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Audrain A, Cornu JN, Kerdelhue G, Combret Y, Steenstrup B. Do pelvic floor muscle function parameters differ in women according to continence status? A systematic review. THE FRENCH JOURNAL OF UROLOGY 2024; 34:102592. [PMID: 38377645 DOI: 10.1016/j.fjurol.2024.102592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 01/18/2024] [Accepted: 01/28/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Current literature highlights the difficulty in identifying which pelvic floor muscle (PFM) functions are correlated with urinary incontinence (UI). AIM In this study, we compared parameters of PFM function (strength, endurance, tone, control, reaction, and/or coordination) according to continence status in women (presence or absence, type and/or severity of urinary incontinence). EVIDENCE ACQUISITION A systematic review was conducted following the 2020 PRISMA guidelines. Three databases (Pubmed, Web of Science, and LiSSa) were searched from inception to December 31, 2021. Assessment of risk of bias was performed using the Joanna Briggs Institute critical appraisal checklist. EVIDENCE SYNTHESIS The initial research yielded 4733 studies. Forty-two studies met the inclusion criteria, including 4015 participants. No statistical association was found between PFM function and the presence or absence of UI, the different type of UI or the different levels of severity of UI. The heterogeneity in methodologies and analyzes of the results only with the P-value are important limitations of this review. CONCLUSION It appears that muscle function is not always associated with presence or absence of UI. No association is found between PFM function and type or severity of UI. These results reinforce the need to carry out a bio-psycho-social evaluation of UI that does not only focus on PFM functions. As such, the results reported herein can be considered a resource for more specific research.
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Affiliation(s)
| | | | - Gaëtan Kerdelhue
- Department of Biomechanical Informatics, Rouen University Hospital, Rouen, France
| | - Yann Combret
- Physiotherapy Department, Le Havre Hospital, La Havre, France; ERPHAN, Paris-Saclay University, UVSQ, Versailles, France
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Azhdari N, Ebrahimi S, Abolahrari-Shirazi S, Rojhani-Shirazi Z, Bervis S, Ghahramani L. Investigating the lumbar proprioception and core muscles recruitment pattern while getting up from a chair with weight lifting in patients with chronic functional constipation: cross-sectional study. Int Urogynecol J 2024; 35:109-117. [PMID: 37991565 DOI: 10.1007/s00192-023-05673-4] [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: 07/10/2023] [Accepted: 10/01/2023] [Indexed: 11/23/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Patients with chronic functional constipation have some problems such as weakness of pelvic floor muscles, and a lack of coordination of pelvic floor and abdominal muscles has been seen. The goal of this study was to investigate the lumbar proprioception and the core muscle recruitment pattern. METHODS The study type is a cross-sectional case-control study. There were 30 participants (case, n = 15, and control, n = 15). Electromyography of the core muscles was recorded while the subjects were getting up from the chair accompanied by lifting a weight, to check the pattern of muscle recruitment. Moreover, the lumbar proprioception was evaluated by an isokinetic device in both groups. The study was analyzed using independent t test and Mann-Whitney U test, and a nonparametric Friedman test was performed followed by Bonferroni pairwise comparison. RESULTS The comparison of muscle activity delay between the two groups showed that there was a significant difference between the two groups regarding the abdominal muscles, anal sphincter, and erector spinae (p < 0.05). However, there was no significant difference in the rectus femoris and gluteal muscles between the two groups (p > 0.05). Moreover, the proprioception of the lumbar region showed a significant difference (p < 0.05) between the two groups. CONCLUSIONS The results of this study demonstrated that the lumbar proprioception sense was reduced in the case group. This result can be justified, based on the problems in constipation (lack of coordination of muscles, weakness of pelvic floor muscles). The coordination of core muscles changed in patients with chronic functional constipation during a functional task.
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Affiliation(s)
- Negar Azhdari
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, 1st, Abivardi Avenue, Chamran Blvd, Shiraz, Iran
| | - Samaneh Ebrahimi
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, 1st, Abivardi Avenue, Chamran Blvd, Shiraz, Iran.
