Incontinent Women Have Altered Pelvic Floor Muscle Contraction Patterns

Exercise Position to Improve Synergy Between the Diaphragm and Pelvic Floor Muscles in Women With Pelvic Floor Dysfunction: A Cross Sectional Study

OBJECTIVE

This study aimed to investigate the synergy between the diaphragm and pelvic floor muscles (PFM) according to different exercise positions in women with pelvic floor dysfunction. Our secondary aim was to determine the short-term effects of single-week pelvic floor muscle training (PFMT) program on diaphragmatic function.

METHODS

The cross-sectional study included 64 women with pelvic floor dysfunction. The participants' diaphragm and abdominal muscle functions during voluntary PFM contraction and relaxation were assessed by surface electromyography and ultrasonography. The surface electromyography assessments were performed in supine (P1), crawling (P2) and sitting (P3) positions. A single week-PFMT was conducted on women who agreed to determine the short-term responses of the diaphragm function. The muscle functions according to exercise positions were compared with Friedman Analysis of Variance, and the short-term effects of single-week PFMT on diaphragm function was analyzed with Wilcoxon Signed-Ranks Test.

RESULTS

The diaphragm activity during voluntary PFM contraction was highest in P2 before and after single-week PFMT (P < .001). Positive significant correlations were found between the activities diaphragm and abdominal muscles in different exercise positions (P < .05). After single-week PFMT, diaphragm thickness increased (P = .030) in P1, but diaphragm activity did not change in all 3 exercise positions (P > .05).

CONCLUSION

The synergy between the diaphragm and PFM was greater in the crawling position in women with pelvic floor dysfunction. The abdominal muscles seemed to contribute to maintaining this synergy. Therefore, PFMT combined with diaphragmatic breathing exercises in the crawling position should be considered. In addition, single-week PFMT may positively affect diaphragm function in the short-term.

Can pelvic floor muscle training positions be selected according to the functional status of pelvic floor muscles?

Background

Pelvic floor muscle (PFM) training varies according to the functional status of PFM. It is used to strengthen underactive PFM and relax overactive PFM.

Aim

This study aimed to determine the appropriate PFM training positions according to the functional status of the PFM in women with pelvic floor dysfunction.

Materials and Methods

Seventy-six women diagnosed with pelvic floor dysfunction were included. After the digital palpation, participants were divided into four groups according to the functional status of PFM: normal, overactive, underactive, and nonfunctional. Participants' PFM and abdominal muscle functions were assessed with superficial electromyography in three positions (modified butterfly pose-P1, modified child pose-P2, and modified deep squat with block pose-P3). Friedman's analysis of variance and the Kruskal-Wallis test were used to assess whether the function of the muscles differed according to the functional status of the PFM and training positions.

Results

Normal PFM maximally contracted and relaxed in P1, whereas nonfunctional PFM was in P3 (P > 0.05). Overactive and underactive PFM was most contracted in P2 (P > 0.05) and relaxed in P1 (P < 0.001). In each functional state of the PFM, all abdominal muscles were most relaxed in P1, while their most contracted positions varied (P < 0.05).

Conclusion

This study showed that the positions in which the PFM relaxes and contracts the most may vary according to the functional status of the PFM. Therefore, different PFM training positions may be preferred according to the functional status of the PFM in women with pelvic floor dysfunction. However, more study needs to be done in this subject.

Breathing, (S)Training and the Pelvic Floor—A Basic Concept

Background: The current scientific literature is inconsistent regarding the potential beneficial or deleterious effects of high-intensity physical activities on the pelvic floor (PF) in women. So far, it has not been established with certainty whether disparate breathing mechanisms may exert short- or long-term influence on the PF function in this context, although based on the established physiological interrelationship of breathing with PF activation, this seems plausible. Objective: To propose a basic concept of the influence of different breathing patterns on the PF during strenuous physical efforts. Methodical approaches: Review of the recent literature, basic knowledge of classical western medicine regarding the principles of muscle physiology and the biomechanics of breathing, additional schematic illustrations, and magnetic resonance imaging (MRI) data corroborate the proposed concept and exemplify the consequences of strenuous efforts on the PF in relation to respective breathing phases. Conclusion: The pelvic floor muscles (PFMs) physiologically act as expiratory muscles in synergy with the anterolateral abdominal muscles, contracting during expiration and relaxing during inspiration. Obviously, a strenuous physical effort requires an expiratory motor synergy with the PFM and abdominal muscles in a co-contracted status to train the PFM and protect the PF against high intra-abdominal pressure (IAP). Holding breath in an inspiratory pattern during exertion stresses the PF because the high IAP impinges on the relaxed, hence insufficiently protected, PFMs. It seems conceivable that such disadvantageous breathing, if performed regularly and repeatedly, may ultimately cause PF dysfunction. At any rate, future research needs to take into account the respective breathing cycles during measurements and interventions addressing PFM function.

