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Berhanu T, Abera M, Girma S, Tesfaye Y. Elimination disorders and associated factors among children and adolescents age 5-14 year-old attending paediatric outpatient clinic at Wolaita Sodo University comprehensive specialized hospital, South Ethiopia. Child Adolesc Psychiatry Ment Health 2024; 18:52. [PMID: 38702758 PMCID: PMC11069281 DOI: 10.1186/s13034-024-00739-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 04/03/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Elimination disorder occurs in children over the age of normal toileting who continue to have an inability to control urination or feces, either during the day, at night, or both. Paediatric elimination disorders are not well understood by parents, teachers, medical professionals, mental health practitioners, and researchers. Hence, this study aimed to assess the magnitude of elimination disorder and associated factors among children and Adolescents aged 5-14 years old at Wolaita Sodo University Comprehensive Specialized Hospital, South Ethiopia, in 2022. METHOD A hospital-based cross-sectional study was conducted from September 22 to November 22, 2022, at Wolaita Sodo University Comprehensive Specialized Hospital. A systematic random sampling technique was employed to select 423 study subjects. The data were gathered using a structured, face-to-face interviewer-administered questionnaire. The development of the symptom score for dysfunctional elimination syndrome of Vancouver questionnaires was used to screen for elimination disorders. Logistic regression model was used to determine the association between the outcome and independent variables. A 95% CI and Odds ratio with corresponding p-value < 0.05 were used to determine the predictors of the outcome variable. RESULT The overall magnitude of elimination disorder among children and Adolescents age 5-14 in this study was (n 70, 16.8%); in boys (n 47, 17.3%) and girls (n 23, 15.75%). The prevalence of enuresis was (n 64, 15.3%), encopresis (n 15, 3.6%), both enuresis and encopresis, or combined elimination disorder (n 9, 2.2%). Age 9-11 years (AOR = 3.2, 95%CI:1.09, 9.43), family size four and above (AOR = 3.4, 95%CI:1.78, 6.56), family history of elimination disorder (AOR = 3.9, 95%CI:2.12, 7.45), emotional problem (AOR = 2.2, 95%CI:1.18, 4.05), hyperactive problem (AOR = 3.8, 95%CI:1.83, 7.83), low toilet training skills (AOR = 5.9, 95%CI:2.61, 13.33), bad parenting practices, were poor supervision (AOR = 4.4, 95%CI 1.29, 14.69) were significantly associated with elimination disorder. CONCLUSION AND RECOMMENDATION In this study, approximately one in five children and adolescents had an elimination disorder. Younger age, family size four and above, positive family history of elimination disorder, presence of emotional and hyperactive problems, bad parenting practices, and low toilet training skills were factors associated with elimination disorders. Therefore, preventative, etiological, and therapeutic measure, early toilet training, supportive parenting practices, screening for children's and adolescents' behavioral problems, and elimination disorders need attention to reduce the effect of the problem.
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Affiliation(s)
- Tamene Berhanu
- Wolaita Sodo University College of Health Science and Medicine, Wolaita Sodo, Ethiopia.
| | - Mubarek Abera
- Department of Psychiatry, Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Shimelis Girma
- Department of Psychiatry, Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Yonas Tesfaye
- Department of Psychiatry, Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
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de Oliveira Ferro JK, Lemos A, de Santana Chagas AC, de Moraes AA, de Oliveira-Souza AIS, de Oliveira DA. Techniques for Registration of Myoelectric Activity of Women's Pelvic Floor Muscles: A Scoping Review. Int Urogynecol J 2024:10.1007/s00192-024-05744-0. [PMID: 38472341 DOI: 10.1007/s00192-024-05744-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 01/20/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Surface electromyography is commonly applied to measure the electrophysiological activity of the neuromuscular system. However, there is no consensus regarding the best protocol to assess pelvic floor muscles. METHODS A scoping literature review was carried out in six databases, using MeSH descriptors. It included studies with electromyographic assessment in adult women presenting or not with pelvic floor dysfunction. The results were presented in categories to contribute to the development of a protocol considering the most used parameters for non-invasive assessment of myoelectric activity of pelvic floor muscles. RESULTS A total of 1,074 articles were identified, and 146 studies were selected for analysis. The intravaginal probe was used in 80.8% of the studies, the bipolar sensor with metallic plates placed on both sides of the vagina was the most frequent (71.3%), with a reference electrode positioned on the anterior superior iliac spine (33.5%). The supine position with hip and knee flexed (45.2%) was the most frequent position used. Of the studies, 44.5% normalized the data by maximum voluntary contraction (MVC) whereas 44.5% performed an average of 3 MVCs. CONCLUSIONS The most frequently used protocol for the pelvic floor is the bipolar intracavitary probe with metal plates positioned at 3-9 o'clock and introduced distally to the vaginal introitus with the volunteer in the supine position and the hip and knee flexed with the reference placed on the anterior-superior iliac spine.
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Affiliation(s)
- Josepha Karinne de Oliveira Ferro
- Department of Physical Therapy, Health Sciences Center, Federal University of Pernambuco, Av. Jorn. Aníbal Fernandes, 173 - Cidade Universitária, Recife, Pernambuco, 50740-560, Brazil
| | - Andrea Lemos
- Department of Physical Therapy, Health Sciences Center, Federal University of Pernambuco, Av. Jorn. Aníbal Fernandes, 173 - Cidade Universitária, Recife, Pernambuco, 50740-560, Brazil
| | - Alessandra Carolina de Santana Chagas
- Department of Physical Therapy, Health Sciences Center, Federal University of Pernambuco, Av. Jorn. Aníbal Fernandes, 173 - Cidade Universitária, Recife, Pernambuco, 50740-560, Brazil
| | - Alexa Alves de Moraes
- Department of Physical Therapy, Health Sciences Center, Federal University of Pernambuco, Av. Jorn. Aníbal Fernandes, 173 - Cidade Universitária, Recife, Pernambuco, 50740-560, Brazil
| | | | - Daniella Araújo de Oliveira
- Department of Physical Therapy, Health Sciences Center, Federal University of Pernambuco, Av. Jorn. Aníbal Fernandes, 173 - Cidade Universitária, Recife, Pernambuco, 50740-560, Brazil.
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Tadesse S, Mekete D, Negese S, Belachew DZ, Namara GT. Urinary incontinence following successful closure of obstetric vesicovaginal fistula repair in Southern Ethiopia. BMC Womens Health 2024; 24:164. [PMID: 38454367 PMCID: PMC10919033 DOI: 10.1186/s12905-024-02979-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 02/17/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Urinary incontinence (UI) after successful closure of obstetric vesicovaginal fistula (VVF) repair is a widely recognized public health problem. However, there is insufficient research evaluating the factors associated with UI after successful obstetric VVF repair in Ethiopia. OBJECTIVES The main aim of this study was to assess the magnitude and associated factors of UI following the successful closure of obstetric VVF repair at the Yirgalem Hamlin Fistula Center in the Sidama region of southern Ethiopia. METHODS A retrospective cross-sectional analytical study was performed on patients who underwent obstetric VVF repair at the Yirgalem Hamlin Fistula Center between 2016 and 2020. The data were collected from September to October 2021. EPI Data Version 3.1 and SPSS Version 25.0 were used for data entry and analysis. A multivariable binary logistic regression model was used for all variables significant in the bivariate binary logistic analysis to determine the association between the independent variables and outcome variables. The data are presented in tables and figures. Variables with a p-value < 0.05 were considered to be statistically associated with the study outcome. RESULTS In total, 499 study subjects were included. The magnitude of UI after successful closure of obstetric VVF repair was 23.25%. A Goh type 4 fistula (AOR = 4.289; 95% CI 1.431, 12.852), a fistula size > 3 cm (AOR = 8.855; 95% CI 4.786, 16.382), a partially damaged urethra (AOR = 2.810; 95% CI 1.441, 5.479), and a completely destroyed urethra (AOR = 5.829; 95% CI 2.094, 16.228) were found to be significantly associated factors with the outcome variable. CONCLUSIONS Nearly one in four patients who had successful closure of obstetric VVF repair at the Yirgalem Hamlin fistula center had UI, which is above the WHO recommendations. The presence of a Goh type 4 fistula, large fistula size, and damaged urethral status significantly affect the presence of UI. Therefore, interventions are necessary to prevent and manage UI among patients who underwent obstetric VVF repair and had a closed fistula.
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Affiliation(s)
- Shimelis Tadesse
- Department of Midwifery, College of Health Science, Mattu University, P. O. Box 318, Mattu, Ethiopia.
| | - Desta Mekete
- Department of Midwifery, College of Health Science, Mattu University, P. O. Box 318, Mattu, Ethiopia
| | - Shambel Negese
- Department of Midwifery, College of Health Science, Mattu University, P. O. Box 318, Mattu, Ethiopia
| | - Dereje Zeleke Belachew
- Department of Midwifery, College of Medicine and Health Science, Mizan Tepi University, Mizan Tefere, Ethiopia
| | - Galana Takele Namara
- Department of Midwifery, College of Medicine and Health Science, Ambo University, Ambo, Ethiopia
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Çiçek S, Çeliker Tosun Ö, Parlas M, Bilgiç D, Yavuz O, Kurt S, Başer Seçer M, Tosun G, Özer M, İleri A. Is there a synergistic relationship between diaphragm and pelvic floor muscles in pregnant women? Eur J Obstet Gynecol Reprod Biol 2024; 293:125-131. [PMID: 38157829 DOI: 10.1016/j.ejogrb.2023.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/18/2023] [Accepted: 12/16/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE The aim of this study is to examine whether there is a synergistic relationship between the diaphragm and pelvic floor muscles (PFM) in pregnant women. MATERIAL AND METHODS Our study was carried out as a cross-sectional study in primigravid pregnants in the second and third trimesters. Superficial electromyography (EMG), 2D/3D ultrasonography (USG), pulmonary function test (PFT), PERFECT, maximum expiratory pressure (MEP) and inspiratory pressure (MIP) measurements were used to evaluate pelvic floor and diaphragm muscle functions during pregnancy. Mann-Whitney U test was used to show the change in the second and third trimesters, and Spearman correlation was used to determine the relationship. RESULTS No correlation was found between the EMG data of the PFM and diaphragm, or between the USG data of the PFM and diaphragm in all participants, in the second and third trimesters. In the third trimester of the study, diaphragmatic thickness and levator hiatal area (LHA) decreased and both diaphragm and PFM % MVC EMG parameters increased. In the third trimester, FVC, MIP, MEP decreased, and nonsignificant increase in FEV1, FEV1/FVC and peak ekspiratuar flow(PEF) were detected. A significant correlation was found between pelvic floor levator hiatal area USG and FEV1/FVC in both trimesters (r: 0,577p: 0,004). CONCLUSION There may be a synergistic relationship between the diaphragm and PFM in pregnant women, the relationship may weaken as pregnancy progresses, and there may be no coactivation relationship between the two muscles. In order to prevent the occurrence of pelvic floor dysfunction during pregnancy and to increase the effect of rehabilitation programs, the relationship between the diaphragm and the PFM should be determined and more studies should be conducted.
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Affiliation(s)
- Sinem Çiçek
- Dokuz Eylul University, Institute Of Health Sciences, Izmir, Turkey
| | - Özge Çeliker Tosun
- Dokuz Eylül University, Faculty of Physical Therapy and Rehabilitation, Izmir, Turkey
| | - Manolya Parlas
- Dokuz Eylul University Faculty of Nursing, Izmir, Turkey
| | - Dilek Bilgiç
- Dokuz Eylul University Faculty of Nursing, Izmir, Turkey
| | - Onur Yavuz
- Dokuz Eylul University Faculty Of Medicine Department Of Surgical Medical Sciences Gynecological Diseases And Obstetrics, Turkey
| | - Sefa Kurt
- Dokuz Eylul University Faculty of Medicine Department Of Surgical Medical Sciences Gynecological Oncology Department Of Gynecological Oncology, Turkey
| | - Melda Başer Seçer
- Dokuz Eylul University, Institute Of Health Sciences, Izmir, Turkey; Manisa Celal Bayar University Health Services Vocational School, Manisa, Turkey.
| | - Gökhan Tosun
- Department of Obstetrics and Gynecology, University of Health Sciences, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Mehmet Özer
- Department of Obstetrics and Gynecology, University of Health Sciences, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Alper İleri
- Department of Obstetrics and Gynecology, University of Health Sciences, Tepecik Education and Research Hospital, Izmir, Turkey
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Çiçek S, Çeliker Tosun Ö, Parlas M, Bilgiç D, Yavuz O, Kurt S, Başer Seçer M, Tosun G. Is the function of the core muscles affected during pregnancy? Int Urogynecol J 2023; 34:2725-2736. [PMID: 37417993 DOI: 10.1007/s00192-023-05597-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 06/04/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of our study is to examine the changes in core muscle functions during pregnancy. METHODS Our study was carried out in 67 primigravida pregnant women. Superficial electromyography (EMG) and non-invasive 2D/3D ultrasonography (USG) were used to evaluate core muscle (diaphragm, transversus abdominus [TA], internal oblique [IO]-external oblique [EO] muscles, pelvic floor muscles, multifidus) function during pregnancy. Pelvic floor muscle strength was also measured by a digital palpation method (PERFECT system). USG was used to measure expected fetal weight and the diastasis recti (DR) distance. Mann-Whitney U test was used to show changes in trimesters in the core muscles, and Spearman correlation analysis was used to determine the relationship. RESULTS In the third trimester, an nonsignificant increase in EMG parameters was observed in all of the core muscles. Although a statistically significant decrease was observed in muscle thickness values measured by EO and IO USG in the third trimester, DR was found to increase at all levels (p < 0.005). When we evaluated both trimesters and all pregnant women together, no relationship was found between all core muscles and pelvic floor muscles in the data evaluated by EMG and USG. We found a negative correlation in USG values between fetal weight and IO and the upper part of the rectus abdominus muscle, and a positive correlation between the EMG data of the EO and rectus abdominus muscles. CONCLUSIONS In women, the coactivation relationship between the core muscles may disappear during pregnancy. As the trimesters progress during pregnancy, a decrease in thickness and an increase in muscle activity can be observed in the core muscles. Pregnant women can be given exercise training for core muscles for protection in both the prenatal and postnatal periods. But more research needs to be done.
