developed and used by researcher to collect the necessary data as follow:
Tool (I): Basic dataStructured interview
This tool was developed by the researcher and included 3 parts:
Part one: Socio- demographic characteristics such as age, level of education, occupation etc.
Part two: Reproductive history such as: gravidity & parity, mode of delivery, size of baby, previous gynecological surgeries such as hysterectomy or obstetric injury to the anal sphincter or episiotomy).
Part three: Medical and Surgical history which included:
• Chronic straining factors: chronic constipation and chronic cough.
• Colonic disease e.g. inflammatory bowel disease, diverticulosis, colorectal carcinoma or painful anal conditions e.g. hemorrhoids.
• Drug history: oral contraceptive pills or drugs affect lower urinary tract function or cause constipation e.g. diuretic, antihistamines, antidepressants, antipsychotic, anti-Parkinson’s agents, sedative, hypnotics.
• Surgical history: Any previous surgery in the pelvis or following anal stretch for recurrent anal fissure or low anterior resection for rectal carcinoma).
Tool (II):Pelvic Floor Interview Schedule:
- It was adopted from Pelvic Floor Questionnaire (PFQ) that was used to identify improvement of PFMD symptoms which had been affected by bladder, bowel or vaginal symptoms. Such as: urinary incontinence, fecal incontinence, vaginal heaviness or pressure etc. (Mattson et al., 2017)
- It included 4 sections : Bladder section contained 14 questions related to urinary symptoms with total score (42), Bowel section contained 12 questions related to bowel symptoms with total score (36), Prolapse section contained 5 questions related to prolapse symptoms with total score (15) and Sexual function section contained 6 questions related to sexual symptoms with total score (19).
- For each of the four sections, each question was scored according to a four point scale (0-3) where 0 (Not at all), 1 (somewhat), 2 (moderately), 3 (greatly).The total score for each section was compared before and after intervention to find out any change (effect).
Tool (III): Pelvic floor muscles strength test (Manometric assisted biofeedback) MBF:
Manometric assisted biofeedback (MBF): It is non-invasive, easily applied and well tolerated method which can be used by the examiner to measure pelvic floor muscle strength. The patient was positioned in the lithotomy position. The tip of the vaginal or anal pressure sensor was lubricated with sterile gel to be easily inserted about three to four cm from the introitus with one cm remained outside where its sensitive area crosses muscle sheet of PFMs. Then vaginal or anal pressure was set to zero to start measurement and patient asked to squeeze (contract) forcibly to perform three maximum PFMS contractions holding each for ten seconds if possible with one minute rest interval .The average of three peak values of vaginal squeeze pressure taken to make up the baseline pre-treatment value for each patient . (Herderschee, Hay-Smith, Herbison, Roovers&Heineman , 2011)
- Tools were tested for face validity and applicability by jury of (5) experts in the field. Their suggestions and recommendations were taken into consideration.
- The reliability of the tools was tested using internal consistency (Cronbach α) test.
- A pilot study was carried out on 4 women to ensure the clarity and applicability of the tools, identify obstacles and problems that may be encountered as well as to estimate the time needed for data collection. Accordingly, the necessary modifications were made. Women participating in the pilot study were excluded from the study sample.
- The program started from: 20/4/2021 until 27/9/2021.
- Finally, after collecting the necessary data, data was revised, categorized, coded, computerized, tabulated and properly analyzed.
The main findings of the present study were:
Subjects’ socio demographic data:
The current study revealed: no statistically significant differences between study group (1) and study group (2) regarding their socio-demographic characteristics.
Subjects’ reproductive history:
• Three -quarters (75%) of the study group (1) compared to the vast majority (95%) of the study group (2) were multigravida and multipara, respectively.
• One-half (50%) of the study group (1)compared to slightly more than two-third (70%) of study group(2) had less than two years interval between pregnancies.
• The majority (85%, 75%, respectively) of both study groups had health problems during previous pregnancy.
• One-half (50%) of study group (1) versus almost one-third (35%) of study group (2) had normal vaginal delivery with episiotomy.