- Rehabilitation Science Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Sara Abolahrari-Shirazi
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, 1st, Abivardi Avenue, Chamran Blvd, Shiraz, Iran
- Rehabilitation Science Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Rojhani-Shirazi
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, 1st, Abivardi Avenue, Chamran Blvd, Shiraz, Iran
- Rehabilitation Science Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Soha Bervis
- Rehabilitation Science Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Leila Ghahramani
- Department of Colorectal Surgery, School of Medicine Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Steenstrup B, Pelleray M, Cornu JN, Verdun S, Gilliaux M. Neutral posture education during cough can reduce urine leakage in women with cough-related stress urinary incontinence. Prog Urol 2023; 33:1083-1091. [PMID: 37758607 DOI: 10.1016/j.purol.2023.09.002] [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: 07/20/2023] [Revised: 09/03/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Current literature highlights the difficulty in identifying an optimal educational technique for maintaining continence during cough. OBJECTIVE To characterize the effects of an educational intervention focusing on neutral posture during cough in women with cough-induced urinary incontinence (UI). METHODS This interventional study design included women with cough-induced UI. We recorded PFMs surface electromyographic (sEMG) peak activity, and assessed symptoms and quality of life (QoL) 6 weeks after the intervention. The effect of the experimental situation was estimated using a linear mixed model, sEMG measurements during coughing were indexed to each situation and adjusted to the resting value at, and a moderation analysis was used. RESULTS/FINDINGS Eighteen participants were included. The measurement situations (control versus experimental) did not have a statistically significant impact on sEMG peak activity during coughing: mean effect [95% CI] 3.42 [-1.28; 7.66]. Six weeks post-intervention, participants reported statistically significant decrease in urinary symptoms (P=0.0246) and significant improvement in QoL (P=0.00776). This was also particularly marked on the dimension related to effort activities (P=0.00162). CONCLUSION This study suggests that a brief educational intervention focusing on neutral posture during cough, without voluntary pre-contraction of the PFMs, has no clinically significant influence on sEMG peak activity of the PFMs in women with cough-induced UI. However, this intervention can lead to a significant improvement in urinary symptoms and QoL at 6 weeks. These improvements seem to be independent of electromyographic PFMs peak activity recorded during cough. As such, our preliminary results pave the way for future research. LEVEL OF EVIDENCE NP4.
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Affiliation(s)
- B Steenstrup
- Rouen University Hospital, Department of Urology, Rouen, France; La Musse Clinical Research Department and Physiotherapy Training Institute (Fondation La Renaissance Sanitaire), Saint-Sébastien-de-Morsent, France.
| | - M Pelleray
- La Musse Clinical Research Department and Physiotherapy Training Institute (Fondation La Renaissance Sanitaire), Saint-Sébastien-de-Morsent, France
| | - J N Cornu
- Rouen University Hospital, Department of Urology, Rouen, France
| | - S Verdun
- Lille Catholic hospitals, Biostatistics Department- Delegations for Clinical Research and Innovation, Lille Catholic University, Lille, France
| | - M Gilliaux
- La Musse Clinical Research Department and Physiotherapy Training Institute (Fondation La Renaissance Sanitaire), Saint-Sébastien-de-Morsent, France; Clinical Research Department, Axinesis, Wavre, Belgium
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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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Martinez RFL, Sato TDO, Silva JBD, Figueiredo VBD, Avila MA, Driusso P. Pelvic floor muscle activity during coughing and valsalva maneuver in continent women and women with stress urinary incontinence: a systematic review. PHYSICAL THERAPY REVIEWS 2022. [DOI: 10.1080/10833196.2022.2145444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | | | | | | | - Mariana Arias Avila
- Physical Therapy Department, Federal University of São Carlos, São Carlos, Brazil
| | - Patricia Driusso
- Physical Therapy Department, Federal University of São Carlos, São Carlos, Brazil
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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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Scime NV, Hetherington E, Metcalfe A, Chaput KH, Dumanski SM, Seow CH, Brennand EA. Association between chronic conditions and urinary incontinence in females: a cross-sectional study using national survey data. CMAJ Open 2022; 10:E296-E303. [PMID: 35383034 PMCID: PMC9259416 DOI: 10.9778/cmajo.20210147] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Urinary incontinence affects up to half of women, yet few speak to their health care provider about or receive treatment for the condition. To aid with identifying subpopulations at risk for urinary incontinence, we examined the associations between 10 chronic health conditions and urinary incontinence among Canadian adult females. METHODS We conducted a cross-sectional analysis of survey data from the Canadian Community Health Survey (2013-2014) involving female respondents aged 25 years or older living in a private dwelling. Presence of chronic conditions and urinary incontinence were measured by self-report. We used logistic regression modelling with sampling weights, controlling for age, income, ethnicity, body mass index and smoking. Multiple imputation and probabilistic bias analysis were used to address missing covariate data and unmeasured confounding from parity. RESULTS Our analysis included 60 186 respondents representing more than 12 million Canadian females, of whom 45.8% (95% confidence interval [CI] 45.0%-46.6%) reported at least 1 chronic condition. Chronic conditions were associated with more than twice the odds of urinary incontinence (adjusted odds ratio [OR] 2.42, 95% CI 2.02-2.89). Associations were largest for bowel disorders (adjusted OR 2.92, 95% CI 2.44-3.49); modest for chronic obstructive pulmonary disease (adjusted OR 2.00, 95% CI 1.63-2.45), asthma (adjusted OR 1.82, 95% CI 1.52-2.19), arthritis (adjusted OR 1.98, 95% CI 1.74-2.24) and heart disease (adjusted OR 1.73, 95% CI 1.48-2.02); and smallest for diabetes (adjusted OR 1.20, 95% CI 1.02-1.41) and high blood pressure (adjusted OR 1.27, 95% CI 1.12-1.44). Results slightly attenuated but did not substantively change after imputation and bias analysis. INTERPRETATION We found that chronic conditions are associated with significantly higher odds of comorbid urinary incontinence among Canadian adult females, which is consistent with previous research. Our findings support routine inquiry regarding urinary incontinence symptoms among women accessing health care for chronic conditions.