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Affiliation(s)
- Sinem Çiçek
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
| | - Özge Çeliker Tosun
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
| | - Manolya Parlas
- Faculty of Nursing, Dokuz Eylul University, Izmir, Turkey
| | - Dilek Bilgiç
- Faculty of Nursing, Dokuz Eylul University, Izmir, Turkey
| | - Onur Yavuz
- Department of Surgical Medical Sciences Gynecological Diseases and Obstetrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Sefa Kurt
- Department of Gynecological Oncology, Department of Surgical Medical Sciences Gynecological Oncology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Melda Başer Seçer
- Manisa Celal Bayar University Health Services Vocational School, Manisa, Turkey.
| | - Gökhan Tosun
- Department of Obstetrics and Gynecology, University of Health Sciences, Tepecik Education and Research Hospital, Izmir, Turkey
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Chi X, Yu S, Zhu K, Chen Y, Chu Y, Chen X. Influence of Different Obstetric Factors on Early Postpartum Pelvic Floor Function in Primiparas After Vaginal Delivery. Int J Womens Health 2023; 15:81-90. [PMID: 36713132 PMCID: PMC9879044 DOI: 10.2147/ijwh.s390626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/18/2023] [Indexed: 01/23/2023] Open
Abstract
Purpose This study sought to explore the obstetric factors affecting early postpartum pelvic floor function of primiparas after vaginal delivery. Patients and Methods We included 3362 primiparas who underwent postpartum re-examination in International Peace Maternity and Child Health Hospital at 42-60 days after delivery. The Glazer Protocol was used to evaluate their pelvic floor function, and univariate and multivariate logistic regression analyses were performed to identify obstetric factors that might affect it. Results Forceps-assisted delivery significantly increased the risk of the decline in fast- and slow-twitch muscle strength in the early postpartum period when compared with natural vaginal delivery (P < 0.05). Women with a pre-pregnancy body mass index (BMI) of ≥18.5 kg/m2 had a decreased risk of decline in fast-twitch muscle strength than those with a pre-pregnancy BMI of <18.5 kg/m2 (P < 0.05). Women who had a pre-pregnancy BMI of 24.0 to <28.0 kg/m2 bore a decreased risk of decline in slow-twitch muscle strength than those with a pre-pregnancy BMI of <18.5 kg/m2 (P < 0.05). The risk of decline in fast-twitch muscle strength and slow-twitch muscle in women with anemia during pregnancy was significantly increased (P < 0.05); women with second-stage labors of >2 h had an increased risk of fast-twitch and slow-twitch muscle strength decline than those with <2 h (P < 0.05). Conclusion Both pre-pregnancy underweight and obesity may cause impairment of early postpartum pelvic floor function. Forceps delivery, anemia during pregnancy, and the length of second stage of labor are independent factors leading to pelvic floor function impairment.
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Affiliation(s)
- Xiaolei Chi
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China,Shanghai Key Laboratory of Embryo Original Disease, Shanghai, People’s Republic of China
| | - Shushu Yu
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China,Shanghai Key Laboratory of Embryo Original Disease, Shanghai, People’s Republic of China
| | - Kun Zhu
- Department of Pathology, Tenth People’s Hospital of Tongji University, Shanghai, People’s Republic of China
| | - Yiyao Chen
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China,Shanghai Key Laboratory of Embryo Original Disease, Shanghai, People’s Republic of China
| | - Yi Chu
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China,Shanghai Key Laboratory of Embryo Original Disease, Shanghai, People’s Republic of China
| | - Xinliang Chen
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China,Shanghai Key Laboratory of Embryo Original Disease, Shanghai, People’s Republic of China,Correspondence: Xinliang Chen, Tel +8618017316169, Fax +86(21)64071243, Email
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Is the Reference Electrode Location Important for the Electromyography Evaluation of the Pelvic Floor in Urodynamic Studies? Int Neurourol J 2022; 26:325-330. [PMID: 36599341 PMCID: PMC9816447 DOI: 10.5213/inj.2244164.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/13/2022] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Perineal electromyography (EMG) is a crucial part of urodynamic studies. Many researchers focused on the standardization of techniques in urodynamics, but no study has yet evaluated the differences with various reference electrode placements. The aim of this study was to determine the optimal placement of the reference electrode for recording pelvic floor activity in urodynamic studies. METHODS Children over 6 years of age without anatomic or neurological abnormalities were invited to participate in the study. Four reference electrodes were placed on the right kneecap, the inner surface of the right inner thigh, the right anterior iliac spine (AIS), and the skin over the left gluteal muscles for simultaneous recording. The EMG signal formed by pelvic contraction during forceful straining was recorded both in the supine and sitting positions. The root mean square (RMS) value of each muscle contraction signal was calculated. RESULTS Twenty-one participants (10 boys and 11 girls) were included. The mean age was 10.19±3.20 years. The highest RMS values were obtained with the reference electrode on the thigh in the supine position and the AIS in the sitting position. Significant differences were found between the mean RMS values of the knee and other locations of reference electrodes in the supine position, as well as between mean RMS values in all regions except the thigh and gluteus in the sitting position. The minimum mean RMS values in both positions were obtained with the reference electrode on the knee. CONCLUSION During urodynamic studies, reference electrodes shall be placed on AIS in the sitting and on the inner thigh in the supine position. The knee is not a suitable option for reference electrode placement. This information may help improve EMG recordings in the evaluation of pelvic floor muscles.
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Min L, Xudong D, Qiubo L, Pingping L, Yuhan L, Guifang Z, Tianzi G, Qing F, Chunxue Y, Yaxin L. Two year follow-up and comparison of pelvic floor muscle electromyography after first vaginal delivery with and without episiotomy and its correlation with urinary incontinence: A prospective cohort study. Acta Obstet Gynecol Scand 2022; 102:200-208. [PMID: 36448197 PMCID: PMC9889321 DOI: 10.1111/aogs.14487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 11/06/2022] [Accepted: 11/09/2022] [Indexed: 12/02/2022]
Abstract
INTRODUCTION Few prospective studies have revealed the long-term neuromuscular alterations of pelvic floor after vaginal delivery. The aim of this study was to evaluate the impact of episiotomy on the electrical activity of pelvic floor muscle 2 years following vaginal delivery, and explore the relation between surface electromyography (sEMG) amplitudes and urinary incontinence. MATERIAL AND METHODS A total of 427 primiparous women with full-term singleton vaginal delivery were included in the cohort and 362 with no further births within the 2 year follow-up completed observations. Of these, 200 underwent episiotomy and 162 underwent nonepisiotomy. Clinical demographic characteristics, vaginal EMG variables and urinary incontinence-specific questionnaire scores were collected at 6 weeks, 6, 12 and 24 months after childbirth, respectively. Primary outcomes were the comparison of sEMG values between the episiotomy and nonepisiotomy groups throughout 2 years. Secondary outcomes were the correlation between sEMG of both groups and the incidence and severity of urinary incontinence. Spearman's correlation analysis, Kruskal-Wallis test and ANOVA with Bonferroni correction were used to analyze the variables. RESULTS Amplitude of maximal fast and endurance contractions on sEMG in the episiotomy group was significantly lower than the nonepisiotomy counterpart. Such difference of sEMG persisted for a long period after birth: endurance contraction, 33.12 ± 8.92 vs 35.085 ± 9.98, p < 0.01 at 24 months, and fast contraction, 36.53 ± 8.87 vs 39.05 ± 9.98, p = 0.01 at 12-month. Although there was no significant difference in incidence and severity of urinary incontinence between both groups, a negative correlation existed between EMG values of muscle contraction and urinary incontinence symptoms throughout. CONCLUSIONS Primiparous women delivered with episiotomy demonstrated lower contractile sEMG activity of pelvic floor muscle in the long term. The lower sEMG values of fast contraction were associated with urinary incontinence symptoms.
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Affiliation(s)
- Li Min
- Department of Gynecology and ObstetricsBeijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical SciencesBeijingChina,The First People's Hospital of Yunnan ProvinceAffiliated Hospital of Kunming University of Science and TechnologyKunmingChina
| | - Dong Xudong
- Department of Obstetrics, The First People's Hospital of Yunnan ProvinceAffiliated Hospital of Kunming University of Science and TechnologyKunmingChina
| | - Lyu Qiubo
- Department of Gynecology and ObstetricsBeijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical SciencesBeijingChina
| | - Li Pingping
- Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing HospitalBeijingChina
| | - Lyu Yuhan
- Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing HospitalBeijingChina
| | - Zhang Guifang
- Department of Epidemiology, The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Beijing Hospital, National Center of GerontologyInstitute of Geriatric Medicine, Chinese Academy of Medical SciencesBeijingChina
| | - Gai Tianzi
- Department of Gynecology and ObstetricsBeijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical SciencesBeijingChina
| | - Feng Qing
- Department of Gynecology and ObstetricsBeijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical SciencesBeijingChina
| | - Yang Chunxue
- Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing HospitalBeijingChina
| | - Liang Yaxin
- The Key Laboratory of Geriatrics, Beijing Institute of GeriatricsBeijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical SciencesBeijingChina
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Prudencio CB, Nunes SK, Pinheiro FA, Sartorão Filho CI, Nava GTDA, Salomoni SE, Pedroni CR, Rudge MVC, Barbosa AMP. Gestational diabetes is associated with alteration on pelvic floor muscle activation pattern during pregnancy and postpartum: Prospective cohort using electromyography assessment. Front Endocrinol (Lausanne) 2022; 13:958909. [PMID: 36277705 PMCID: PMC9582526 DOI: 10.3389/fendo.2022.958909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
Background and objective Gestational diabetes mellitus (GDM) is a comorbidity which may cause acute and lifelong disorders to mother and child. Alterations in muscular and connective tissues have been associated with GDM in translation studies, characterizing gestational diabetic myopathy. Pregnancy-specific urinary incontinence and sexual disabilities, disorders that depend on the pelvic floor muscle (PFM) integrity, are also associated with GDM both during and after pregnancy. The aim was to compare PFM activation patterns between GDM and non-GDM women from 24-30 gestational weeks to 18-24 months postpartum during a standard clinical test during gestation and postpartum. Methods We conducted a prospective three-time-point cohort study from gestation (24-30 weeks-T1, and 36-38 weeks-T2) to 18-24 months postpartum (T3). PFM electromyography was recorded in primigravida or primiparous women with one previous elective c-section with or without the diagnosis of GDM according to the American Diabetes Association criteria. A careful explanation of the muscle anatomy and functionality of the PFM was given to participants before EMG assessment. The outcome measures were PFM activation patterns assessed during pregnancy and postpartum, comparing intra and between groups. PFM activation patterns were assessed by normalized electromyography signal at rest and during 1-second (sec) phasic, 10-sec hold, and 60-sec sustained contractions. Results Demographic and obstetric data showed homogeneity between groups. The GDM group achieved peak PFM EMG amplitudes similarly to the non-GDM group, but they took longer to return to baseline levels during the ~1-sec contraction (flicks). During 10-sec hold contractions, the GDM group sustained lower levels of PFM activation than the non-GDM group at both 36-38 weeks of gestation and 18-24 months postpartum when compared to the non-GDM group. Conclusion The results suggest that GDM impaired PFM control mainly on 1-sec flicks and 10-sec hold contraction, which appears to develop during late pregnancy and extends long-term postpartum. This motor behavior may play a role on pelvic floor dysfunctions.
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Affiliation(s)
- Caroline Baldini Prudencio
- São Paulo State University (Unesp), Postgraduate Program on Tocogynecology, Botucatu Medical School, Botucatu, Brazil
| | - Sthefanie Kenickel Nunes
- São Paulo State University (Unesp), Postgraduate Program on Tocogynecology, Botucatu Medical School, Botucatu, Brazil
| | - Fabiane Affonso Pinheiro
- São Paulo State University (Unesp), Postgraduate Program on Tocogynecology, Botucatu Medical School, Botucatu, Brazil
| | - Carlos Izaias Sartorão Filho
- São Paulo State University (Unesp), Postgraduate Program on Tocogynecology, Botucatu Medical School, Botucatu, Brazil
| | | | | | | | - Marilza Vieira Cunha Rudge
- São Paulo State University (Unesp), Postgraduate Program on Tocogynecology, Botucatu Medical School, Botucatu, Brazil
| | - Angélica Mércia Pascon Barbosa
- São Paulo State University (Unesp), Postgraduate Program on Tocogynecology, Botucatu Medical School, Botucatu, Brazil
- São Paulo State University (Unesp), School of Philosophy and Sciences, Marilia, Brazil
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Ferreira LA, Fitz FF, Gimenez MM, Matias MM, Bortolini MA, Castro RA. Management of Stress Urinary Incontinence With Pelvic Floor Muscle Training for a Woman With Charcot-Marie-Tooth Disease: A Case Report. J Chiropr Med 2022; 21:220-224. [PMID: 36118110 PMCID: PMC9479200 DOI: 10.1016/j.jcm.2022.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 10/18/2022] Open
Abstract
Objective The purpose of this report is to describe the effects of pelvic floor muscle training (PFMT) in stress urinary incontinence (SUI) of a woman with Charcot-Marie-Tooth (CMT) disease. Clinical Features A 50-year-old female patient with a diagnosis of type II CMT disease was referred to treatment as a result of a complaint of urinary loss upon effort (ie, coughing and sneezing). She reported that the symptoms started about 36 months prior. The urodynamic study revealed SUI with a Valsalva leak point pressure of 84 cmH2O. Intervention and Outcome The treatment of SUI was carried out through a PFMT program for 12 weeks (with supervision) and exercises at home for another 12 weeks. A specialized physiotherapist measured symptoms and severity of SUI (3-day urinary diary, 1-hour pad test), pelvic floor muscle function (digital palpation, manometry and dynamometry), effect of the SUI on quality of life (Incontinence Quality of Life Questionnaire), and adherence to the outpatient sessions and to home exercise sets, which also were assessed (exercise diary). Conclusion In this patient with CMT disease, improvements in urinary symptoms and severity of SUI, pelvic floor muscle function, and effect of SUI on quality of life were noted after PFMT.