The pathophysiology of stress urinary incontinence: a systematic review and meta-analysis

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.

Pelvic floor muscle strength is correlated with sexual function

Purpose

Sexual performance is related to proprioception and pelvic floor muscle strength (PFMS). The aim of this study was to correlate sexual activity and orgasm with PFMS.

Materials and Methods

A total of 140 healthy continent female were prospectively distributed into 4 groups according to age: Group 1 (G1), 30–40; Group 2 (G2), 41–50; Group 3 (G3), 51–60; Group 4 (G4), over 60 years old. Evaluated parameters were: frequency of sexual activity and orgasm achievement; body mass index (BMI) and objective evaluation of PFMS using perineometer and surface electromyography.

Results

BMI was higher in G4 compared to G1 (p=0.042). Women who reported sexual activity was significantly higher in G1 compared to G3 and G4 (94.1% vs. 66.7% and 37.5%, respectively; p=0.001). Orgasm was more frequently in G1 compared to G3 and G4 (91.2% vs. 63.9% and 28.1%, respectively; p=0.001), demonstrating that sexual activity and orgasm decrease after age 51. The duration of PFM contraction was significantly higher in women who had sexual intercourse (p=0.033) and orgasm (p=0.018).

Conclusions

Although the frequency of sexual intercourse and orgasm may decrease with aging, a relationship between sexual activity and PFMS remains apparent, once both sexually active women and those who have orgasms showed better PFM endurance than non-sexually active ones.

Novel insight into pressurization of the male and female urethra through application of a multi-channel fibre-optic pressure transducer: Proof of concept and validation

Purpose

To confirm feasibility of recording pressure along the length of the urethra using a multi-sensor fibre-optic pressure catheter; to identify the spatial and temporal features of changes in pressure along the urethra at sites related to specific striated pelvic floor muscles; and to investigate the relationship between urethral pressures and activation of individual pelvic floor muscles estimated from ultrasound imaging.

Materials and Methods

Proof-of-concept study including one male (47 years old) and one female (33 years old). A multi-sensor fibre optic pressure catheter (10 mm sensor separation) was inserted into the urethra. Pressure data were recorded simultaneously with trans-perineal ultrasound imaging measures of pelvic floor muscle activity during sub-maximal and maximal voluntary contractions and evoked coughs.

Results

Pressure changes along the urethra were recorded in all tasks in both participants. Face validity of interpretation of pressure measures with respect to individual muscles was supported by correlation with ultrasound-measured displacements induced by the relevant muscles. Onset of pressure increase occurred in a distal to proximal sequence in the urethra of the male but not the female during voluntary contraction. Peak urethral pressures varied in location, timing and amplitude between tasks. Evoked cough induced in the greatest urethral pressure increase across all tasks for both participants.

Conclusions

The high spatial resolution pressure catheter provide viable and valid recordings of urethral pressure in a male and female. Data provide preliminary evidence of sex differences in spatial and temporal distribution of urethral pressure changes.

Linking Pelvic Floor Muscle Function Terminology to the International Classification of Functioning, Disability and Health

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.

Transabdominal Ultrasound Imaging of Pelvic Floor Muscle Activity in Women With and Without Stress Urinary Incontinence: A Case-Control Study

OBJECTIVE

Transabdominal ultrasound (TAU) is an easy and noninvasive way to evaluate and retrain pelvic floor muscle (PFM) function. The purpose of this study was to compare PFM activity in women with and without urinary incontinence (UI) by measuring bladder base displacement (as a marker for PFM activity) using TAU during PFM contraction, Valsalva's maneuver, and abdominal curl.

METHODS

Sixty-three women, aged 20-55 years, volunteered to participate in this cross-sectional study: 21 were continent and 42 had UI (21 stress urinary incontinence [SUI] and 21 mixed urinary incontinence [MUI]). Mean bladder base displacement in millimeters was measured to evaluate differences between the three groups (continent, SUI, and MUI) and also between the continent and UI groups during the performance of each maneuver.

RESULTS

No significant differences were seen between the three groups in bladder base elevation during PFM contraction (P > 0.05). Descent of the bladder base during Valsalva's maneuver and abdominal curl was significantly greater in women with SUI and MUI than in women in the continent group (P < 0.05). Comparison of the continent and UI groups showed no significant differences in elevation of the bladder base during PFM contraction, while descent of the bladder base was significantly greater in women with UI than in women in the continent group during Valsalva's maneuver and abdominal curl (P < 0.05).