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Affiliation(s)
- Natalie V Scime
- Department of Community Health Sciences (Scime, Metcalfe, Seow, Brennand), University of Calgary, Calgary, Alta.; Department of Epidemiology, Biostatistics and Occupational Health (Hetherington), McGill University, Montréal, Que.; Department of Obstetrics and Gynecology (Metcalfe, Chaput, Brennand), University of Calgary; Division of Nephrology (Dumanski), Division of Gastroenterology & Hepatology (Seow), Department of Medicine, University of Calgary, Calgary, Alta
| | - Erin Hetherington
- Department of Community Health Sciences (Scime, Metcalfe, Seow, Brennand), University of Calgary, Calgary, Alta.; Department of Epidemiology, Biostatistics and Occupational Health (Hetherington), McGill University, Montréal, Que.; Department of Obstetrics and Gynecology (Metcalfe, Chaput, Brennand), University of Calgary; Division of Nephrology (Dumanski), Division of Gastroenterology & Hepatology (Seow), Department of Medicine, University of Calgary, Calgary, Alta
| | - Amy Metcalfe
- Department of Community Health Sciences (Scime, Metcalfe, Seow, Brennand), University of Calgary, Calgary, Alta.; Department of Epidemiology, Biostatistics and Occupational Health (Hetherington), McGill University, Montréal, Que.; Department of Obstetrics and Gynecology (Metcalfe, Chaput, Brennand), University of Calgary; Division of Nephrology (Dumanski), Division of Gastroenterology & Hepatology (Seow), Department of Medicine, University of Calgary, Calgary, Alta
| | - Kathleen H Chaput
- Department of Community Health Sciences (Scime, Metcalfe, Seow, Brennand), University of Calgary, Calgary, Alta.; Department of Epidemiology, Biostatistics and Occupational Health (Hetherington), McGill University, Montréal, Que.; Department of Obstetrics and Gynecology (Metcalfe, Chaput, Brennand), University of Calgary; Division of Nephrology (Dumanski), Division of Gastroenterology & Hepatology (Seow), Department of Medicine, University of Calgary, Calgary, Alta
| | - Sandra M Dumanski
- Department of Community Health Sciences (Scime, Metcalfe, Seow, Brennand), University of Calgary, Calgary, Alta.; Department of Epidemiology, Biostatistics and Occupational Health (Hetherington), McGill University, Montréal, Que.; Department of Obstetrics and Gynecology (Metcalfe, Chaput, Brennand), University of Calgary; Division of Nephrology (Dumanski), Division of Gastroenterology & Hepatology (Seow), Department of Medicine, University of Calgary, Calgary, Alta
| | - Cynthia H Seow
- Department of Community Health Sciences (Scime, Metcalfe, Seow, Brennand), University of Calgary, Calgary, Alta.; Department of Epidemiology, Biostatistics and Occupational Health (Hetherington), McGill University, Montréal, Que.; Department of Obstetrics and Gynecology (Metcalfe, Chaput, Brennand), University of Calgary; Division of Nephrology (Dumanski), Division of Gastroenterology & Hepatology (Seow), Department of Medicine, University of Calgary, Calgary, Alta
| | - Erin A Brennand
- Department of Community Health Sciences (Scime, Metcalfe, Seow, Brennand), University of Calgary, Calgary, Alta.; Department of Epidemiology, Biostatistics and Occupational Health (Hetherington), McGill University, Montréal, Que.; Department of Obstetrics and Gynecology (Metcalfe, Chaput, Brennand), University of Calgary; Division of Nephrology (Dumanski), Division of Gastroenterology & Hepatology (Seow), Department of Medicine, University of Calgary, Calgary, Alta.