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Affiliation(s)
- Letícia A. Ferreira
- Corresponding author: Letícia A. Ferreira, PT, MSc. Rua Napoleão de Barros, 608 – Vila Clementino, CEP 04024-002, São Paulo, SP, Brazil
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11
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Ferro JKDO, de Moura Filho AG, de Amorim KCS, Lima CRODP, Martins JVP, Barboza PJM, Lemos A, de Oliveira DA. Electromyographic analysis of pelvic floor muscles during the execution of pelvic patterns of proprioceptive neuromuscular facilitation-concept: An observational study. Neurourol Urodyn 2022; 41:1458-1467. [PMID: 35665533 DOI: 10.1002/nau.24981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/26/2022] [Accepted: 05/19/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To assess the effect of pelvic patterns of proprioceptive neuromuscular facilitation (PNF-concept) on pelvic floor muscles (PFM) recruitment, as well as the electromyographic activity of muscles synergic to the pelvic floor in healthy women. METHODS Observational study conducted with 31 women aged between 18 and 35 years, with mean age of 23.3 ± 3.2 (22.1-24.4). PFM activity was monitored by surface electromyography during the combination of isotonics technique of four pelvic patterns of PNF-concept (i.e., anterior elevation, posterior depression, anterior depression, and posterior elevation). The electromyographic signal was analyzed using root mean square amplitude. Two-way repeated measures analysis of variance was performed to analyze differences in PFM activity between types of contraction (i.e., concentric, isometric, and eccentric) and the four pelvic patterns. RESULTS PFM activity did not differ among the four pelvic pattens. However, PFM activity was significantly different between the combination of isotonics technique and baseline, F(1.6, 48.2) = 71.5; p < 0.000, with a large effect size (partial ƞ² = 0.705). Concentric (22.4 µV ± 1.1), isometric (17.3 µV ± 0.6), and eccentric (15 µV ± 0.5) contractions of combination of isotonics technique increased PFM activity compared with baseline (10.8 µV ± 0.4) in all pelvic patterns. By analyzing the electromyographic activity of the muscles synergistic to the pelvic floor, there is effect of the interaction of the type of contraction, the pelvic pattern of the PNF concept, and the synergistic muscles on the myoelectric activity of the external anal sphincter, F(3.2, 96.5) = 5.6; p < 0.000, with a large magnitude of effect (partial ƞ² = 0.15). In the anterior elevation pattern, the muscles synergistic to the pelvic floor present synergy in phase with the PFM, and in the posterior patterns there was a decrease in the activity level of all synergistic muscles, without changing the activity level of the PFM. CONCLUSION PFM activity did not differ among the four pelvic patterns of PNF-concept. Nonetheless, the combination of isotonics technique showed a significant effect on PFM compared with baseline, with greater PFM activity during concentric contraction. Pelvic patterns of PNF-concept may be used to increase PFM recruitment in young healthy women.
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Affiliation(s)
- Josepha Karinne de O Ferro
- Department of Physical Therapy, Health Sciences Center, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Alberto G de Moura Filho
- Department of Physical Therapy, Health Sciences Center, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Keytte Camilla S de Amorim
- Department of Physical Therapy, Health Sciences Center, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | | | - José Vicente P Martins
- Department of Physical Therapy, Health Sciences Center, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Paulo José M Barboza
- Integrated Rehabilitation and Aquatic Therapy Center (CIRTA), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Andrea Lemos
- Department of Physical Therapy, Health Sciences Center, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Daniella A de Oliveira
- Department of Physical Therapy, Health Sciences Center, Federal University of Pernambuco, Recife, Pernambuco, Brazil
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12
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Gimenez MM, Fitz FF, de Azevedo Ferreira L, Bortolini MAT, Lordêlo PVS, Castro RA. Pelvic floor muscle function differs between supine and standing positions in women with stress urinary incontinence: an experimental crossover study. J Physiother 2022; 68:51-60. [PMID: 34952814 DOI: 10.1016/j.jphys.2021.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/12/2021] [Accepted: 12/10/2021] [Indexed: 02/08/2023] Open
Abstract
QUESTION In women with stress urinary incontinence, how does pelvic floor muscle (PFM) function differ between supine and standing when assessed using manometry, vaginal palpation, dynamometry and electromyography? DESIGN An experimental crossover study. PARTICIPANTS A total of 101 women with stress urinary incontinence were included. INTERVENTION The PFM evaluations were performed and compared in supine and standing positions. The participants were assigned to either Group 1 (assessments in supine followed by standing) or Group 2 (assessments in standing followed by supine). OUTCOME MEASURES The primary outcome was the PFM pressure during the maximum voluntary contraction (MVC). Secondary outcomes were the measures of PFM pressure at rest; PFM function (PERFECT scheme); active and passive forces (dynamometry); and PFM electromyography (EMG) activity. RESULTS The mean MVC pressure was significantly lower in standing (MD -7 cmH2O, 95% CI -10 to -4). The mean PFM resting pressure was higher in standing (7 cmH2O, 95% CI 5 to 10). Three measures of PFM function derived from vaginal palpation were better in supine than in standing. The PFM active and the passive forces measured using dynamometry were higher in standing (0.18 kgf, 95% CI 0.16 to 0.20). The resting EMG activity was higher in standing than in supine (MD 3.6 μV, 95% CI 2.6 to 4.5), whereas EMG activity during MVC was higher in supine than standing (MD -8.7 μV, 95% CI -12.5 to -4.8). CONCLUSION The pressure and EMG activity during MVC, and PFM function were lower in standing. The resting pressure, the passive and active forces of the PFM and the resting EMG activity of the PFM were higher in standing.
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Affiliation(s)
| | - Fátima Faní Fitz
- Department of Gynecology, Universidade Federal de São Paulo, São Paulo, Brazil
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13
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Volpato MP, Menezes M, Prado TS, Piccini A, Ferreira AS, Botelho S. Electromyographic analysis of maximal voluntary contraction of female pelvic floor muscles: Intrarater and interrater reliability study. Neurourol Urodyn 2021; 41:383-390. [PMID: 34779055 DOI: 10.1002/nau.24834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/07/2021] [Accepted: 10/29/2021] [Indexed: 11/10/2022]
Abstract
AIMS To investigate the intrarater and interrater reliability of the surface electromyography (sEMG) of female pelvic floor muscles (PFM) by visual determination of the onset-offset during maximal voluntary contraction (MVC). METHODS Intrarater and interrater reliability study. Three MVC, recorded for 5 s (s) each and separated by intervals of 60 s, were requested. Two independent raters visually determined the onset and offset of each MVC. The agreement between raters on the quality of the signals was analyzed both qualitatively (visual inspection) and quantitatively (signal-to-noise ratio, SNR). The reliability of integral and median frequency (MDF) of sEMG signals during MVC was analyzed using intraclass correlation coefficient (ICC) models (ICC2,1 , ICC2,3 ) and repeated measures analysis of variance. RESULTS A total of 58 women (mean age of 54 years) and two independent raters participated in the analyses. Of the total, 22 (37.9%) were considered of high quality by both raters and the SNR ranged 34.3-22.2 decibels (dB). The agreement of qualitative visual evaluation of the sEMG signal was fair (Cohen's κ = 0.306 [0.148; 0.463]). Intrarater and interrater reliability were excellent for the average of the three MVC, both for integral (ICC2,3 = 0.884 [0.821; 0.925]; ω2 = -0.006, p = 0.558) and MDF (ICC2,3 = 0.998 [0.998; 0.999]; ω2 = -0.009, p = 0.992). CONCLUSION Qualitative visual analysis of the sEMG signal presents fair interrater agreement and reflects the SNR. Visual determination of the onset and offset of the MVC of PFM using the standard interface of the sEMG software has excellent reliability for determination of muscle activation variables.
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Affiliation(s)
- Maria P Volpato
- Postgraduate Program in Rehabilitation Sciences, Motor Science Institute, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil
| | - Michele Menezes
- Postgraduate Program in Rehabilitation Sciences, Augusto Motta University Center, Rio de Janeiro, Brazil
| | - Tirza Sathler Prado
- Postgraduate Program in Rehabilitation Sciences, Motor Science Institute, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil.,Physical Therapy Course, College Madre Thais, Ilhéus, Bahia, Brazil
| | - Adriana Piccini
- Postgraduate Program in Rehabilitation Sciences, Motor Science Institute, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil
| | - Arthur Sá Ferreira
- Postgraduate Program in Rehabilitation Sciences, Augusto Motta University Center, Rio de Janeiro, Brazil
| | - Simone Botelho
- Postgraduate Program in Rehabilitation Sciences, Motor Science Institute, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil.,Postgraduate Program in Surgical Science, School of Medical Sciences, State University of Campinas, Campinas, São Paulo, Brazil
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14
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Gondim R, Gorjão J, Nacif A, Franco I, Barroso U. Evaluation of autonomic function in children and adolescents with overactive bladder. Int Braz J Urol 2021; 47:1178-1188. [PMID: 34472767 PMCID: PMC8486459 DOI: 10.1590/s1677-5538.ibju.2021.0177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/15/2021] [Indexed: 11/29/2022] Open
Abstract
Aims: To evaluate autonomic activity in children/adolescents with isolated overactive bladder. Materials and Methods: Descriptive, analytical, non-interventional, cross-sectional study conducted between February 2017 and January 2018 with individuals aged between 5 and 17 years old, with overactive bladder (OAB group) or asymptomatic (control). Neurological or anatomical abnormalities, diabetes mellitus and kidney failure constituted exclusion criteria. The DVSS and the Rome III questionnaire were applied, and heart rate variability (HRV) was assessed. The chi-square test, Student's t-test, ANOVA and the Mann Whitney U test were used in the statistical analysis. Results: 41 patients with OAB and 20 controls were included. In the OAB group, there were more girls (p=0.23), more overweight/obese and constipated patients. The DVSS score was higher in the OAB group. HRV showed a higher heart rate variability at the frequency domain and LF/HF variation in the control group (p=0.02 and p=0.05 respectively). In the intergroup evaluation, LF (Hz) was predominant in the control group at the post-voiding evaluation moment (p=0.03). Conclusion: The control group demonstrated a physiological heart rate variation during the voiding process, with a predominance of sympathetic activity during urinary storage.
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Affiliation(s)
- Rhaiana Gondim
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brasil
| | - Julia Gorjão
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brasil
| | - Ananda Nacif
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brasil
| | - Israel Franco
- Department of Urology, Yale School of Medicine, New Haven, CT, United States
| | - Ubirajara Barroso
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brasil.,Departamento de Urologia da Universidade Federal da Bahia, Salvador, BA, Brasil
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Fitz FF, Gimenez MM, de Azevedo Ferreira L, Matias MMP, Bortolini MAT, Castro RA. Effects of voluntary pre-contraction of the pelvic floor muscles (the Knack) on female stress urinary incontinence-a study protocol for a RCT. Trials 2021; 22:484. [PMID: 34301324 PMCID: PMC8299632 DOI: 10.1186/s13063-021-05440-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/09/2021] [Indexed: 11/21/2022] Open
Abstract
Background Stress urinary incontinence (SUI) is a subtype of urinary incontinence that occurs more commonly amongst women. The pelvic floor muscle training (PFMT) is considered the gold standard for treating SUI. Another technique called the Knack postulated that pre-contraction of the pelvic floor muscles (PFM) during activities of increasing intra-abdominal pressure prevents urinary loss. Currently, there are no studies supporting the Knack for the treatment of SUI. Thus, the aim of this study is to test the hypothesis that voluntary pre-contraction of PFM can treat SUI. For this purpose, the following parameters will be analysed and compared amongst (1) the Knack, (2) PFMT and (3) the Knack + PFMT groups: urine leakage as assessed by the pad test, urinary symptoms, muscle function, quality of life, subjective cure, adherence to exercises in the outpatient setting and at home and perceived self-efficacy of PFM exercises. Methods A single-centre, double-blind (investigator and outcome assessor) randomised controlled trial with a 3-month follow-up of supervised treatment and an additional 3 months of follow-up (unsupervised) for a total of 6 months of follow-up. Two hundred ten women with mild to moderate SUI will be included, aged between 18 and 70 years. To compare the primary and secondary outcome measures within and between the groups studied (before and after intervention), the ANOVA statistical test will be used. Primary and secondary outcome measures will be presented as mean, standard deviation, 95% confidence interval and median and minimum and maximum values. Discussion/significance This study closes a gap, as voluntary PFM pre-contraction (the Knack) has not yet been included in the physiotherapeutic treatment of SUI, and if shown successful could be implemented in clinical practice. Trial registration ClinicalTrials.gov NCT03722719. Registered on October 29, 2018. Study protocol version 1. Was this trial prospectively registered? Yes Funded by: The present study did not receive funding. Anticipated completion date: The anticipated trial commencement and completion dates are October 2018 and October 2021, respectively. Provenance: Not invited. Peer reviewed. Human research ethics approval committee: Research Ethical Board of the Universidade Federal de São Paulo (UNIFESP), Brazil. Human research ethics approval number: 2.517.312. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05440-0.
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Affiliation(s)
- Fátima Faní Fitz
- Department of Gynaecology, Universidade Federal de São Paulo, Rua Napoleão de Barros, 608 - Vila Clementino, CEP, São Paulo, SP, 04024-002, Brazil.
| | - Márcia Maria Gimenez
- Department of Gynaecology, Universidade Federal de São Paulo, Rua Napoleão de Barros, 608 - Vila Clementino, CEP, São Paulo, SP, 04024-002, Brazil
| | - Letícia de Azevedo Ferreira
- Department of Gynaecology, Universidade Federal de São Paulo, Rua Napoleão de Barros, 608 - Vila Clementino, CEP, São Paulo, SP, 04024-002, Brazil
| | - Mayanni Magda Perreira Matias
- Department of Gynaecology, Universidade Federal de São Paulo, Rua Napoleão de Barros, 608 - Vila Clementino, CEP, São Paulo, SP, 04024-002, Brazil
| | - Maria Augusta Tezelli Bortolini
- Department of Gynaecology, Universidade Federal de São Paulo, Rua Napoleão de Barros, 608 - Vila Clementino, CEP, São Paulo, SP, 04024-002, Brazil
| | - Rodrigo Aquino Castro
- Department of Gynaecology, Universidade Federal de São Paulo, Rua Napoleão de Barros, 608 - Vila Clementino, CEP, São Paulo, SP, 04024-002, Brazil
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Conta G, Libanori A, Tat T, Chen G, Chen J. Triboelectric Nanogenerators for Therapeutic Electrical Stimulation. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2021; 33:e2007502. [PMID: 34014583 DOI: 10.1002/adma.202007502] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/03/2020] [Indexed: 06/12/2023]
Abstract
Current solutions developed for the purpose of in and on body (IOB) electrical stimulation (ES) lack autonomous qualities necessary for comfortable, practical, and self-dependent use. Consequently, recent focus has been placed on developing self-powered IOB therapeutic devices capable of generating therapeutic ES for human use. With the recent invention of the triboelectric nanogenerator (TENG), harnessing passive human biomechanical energy to develop self-powered systems has allowed for the introduction of novel therapeutic ES solutions. TENGs are especially effective at providing ES for IOB therapeutic systems given their bioconformability, low cost, simple manufacturability, and self-powering capabilities. Due to the key role of naturally induced electrical signals in many physiological functions, TENG-induced ES holds promise to provide a novel paradigm in therapeutic interventions. The aim here is to detail research on IOB TENG devices applied for ES-based therapy in the fields of regenerative medicine, neurology, rehabilitation, and pharmaceutical engineering. Furthermore, considering TENG-produced ES can be measured for sensing applications, this technology is paving the way to provide a fully autonomous personalized healthcare system, capable of IOB energy generation, sensing, and therapeutic intervention. Considering these grounds, it seems highly relevant to review TENG-ES research and applications, as they could constitute the foundation and future of personalized healthcare.