• Slightly more than one –half (55%, 60%, respectively) of both study groups had delivered in private clinic.
• The vast majority (95%, 90%, respectively)of the two study groups had delivered by obstetrician .
• As much as (85%, 90%, respectively) of both study groups had complications during previous labor.
• About two-thirds (65%) of study group (1) and more than half (55%) of study group (2) had high birth weight baby.
• All(100 %) of study group (1) as well as study group (2) done bearing down during first stage of labor. While two-fifth (40%) of study group (1) compared to more than half (55%) of study group (2) had fundal pressure during labor.
• Three- fifth (60%) of study group (1) assumed usual home daily activities after 1 week while equal percents (50%) of study group (2) assumed usual home daily activities after 1 week and after 2-3 weeks.
• One-fourth (25%) of both study groups lifted heavy weights during post-partum period.
• Only one - fifth (20%) of study group (2) compared to none (0.0%) of study group (1) practiced exercises during post-partum period.
Subjects’ medical and surgical history:
• As much as (80%, 95%, respectively) of both study groups had history of medical diseases.
• The majority (80%) of study group (1) compared to 65% of study group (2) had used oral contraceptive pills.
• Slightly more than two -fifth (45%) of study group (1) versus half (50%) of study group (2) had surgical history.
Pelvic floor muscles strength test (Manometric assisted biofeedback):
Pelvic floor muscles strength at pre, six weeks and three months after intervention:
• Before intervention: less than two- thirds (60%) of the study group (1) compared to slightly more than two- fifth (45%) of the study group (2) had suffered from a weak pelvic floor muscle strength.
• After six weeks: more than half (55%) of the study group (1) compared to only (20%) of the study group (2) had strong pelvic floor muscle contraction. The differences was statistically significant (p=0.003).
• After three months: more than half (55%) of the study group (1) compared to none (0.0%) of the study group (2) had strong pelvic floor muscle contraction. The differences was statistically significant (p<0.001).
Pelvic floor muscles strength test (pelvic floor questionnaire):
• Before and after six weeks of intervention, there is no statistically significant difference between both study groups (1&2) where (p= (0.644, 0.205, respectively).
• After three months of intervention, the differences was statistically significant between both study groups where (p=0.026).
The relation between studied subject’s pelvic floor muscle strength and their age:
• It was noticed that there wasn’t a statistically significant relation between the studied subject’s pelvic floor muscle strength and their age (years).
The relation between studied subject’s pelvic floor muscle strength and their reproductive history:
• It was noticed that before intervention, there was statistically significant relation between study subject’s pelvic floor muscle strength and their reproductive history in relation to parity, time spacing between pregnancies, health problems during previous pregnancy, mode of delivery, complications during previous labor and fundal pressure during previous labor where (p≤0.005) .
The relation between studied subject’s pelvic floor muscle strength and their medical and surgical history:
• It was noticed that before intervention, there was statistically significant relation between study subject’s pelvic floor muscle strength and their medical and surgical history.
Based on the findings of this study, the following recommendations are suggested:
1. In service training program should be carried out for nurses who are working in antenatal clinics to upgrade their knowledge regarding the importance of pelvic floor muscle training (kegel exercise) during pregnancy.
2. Enforce good postpartum care with more emphasis on an importance of pelvic floor muscles exercise for prevention of pelvic floor muscle dysfunction.
3. Kegel’s exercises should be followed during each development phase of women’s life span and should form an essential part of sexual education and the nurse should work as educator and counselor to teach women benefits and technique of kegel’s exercises.
4. Introduce electromagnetic stimulation chair and birth ball as new modalities for performing PFMT in governmental maternity hospitals.
For further researches
• Replication of the same study on large sample size to promote generalization of the study results.
• Replication of the same study by using the birth ball alone and compare results with electromagnetic stimulation chair.
• Investigate barriers that may hinder the women for practicing the pelvic floor muscles exercise incuding: availability of facilities, economical status, different socio-cultural groups such as rural and Upper Egypt and try to find ways to overcome it.