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What improvements in levator ani motor function lead to improvement in stress urinary incontinence signs and symptoms in females? Int Urogynecol J 2021; 33:2735-2747. [PMID: 34477898 DOI: 10.1007/s00192-021-04931-7] [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: 02/19/2021] [Accepted: 06/25/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objectives were to determine whether levator ani muscle (LAM) motor function is associated with female stress urinary incontinence (SUI) severity, and whether changes in LAM motor function induced through pelvic floor muscle training (PFMT) are associated with improvements in SUI signs and symptoms. METHODS Pelvic morphology and LAM function were evaluated using ultrasound imaging and manual palpation using the elements of the PERFECT Scheme (Power, Endurance, Repetitions, Fast contractions, Elevation, Co-contraction and Timing) before and after women with SUI underwent a 12-week PFMT intervention. SUI severity was determined subjectively (ICIQ-FLUTS-UI) and objectively (30-min pad test [30MPT]). RESULTS At baseline (n = 97), less leakage on the 30MPT was weakly associated with higher bladder neck position (ρs = -0.209,p = 0.044), yet with lower LAM function based on the PERFECT Scheme (overall score: ρs = 0.206, p = 0.043; repeated maximum voluntary contractions (MVCs): ρs = 0.203, p = 0.046; power/motor control: ρs = 0.214, p = 0.035). Lower symptom severity (ICIQ-FLUTS-UI) was associated with observed perineal lift during coughing (U = 34.000; p = 0.042). All measures of SUI severity and LAM function were significantly improved after PFMT intervention. Greater improvements in bladder neck elevation during MVC (ρs = -0.261, p = 0.027) and greater reductions in levator plate length during MVC (ρs = 0.292, p = 0.016) were weakly associated with greater reductions in leakage (30MPT), the latter also being associated with more improvement symptoms (ICIQ-FLUTS-UI; ρs = 0.238, p = 0.041). Greater improvement in the ability to repeat MVCs (ρs = 0.303, p = 0.009) was weakly associated with smaller improvements in symptoms (ICIQ-FLUTS-UI). CONCLUSION Improvements in bladder neck support and elevation show weak associations with improvement in SUI signs and symptoms. LAM function as measured by the PERFECT Scheme is not associated with SUI severity in women, and improvements in LAM function when measured by the PERFECT Scheme are not associated with improvements in SUI signs and symptoms.
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Postural Sensorimotor Control on Anorectal Pressures and Pelvic Floor Muscle Tone and Strength: Effects of a Single 5P ® LOGSURF Session. A Cross-Sectional Preliminary Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073708. [PMID: 33918217 PMCID: PMC8037751 DOI: 10.3390/ijerph18073708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/24/2021] [Accepted: 03/30/2021] [Indexed: 11/23/2022]
Abstract
Pelvic floor dysfunction (PFD) is a functional condition present most frequently in women. Despite pelvic floor muscle training being considered by the International Continence Society (ICS) as the first-line treatment in uncomplicated urinary incontinence, other more comprehensive postural methods as 5P® LOGSURF have emerged. This preliminary cross-sectional study explores the effects of a single 5P® LOGSURF session on pelvic floor muscle (PFM) tone and strength (MVC), resting anal tone, intrarectal pressure, and deep abdominal muscles activation. Thirty women were included (11 without PFD and 19 with PFD). Primary outcome measures were PFM tone, PFM MVC and resting anal tone and secondary measures outcomes were intrarectal pressure and deep abdominal activation. All outcome measures were collected before, throughout and after a single 30′ 5P® LOGSURF session. The findings from this study suggest that PFM tone (PFD group: p = 0.09, d = 0.72; non-PFD group: p = 0.003, d = 0.49) and PFM MVC (PFD group: p = 0.016; non-PFD group: p = 0.005) decreased in both groups after a single 5P® LOGSURF session, with a medium effect size for women with PFD. Contrarily, deep abdominal muscle MVC increased (PFD group: p < 0.001; non-PFD group: p = 0.03). Intrarectal pressure and resting anal tone decreased in both groups throughout the session. These results suggest that 5P® LOGSURF method may be interesting if is performed by women with mild symptoms of PFD or healthy women to achieve a decrease in PFM tone in women who manifested pain to intracavitary techniques or practices. Further research with higher sample sizes and long-term are necessary for generalizing.