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Affiliation(s)
- Giorgio Conta
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Alberto Libanori
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Trinny Tat
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Guorui Chen
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Jun Chen
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
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17
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Reliability, validity and responsiveness of pelvic floor muscle surface electromyography and manometry. Int Urogynecol J 2021; 32:3267-3274. [PMID: 34142181 DOI: 10.1007/s00192-021-04881-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/24/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Vaginal surface electromyography (sEMG) is commonly used to assess pelvic floor muscle (PFM) function and dysfunction but there is a lack of studies regarding the assessment properties. The aim of the study was to test the hypotheses that sEMG has good test-retest intratester reliability, good criterion validity and is responsive to changes compared to manometry. METHODS PFM resting tone, maximum voluntary contraction (MVC) and endurance were measured in 66 women with pelvic floor dysfunction. One assessment by manometry was followed by two testing sessions with sEMG at baseline. After 4 to 42 weeks of supervised PFM strength training, 29 participants were retested with both devices. RESULTS Median age of the participants was 41 years (range 24-83) and parity 2 (range 0-10). Very good test-retest intratester reliability was found for all three sEMG measurements. The correlation between sEMG and manometry was moderate for vaginal resting tone (r = 0.42, n = 66, p < 0.001) and strong for MVC (r = 0.66, n = 66, p < 0.001) and endurance (r = 0.67, n = 66, p < 0.001). Following the strength training period, participants demonstrated increased MVC and endurance measured with manometry, but not with sEMG. A significant reduction in resting tone was found only with sEMG. CONCLUSION sEMG is reliable and correlates well with manometry. However, sEMG is not as responsive as manometry for changes in PFM MVC and endurance. For measurement of PFM resting tone, sEMG seems more responsive than manometry, but this requires further investigation.
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Guo KM, He LC, Feng Y, Huang L, Morse AN, Liu HS. Surface electromyography of the pelvic floor at 6-8 weeks following delivery: a comparison of different modes of delivery. Int Urogynecol J 2021; 33:1511-1520. [PMID: 34132864 DOI: 10.1007/s00192-021-04789-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/24/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective of this study was to compare the impact of different modes of delivery, especially forceps delivery (FD), on pelvic floor muscles (PFMs) through vaginal surface electromyography (sEMG) in primiparous women at early (6-8 weeks) postpartum. METHODS A total of 1259 primiparous women with full-term singleton births were included in this cross-sectional study. Of these, 98 were delivered by forceps, 865 underwent spontaneous vaginal delivery (SD) and 296 underwent elective cesarean delivery (CD). Clinical demographic characteristics and vaginal sEMG variables of parturients 6-8 weeks after birth were collected and analyzed using SPSS software. One-way ANOVA with Bonferroni correction, Chi-square test or Student's t-test was used according to the variable type. Spearman correlation and binary logistic regression analyses were also used. P/α ≤ 0.05 was considered statistically significant. RESULTS Amplitude of fast and sustained contractions on sEMG in the FD group was significantly lower compared with the CD and SD groups. The sEMG amplitude of all contractions was significantly higher in the CD group compared with the FD and SD groups (P < 0.01). According to binary logistic regression analysis, mode of delivery was a major influencing factor in sEMG. CONCLUSIONS An early postpartum sEMG test appears to be helpful for the assessment of PFM activity. Mode of delivery was a major influencing factor on sEMG. Forceps delivery significantly inversely influenced PFM activity.
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Affiliation(s)
- Kai-Min Guo
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, People's Republic of China.,Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Tianhe District, Guangzhou, Guangdong Province, 510623, People's Republic of China
| | - Lang-Chi He
- Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Tianhe District, Guangzhou, Guangdong Province, 510623, People's Republic of China
| | - Yan Feng
- Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Tianhe District, Guangzhou, Guangdong Province, 510623, People's Republic of China
| | - Liu Huang
- Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Tianhe District, Guangzhou, Guangdong Province, 510623, People's Republic of China
| | - Abraham Nick Morse
- Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Tianhe District, Guangzhou, Guangdong Province, 510623, People's Republic of China
| | - Hui-Shu Liu
- Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Tianhe District, Guangzhou, Guangdong Province, 510623, People's Republic of China.
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Chmielewska D, Sobota G, Dolibog P, Dolibog P, Opala-Berdzik A. Reliability of pelvic floor muscle surface electromyography (sEMG) recordings during synchronous whole body vibration. PLoS One 2021; 16:e0251265. [PMID: 34003818 PMCID: PMC8130969 DOI: 10.1371/journal.pone.0251265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 04/23/2021] [Indexed: 02/04/2023] Open
Abstract
The primary aim of the study was to assess intraday and interday reliability of surface electromyography (sEMG) reflex activity of the pelvic floor muscles during synchronous whole-body vibration (S-WBV) of two intensities (30Hz/2mm; 40Hz/4mm) using band-stop filter and high-pass filter signal processing. The secondary aim of the study was to assess intraday and interday (test-retest) reliability of sEMG obtained from maximal voluntary contraction (MVC) test. We evaluated the intraday reliability of sEMG recordings obtained during sessions 1 and 2 performed on the same day. The sessions consisting of maximal voluntary pelvic floor muscle contraction and synchronous vibration sets with 1-hour rest in-between sessions 1 and 2 in healthy nulliparous women. The next intraday reliability was evaluated between the results of sessions 3 and 4 performed on the same day but followed at an interval of 4 weeks. to include the entire menstrual cycle. The interday reliability was determined based on the results of sessions 1 and 3 using the intraclass correlation coefficient (ICC 3,3). The intraday ICCs for band-stop filtered mean and median sEMG frequency and mean normalized sEMGRMS amplitude of the 30Hz/2mm (ICC = 0.89–0.99) and 40Hz/4mm vibration (ICC = 0.95–0.99) indicated substantial reproducibility. The intraday reliability of high-pass filter at 100-450Hz for these parameters was also substantial (30Hz/2mm ICC of 0.92 to 0.98; 40Hz/4mm ICC of 0.88 to 0.98). The interday reliability (session 1 vs. session 3) of the mean normalized sEMGRMS amplitude for band-stop filtered means of 40 Hz/4mm and 30Hz/2mm vibration recordings was substantial (ICC = 0.82 and 0.93). However, ICCs of the mean and median frequency were indicative of fair reliability (ICC of 0.43 to 0.59). The interday reliability of mean normalized sEMGRMS amplitude for high-pass filter at 100-450Hz was substantial (30Hz/2mm ICC of 0.90; 40Hz/4mm ICC of 0.73) for the 30Hz/2mm S-WBV and moderate (ICC = 0.73) for the 40/4mm S-WBV. The ICCs for mean and median sEMG frequency ICCs indicated slight to fair reproducibility (ICC of 0.16 to 0.56). The intraday reliability of the strongest MVC contraction and average MVC turned out substantial (ICC = 0.91–0.98). The interday reliability coefficients of the strongest MVC contraction and average MVCs were 0.91 and 0.82, respectively. Concluded, the intraday reliability proved satisfactory for all variables; however, the interday comparison showed sufficient ICC levels only for the mean amplitude. We therefore recommend this parameter should be used when analyzing PFM sEMG recorded during vibration. ICCs of the mean and median frequency for both signal processing methods were indicative of insufficient reliability and did not reach the threshold for usefulness. Our study showed similar reliability of PFM sEMG during S-WBV in case of the two filtering methods used.
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Affiliation(s)
- Daria Chmielewska
- Electromyography and Pelvic Floor Muscles Laboratory, Department of Physical Medicine, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
- * E-mail:
| | - Grzegorz Sobota
- Department of Human Motor Behavior, Institute of Sport Science, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Paweł Dolibog
- Department and Faculty of Medical Biophysics, Medical University of Silesia, Katowice, Poland
| | - Patrycja Dolibog
- Department and Faculty of Medical Biophysics, Medical University of Silesia, Katowice, Poland
| | - Agnieszka Opala-Berdzik
- Department of Physiotherapy in Internal Diseases, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
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20
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Chang X, Ge H, Ye G, Quan X, Shen W, Zhang C, Huan M, Wu J. Analysis of pelvic floor electrical physiological parameters in nulliparous women with stress urinary incontinence. Transl Androl Urol 2021; 10:1620-1626. [PMID: 33968650 PMCID: PMC8100828 DOI: 10.21037/tau-20-1235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background To investigate the changes in pelvic floor electrical physiological parameters in nulliparous women with stress urinary incontinence (SUI). Methods A retrospective survey was conducted on 922 women aged 20–40 years who received health examinations at the First Affiliated Hospital of Nanjing Medical University between July 2017 and December 2019. The women were split into two groups: those who had SUI (n=87) and those that did not (n=835). Questionnaires and pelvic floor electrical physiological indexes were collected. Results The mean age of the group of women with SUI was 29.77 years, while the mean age of the group of women with no SUI was 24.49 years. The body mass indexes (BMI) of the women with SUI were significantly higher than those of the women with no SUI. Importantly, the normal rates of type I and II fibers in the women with SUI were obviously lower than those in the women with no SUI. Moreover, the vaginal dynamic pressure in the women with SUI was significantly lower than in the women with no SUI. The study also found that the incidence of SUI in nulliparous women was higher in those aged 30–40 and that both low-weight and obese women had an increased risk of SUI. Type I and type II muscle fibers were more abnormal in the women with SUI than in those with no SUI. In multivariate logistic regression, the ages, BMIs, and type I fiber indexes of nulliparous women were related to SUI. Conclusions Nulliparous women have a higher rate of SUI. Compared to women with no SUI, the possible potential risk factors are age (>30 years), higher BMI, and abnormal type I muscle fiber of the pelvic floor.
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Affiliation(s)
- Xiaoxia Chang
- The State Key Laboratory of Reproductive Medicine, Department of Obstetrics and Gynecology, Women's Rehabilitation Medical Center, Jiangsu Province People's Hospital, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210036, China
| | - Huan Ge
- The State Key Laboratory of Reproductive Medicine, Department of Obstetrics and Gynecology, Women's Rehabilitation Medical Center, Jiangsu Province People's Hospital, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210036, China
| | - Guihua Ye
- The State Key Laboratory of Reproductive Medicine, Department of Obstetrics and Gynecology, Women's Rehabilitation Medical Center, Jiangsu Province People's Hospital, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210036, China
| | - Xiaojie Quan
- The State Key Laboratory of Reproductive Medicine, Department of Obstetrics and Gynecology, Women's Rehabilitation Medical Center, Jiangsu Province People's Hospital, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210036, China
| | - Wei Shen
- The State Key Laboratory of Reproductive Medicine, Department of Obstetrics and Gynecology, Women's Rehabilitation Medical Center, Jiangsu Province People's Hospital, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210036, China
| | - Chunzi Zhang
- The State Key Laboratory of Reproductive Medicine, Department of Obstetrics and Gynecology, Women's Rehabilitation Medical Center, Jiangsu Province People's Hospital, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210036, China
| | - Mengyao Huan
- The State Key Laboratory of Reproductive Medicine, Department of Obstetrics and Gynecology, Women's Rehabilitation Medical Center, Jiangsu Province People's Hospital, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210036, China
| | - Jie Wu
- The State Key Laboratory of Reproductive Medicine, Department of Obstetrics and Gynecology, Women's Rehabilitation Medical Center, Jiangsu Province People's Hospital, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210036, China
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21
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Siswoyo, Lestari C, Susanto T, Rasni H, Hakam M, Ridla AZ. The influences of prompted voiding for urinary incontinence among older people in nursing homes. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2021. [DOI: 10.1111/ijun.12260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Siswoyo
- Department of Medical Surgical Nursing Faculty of Nursing, Universitas Jember Jember Jawa Timur Indonesia
| | - Cicik Lestari
- Undergraduated Student of Internship Program Faculty of Nursing, Universitas Jember Jember Jawa Timur Indonesia
| | - Tantut Susanto
- Department of Community Family, and Geriatric Health Nursing, Faculty of Nursing, Universitas Jember Jember Jawa Timur Indonesia
| | - Hanny Rasni
- Department of Community Family, and Geriatric Health Nursing, Faculty of Nursing, Universitas Jember Jember Jawa Timur Indonesia
| | - Mulia Hakam
- Undergraduated Student of Internship Program Faculty of Nursing, Universitas Jember Jember Jawa Timur Indonesia
| | - Ahmad Zainur Ridla
- Undergraduated Student of Internship Program Faculty of Nursing, Universitas Jember Jember Jawa Timur Indonesia
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22
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Charlanes A, Chesnel C, Jousse M, Le Breton F, Sheikh Ismael S, Amarenco G, Hentzen C. Verbal instruction to obtain voluntary pelvic floor muscle contraction: Acceptability, and understanding. Prog Urol 2021; 31:231-237. [PMID: 33414018 DOI: 10.1016/j.purol.2020.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 12/04/2020] [Accepted: 12/10/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this study was to describe verbal instructions used to obtain a voluntary pelvic floor muscle contraction and to evaluate their understanding and acceptability. METHODS This prospective study led in two phases. A questionnaire was submitted to experts to collect the most frequently used instructions to obtain a PFMC. Then a questionnaire was submitted to subjects in order to: estimate the pelvic floor anatomical knowledge; estimate understanding and acceptability of these instructions; select the best instruction. RESULTS First phase: 46 experts proposed 356 instructions. Forty-four percent were functional instructions ("hold a gas"), 40% anatomical ("squeeze your anus") and 16% allied both. Fifteen instructions for the women and 11 for the men were selected. Second phase: 33 subjects completed the questionnaire. More than 75% had correct answers for anatomical knowledge. The instructions judged by the subjects as the most adapted to obtain a PFMC were: "contract the anus", "do as if you wanted to hold a strong desire to void". The items including "perineum" or "vagina" were less understood. CONCLUSIONS The more understandable and acceptable instruction to assess the PFMC is the association of two simple instructions: one anatomical and one functional. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- A Charlanes
- GREEN Groupe de recherche clinique en neuro-urologie, GRC 001, Sorbonne université, hôpital Tenon, AP-HP, 75020 Paris, France
| | - C Chesnel
- GREEN Groupe de recherche clinique en neuro-urologie, GRC 001, Sorbonne université, hôpital Tenon, AP-HP, 75020 Paris, France
| | - M Jousse
- GREEN Groupe de recherche clinique en neuro-urologie, GRC 001, Sorbonne université, hôpital Tenon, AP-HP, 75020 Paris, France; Département de médecine physique et de réadaptation, GH Saint-Louis-Lariboisière-F.-Widal, Paris-Diderot university, AP-HP, Paris, France
| | - F Le Breton
- GREEN Groupe de recherche clinique en neuro-urologie, GRC 001, Sorbonne université, hôpital Tenon, AP-HP, 75020 Paris, France
| | - S Sheikh Ismael
- GREEN Groupe de recherche clinique en neuro-urologie, GRC 001, Sorbonne université, hôpital Tenon, AP-HP, 75020 Paris, France
| | - G Amarenco
- GREEN Groupe de recherche clinique en neuro-urologie, GRC 001, Sorbonne université, hôpital Tenon, AP-HP, 75020 Paris, France
| | - C Hentzen
- GREEN Groupe de recherche clinique en neuro-urologie, GRC 001, Sorbonne université, hôpital Tenon, AP-HP, 75020 Paris, France.