CONCLUSION

TAU indicated that bladder base descent was greater in women with SUI and MUI than those in the continent group during the performance of maneuvers that increased intra-abdominal pressure. This effect may be due to decreased PFM performance in women with urinary incontinence.

Task-specific differences in respiration-related activation of deep and superficial pelvic floor muscles

The female pelvic floor muscles (PFM) are arranged in distinct superficial and deep layers that function to support the pelvic/abdominal organs and maintain continence, but with some potential differences in function. Although general recordings of PFM activity show amplitude modulation in conjunction with fluctuation in intra-abdominal pressure such as that associated with respiration, it is unclear whether the activities of the two PFM layers modulate in a similar manner. This study aimed to investigate the activation of the deep and superficial PFM during a range of respiratory tasks in different postures. Twelve women without pelvic floor dysfunction participated. A custom-built surface electromyography (EMG) electrode was used to record the activation of the superficial and deep PFM during quiet breathing, breathing with increased dead space, coughing, and maximal and submaximal inspiratory and expiratory efforts. As breathing demand increased, the deep PFM layer EMG had greater coherence with respiratory airflow at the frequency of respiration than the superficial PFM (P = 0.038). During cough, the superficial PFM activated earlier than the deep PFM in the sitting position (P = 0.043). In contrast, during maximal and submaximal inspiratory and expiratory efforts, the superficial PFM EMG was greater than that for the deep PFM (P = 0.011). These data show that both layers of PFM are activated during both inspiration and expiration, but with a bias to greater activation in expiratory tasks/phases. Activation of the deep and superficial PFM layers differed in most of the respiratory tasks, but there was no consistent bias to one muscle layer. NEW & NOTEWORTHY Although pelvic floor muscles are generally considered as a single entity, deep and superficial layers have different anatomies and biomechanics. Here we show task-specific differences in recruitment between layers during respiratory tasks in women. The deep layer was more tightly modulated with respiration than the superficial layer, but activation of the superficial layer was greater during maximal/submaximal occluded respiratory efforts and earlier during cough. These data highlight tightly coordinated recruitment of discrete pelvic floor muscles for respiration.

Terminology of Pelvic Floor Muscle Function in Women With and Without Urinary Incontinence: A Systematic Review

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.

Functional assessment of the pelvic floor muscles by electromyography: is there a normalization in data analysis? A systematic review

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.

High spatial resolution pressure distribution of the vaginal canal in Pompoir practitioners: A biomechanical approach for assessing the pelvic floor

BACKGROUND

Pompoir is a technique poorly studied in the literature that claims to improve pelvic floor strength and coordination. This study aims to investigate the pelvic floor muscles' coordination throughout the vaginal canal among Pompoir practitioners and non-practitioners by describing a high resolution map of pressure distribution.

METHODS

This cross-sectional, study included 40 healthy women in two groups: control and Pompoir. While these women performed both sustained and "waveform" pelvic floor muscle contractions, the spatiotemporal pressure distribution in their vaginal canals was evaluated by a non-deformable probe fully instrumented with a 10×10 matrix of capacitive transducers.

FINDINGS

Pompoir group was able to sustain the pressure levels achieved for a longer period (40% longer, moderate effect, P=0.04). During the "waveform" contraction task, Pompoir group achieved lower, earlier peak pressures (moderate effect, P=0.05) and decreased rates of contraction (small effect, P=0.04) and relaxation (large effect, P=0.01). During both tasks, Pompoir group had smaller relative contributions by the mid-region and the anteroposterior planes and greater contributions by the caudal and cranial regions and the latero-lateral planes.

INTERPRETATION

Results suggest that specific coordination training of the pelvic floor muscles alters the pressure distribution profile, promoting a more-symmetric distribution of pressure throughout the vaginal canal. Therefore, this study suggests that pelvic floor muscles can be trained to a degree beyond strengthening by focusing on coordination, which results in changes in symmetry of the spatiotemporal pressure distribution in the vaginal canal.

Bioelectrical activity of the pelvic floor muscles during synchronous whole-body vibration--a randomized controlled study

Background

More and more frequently stress urinary incontinence affects young healthy women. Hence, early implementation of effective preventive strategies in nulliparous continent women is essential, including pelvic floor muscle training. An initial evaluation based on the bioelectrical activity of the pelvic floor muscles (PFM) during whole-body vibration (WBV) would help to devise the best individualized training for prevention of stress urinary incontinence in woman. We hypothesized that synchronous WBV enhances bioelectrical activity of the PFM which depends on vibration frequency and peak-to-peak vibration displacement.