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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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Vieira GF, Saltiel F, Miranda-Gazzola APG, Kirkwood RN, Figueiredo EM. Pelvic floor muscle function in women with and without urinary incontinence: are strength and endurance the only relevant functions? a cross-sectional study. Physiotherapy 2020; 109:85-93. [DOI: 10.1016/j.physio.2019.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Indexed: 10/25/2022]
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Saltiel F, Miranda-Gazzola APG, Vitória RO, Sampaio RF, Figueiredo EM. Linking Pelvic Floor Muscle Function Terminology to the International Classification of Functioning, Disability and Health. Phys Ther 2020; 100:1659-1680. [PMID: 32201881 DOI: 10.1093/ptj/pzaa044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 02/11/2020] [Indexed: 02/09/2023]
Abstract
OBJECTIVE A previous systematic review on pelvic floor muscle function (PFMF) identified a miscellaneity of terms. The lack of consensual terminology might have come from the complexity of neuromusculoskeletal function itself. This study sought to link the previously identified PFMF terms to the International Classification of Functioning, Disability and Health (ICF) terminology. METHODS In this secondary analysis study, 10 linkage rules were applied to link 196 previously identified PFMF terms to the ICF. Two researchers performed the linking process independently. Disagreements were solved by open dialogue with a third researcher. Percentage agreement was computed for main outcome. RESULTS A total of 184 (93.9%) PFMF terms were subsumed into the following 6 ICF terms: tone, involuntary movement reaction, control, coordination, strength, and endurance. The most frequently investigated PFMF was strength (25.5%), followed by involuntary movement reaction (22.9%), endurance (17.2%), control (14.1%), coordination (9.9%), and tone (4.2%). Only 6.2% PFMF could not be linked to ICF terminology. A wide variation of instruments/methods was used to measure PFMF. Vaginal palpation was the only method employed to measure all 6 PFMF. Percentage agreement between raters was 100%. CONCLUSIONS Linking PFMF terminology to the ICF was feasible and valid. It allowed the identification of the most investigated PFMF and their measuring methods. ICF terminology to describe PFMF should be used since it may improve communication, data gathering, and the advance in scientific knowledge. IMPACT Standardized terminology anchored in a theoretical framework is crucial to data gathering, communication, and dissemination of evidence-based practice. PFMF terminology based on ICF can be used to improve data pooling and communication.
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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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Battaglia S, Benfante A, Principe S, Basile L, Scichilone N. Urinary Incontinence in Chronic Obstructive Pulmonary Disease: A Common Co-morbidity or a Typical Adverse Effect? Drugs Aging 2019; 36:799-806. [DOI: 10.1007/s40266-019-00687-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Saltiel F, Miranda-Gazzola APG, Vitória RO, Figueiredo EM. Terminology of Pelvic Floor Muscle Function in Women With and Without Urinary Incontinence: A Systematic Review. Phys Ther 2018; 98:876-890. [PMID: 30010919 DOI: 10.1093/ptj/pzy084] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 04/08/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND Pelvic floor muscle function (PFMF) is a target of the physical therapist intervention for women with urinary incontinence (UI). However, possible variations in PFMF terminology might hamper communication among researchers and health care professionals in Women's Health. OBJECTIVE The objective of this study was to investigate the terminology of PFMF regarding clear terms, conceptual definitions, and operational definitions. DATA SOURCES Data sources include PUBMED, CINAHL, LILACS, and SCIELO. STUDY SELECTION Observational studies investigating any PFMF in women with or without UI, published in English, Spanish, or Portuguese from 2005 through 2017, were considered. DATA EXTRACTION The risk of bias was assessed by a questionnaire on the quality of observational studies. Data on terminology were extracted as terms, conceptual definitions, and operational definitions of PFMF and were synthesized according to key words, key ideas, and key operationalization, respectively. Consistencies and variations were identified for the most frequently investigated PFMF. DATA SYNTHESIS Sixty-four studies were included, and a low risk of bias was identified. All studies presented terms and operational definitions of PFMF, but only 29.7% presented conceptual definitions of those terms. One hundred ninety-six different terms referred to PFMF. According to similarities in terminology, 161 PFMF terms could be grouped under 26 terms; the other 35 were left ungrouped. Therefore, a total of 61 different PFMF terms were identified in the literature. LIMITATIONS A limitation in the study was that only observational studies were included. CONCLUSIONS A large variation in PFMF terminology was identified, precluding data gathering and meta-analysis. The lack of use of standardized terminology delays the progress of scientific knowledge and evidence-based practice dissemination. Efforts toward creating a collaborative, consensual terminology based on a sound framework are necessary.