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The pathophysiology of stress urinary incontinence: a systematic review and meta-analysis. Int Urogynecol J 2021; 32:501-552. [PMID: 33416968 PMCID: PMC8053188 DOI: 10.1007/s00192-020-04622-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/16/2020] [Indexed: 01/15/2023]
Abstract
Introduction and hypothesis To evaluate the evidence for pathologies underlying stress urinary incontinence (SUI) in women. Methods For the data sources, a structured search of the peer-reviewed literature (English language; 1960–April 2020) was conducted using predefined key terms in PubMed and Embase. Google Scholar was also searched. Peer-reviewed manuscripts that reported on anatomical, physiological or functional differences between females with signs and/or symptoms consistent with SUI and a concurrently recruited control group of continent females without any substantive urogynecological symptoms. Of 4629 publications screened, 84 met the inclusion criteria and were retained, among which 24 were included in meta-analyses. Results Selection bias was moderate to high; < 25% of studies controlled for major confounding variables for SUI (e.g., age, BMI and parity). There was a lack of standardization of methods among studies, and several measurement issues were identified. Results were synthesized qualitatively, and, where possible, random-effects meta-analyses were conducted. Deficits in urethral and bladder neck structure and support, neuromuscular and mechanical function of the striated urethral sphincter (SUS) and levator ani muscles all appear to be associated with SUI. Meta-analyses showed that observed bladder neck dilation and lower functional urethral length, bladder neck support and maximum urethral closure pressures are strong characteristic signs of SUI. Conclusion The pathology of SUI is multifactorial, with strong evidence pointing to bladder neck and urethral incompetence. While there is also evidence of impaired urethral support and levator ani function, standardized approaches to measurement are needed to generate higher levels of evidence.
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24
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de Oliveira Ferro JK, Lemos A, de Santana Chagas AC, de Moraes AA, de Moura Filho AG, de Oliveira DA. Techniques for registration of myoelectric activity of women's pelvic floor muscles: a scoping review protocol. JBI Evid Synth 2020; 19:727-733. [PMID: 33230013 DOI: 10.11124/jbies-20-00159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this review is to identify the most frequently used protocols for analyzing the myoelectric activity of the pelvic floor muscles during surface electromyography in women aged 18 years or older. INTRODUCTION Surface electromyography is normally used in assessment and treatment for research purposes when it is intended to quantitatively measure the electrophysiological behavior of the neuromuscular system. However, although there are internationally standardized, non-invasive assessment protocols for most muscle groups, there is no consensus for pelvic floor muscles, which makes it difficult to standardize in scientific research and clinical applicability. INCLUSION CRITERIA Studies that explore registration protocols and filtering parameters of surface electromyographic signals in women aged over 18 years old with or without pelvic floor dysfunction will be considered. Studies encompassing either electromyographic biofeedback as a treatment resource only or electroneuromyography (needle electrode) will be excluded. METHODS Primary studies published in the previous 10 years in MEDLINE, Embase, Scopus, Web of Science, CINAHL, and Cochrane Central databases will be included. The search will encompass descriptors registered in MeSH. The identified articles will be assessed for eligibility by two independent reviewers in three stages: evaluation by title, abstract, and full text. If there is any disagreement, a third reviewer will be consulted. Data will be extracted and organized in standardized spreadsheets. The results will be assigned to categories in order to facilitate the organization of a protocol with the most commonly used parameters for non-invasive assessment of myoelectric activity of pelvic floor muscles.
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25
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Zuppone S, Bresolin A, Spinelli AE, Fallara G, Lucianò R, Scarfò F, Benigni F, Di Muzio N, Fiorino C, Briganti A, Salonia A, Montorsi F, Vago R, Cozzarini C. Pre-clinical Research on Bladder Toxicity After Radiotherapy for Pelvic Cancers: State-of-the Art and Challenges. Front Oncol 2020; 10:527121. [PMID: 33194587 PMCID: PMC7642999 DOI: 10.3389/fonc.2020.527121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 08/31/2020] [Indexed: 01/01/2023] Open
Abstract
Despite the dramatic advancements in pelvic radiotherapy, urinary toxicity remains a significant side-effect. The assessment of clinico-dosimetric predictors of radiation cystitis (RC) based on clinical data has improved substantially over the last decade; however, a thorough understanding of the physiopathogenetic mechanisms underlying the onset of RC, with its variegated acute and late urinary symptoms, is still largely lacking, and data from pre-clinical research is still limited. The aim of this review is to provide an overview of the main open issues and, ideally, to help investigators in orienting future research. First, anatomy and physiology of bladder, as well as the current knowledge of dose and dose-volume effects in humans, are briefly summarized. Subsequently, pre-clinical radiobiology aspects of RC are discussed. The findings suggest that pre-clinical research on RC in animal models is a lively field of research with growing interest in the development of new radioprotective agents. The availability of new high precision micro-irradiators and the rapid advances in small animal imaging might lead to big improvement into this field. In particular, studies focusing on the definition of dose and fractionation are warranted, especially considering the growing interest in hypo-fractionation and ablative therapies for prostate cancer treatment. Moreover, improvement in radiotherapy plans optimization by selectively reducing radiation dose to more radiosensitive substructures close to the bladder would be of paramount importance. Finally, thanks to new pre-clinical imaging platforms, reliable and reproducible methods to assess the severity of RC in animal models are expected to be developed.
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Affiliation(s)
- Stefania Zuppone
- Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Fondazione Centro San Raffaele, Milan, Italy
| | - Andrea Bresolin
- Fondazione Centro San Raffaele, Milan, Italy.,Department of Medical Physics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonello E Spinelli
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Fallara
- Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberta Lucianò
- Unit of Pathology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federico Scarfò
- Unit of Pathology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabio Benigni
- Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nadia Di Muzio
- Department of Radiotherapy, IRCCS San Raffaele Scientific Institute, Milan, Italy.,University Vita-Salute San Raffaele, Milan, Italy
| | - Claudio Fiorino
- Department of Medical Physics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Briganti
- Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.,University Vita-Salute San Raffaele, Milan, Italy
| | - Andrea Salonia
- Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.,University Vita-Salute San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.,University Vita-Salute San Raffaele, Milan, Italy
| | - Riccardo Vago
- Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.,University Vita-Salute San Raffaele, Milan, Italy
| | - Cesare Cozzarini
- Department of Radiotherapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
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26
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Campanini I, Disselhorst-Klug C, Rymer WZ, Merletti R. Surface EMG in Clinical Assessment and Neurorehabilitation: Barriers Limiting Its Use. Front Neurol 2020; 11:934. [PMID: 32982942 PMCID: PMC7492208 DOI: 10.3389/fneur.2020.00934] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/20/2020] [Indexed: 12/23/2022] Open
Abstract
This article addresses the potential clinical value of techniques based on surface electromyography (sEMG) in rehabilitation medicine with specific focus on neurorehabilitation. Applications in exercise and sport pathophysiology, in movement analysis, in ergonomics and occupational medicine, and in a number of related fields are also considered. The contrast between the extensive scientific literature in these fields and the limited clinical applications is discussed. The "barriers" between research findings and their application are very broad, and are longstanding, cultural, educational, and technical. Cultural barriers relate to the general acceptance and use of the concept of objective measurement in a clinical setting and its role in promoting Evidence Based Medicine. Wide differences between countries exist in appropriate training in the use of such quantitative measurements in general, and in electrical measurements in particular. These differences are manifest in training programs, in degrees granted, and in academic/research career opportunities. Educational barriers are related to the background in mathematics and physics for rehabilitation clinicians, leading to insufficient basic concepts of signal interpretation, as well as to the lack of a common language with rehabilitation engineers. Technical barriers are being overcome progressively, but progress is still impacted by the lack of user-friendly equipment, insufficient market demand, gadget-like devices, relatively high equipment price and a pervasive lack of interest by manufacturers. Despite the recommendations provided by the 20-year old EU project on "Surface EMG for Non-Invasive Assessment of Muscles (SENIAM)," real international standards are still missing and there is minimal international pressure for developing and applying such standards. The need for change in training and teaching is increasingly felt in the academic world, but is much less perceived in the health delivery system and clinical environments. The rapid technological progress in the fields of sensor and measurement technology (including sEMG), assistive devices, and robotic rehabilitation, has not been driven by clinical demands. Our assertion is that the most important and urgent interventions concern enhanced education, more effective technology transfer, and increased academic opportunities for physiotherapists, occupational therapists, and kinesiologists.
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Affiliation(s)
- Isabella Campanini
- LAM-Motion Analysis Laboratory, Neuromotor and Rehabilitation Department, San Sebastiano Hospital, Correggio, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Catherine Disselhorst-Klug
- Department of Rehabilitation & Prevention Engineering, Institute of Applied Medical Engineering, RWTH Aachen University, Aachen, Germany
| | - William Z. Rymer
- Shirley Ryan Ability Lab, Single Motor Unit Laboratory, Chicago, IL, United States
| | - Roberto Merletti
- Laboratory for Engineering of the Neuromuscular System (LISiN), Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
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27
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Dias N, Zhang C, Smith CP, Lai HH, Zhang Y. High-density surface electromyographic assessment of pelvic floor hypertonicity in IC/BPS patients: a pilot study. Int Urogynecol J 2020; 32:1221-1228. [PMID: 32761375 DOI: 10.1007/s00192-020-04467-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 07/23/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To assess the feasibility of objectively assessing pelvic floor hypertonicity (PFH) in women with interstitial cystitis/bladder pain syndrome (IC/BPS) using an intra-vaginal high-density surface electromyography (HD-sEMG) probe. METHODS Seven female subjects (mean age 44 ± 13 years) with a prior diagnosis of IC/BPS were recruited. A full digital pelvic examination was administered to identify hypertonic muscles. Intra-vaginal HD-sEMG was acquired during rest. Root-mean-squared (RMS) amplitude during rest was calculated for each channel to define a hypertonicity index and hypertonic zone. Innervation zones (IZs) were identified from the bipolar mapping of decomposed HD-sEMG signals and summarized into an IZ distribution mapping. RESULTS Of the seven subjects recruited, five had normal pelvic floor muscle tone and two exhibited hypertonicity upon muscle palpation. Subjects with PFH demonstrated a higher hypertonicity index (12.6 ± 3.5 vs. 4.5 ± 1.2) in sessions 1 and 2. The hypertonic zone defined by the 64-channel RMS mapping coincided with the digital pelvic examination findings. The corresponding IZs were localized for each motor unit. The hypertonicity indices between two consecutive sessions were well correlated (CC = 0.95). CONCLUSIONS This study represents the first effort to employ intra-vaginal HD-sEMG to assess PFH in women with IC/BPS. Our results demonstrate the feasibility of HD-sEMG to provide a quantitative diagnosis of PFH and the precise localization of hypertonic muscles and IZs. The proposed HD-sEMG-based techniques provide promising tools for clinical diagnosis and treatment of PFH, such as the personalized guidance of BoNT injections.
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Affiliation(s)
- Nicholas Dias
- Department of Biomedical Engineering, University of Houston, Houston, TX, 77204, USA
| | - Chuan Zhang
- Department of Biomedical Engineering, University of Houston, Houston, TX, 77204, USA
| | | | - H Henry Lai
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Yingchun Zhang
- Department of Biomedical Engineering, University of Houston, Houston, TX, 77204, USA.
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Padoa A, McLean L, Morin M, Vandyken C. The Overactive Pelvic Floor (OPF) and Sexual Dysfunction. Part 2: Evaluation and Treatment of Sexual Dysfunction in OPF Patients. Sex Med Rev 2020; 9:76-92. [PMID: 32631813 DOI: 10.1016/j.sxmr.2020.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 03/30/2020] [Accepted: 04/08/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The assessment of pelvic floor muscle (PFM) overactivity is part of a comprehensive evaluation including a detailed history (medical, gynecological history/antecedent), appraisal of the psychosocial contexts of the patient, as well as a musculoskeletal and a neurological examination. OBJECTIVES The aims of this article are to review (i) the assessment modalities evaluating pelvic floor function in women and men with disorders associated with an overactive pelvic floor (OPF), and (ii) therapeutic approaches to address OPF, with particular emphases on sexual pain and function. METHODS We outline assessment tools that evaluate psychological and cognitive states. We then review the assessment techniques to evaluate PFM involvement including digital palpation, electromyography, manometry, ultrasonography, and dynamometry, including an overview of the indications, efficacy, advantages, and limitations of each instrument. We consider each instrument's utility in research and in clinical settings. We next review the evidence for medical, physiotherapy, and psychological interventions for OPF-related conditions. RESULTS Research using these assessment techniques consistently points to findings of high PFM tone among women and men reporting disorders associated with OPF. While higher levels of evidence are needed, options for medical treatment include diazepam suppositories, botulinum toxin A, and other muscle relaxants. Effective psychological therapies include cognitive behavioral therapy, couple therapy, mindfulness, and educational interventions. Effective physiotherapy approaches include PFM exercise with biofeedback, electrotherapy, manual therapy, and the use of dilators. Multimodal approaches have demonstrated efficacy in reducing pain, normalizing PFM tone, and improving sexual function. Multidisciplinary interventions and an integrative approach to the assessment and management of OPF using a biopsychosocial framework are discussed. CONCLUSION Although the efficacy of various intervention approaches has been demonstrated, further studies are needed to personalize interventions according to a thorough assessment and determine the optimal combination of psychological, physical, and behavioral modalities. Padoa A, McLean, L, Morin M, et al. The Overactive Pelvic Floor (OPF) and Sexual Dysfunction. Part 2: Evaluation and Treatment of Sexual Dysfunction in OPF Patients. Sex Med 2021;9:76-92.