Methods

The sample consisted of 36 nulliparous continent women randomly allocated to three comparative groups. Group I and II subjects participated in synchronous whole-body vibrations on a vibration platform; the frequency and peak-to-peak displacement of vibration were set individually for each group. Control participants performed exercises similar to those used in the study groups but without the concurrent application of vibrations. Pelvic floor surface electromyography (sEMG) activity was recorded using a vaginal probe during three experimental trials limited to 30s, 60s and 90s. The mean amplitude and variability of the signal were normalized to the Maximal Voluntary Contraction – MVC.

Results

Friedman’s two-way ANOVA revealed a statistically significant difference in the mean normalized amplitudes (%MVC) of the sEMG signal from the PFM during 60s- and 90s-trials between the group exposed to high-intensity WBV and control participants (p < 0.05). Longer trial duration was associated with a statistically significant decrease in the variability of sEMG signal amplitude in the study and control groups (p < 0.05).

Conclusions

Synchronous high-intensity WBV (40 Hz, 4 mm) of long duration (60s, 90s) significantly enhances the activation of the PFM in young continent women. Prolonged maintenance of a static position significantly decreases the variability of sEMG signal amplitude independent of whole-body vibrations. Single whole-body vibrations in nulliparous continent women does not cause pelvic floor muscle fatigue.

Trial registration

The trial was registered in the Australian and New Zealand Clinical Trials Registry (no. ACTRN12615000966594); registration date: 15/09/2015.

Assessment of bioelectrical activity of synergistic muscles during pelvic floor muscles activation in postmenopausal women with and without stress urinary incontinence: a preliminary observational study

OBJECTIVE

Muscles such as adductor magnus (AM), gluteus maximus (GM), rectus abdominis (RA), and abdominal external and internal oblique muscles are considered to play an important role in the treatment of stress urinary incontinence (SUI), and the relationship between contraction of these muscles and pelvic floor muscles (PFM) has been established in previous studies. Synergistic muscle activation intensifies a woman's ability to contract the PFM. In some cases, even for continent women, it is not possible to fully contract their PFM without involving the synergistic muscles. The primary aim of this study was to assess the surface electromyographic activity of synergistic muscles to PFM (SPFM) during resting and functional PFM activation in postmenopausal women with and without SUI.

MATERIALS AND METHODS

This study was a preliminary, prospective, cross-sectional observational study and included volunteers and patients who visited the Department and Clinic of Urology, University Hospital in Wroclaw, Poland. Forty-two patients participated in the study and were screened for eligibility criteria. Thirty participants satisfied the criteria and were categorized into two groups: women with SUI (n=16) and continent women (n=14). The bioelectrical activity of PFM and SPFM (AM, RA, GM) was recorded with a surface electromyographic instrument in a standing position during resting and functional PFM activity.

RESULTS

Bioelectrical activity of RA was significantly higher in the incontinent group than in the continent group. These results concern the RA activity during resting and functional PFM activity. The results for other muscles showed no significant difference in bioelectrical activity between groups.

CONCLUSION

In women with SUI, during the isolated activation of PFM, an increased synergistic activity of RA muscle was observed; however, this activity was not observed in asymptomatic women. This may indicate the important accessory contribution of these muscles in the mechanism of continence.

Impact of different body positions on bioelectrical activity of the pelvic floor muscles in nulliparous continent women

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.

Does childbirth alter the reflex pelvic floor response to coughing?

OBJECTIVE

To determine the prevalence of and to quantify the effect of reflex pelvic floor activation on coughing in nulliparous pregnant women, and to assess peripartal changes and any association with stress urinary incontinence.

METHODS

Between April 2008 and March 2010, 131 nulliparous pregnant women were recruited from an antenatal clinic. All participants were interviewed and underwent four-dimensional translabial ultrasound examination at antepartum (35.8 (mean) weeks' gestation) and postpartum (4.6 (mean) months) visits. Four-dimensional ultrasound volume datasets of the pelvic floor during coughs were obtained at a minimum frame rate of 16 Hz, using a 10° volume acquisition angle. To quantify a reflex levator contraction we measured the midsagittal hiatal diameter at multiple time points. Levator integrity was determined using tomographic ultrasound imaging.