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Affiliation(s)
- Fernanda Saltiel
- Rehabilitation Sciences Program, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Women's Health Specialist, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Elyonara M Figueiredo
- Physical Therapy Department, Rehabilitation Sciences Program, Universidade Federal de Minas Gerais, Av. Antonio Carolos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901 Brazil
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Thibault-Gagnon S, Auchincloss C, Graham R, McLean L. The temporal relationship between activity of the pelvic floor muscles and motion of selected urogenital landmarks in healthy nulliparous women. J Electromyogr Kinesiol 2018; 38:126-135. [DOI: 10.1016/j.jelekin.2017.11.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 11/17/2017] [Accepted: 11/28/2017] [Indexed: 12/11/2022] Open
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Moser H, Leitner M, Baeyens JP, Radlinger L. Pelvic floor muscle activity during impact activities in continent and incontinent women: a systematic review. Int Urogynecol J 2017; 29:179-196. [DOI: 10.1007/s00192-017-3441-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 07/24/2017] [Indexed: 11/28/2022]
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Amorim AC, Cacciari LP, Passaro AC, Silveira SRB, Amorim CF, Loss JF, Sacco ICN. Effect of combined actions of hip adduction/abduction on the force generation and maintenance of pelvic floor muscles in healthy women. PLoS One 2017; 12:e0177575. [PMID: 28542276 PMCID: PMC5443498 DOI: 10.1371/journal.pone.0177575] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 04/27/2017] [Indexed: 11/18/2022] Open
Abstract
Pelvic floor muscle (PFM) force and coordination are related to urinary incontinence severity and to sexual satisfaction. Health professionals frequently combine classic PFM exercises with hip adduction/abduction contraction to treat these disorders, but the real benefits of this practice are still unknown. Based on a theoretical anatomy approach whereby the levator ani muscle is inserted into the obturator internus myofascia and in which force generated by hip movements should increase the contraction quality of PFMs, our aim was to investigate the effects of isometric hip adduction and abduction on PFM force generation. Twenty healthy, nulliparous women were evaluated using two strain-gauge dynamometers (one cylinder-like inside the vaginal cavity, and the other measuring hip adduction/abduction forces around both thighs) while performing three different tasks: (a) isolated PFM contraction; (b) PFM contraction combined with hip adduction (30% and 50% maximum hip force); and (c) PFM contraction combined with hip abduction (30% and 50% maximum hip force). Data were sampled at 100Hz and subtracted from the offset if existent. We calculated a gradient between the isolated PFM contraction and each hip condition (Δ Adduction and Δ Abduction) for all variables: Maximum force (N), instant of maximum-force occurrence (s), mean force in an 8-second window (N), and PFM force loss (N.s). We compared both conditions gradients in 30% and 50% by paired t-tests. All variables did not differ between hip conditions both in 30% and 50% of maximum hip force (p>.05). PFM contraction combined with isometric hip abduction did not increase vaginal force in healthy and nulliparous women compared to PFM contraction combined with isometric hip adduction. Therefore, so far, the use of hip adduction or abduction in PFM training and treatments are not justified for improving PFM strength and endurance.
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Affiliation(s)
- Amanda C. Amorim
- Physical Therapy, Speech and Occupational Therapy, School of Medicine, University of Sao Paulo, São Paulo, Brazil
| | - Licia P. Cacciari
- Physical Therapy, Speech and Occupational Therapy, School of Medicine, University of Sao Paulo, São Paulo, Brazil
| | - Anice C. Passaro
- Physical Therapy, Speech and Occupational Therapy, School of Medicine, University of Sao Paulo, São Paulo, Brazil
| | | | - Cesar F. Amorim
- Physical Therapy Master Program, University of the City of Sao Paulo (UNICID), São Paulo, Brazil
| | | | - Isabel C. N. Sacco
- Physical Therapy, Speech and Occupational Therapy, School of Medicine, University of Sao Paulo, São Paulo, Brazil
- * E-mail:
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Burge A, Lee A, Kein C, Button B, Sherburn M, Miller B, Holland A. Prevalence and impact of urinary incontinence in men with chronic obstructive pulmonary disease: a questionnaire survey. Physiotherapy 2017; 103:53-58. [DOI: 10.1016/j.physio.2015.11.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 11/16/2015] [Indexed: 01/23/2023]
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Villot A, Deffieux X, Billecocq S, Auclair L, Amarenco G, Thubert T. Influence of cognitive rehabilitation on pelvic floor muscle contraction: A randomized controlled trial. Neurourol Urodyn 2016; 36:1636-1644. [PMID: 27794195 DOI: 10.1002/nau.23169] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 09/29/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Anne Villot
- GRC-UPMC 01; GREEN (Group of clinical Research in Neuro-urology, University Pierre and Marie Curie); Paris France
- Department of Neuro-Urology; Tenon Hospital, Assistance Publique des Hôpitaux de Paris; Paris France
| | - Xavier Deffieux