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Affiliation(s)
- Anna Padoa
- Department of Obstetrics and Gynecology, Yitzhak Shamir (formerly Assaf Harofe) Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Linda McLean
- School of Rehabilitation Sciences, Chair in Women's Health Research, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Melanie Morin
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke and Research Center of the Centre hospitalier de l'Université de Sherbrooke (CHUS), Sherbrooke, QC, Canada
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The Prognostic Value of the Surface Electromyographic Assessment of Pelvic Floor Muscles in Women with Stress Urinary Incontinence. J Clin Med 2020; 9:jcm9061967. [PMID: 32586007 PMCID: PMC7356276 DOI: 10.3390/jcm9061967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 11/17/2022] Open
Abstract
Background: The use of surface electromyography (sEMG) measurements to evaluate the bioelectrical activity of the pelvic floor muscle (PFM) during therapeutic intervention is now well established. This study investigates the diagnostic possibilities of sEMG in women with stress urinary incontinence (SUI). The aim of this study was to carry out objective assessments of the bioelectrical activity of the PFM in women after menopause and determine the prognostic value of sEMG for assessing the PFM in patients with SUI. Methods: This was a prospective, observational study that evaluated the bioelectrical activity of the PFM in postmenopausal women with or without SUI (SUI group, n = 89 vs. non-SUI group, n = 62). The study was carried out between January 2013 and December 2018 at the Clinic of Urology (Wroclaw, Poland). The protocol for all sEMG measurements of PFM activity consisted of following elements: “baseline”, “quick flicks”, “contractions”, “static hold”, and “rest tone”; we then compared these results between groups. To determine the optimal cutoff level for sEMG activation of the PFM to detect the occurrence of SUI, we performed receiver operating characteristic (ROC) curve analysis (with Youden’s index). Results: Significantly lower results were obtained for all PFM measurements in women with SUI. The optimum diagnostic cutoff for “baseline” was 3.7 μV (area under curve (AUC), 0.63), “quick flicks” was 9.15 μV (AUC, 0.84), “contractions” was 11.33 μV (AUC, 0.80), “static hold” was 9.94 μV (AUC, 0.84), and “rest” was 3.89 μV (AUC, 0.63). Conclusions: Measuring sEMG activity in the PFM may be a useful diagnostic tool to confirm the absence of SUI. We can expect that the sEMG activity of subjects with SUI will be lower than that of healthy people. In order to determine appropriate reference values for assessing sEMG activity data in the PFM, it is now necessary to conduct multicenter studies.
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Pecchio S, Novara L, Sgro LG, Rapetti G, Fuso L, Menato G, Biglia N. Concomitant stress urinary incontinence and pelvic organ prolapse surgery: Opportunity or overtreatment? Eur J Obstet Gynecol Reprod Biol 2020; 250:36-40. [PMID: 32387890 DOI: 10.1016/j.ejogrb.2020.04.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 04/20/2020] [Accepted: 04/24/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The association between pelvic organ prolapse (POP) and stress urinary incontinence (SUI) is very common. When POP surgery is indicated and the patient has concomitant SUI, there are two treatment strategies: the one-step strategy (concomitant correction of POP and SUI) and the two-step strategy (correction of POP with subsequent evaluation of SUI). Guidelines from the International Continence Society and International Consultation on Incontinence recommend that a urodynamic assessment (UA) should be performed before surgery as this can reveal the presence of urodynamic SUI, but the role of UA is the subject of debate as it does not seem to improve treatment decisions. The aim of this study was to identify the presence of pre-operative urodynamic parameters that were predictive of POSUI, and to identify patients who could benefit from concomitant correction of SUI during POP surgery STUDY DESIGN: A retrospective evaluation was undertaken of 155 patients with at least second-degree POP who underwent POP surgery after UA between 2009 and 2016 in an Italian gynaecology and obstetrics department. Of these, 61 patients were clinically incontinent before surgery and 94 patients were clinically continent. After UA, patients were stratified using a maximum urethral closure pressure (MUCP) cut-off of 50 cmH2O; the risk of POSUI was calculated using this value. RESULTS POP surgery alone resolved SUI in 60 % of the 61 clinically incontinent patients; only 30 % of these patients had urodynamic SUI and >50 % did not have POSUI. Thirty-six percent of the 94 continent patients had occult SUI on UA and 16 % developed de-novo POSUI. Seventy-five percent of all patients with occult SUI did not develop de-novo SUI. MUCP was lower in patients with POSUI than in patients without POSUI (p=0.013). The probability of POSUI was higher in patients with MUCP ≤50 cmH2O. The number needed to treat (NNT) to prevent one case of POSUI in these patients was 2, compared with an NNT of 4 in the continent group. Eight percent of patients underwent further surgery for SUI. CONCLUSIONS Clinically incontinent patients with MUCP ≤50 cmH2O will gain the greatest benefit from concomitant POP and SUI surgery. However, concomitant surgery has more severe adverse events. Given that 62.3 % of patients resolved SUI after POP surgery alone, it is important not to overtreat these women. Clinical pre-operative SUI is the best indicator of POSUI and was found to increase the risk of POSUI (odds ratio 3.2, 95 % confidence interval 1.5-6.8; p=0.003). Despite the small sample size, the two-step strategy appears to result in lower use of mid-urethral slings and a clear reduction in complications. It is important not to focus on the diagnosis of urodynamic SUI in continent patients but to evaluate MUCP carefully.
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Pereira-Baldon VS, de Oliveira AB, Padilha JF, Degani AM, Avila MA, Driusso P. Reliability of different electromyographic normalization methods for pelvic floor muscles assessment. Neurourol Urodyn 2020; 39:1145-1151. [PMID: 32119158 DOI: 10.1002/nau.24332] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 02/24/2020] [Indexed: 11/12/2022]
Abstract
AIMS To evaluate the reliability of different methods to normalize pelvic floor muscles (PFM) electromyography (EMG). METHODS Thirty nulliparous women (23.9 ± 3.2 years), free from PFM dysfunction, completed two test sessions 7 days apart. For EMG normalization, signals were acquired during four different tasks using a vaginal probe in situ: PFM maximal voluntary contraction (MVC) and three daily activities with increased intra-abdominal pressure (coughing, Valsalva maneuver, and abdominal contraction). The intraclass correlation coefficients (ICC), standard error of measurement (SEM), relative standard error of measurement (%SEM), and minimal detectable change (MDC) were calculated for each variable. RESULTS ICC values for test-retest reliability of normalization methods ranged from 0.61 to 0.95. The highest values were obtained for mean root mean square (RMS) of the abdominal contraction and peak RMS of PFM-MVC. Normalization using RMS of PFM-MVC showed the lowest values of SEM and MDC. CONCLUSIONS The normalization of EMG data is considered a fundamental part of EMG investigations. These findings suggest that the normalization of PFM-EMG by either peak RMS of PFM-MVC or mean and peak RMS of abdominal contraction has excellent reliability and it can be applied in studies involving the evaluation of young women.
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Affiliation(s)
- Vanessa S Pereira-Baldon
- Physical Therapy Department, Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil.,Physical Therapy Department, Universidade Federal de Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Ana B de Oliveira
- Physical Therapy Department, Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil
| | - Juliana F Padilha
- Physical Therapy Department, Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil
| | - Adriana M Degani
- Department of Physical Therapy, Kalamazoo, Michigan, United States
| | - Mariana A Avila
- Physical Therapy Department, Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil
| | - Patricia Driusso
- Physical Therapy Department, Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil
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Electromyography of pelvic floor muscles with true differential versus faux differential electrode configuration. Int Urogynecol J 2020; 31:2051-2059. [PMID: 32067059 DOI: 10.1007/s00192-020-04225-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 01/14/2020] [Indexed: 10/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS In pelvic floor muscle (PFM) electromyography (EMG) two different bipolar configurations are applied: "true differential" configuration (TD) measures neuromuscular activity with two ipsilateral electrodes, whereas "faux differential" configuration (FD) has two electrodes placed on each side of the PFMs. The aim of the study was to determine possible differences and the relationship between both configurations. METHODS A secondary data analysis of 28 continent (CON) and 22 stress urinary incontinent (SUI) women was performed. Surface EMG was measured using a vaginal probe during maximal voluntary (MVC) and fast voluntary (FVC) contractions. TD and FD were explored with amplitude- and time-related EMG parameters, cross-correlation coefficients (R(0)) and statistical parametric mapping (SPM). RESULTS Of a total of 62 comparisons of EMG parameters of MVC and FVC, only one comparison showed significant differences between the two configurations (CON group, FVC4peak TD versus FD, p = 0.015). R(0) were high in both groups for all MVC and FVC variables (R(0) ≥ 0.989). SPM detected 3 out of 28 comparisons with short (0.124-0.404 s) significant supra-threshold clusters (p < 0.025). CONCLUSIONS The findings suggest that TD and FD might measure neuromuscular activity almost the same. Very high cross-correlation coefficients and a very limited number of significant results from EMG parameters, as well as SPM, suggest that in the measured sample the choice of TD or FD might remain practically irrelevant. To gain further insight into the scientific and clinical relevance of choosing either of the electrode configurations, the comparisons should be re-evaluated on a sample with more severe incontinence symptoms.
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Chmielewska D, Stania M, Kucab–Klich K, Błaszczak E, Kwaśna K, Smykla A, Hudziak D, Dolibog P. Electromyographic characteristics of pelvic floor muscles in women with stress urinary incontinence following sEMG-assisted biofeedback training and Pilates exercises. PLoS One 2019; 14:e0225647. [PMID: 31790463 PMCID: PMC6886793 DOI: 10.1371/journal.pone.0225647] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 11/09/2019] [Indexed: 02/07/2023] Open
Abstract
The aim of this study was to compare the effect of pelvic floor muscle training with surface electromyographic (sEMG) biofeedback (BF group) and Pilates exercises (P group) on the bioelectrical activity of pelvic floor muscles in women with stress urinary incontinence. The other aim aim was to compare changes in voiding diaries and scores on quality of life questionnaire against baseline values and between the groups. Women in the BF group (n = 18) participated in pelvic floor muscle training with sEMG biofeedback; the P group (n = 13) participated in basic level Pilates workouts. Both protocols were continued for eight weeks. Voiding diary, quality of life and electromyographic characteristics of the pelvic floor muscles were assessed at the three-time points: at baseline, after eight weeks’ training, and at month six post-training. The sEMG activity of the pelvic floor muscles was tested during five trials in two positions. There was no marked improvement in bioelectrical activity of the pelvic floor muscles during contraction following training with sEMG biofeedback or Pilates exercises. Following eight weeks of sEMG biofeedback training, a decrease was noted in resting bioelectrical activity of pelvic floor muscles and during relaxation after sustained contraction but only in supine-lying. No such effect was observed in the Pilates group. In the BF group, the number of incontinence episodes after end of treatment (timpepoints: 1vs. 2) and at six month follow-up (timpepoints: 1vs. 3) decreased by 68.5% and 89.3%, respectively. The respective values in the P group were 78.6%, and 86.4%. The intergroup differences did not reach the level of statistical significance. As regards the quality of life, the questionnaire demonstrated that Pilates exercises had significantly better effects compared to biofeedback training both at the end of the eight-week exercise program and (p = 0.003) and at six month follow-up (p = 0.0009). The International Consultation on Incontinence Questionnaire—Short Form (ICIQ- SF) showed comparable efficacy of Pilates exercises and training with sEMG biofeedback. Intragroup improvements in micturition frequency, incontinence (leakage) episodes, and nocturia frequency were comparable. Alleviation of urinary incontinence symptoms was comparable in both groups, whereas the improvement in the quality of life was more notable in the Pilates group. The obtained results failed to demonstrate the superiority of any of the two methods regarding the bioelectrical activity of pelvic floor muscles in patients with stress urinary incontinence.
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Affiliation(s)
- Daria Chmielewska
- Department of Physiotherapy Basics, Faculty of Physiotherapy, Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
- * E-mail:
| | - Magdalena Stania
- Department of Physiotherapy Basics, Faculty of Physiotherapy, Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Katarzyna Kucab–Klich
- Department of Physiotherapy Basics, Faculty of Physiotherapy, Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Edward Błaszczak
- Department and Faculty of Medical Biophysics, Medical University of Silesia, Katowice, Poland
| | - Krystyna Kwaśna
- Department of Physiotherapy Basics, Faculty of Physiotherapy, Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Agnieszka Smykla
- Department of Physiotherapy Basics, Faculty of Physiotherapy, Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Dominika Hudziak
- Health Center, Department of Gynecology and Obstetrics, Mikołów, Poland
| | - Patrycja Dolibog
- Department and Faculty of Medical Biophysics, Medical University of Silesia, Katowice, Poland
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Scharschmidt R, Derlien S, Siebert T, Herbsleb M, Stutzig N. Intraday and interday reliability of pelvic floor muscles electromyography in continent woman. Neurourol Urodyn 2019; 39:271-278. [PMID: 31642114 DOI: 10.1002/nau.24187] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 10/02/2019] [Indexed: 11/08/2022]
Abstract
AIMS Vaginal surface electromyography (sEMG) is a tool used for the diagnosis and therapeutic intervention of urinary incontinence. Current sEMG systems differ in regard to electrode arrangement and data reproducibility. The aim of this study was to determine the intrasession, intraday, and interday reliabilities of sEMG parameters using a probe with circumferential electrode-position. METHODS The intrasession, intraday, and interday reliabilities of maximum isometric voluntary contractions (MVC) of the pelvic floor muscles were assessed for 19 healthy continent women. Three sEMG parameters that are used to describe muscle activity were verified: maximal EMG (EMGmax ), mean over 500 ms around EMGmax (EMGA0.5 ), and mean over 2 seconds during MVC plateau (EMGA2-4 ). Relative and absolute reliability parameters were calculated, and the statistical methods described by Bland and Altman were applied to the data. RESULTS We observed substantial reliabilities for all obtained parameters (EMGmax , EMGA2-4 , and EMGA0.5 ) in regard to the intrasession measurements (ICC = 0.93-0.97; CI = 0.86-0.99). Overall, the intraday reliability has been moderate (ICC = 0.64-0.75; CI = 0.27-0.90). EMGmax (ICC = 0.75; CI = 0.45-0.90) and EMGA2-4 (ICC = 0.73, CI = 0.42-0.89) were higher than EMGA0.5 (ICC = 0.64; CI = 0.27-0.85). However, the interday reliability was only fair for EMGmax (ICC = 0.48; CI = 0.04-0.77) and EMGA0.5 (ICC = 0.51; CI = 0.07-0.78) but moderate for EMGA2-4 (ICC = 0.65; CI = 0.28-0.85). CONCLUSIONS This intrasession, intraday, and interday reliability results are similar to the results reported in the literature using probes with longitudinally oriented bars. The mean sEMG signal over 2 seconds (EMGA2-4 ) exhibited the highest reliability and is recommended for further studies. The interday reliability might be enhanced by considering the menstruation cycle.