RESULTS

From 131 women recruited, 47 datasets were technically suboptimal, leaving 84. There was a visible pelvic floor reflex in 82 (98%) cases. At the postpartum visit this was reduced to 63/84, i.e. 75% (P < 0.001). The magnitude of a reflex contraction was markedly reduced postpartum, from 4.8 mm to 2.0 mm (P < 0.001), and this effect was associated with delivery mode (P = 0.042). There was a trend towards an association between lower reflex contraction magnitude and stress incontinence (0.87 ± 3.18 mm vs. 2.36 ± 3.5 mm; P = 0.08) at the postpartum follow-up visit.

CONCLUSIONS

Pelvic floor reflexes are altered by childbirth. This alteration may be associated with vaginal delivery. Reflex magnitude may be associated with postpartum stress urinary incontinence. The clinical significance of this finding is uncertain.

Eletromiografia de superfície para avaliação dos músculos do assoalho pélvico feminino: revisão de literatura

A eletromiografia de superfície tem grande importância clínica e de pesquisa para o fisioterapeuta. Apesar de captar a atividade elétrica promovida pelo recrutamento das unidades motoras, há boa correlação entre o número de unidades ativadas e a força muscular. É um dos métodos de maior especificidade na avaliação do assoalho pélvico, embora não haja consenso em relação à sua aplicação. Essa revisão de literatura foi desenvolvida com o objetivo de agrupar as informações sobre o uso da eletromiografia de superfície na avaliação do assoalho pélvico. Foram pesquisados artigos nas bases de dados Medline, PubMed, Lilacs, SciELO e Biblioteca Cochrane, e selecionados os que avaliassem o assoalho pélvico feminino por meio de eletromiografia de superfície. Apesar de sua metodologia ainda carecer de padronização, é um instrumento que deve ser considerado nas pesquisas científicas em nosso meio, pois parece apresentar boa reprodutibilidade e confiabilidade. Pacientes com disfunções do assoalho pélvico possuem alterações no tempo de ativação dos músculos do assoalho pélvico (MAP) e músculos abdominais. Quanto à gestação e puerpério, ainda faltam evidências sobre possíveis alterações da ativação elétrica dos MAP nesses períodos.

Postpartum stress urinary incontinence: lessons from animal models

Postpartum stress urinary incontinence (SUI) is associated with chronic SUI in later life, which is 240% more likely to occur in women who deliver vaginally than those who did not. The etiology of SUI is multifactoral and has been associated with defects in both neuromuscular and structural components of continence. Specifically, clinical studies have demonstrated that pudendal nerve damage occurs during vaginal delivery, supporting the concept that neuromuscular damage to the continence mechanism can result in postpartum SUI. Urethral hypermobility and the loss of pelvic floor support, such as that involved in pelvic organ prolapse, have also been associated with SUI. Animal models provide an opportunity to investigate these injuries, individually and in combination, enabling researchers to gain further insight into their relative contributions to the development of SUI and the effectiveness of potential therapies for it. This article discusses the use of animal models of postpartum SUI in addition to the broad insights into treatment efficacy they provide.

The effect of ankle position on pelvic floor muscle contraction activity in women

PURPOSE

Stress urinary incontinence is extremely common in women. Conservative management includes pelvic floor muscle exercises to increase strength and muscular contraction forces to improve incontinence. We examined the effects of passive and active ankle flexion on pelvic floor muscle activity during exercises.

MATERIALS AND METHODS

A total of 31 married women performed random pelvic floor muscle contractions while standing, and in 8 passive and active positions while pelvic floor muscle activity was simultaneously measured by electromyography.

RESULTS

All ankle positions resulted in greater pelvic floor muscle activity than the horizontal foot position. Significantly greater muscle activity was seen with ankles in the plantar position with raised arms (p = 0.0051).

CONCLUSIONS

Pelvic floor muscle exercises performed with active ankle positions may increase the effectiveness of these exercises. Further studies are required to elucidate mechanisms for this finding.

SOGC Committee opinion on urodynamics testing

OBJECTIVE

To provide a description of the components of urodynamic testing for the evaluation of urinary tract dysfunction and the indications for these tests.

OPTIONS

Urodynamic testing is useful in investigating of urinary incontinence.

EVIDENCE

A search of PubMed and the Cochrane Library identified the relevant literature. The evidence obtained was rated using the criteria developed by the Canadian Task Force on Preventive Health Care.

VALUES

This is a consensus opinion of the Society of Obstetricians and Gynaecologists of Canada Sub-Committee on Urogynaecology.

BENEFITS, HARMS, AND COSTS

Urinary incontinence is a pervasive problem that can be treated effectively once properly diagnosed.