Pelvic floor dysfunction (PFD) is a common health condition that affects hundreds of millions of women around the world and is associated with considerable financial and human costs for healthcare systems and women as a population[1,2]. Urinary incontinence, pelvic organ prolapse, and anal incontinence are the most prevalent symptoms of PFD with 25-40% of all mothers globally experiencing at least one of these, and one third of those, experience two or more. [3, 4,5]. PFD adversely impacts various domains of women's life including psychological, physical, social and sexual wellbeing [6]. Currently, treatment options include pelvic floor rehabilitation, pelvic floor electrical stimulation, nerve blocks, botulinum toxin injections, or surgical fixation. However, none of these treatments treat the root cause of the PFD, which is soft tissue injury to various components of the pelvic floor.  

In this study we present a novel technique using 2D trans-labial and Trans-perineal diagnostic ultrasound to identify injury to the pelvic floor. Structures interrogated include external urethral sphincter, pubourethral ligaments, vaginal walls, bulbocavernosus, levator ani, arcus tendineus, perineal body, transverse perineum, external/internal anal sphincter, Pubocerivcal fascia, Pubocervical ligaments, rectovaginal fascia, and Uterosacral ligaments. 

Using this ultrasound protocol, we identified significant injuries in 17 postpartum women with PFD. These patients were treated with one session of platelet rich plasma (PRP) targeting all areas of injury. Pre and Post treatment Pelvic Dysfunction Index (PDI-20) scores were collected. Sample t-test were performed comparing pre and post treatment scores. 

There was statistically significant improvement in PDI-20 scores at 6 weeks compared to baseline (P=.02), which shows that comprehensive, targeted Ultrasound-guided PRP injections to pelvic floor injuries can significantly improve PFD symptoms in the short term. Further data collection on the long-term efficacy is necessary and ongoing. 

Imran James Siddiqui graduated Cume Laude from Jefferson Medical College and is an inductee in the Alpha Omega Alpha honors society. He completed his residency in Physical Medicine and Rehabilitation at Harvard University. He is the founder and president of the regenerative Pelvic Institute. He is also a Partner and Director of Clinical Operations at Regenerative Orthopedics and Sports Medicine and is a board member for the Interventional Orthobiologic Foundation. He has extensive clinical and research experience in diagnostic and interventional musculoskeletal ultrasound and regenerative medicine. He has lectured and taught for multiple organizations including: The Orthobiologic Institute, Interventional Orthobiologic Foundation, Harvard Medical School, Gulf Coast Ultrasound Institute, Orthosound Institute, American Academy of Physical Medicine and Rehabilitation, and the Association of Academic Physiatry.