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Affiliation(s)
| | - Steffen Derlien
- Institute of Physiotherapy, University Hospital Jena, Jena, Germany
| | - Tobias Siebert
- Institute of Sport and Movement Science, University of Stuttgart, Stuttgart, Germany
| | - Marco Herbsleb
- Department of Sports Medicine and Health Promotion, University of Jena, Jena, Germany
| | - Norman Stutzig
- Institute of Sport and Movement Science, University of Stuttgart, Stuttgart, Germany
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The Use of Disposable Tampons as Visual Biofeedback in Pelvic Floor Muscle Training. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16122143. [PMID: 31212987 PMCID: PMC6616577 DOI: 10.3390/ijerph16122143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/13/2019] [Accepted: 06/14/2019] [Indexed: 12/02/2022]
Abstract
Background: Urinary incontinence represents a complex problem which commonly affects women and influences their physical, mental and social wellbeing. The objective was to determine the effect of pelvic floor muscle training using a tampon as visual biofeedback. Methods: A non-randomized clinical trial involving 60 women >18 years of age, both with, and without, urinary incontinence. All women exercised with a program involving visual biofeedback using disposable tampons at home for three months. The compliance rate was 76.8 ± 24.1 An electromyographic assessment of the pelvic floor was performed and assessments of the impact of the exercise program. Results: 54.5% of women without incontinence and 81.6% of women incontinence reported improvements (p = 0.041). In both groups, there was increased quality life (p > 0.05). The women without incontinence experienced greater improvement in the quality of their sexual relations (Pre 6.8 ± 1.4–Post 7.2 ± 1.0). Conclusions: After the intervention, a high percentage of women showed a statistically significant improvement in their symptoms. The participants reported an increase in quality of life and the women without incontinence reported an improvement in quality of their sexual relations. Our findings suggest that visual BFB for training the PFM may be beneficial for women with or without incontinence.
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Pekbay Y, Ergin O, Topuz B, Sarikaya S, Acar ZZ, Irkilata HC, Dayanç M. The effects of pelvic floor muscle therapy on symptoms, voiding, and pelvic floor muscle activity parameters in children with overactive bladder. Neurourol Urodyn 2019; 38:1430-1442. [DOI: 10.1002/nau.24007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 03/07/2019] [Accepted: 04/01/2019] [Indexed: 01/21/2023]
Affiliation(s)
- Yelda Pekbay
- Division of Pediatric UrologyPrivate Dayanc Urology CenterAnkara Turkey
| | - Oguz Ergin
- Department of UrologyPrivate Yasam HospitalAntalya Turkey
| | - Bahadir Topuz
- Department of UrologyGulhane Training and Research HospitalAnkara Turkey
| | - Selçuk Sarikaya
- Department of UrologyGulhane Training and Research HospitalAnkara Turkey
| | | | | | - Murat Dayanç
- Division of Pediatric UrologyPrivate Dayanc Urology CenterAnkara Turkey
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Leitner M, Moser H, Eichelberger P, Kuhn A, Radlinger L. Pelvic floor muscle activity during fast voluntary contractions in continent and incontinent women. Neurourol Urodyn 2019; 38:625-631. [PMID: 30620113 DOI: 10.1002/nau.23911] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 11/25/2018] [Indexed: 11/08/2022]
Abstract
AIMS Stress urinary incontinence (SUI) has also been attributed to a lower speed of contraction of the pelvic floor muscles (PFM). Therefore, PFM assessment and training implement fast voluntary contractions (FVC). The purpose of the study was to explore FVC regarding feasibility, on-/offset and rate of activity determination, as well as differences between continent (CON) and stress urinary incontinent (SUI) women. METHODS Fifty women were included and examined by means of PFM EMG during rest, maximum voluntary contractions (MVC), and five FVC. MVC-peak activity was used to normalize EMG-data. On-/offset of muscle activity was determined as mean of rectified rest activity plus 1 standard deviation. Linear regression was calculated for rate of activity from onset to peak, peak to offset, and within 200 ms after both onset and peak. Peak activity and time variables related to onset, peak, and offset were calculated. RESULTS On-/offsets were evaluable for 234/222 of 250 FVC by a computer-based algorithm, 16/28 on-/offsets had to be determined manually. There was no significant difference between groups (CON/SUI) regarding FVC peak (92.1/99.3 %MVC), time to peak (514.2/525.6 ms), and increase of activity (182.8/182.1 %MVC/s). The SUI group showed a significantly slower activity decrease (-120.7/-74.4 %MVC/s). CONCLUSIONS FVC analyses were shown to be feasible. The significant difference observed between the groups did not refer to activity increase but instead to a prolonged relaxation phase in the SUI group. This prompts to reconsider the interpretation of FVC in PFM testing and training.
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Affiliation(s)
- Monika Leitner
- Bern University of Applied Sciences, Department of Health Professions, Division of Physiotherapy, Bern, Switzerland
| | - Helene Moser
- Bern University of Applied Sciences, Department of Health Professions, Division of Physiotherapy, Bern, Switzerland
| | - Patric Eichelberger
- Bern University of Applied Sciences, Department of Health Professions, Division of Physiotherapy, Bern, Switzerland
| | - Annette Kuhn
- Bern University Hospital, Gynaecology, Bern, Switzerland
| | - Lorenz Radlinger
- Bern University of Applied Sciences, Department of Health Professions, Division of Physiotherapy, Bern, Switzerland
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Effectiveness of Intra-anal Biofeedback and Electrical Stimulation in the Treatment of Children With Refractory Monosymptomatic Nocturnal Enuresis: A Comparative Randomized Controlled Trial. Int Neurourol J 2018; 22:295-304. [PMID: 30599501 PMCID: PMC6312976 DOI: 10.5213/inj.1836142.071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 08/25/2018] [Indexed: 11/08/2022] Open
Abstract
Purpose To compare the effects of intra-anal biofeedback (BF) and intra-anal electrical stimulation (ES) on pelvic floor muscles (PFMs) activity, nocturnal bladder capacity, and frequency of wet night episodes in children with refractory primary monosymptomatic nocturnal enuresis (PMNE). Methods Ninety children of both sexes aged 8–12 years with refractory PMNE participated in this study. They were randomly assigned to 3 groups of equal number: control group (CON) that underwent behavioral therapy and PFM training, and 2 study groups (BF and ES) that underwent the same program in addition to intra-anal BF training and intra-anal ES, respectively. PFMs activity was assessed using electromyography, nocturnal bladder capacity was evaluated by measuring the first morning voided volume, and a nocturnal enuresis diary was used for documenting wet night episodes before treatment and after 3 months of treatment. Results After training, all groups showed statistically significant improvements in all measured outcomes compared to their pretreatment findings. The ES group showed significantly greater improvements in all measured outcomes than the CON and BF groups. Conclusions Both intra-anal BF training and ES combined with behavioral therapy and PFMs training were effective in the treatment of PMNE, with intra-anal ES being superior to BF training.
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Gondim Oliveira R, Barroso, Jr U. Overactive Bladder in Children. EUROPEAN MEDICAL JOURNAL 2018. [DOI: 10.33590/emj/10314428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023] Open
Abstract
Overactive bladder (OAB) is clinically defined as the presence of urinary urgency and may be associated with diurnal urinary incontinence, frequency, and enuresis, and/or constipation. In children aged 5–10 years, the prevalence is 5–12%. Association with emotional disorders is widely described in the literature. Constipation is associated with voiding symptoms because of crosstalk between the gastrointestinal tract and the urinary tract. OAB is believed to be multifactorial. Correct functioning between the pontine micturition centre, the periaqueductal grey matter, anterior cingulate gyrus, and prefrontal cortex is important for correct voiding development and the process of maturation. Patients with OAB have greater anterior cingulate gyrus activity and deactivation of the pontine micturition centre urinary inhibition process, leading to a greater frequency of bladder repletion sensation. Urotherapy is the first treatment to be initiated and aims to change behavioural patterns inthese patients. Other treatment options are anticholinergics, with oxybutynin being the most widely studied, but also described is the use of tolterodine, darifenacin, and mirabegron. Alternative treatments, such as nerve stimulation in the parasacral or the posterior tibial area, have shown improvement of symptoms in comparative studies with conventional drug treatment, and, in refractory cases, botulinum toxin A is an option. In this article, we review the pathophysiology, associated conditions, and aspects related to diagnosis and treatment of OAB.
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Affiliation(s)
| | - Ubirajara Barroso, Jr
- Unit of Uro Nephrology and Discipline of Urology, Bahiana School of Medicine and Federal University of Bahia, Salvador, Brazil
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Fitz F, Sartori M, Girão MJ, Castro R. Pelvic floor muscle training for overactive bladder symptoms - A prospective study. ACTA ACUST UNITED AC 2018; 63:1032-1038. [PMID: 29489983 DOI: 10.1590/1806-9282.63.12.1032] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 05/22/2017] [Indexed: 05/29/2023]
Abstract
INTRODUCTION Pelvic floor muscle training (PFMT) involves the contraction of the puborectal, anal sphincter and external urethral muscles, inhibiting the detrusor contraction, what justify its use in the treatment of overactive bladder (OAB) symptoms. OBJECTIVE To verify the effects of isolated PFMT on the symptoms of OAB. METHOD Prospective clinical trial with 27 women with mixed urinary incontinence (MUI), with predominance of OAB symptoms and loss ≥ 2 g in the pad test. It was evaluated: pelvic floor muscles (PFMs) function (digital palpation and manometry); urinary symptoms (nocturia, frequency and urinary loss); degree of discomfort of OAB symptoms; and quality of life (Incontinence Quality-of-Life Questionnaire [I-QoL]). The PFMT program consisted of 24 outpatient sessions (2x/week + home PFMT). The Mann-Whitney and Wilcoxon tests (with a significance level of 5%) were used to analyse the data. RESULTS There was a significant improvement of the urinary symptoms to the pad test (5.8±9.7, p<0.001), urinary loss (0.7±1.1, p=0.005) and nocturia (0.8±0.9, p=0.011). Reduction in the degree of discomfort of urinary symptoms was observed according to OAB-V8 questionnaire (10.0±7.7, p=0.001). There were also significant results in PFMs function: Oxford (3.6±0.9, p=0.001), endurance (5.2±1.8, p<0.001), fast (8.9±1.5, p<0.001) and manometry (26.6±15.8, p=0.003). In addition, quality of life had a significant improvement in the three domains evaluated by I-QoL. CONCLUSION The PFMT without any additional guidelines improves the symptomatology, the function of PFMs and the quality of life of women with OAB symptoms.
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Affiliation(s)
- Fátima Fitz
- Department of Gynecology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Marair Sartori
- Department of Gynecology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Manoel João Girão
- Department of Gynecology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Rodrigo Castro
- Department of Gynecology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Macêdo LC, Lemos A, A Vasconcelos D, Katz L, Amorim MMR. Correlation between electromyography and perineometry in evaluating pelvic floor muscle function in nulligravidas: A cross-sectional study. Neurourol Urodyn 2018; 37:1658-1666. [PMID: 29572913 DOI: 10.1002/nau.23402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 08/20/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To correlate the results of electromyography and perineometry in the assessment of PFM function in nulligravidas. METHODS The cross-sectional observational study was approved by the internal review board of the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) and was conducted in the Instituto Paraibano de Pesquisa Professor Joaquim Amorim Neto (IPESQ). Thirty-eight nulligravidas aged 18-39 years of age, who had already initiated their sexual life, participated in the study. Exclusion criteria consisted of the presence of genital prolapse, a history of pelvic or urogenital surgery and the presence of neurological disease producing muscle disorders. For the evaluation procedure, the women were submitted to a clinical evaluation of the pelvic floor muscles followed by electromyography. Perineometry was performed 72 h later. Prior to electromyography and perineometry, the women were given standardized training with electromyographic biofeedback to teach them to contract only their pelvic floor muscles. RESULTS A highly positive, statistically significant correlation (r = 0.968; P < 0.001) was found between the electromyographic and perineometric findings. CONCLUSIONS A strong correlation was found between perineometric and electromyographic findings of pelvic floor muscle function.
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Affiliation(s)
- Lorena C Macêdo
- Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Pernambuco, Brazil.,Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), Campina Grande, Paraíba, Brazil
| | - Andrea Lemos
- Federal Universityof Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | | | - Leila Katz
- Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Pernambuco, Brazil
| | - Melania M R Amorim
- Federal University of Campina Grande (UFCG), Instituto Paraibano de Pesquisa Prof. Joaquim Amorim Neto (IPESQ), Campina Grande, Paraíba, Brazil
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Can maximal voluntary pelvic floor muscle contraction reduce vaginal resting pressure and resting EMG activity? Int Urogynecol J 2018. [DOI: 10.1007/s00192-018-3599-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Ribeiro AM, Mateus-Vasconcelos ECL, Silva TDD, Brito LGDO, Oliveira HFD. Functional assessment of the pelvic floor muscles by electromyography: is there a normalization in data analysis? A systematic review. FISIOTERAPIA E PESQUISA 2018. [DOI: 10.1590/1809-2950/16559525012018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
ABSTRACT This study aims to evaluate the method of analysis of electromyographic data considering the functional assessment of pelvic floor muscles (PFM). We have included in our search strategy the following databases: Medline, PubMed, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, PEDro, and IBECS, considering articles published in the last ten years (2004-2014). The identified articles were independently examined by two evaluators, according to these inclusion criteria: (1) population: female adults; (2) PFM assessment by electromyography (EMG) with vaginal/anal probe; and (3) description of how electromyographic data analysis is performed. The Newcastle-Ottawa Scale (NOS) was used to assess the risk of bias. We identified 508 articles, of which 23 were included in the review. The data showed differences between the collection protocols, and a significant number of studies did not normalize the electromyographic data. Physiotherapists are among the clinicians who most frequently use EMG to evaluate the function and dysfunction of the neuromuscular system. Although some previous studies have provided an overview to guide the evaluator in the assessment, few succeeding studies followed their recommendations.