- GRC-UPMC 01; GREEN (Group of clinical Research in Neuro-urology, University Pierre and Marie Curie); Paris France
- APHP; Hopital Antoine Béclère, Service de gynécologie obstétrique et biologie de la reproduction; Clamart France
| | | | - Laurent Auclair
- Université Paris Descartes, Inserm UMR 1129; Boulogne France
| | - Gérard Amarenco
- GRC-UPMC 01; GREEN (Group of clinical Research in Neuro-urology, University Pierre and Marie Curie); Paris France
- Department of Neuro-Urology; Tenon Hospital, Assistance Publique des Hôpitaux de Paris; Paris France
| | - Thibault Thubert
- GRC-UPMC 01; GREEN (Group of clinical Research in Neuro-urology, University Pierre and Marie Curie); Paris France
- Department of Neuro-Urology; Tenon Hospital, Assistance Publique des Hôpitaux de Paris; Paris France
- APHP; Hopital Antoine Béclère, Service de gynécologie obstétrique et biologie de la reproduction; Clamart France
- APHP; Hopital Cochin, Service de gynécologie obstétrique et biologie de la reproduction; Paris France
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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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Impact of different body positions on bioelectrical activity of the pelvic floor muscles in nulliparous continent women. BIOMED RESEARCH INTERNATIONAL 2015; 2015:905897. [PMID: 25793212 PMCID: PMC4352464 DOI: 10.1155/2015/905897] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 12/02/2014] [Indexed: 11/17/2022]
Abstract
We examined pelvic floor muscles (PFM) activity (%MVC) in twenty nulliparous women by body position during exercise as well as the activation of abdominal muscles and the gluteus maximus during voluntary contractions of the PFMs. Pelvic floor muscle activity was recorded using a vaginal probe during five experimental trials. Activation of transversus abdominis, rectus abdominis, and gluteus maximus during voluntary PFM contractions was also assessed. Significant differences in mean normalized amplitudes of baseline PFM activity were revealed between standing and lying (P < 0.00024) and lying and ball-sitting positions (P < 0.0053). Average peak, average time before peak, and average time after peak did not differ significantly during the voluntary contractions of the PFMs.
Baseline PFM activity seemed to depend on the body position and was the highest in standing. Pelvic floor muscles activity during voluntary contractions did not differ by position in continent women. Statistically significant differences between the supine lying and sitting positions were only observed during a sustained 60-second contraction of the PFMs.
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Pereira LC, Botelho S, Marques J, Adami DBV, Alves FK, Palma P, Riccetto C. Electromyographic pelvic floor activity: Is there impact during the female life cycle? Neurourol Urodyn 2014; 35:230-4. [DOI: 10.1002/nau.22703] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 10/10/2014] [Indexed: 11/07/2022]
Affiliation(s)
| | - Simone Botelho
- Faculty of Medical Sciences of the State University of Campinas (UNICAMP); Sao Paulo Brazil
- Federal University of Alfenas (UNIFAL-MG)-MG; Sao Paulo Brazil
| | - Joseane Marques
- Faculty of Medical Sciences of the State University of Campinas (UNICAMP); Sao Paulo Brazil
| | - Delcia BV Adami
- Pontifical Catholic University in Minas Gerais campus Pocos de Caldas; Minas Gerais Brazil
| | - Fabiola K. Alves
- Faculty of Medical Sciences of the State University of Campinas (UNICAMP); Sao Paulo Brazil
| | - Paulo Palma
- Faculty of Medical Sciences of the State University of Campinas (UNICAMP); Sao Paulo Brazil
| | - Cassio Riccetto
- Faculty of Medical Sciences of the State University of Campinas (UNICAMP); Sao Paulo Brazil
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Key J. 'The core': understanding it, and retraining its dysfunction. J Bodyw Mov Ther 2013; 17:541-59. [PMID: 24139017 DOI: 10.1016/j.jbmt.2013.03.012] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 02/07/2013] [Accepted: 03/07/2013] [Indexed: 10/26/2022]
Abstract
"Core stability training" is popular in both the therapeutic and fitness industries but what is actually meant and understood by this concept? And does everyone need the same training approach? This paper examines the landscape of 'the core' and its control from both a clinical and research perspective. It attempts a comprehensive review of its healthy functional role and how this is commonly changed in people with spinal and pelvic girdle pain syndromes. The common clinically observable and palpable patterns of functional and structural change associated with 'problems with the core' have been relatively little described. This paper endeavors to do so, introducing a variant paradigm aimed at promoting the understanding and management of these altered patterns of 'core control'. Clinically, two basic subgroups emerge. In light of these, the predictable difficulties that each group finds in establishing the important fundamental elements of spino-pelvic 'core control' and how to best retrain these, are highlighted. The integrated model presented is applicable for practitioners re-educating movement in physiotherapy, rehabilitation, Pilates, Yoga or injury prevention within the fitness industry in general.
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Affiliation(s)
- Josephine Key
- Edgecliff Physiotherapy Sports and Spinal Centre, Suite 505 Eastpoint Tower, 180 Ocean Street Edgecliff, Sydney, NSW 2027, Australia.