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Peng Y, Miller BD, Boone TB, Zhang Y. Modern Theories of Pelvic Floor Support : A Topical Review of Modern Studies on Structural and Functional Pelvic Floor Support from Medical Imaging, Computational Modeling, and Electromyographic Perspectives. Curr Urol Rep 2018; 19:9. [PMID: 29435856 DOI: 10.1007/s11934-018-0752-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW Weakened pelvic floor support is believed to be the main cause of various pelvic floor disorders. Modern theories of pelvic floor support stress on the structural and functional integrity of multiple structures and their interplay to maintain normal pelvic floor functions. Connective tissues provide passive pelvic floor support while pelvic floor muscles provide active support through voluntary contraction. Advanced modern medical technologies allow us to comprehensively and thoroughly evaluate the interaction of supporting structures and assess both active and passive support functions. The pathophysiology of various pelvic floor disorders associated with pelvic floor weakness is now under scrutiny from the combination of (1) morphological, (2) dynamic (through computational modeling), and (3) neurophysiological perspectives. This topical review aims to update newly emerged studies assessing pelvic floor support function among these three categories. RECENT FINDINGS A literature search was performed with emphasis on (1) medical imaging studies that assess pelvic floor muscle architecture, (2) subject-specific computational modeling studies that address new topics such as modeling muscle contractions, and (3) pelvic floor neurophysiology studies that report novel devices or findings such as high-density surface electromyography techniques. We found that recent computational modeling studies are featured with more realistic soft tissue constitutive models (e.g., active muscle contraction) as well as an increasing interest in simulating surgical interventions (e.g., artificial sphincter). Diffusion tensor imaging provides a useful non-invasive tool to characterize pelvic floor muscles at the microstructural level, which can be potentially used to improve the accuracy of the simulation of muscle contraction. Studies using high-density surface electromyography anal and vaginal probes on large patient cohorts have been recently reported. Influences of vaginal delivery on the distribution of innervation zones of pelvic floor muscles are clarified, providing useful guidance for a better protection of women during delivery. We are now in a period of transition to advanced diagnostic and predictive pelvic floor medicine. Our findings highlight the application of diffusion tensor imaging, computational models with consideration of active pelvic floor muscle contraction, high-density surface electromyography, and their potential integration, as tools to push the boundary of our knowledge in pelvic floor support and better shape current clinical practice.
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Affiliation(s)
- Yun Peng
- Department of Biomedical Engineering, Cullen College of Engineering, University of Houston, 360 HBS Building, 4811 Calhoun Rd., Houston, TX, 77004, USA
| | - Brandi D Miller
- Department of Urology, Houston Methodist Hospital, Houston, TX, 77030, USA
| | - Timothy B Boone
- Department of Urology, Houston Methodist Hospital, Houston, TX, 77030, USA
| | - Yingchun Zhang
- Department of Biomedical Engineering, Cullen College of Engineering, University of Houston, 360 HBS Building, 4811 Calhoun Rd., Houston, TX, 77004, USA.
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Koenig I, Luginbuehl H, Radlinger L. Reliability of pelvic floor muscle electromyography tested on healthy women and women with pelvic floor muscle dysfunction. Ann Phys Rehabil Med 2017; 60:382-386. [DOI: 10.1016/j.rehab.2017.04.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 03/24/2017] [Accepted: 04/07/2017] [Indexed: 10/19/2022]
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Fitz FF, Stüpp L, Costa TF, Sartori MGF, Girão MJBC, Castro RA. Correlation between maximum voluntary contraction and endurance measured by digital palpation and manometry: An observational study. Rev Assoc Med Bras (1992) 2017; 62:635-640. [PMID: 27925042 DOI: 10.1590/1806-9282.62.07.635] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 07/06/2015] [Indexed: 11/21/2022] Open
Abstract
Introduction: Digital palpation and manometry are methods that can provide information regarding maximum voluntary contraction (MVC) and endurance of the pelvic floor muscles (PFM), and a strong correlation between these variables can be expected. Objective: To investigate the correlation between MVC and endurance, measured by digital palpation and manometry. Method: Forty-two women, with mean age of 58.1 years (±10.2), and predominant symptoms of stress urinary incontinence (SUI), were included. Examination was firstly conducted by digital palpation and subsequently using a Peritron manometer. MVC was measured using a 0-5 score, based on the Oxford Grading Scale. Endurance was assessed based on the PERFECT scheme. Results: We found a significant positive correlation between the MVC measured by digital palpation and the peak manometric pressure (r=0.579, p<0.001), and between the measurements of the endurance by Peritron manometer and the PERFECT assessment scheme (r=0.559, P<0.001). Conclusion: Our results revealed a positive and significant correlation between the capacity and maintenance of PFM contraction using digital and manometer evaluations in women with predominant symptoms of SUI.
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Affiliation(s)
- Fátima Faní Fitz
- PT, MSc, Department of Gynecology, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil
| | - Liliana Stüpp
- PT, PhD, Department of Gynecology, Unifesp, São Paulo, SP, Brazil
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McLean L, Brooks K. What Does Electromyography Tell Us About Dyspareunia? Sex Med Rev 2017; 5:282-294. [PMID: 28330675 DOI: 10.1016/j.sxmr.2017.02.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 02/13/2017] [Accepted: 02/14/2017] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Emergent evidence suggests that pelvic floor muscle (PFM) dysfunction contributes to dyspareunia, the experience of pain on vaginal penetration. Electromyography (EMG) is a valuable tool for the assessment of neuromuscular control and could be very useful in enhancing our understanding of PFM involvement in sexual function and in conditions such as dyspareunia. However, PFM EMG must be interpreted within the context of the many factors that can influence findings. AIM To outline the main factors to consider when evaluating PFM EMG for female sexual function and dyspareunia and to synthesize the literature in which EMG has been acquired and interpreted appropriately in this context. METHODS Standards for the acquisition and interpretation of EMG were retrieved and consulted. An exhaustive search of four electronic databases (Embase, CINAHL, PubMed, and PsycLit) and hand searching references from relevant articles were performed to locate articles relevant to PFM involvement in sexual function and in dyspareunia in which EMG was used as a primary outcome. Study outcomes were evaluated within the context of the appropriate application and interpretation of EMG and their contribution to knowledge. MAIN OUTCOME MEASURES A synthesis of the evidence was used to present the current state of knowledge on PFM involvement in sexual function and in dyspareunia. RESULTS Few standards documents and no practice guidelines for the acquisition and interpretation of PFM EMG are available. Some cohort studies with small samples of women have described the role of the PFMs in female sexual function. The literature on PFM involvement in dyspareunia also is limited, with outcomes suggesting that higher than normal tonic activation and higher than normal reflex responses might be present in the superficial PFM layer and might be characteristic features of dyspareunia. The data are less clear on the involvement of the deep layer of the PFMs in dyspareunia. CONCLUSION Guidelines for the application and interpretation of PFM EMG in the context of sexual function and dyspareunia are needed. When interpreted within the context of their strengths and limitations, EMG data have contributed valuable information to our understanding of PFM involvement in dyspareunia. The literature to date suggests that the superficial PFMs might have higher than normal tone and exaggerated responses to tactile or penetrative provocation in at least some women with dyspareunia. McLean L, Brooks K. What Does Electromyography Tell Us About Dyspareunia? Sex Med Rev 2017;5:282-294.
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Affiliation(s)
- Linda McLean
- School of Rehabilitation Science, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.
| | - Kaylee Brooks
- School of Kinesiology, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
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Flury N, Koenig I, Radlinger L. Crosstalk considerations in studies evaluating pelvic floor muscles using surface electromyography in women: a scoping review. Arch Gynecol Obstet 2017; 295:799-809. [PMID: 28176015 DOI: 10.1007/s00404-017-4300-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 01/13/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE Surface electromyography (sEMG) using intravaginal probes is of widespread use for assessing pelvic floor muscles (PFM) activity in women. Although considered as a reliable method, its validity has been called into question due to the presence of a phenomenon called crosstalk. Crosstalk is described as the recording of sEMG activity originating from neighboring muscles rather than coming exclusively from the muscles being investigated. The purpose of this review was to provide an overview of existing literature about crosstalk during intravaginal surface electromyographic recordings. METHODS A scoping review was performed according to the Arksey and O'Malley framework. An electronic search was conducted on six relevant databases. Additionally, authors were directly contacted to identify grey literature. Data extraction consisted of descriptive numeric analysis as well as thematic analysis, which were conducted by two independent reviewers. RESULTS Forty-nine references written by 34 authors coming from 13 different countries constitute the body of evidence of the present review. Eight main themes have been identified through the thematic analysis. The included material varies greatly in terms of methodology, approach to the crosstalk problem and depth of analysis. CONCLUSIONS A gap in knowledge affecting the validity of the current sEMG investigation methods was identified. Literature addressing the crosstalk problem is scarce and often flawed. Definitive conclusions are regularly drawn from an insufficient basis of evidence. Further research is, therefore, deeply necessary, although it remains unclear whether this issue can be solved at all with current technology.
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Affiliation(s)
- Noémie Flury
- Bern University of Applied Sciences, Bern, Switzerland
| | - Irene Koenig
- Bern University of Applied Sciences, Bern, Switzerland.
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Efficacy of FemiScan Pelvic Floor Therapy for the Treatment of Urinary Incontinence. Female Pelvic Med Reconstr Surg 2016; 22:433-437. [PMID: 27636211 DOI: 10.1097/spv.0000000000000307] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Pelvic floor muscle training can be effective in alleviating urinary incontinence; however, women need instruction, motivation, and feedback to gain optimal benefit from pelvic rehabilitation. The Food and Drug Administration-approved FemiScan Pelvic Floor Therapy System uses office electromyography and an in-home programmable device to provide training, motivation, and feedback between office visits. This study was undertaken to document the outcomes of women who completed an MD-supervised program using the FemiScan Pelvic Floor Therapy System. METHODS In this chart review, women with urinary incontinence, who completed the 8-visit protocol, were included in the analysis. We collected patient demographics, electromyographic measurements, and responses to subjective questions about the status of their urinary incontinence symptoms. RESULTS Two hundred fifteen (60%) of 361 patients who started treatment with FemiScan completed the 8-visit protocol. No adverse events were reported. The mean age was 54.4 ± 12.7 years. There was a statistically significant increase in the mean maximal response comparing the first and final electromyographic measurements obtained during the first and last electromyography office visits. The left side (15.9 ± 10.2 μV vs 28.0± 15.2 μV, P < 001) and the right side (16.6 μV vs 28.2 μV, P < 0.001) were analyzed separately in peak electromyographic measurements between the first and final visits. Seventy-five percent considered their symptoms at least 80% improved with 45% reporting complete subjective cure. Urinary Distress Inventory 6 results confirmed the subjective report with a statistical significant improvement comparing the first and last visit (9.47 ± 3.66 vs 2.71 ± 3.58, P < 001). CONCLUSIONS FemiScan appears to be a safe and effective treatment for urinary incontinence with concomitant increased pelvic floor electromyographic activity.
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Luginbuehl H, Baeyens JP, Kuhn A, Christen R, Oberli B, Eichelberger P, Radlinger L. Pelvic floor muscle reflex activity during coughing - an exploratory and reliability study. Ann Phys Rehabil Med 2016; 59:302-307. [PMID: 27265846 DOI: 10.1016/j.rehab.2016.04.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 02/22/2016] [Accepted: 04/18/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Activities that provoke stress urinary incontinence (SUI) rapidly increase the intra-abdominal pressure and the impact loading on the pelvic floor muscles (PFMs). Coughing can cause urinary leakage and is often used to test SUI. However, PFM characteristics during coughing, including their reliability, have not been investigated. Here, we used electromyography (EMG) to describe PFM pre-activity and reflexivity during coughing and examined the reliability of the measurements. METHODS This was an exploratory and reliability study including 11 young healthy women to characterize EMG reflex activity in PFMs during coughing. We describe 6 variables, averaged over 3 coughs per subject, and tested their reliability (intraclass correlation coefficient 3,1 [ICC(3,1)] and ICC(3,k), related standard error of measurement (SEM) and minimal difference [MD]). The variables represented the mean EMG activity for PFMs during 30-ms time intervals of pre-activity (initial time point of coughing [T0] and minus 30ms) and reflex activity (T0-30, 30-60, 60-90, 90-120 and 120-150ms after T0) of stretch-reflex latency responses. RESULTS The mean %EMG (normalized to maximal voluntary PFM contraction) for EMG variables was 35.1 to 52.2 and was significantly higher during coughing than for PFM activity at rest (mean 24.9±3.7%EMG; P<0.05). ICC(3,k) ranged from 0.67 to 0.91 (SEM 6.1-13.3%EMG and MD 16.7-36.8%EMG) and was higher than ICC(3,1) (range 0.40-0.77; SEM 9.0-18.0%EMG, MD 24.9-50.0%EMG). CONCLUSIONS PFM activity during reflex latency response time intervals during coughing was significantly higher than at rest, which suggests PFM pre-activity and reflex activity during coughing. Although we standardized coughing, EMG variables for PFM activity showed poor reliability [good to excellent ICC(3,k) and fair to excellent ICC(3,1) but high SEM and MD]. Therefore, coughing is expected to be heterogeneous, with low reliability, in clinical test situations. Potential crosstalk from other muscles involved in coughing could limit the interpretation of our results.
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Affiliation(s)
- Helena Luginbuehl
- Bern University of Applied Sciences, Health, Discipline of Physiotherapy, Murtenstrasse 10, 3008 Bern, Switzerland; Vrije Universiteit Brussel, Faculty of Physical Education and Physiotherapy, Pleinlaan 2, 1050 Elsene, Belgium.
| | - Jean-Pierre Baeyens
- Vrije Universiteit Brussel, Faculty of Physical Education and Physiotherapy, Pleinlaan 2, 1050 Elsene, Belgium
| | - Annette Kuhn
- Department of Gynecology, Division of Urogynecology, Inselspital and University of Bern, Effingerstrasse 102, Switzerland
| | - Regula Christen
- Bern University of Applied Sciences, Health, Discipline of Physiotherapy, Murtenstrasse 10, 3008 Bern, Switzerland
| | - Bettina Oberli
- Bern University of Applied Sciences, Health, Discipline of Physiotherapy, Murtenstrasse 10, 3008 Bern, Switzerland
| | - Patric Eichelberger
- Bern University of Applied Sciences, Health, Discipline of Physiotherapy, Murtenstrasse 10, 3008 Bern, Switzerland
| | - Lorenz Radlinger
- Bern University of Applied Sciences, Health, Discipline of Physiotherapy, Murtenstrasse 10, 3008 Bern, Switzerland
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