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26
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Deffieux X, Billecocq S, Demoulin G, Rivain AL, Trichot C, Thubert T. Mécanismes d’action de la rééducation périnéale pour l’incontinence urinaire de la femme. Prog Urol 2013; 23:491-501. [DOI: 10.1016/j.purol.2013.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Revised: 04/03/2013] [Accepted: 04/03/2013] [Indexed: 10/26/2022]
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Tannenbaum C, Gray M, Hoffstetter S, Cardozo L. Comorbidities associated with bladder dysfunction. Int J Clin Pract 2013; 67:105-13. [PMID: 23305472 DOI: 10.1111/ijcp.12085] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- C Tannenbaum
- Faculties of Pharmacy and Medicine, University of Montreal, Montreal, QC, Canada
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Madill SJ, Pontbriand-Drolet S, Tang A, Dumoulin C. Effects of PFM rehabilitation on PFM function and morphology in older women. Neurourol Urodyn 2013; 32:1086-95. [PMID: 23359286 DOI: 10.1002/nau.22370] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 12/11/2012] [Indexed: 11/08/2022]
Abstract
AIMS The purpose of this study was to examine the effect of a pelvic floor muscle (PFM) rehabilitation program on incontinence symptoms, PFM function, and morphology in older women with SUI. METHODS Women 60 years old and older with at least weekly episodes of SUI were recruited. Participants were evaluated before and after a 12-week group PFM rehabilitation intervention. The evaluations included 3-day bladder diaries, symptom, and quality of life questionnaires, PFM function testing with dynamometry (force) and electromyography (activation) during seven tasks: rest, PFM maximum voluntary contraction (MVC), straining, rapid-repeated PFM contractions, a 60 sec sustained PFM contraction, a single cough and three repeated coughs, and sagittal MRI recorded at rest, during PFM MVCs and during straining to assess PFM morphology. RESULTS Seventeen women (68.9 ± 5.5 years) participated. Following the intervention the frequency of urine leakage decreased and disease-specific quality of life improved significantly. PFM function improved significantly: the participants were able to perform more rapid-repeated PFM contractions; they activated their PFMs sooner when coughing and they were better able to maintain a PFM contraction between repeated coughs. Pelvic organ support improved significantly: the anorectal angle was decreased and the urethrovescial junction was higher at rest, during contraction and while straining. CONCLUSIONS This study indicated that improvements in urine leakage were produced along with improvements in PFM co-ordination (demonstrated by the increased number of rapid PFM contractions and the earlier PFM activation when coughing), motor-control, pelvic organ support.
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Affiliation(s)
- Stéphanie J Madill
- School of Physical Therapy, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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29
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Auchincloss C, McLean L. Does the presence of a vaginal probe alter pelvic floor muscle activation in young, continent women? J Electromyogr Kinesiol 2012; 22:1003-9. [DOI: 10.1016/j.jelekin.2012.06.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2012] [Revised: 06/19/2012] [Accepted: 06/20/2012] [Indexed: 11/30/2022] Open
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30
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Electromyographic evaluation of pelvic floor muscles in pregnant and nonpregnant women. Int Urogynecol J 2012; 23:1041-5. [PMID: 22415702 DOI: 10.1007/s00192-012-1702-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2011] [Accepted: 02/09/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We compared the maximal voluntary contraction (MVC) and strength of pelvic floor muscles (PFM) of pregnant and nonpregnant women using surface electromyography (SEMG). METHODS Fifteen pregnant primiparous women and 15 nulliparous nonpregnant women were evaluated. The healthy pregnant women were in the third trimester of pregnancy with a single fetus and did not have any neuromuscular alterations. The nonpregnant women did not present with PF dysfunctions and, as with the pregnant women, did not have any previous gynecological surgeries or degenerative neuromuscular alterations. The evaluation methods used were digital palpation (Oxford Grading Scale, which ranges from 0 to 5) and SEMG. In the EMG exam, MVC activity was evaluated, and the better of two contractions was chosen. Before the evaluation, all women received information about PFM localization and function and how to correctly contract PFM. RESULTS In the EMG evaluation, MVC was significantly greater in the nonpregnant group (90.7 μv) than in the pregnant group (30 μv), with p < 0.001. The same results were observed after vaginal palpation, measured by the Oxford scale, which presented an average of 2.1 in the pregnant group and 4.5 in the nonpregnant group (p = 0.005). CONCLUSION In comparison to nulliparous women, pregnant women demonstrated worse PFM function with decreased strength and electrical activity.
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Current World Literature. Curr Opin Obstet Gynecol 2011; 23:396-400. [DOI: 10.1097/gco.0b013e32834b7ee5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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